Public Email About the Measles Outbreak Sent by Senders Pediatrics

Dear Families,

Measles, a highly contagious respiratory disease characterized by a high fever and rash, has made a resurgence in the United States in 2019. Unlike previous outbreaks which have been very localized, this year’s outbreaks have been in 7 distinct areas in the country from New York to California and most recently in the Detroit, Michigan area, making the likelihood of spread that much greater. Thought to have been eradicated as recently as 2000, in just the first 3 months of this year, over 400 cases have been identified nationwide compared to just 86 cases in the entire 2016. Measles is one of the most contagious of viral infections with 90% of unprotected individuals likely to contract it. With increased travel likely over the next few weeks because of the Easter and Passover holidays, the potential for patients of our practice and others in this area to come in contact with someone with measles is that much greater. There are many recommendations floating around the internet, some from lay individuals with unfortunate exposure to the disease. After discussion with personal contacts at the Centers for Disease Control and Prevention (CDC) and local infectious disease experts, we have prepared a measles exposure and vaccination guideline for our patients and their families. We will revise it as more information becomes available.

What is the history of measles? Measles is a viral infection that was first described in the 9th century. In the decade before the first measles vaccine was developed in 1963, almost every child contracted measles by age 15 with an average of 3-4 million cases each year. In the 1950s, per year, there were an average of 500 deaths, 1000 cases of encephalitis (brain swelling) and 48,000 hospitalizations. Widespread vaccination with the measles vaccine and, in 1971, with the combined measles, mumps and rubella vaccine (MMRI), led to an 80% reduction in cases by 1981. A second vaccination dose was added to the schedule in 1989 and by 2000, measles was declared eradicated in the United States although it continued to spread in the international community.

Why is this year different? Because of global travel and an unfortunate and untrue campaign in the anti-vaccine community to identify the MMR with autism, there have been sporadic outbreaks in the United States over the past decade. Because measles is so contagious, it can very rapidly spread in close knit communities and areas of close personal contact. In the past, there have been outbreaks in the Amish, Micronesian and Fillipino communities as well as in travelers to the Disney theme park in California and attendees at the FIFO World Cup finals in Brazil. This year, the largest outbreaks have been in Orthodox Jewish communities in New York, New Jersey and Michigan. Health authority officials have been quick to respond, declaring a health emergency in one NY county with a large unvaccinated population. Religious authorities in outbreak areas have responded with an unprecedented and largely successful push to vaccinate all children. While there has been no measles outbreak in the greater Cleveland area, Cleveland area religious schools have also taken a strong pro vaccination stance.

Who is at risk:

• Children and adolescents who have received 2 dose of MMR: These children are at little risk. The CDC considers all children who have received 2 doses of MMR to be protected even when exposed to an active case of measles. MMR is typically given at 12 months and at 4 or 5 years prior to kindergarten. If you child has received 2 doses of MMR, there should be no worry about travelling anywhere in the continental US or abroad. In our practice, almost all children over the age of 6 have received 2 doses of MMR.
• Children who have received only 1 dose of MMR: Because there is likely to be widespread travel in and out of Cleveland over the Easter and Passover season, we are recommending a second dose of MMR to this category of children. The second dose can be administered as early as 30 days after the first. Please call the office to schedule a medical assistant appointment.
• Children under 1 year: MMR is not as effective under one year. The CDC and local health authorities are not recommending giving an early MMR to most Cleveland children. However, if you know you are going to an area with an active outbreak (such as Rockland, County NY or Detroit, Michigan), our CDC contact is recommending giving an early MMR vaccine between 6-12 months. Please be aware that such children will need to get 3 MMR vaccines for permanent protection.
• Adults born between 1957-1989: Adults born during this period are likely to have received only one MMR. While there is little evidence of waning immunity over time, one dose of MMR is only protective 93% of the time. Unless you have documentation of a second MMR, adults born during these years should receive a second MMR. As with Tdap and influenza, we are happy to provide an MMR to adult parents of our patients. Please call the office to schedule a medical assistant appointment.
• Adults who want to check their immunization status prior to vaccination: The CDC is not recommending this step. If you have only received one dose of MMR, you should get a second dose. For those who would prefer to know their immunization status, we are happy to help. Please schedule a brief measles titer visit and we will draw your blood and report your results.

What clinical signs should I be looking for? Measles looks like many other viral infections with a high fever and a rash and red eyes. Remember the old adage. If you hear hoof beats outside your window, it could be a zebra but it is likely to be a horse. If your child has been vaccinated with two doses of MMR, it is not necessary for him/her to be seen with a fever and a rash. Conjunctivitis or red, draining eyes, is almost never caused by measles. If you are unsure about what to do, we are happy to speak to you (216.291.9210) and to see you in the office.