Monday, February 25, 2019

A Measles Refresher

By Jason R. McKnight, MD
Family Medicine Physician, Bryan
Clinical Assistant Professor, Texas A&M Family Medicine Residency Program
Member, TMA Leadership College

Currently, there are eight confirmed cases of measles in Texas. While this may not sound like many, there were less than 100 measles cases reported nationwide as recently as 2010, and in 2016 only one case was reported in Texas. In the year 2000, the Centers for Disease Control and Prevention declared measles “eliminated.” However, given the increasing number of parents opting their children out of getting vaccinations, measles has crept back into the U.S. health care spotlight. Measles spreads incredibly easily, and 90 percent of unvaccinated persons will contract the disease when exposed to someone who’s infected. Since many physicians and parents are young enough never to have seen a case of the measles, a refresher about the presentation and complications of the disease seems timely.

 A case of measles usually includes the following symptoms: An early fever (which tends to be fairly high), a runny nose, conjunctivitis (eye redness), and a typically dry cough. This tends to start three to four days before the onset of a rash on the skin. Unfortunately, because of those early symptoms, people might at first think they have a common cold or another upper respiratory virus. The danger is that all that time the infected person is contagious with measles and could unknowingly be spreading their infection to others. The rash, once it appears, typically starts on the face and spreads to the trunk (back and chest/stomach) and outward to the arms and legs. Usually the rash does not spread to palms of the hands or soles of the feet. The rash itself is macular (flat), erythematous (red), and when you press on a spot, it usually temporarily becomes more faint or disappears. Sometimes the rash will gather to form larger “splotches.” Patients can also have a rash in their mouth, called Koplik spots, which are whitish in appearance and usually line the insides of the patient’s cheeks.

A measles diagnosis, in the short term, can be made based on the symptoms and physical exam. If you or your physician are highly suspicious, you should contact your county health department and alert them. They can tell you what kinds of tests are recommended to confirm whether it’s measles. If you are diagnosed with measles, you should quarantine yourself at home for four days after the rash appears.
The virus can survive in air for about two hours, so people should minimize contact with the infected person and stay out of the room where they’re resting. This is particularly important for patients who are young, old, pregnant, or have a weakened immune system. As I mentioned earlier, measles spreads VERY easily.

Several groups of people are at greatest risk of developing a serious case of measles and/or complications from the disease: Those who are at the extremes of age (infants, toddlers, and the elderly); those unable to receive the Measles, Mumps, and Rubella (MMR) vaccine (including babies less than 12 months of age or immunosuppressed patients); and pregnant patients. About one in three of these people will suffer a serious illness or complications. The most common complications include diarrhea, a secondary respiratory infection like pneumonia, encephalitis (inflammation of the brain), and other neurological disorders that can cause coma, paralysis, seizures, and death.

The two-dose MMR vaccine series is about 97-percent effective at preventing infection. Therefore, if an individual has been vaccinated appropriately, it is unlikely that they could contract measles, but not impossible. That is why a physician would want to obtain the vaccine history of anyone who has measles-like symptoms. As a patient, this is a great reason to make sure you are up to date on all vaccinations.
The two-dose MMR vaccine series is about 97 percent effective
at preventing infection. 

Now to calm some alarm: Just because someone is having a viral rash or symptoms of a cold, that does not mean they have a measles infection. That’s unlikely to be the case. However, as with all uncommon things in medicine, doctors need to be vigilant and diagnose the condition, especially since measles cases have cropped up again.

Let this be the point that puts measles on your radar: Since patients can be contagious up to five days before rash starts and remain contagious four days after the rash appears, and since measles is highly contagious and has the potential to spread rapidly before anyone even recognizes there may be an outbreak, it’s clear why vaccination against this preventable disease is so important. This is especially critical to protect to the health of patients who cannot be vaccinated.

For more information visit: 

No comments :

Post a Comment

Related Posts Plugin for WordPress, Blogger...