Barefoot Doctor Tells Truth about Measles

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Our new year has been with us now for nearly two months. For some of us in these parts, however, the “new year” begins when we climb out of those frigid 60-something temperatures (I mean, how can anyone live in that weather?) and can begin to wear shorts again. With this coming out of hibernation in mind, I’d like to spend the next few columns looking at a few topics that kid doctors are discussing nowadays, and we’ll likely be hearing more about in the remainder of 2019.

One pediatric topic that never has a shortage of written material is vaccines. Not only are there plenty of readings aimed at parents; child providers are given so many updates on immunization issues that I’m fond of calling the professional papers I receive “The Journals of the I’s and B’s.” (The “B” is for breastfeeding, another frequent topic.) But frequently there is a development that gives us a reason to open up another vaccine discussion. Such is the case with the measles and its vaccine.

Let’s examine why measles appears to be the VPDY (Vaccine Preventable Disease of the Year) for 2019. Since 2018, measles appears to be on the rise. One of the hotbeds of the recent epidemic seems to be Washington state, an area of the country with lower immunization rates than Florida. (Ironically, another one is Monroe County, N.Y.) The problem is that when immunization drops below a certain level, there is no herd immunity, meaning the virus can more easily circulate and infect people.

We see a lot written regarding the safety and effectiveness of MMR, the vaccine that prevents measles and two other diseases. Although I second these findings, what I’d like to do is talk a little more about why we get concerned about measles in the first place. Anyone who’s read Tom Sawyer remembers his recovery from measles and his reversion back to his hell-raising self. And even I, who was born in the pre-vaccine era when everyone got measles, managed to recover. On a good day, I am at least as sane as my husband, who is six years younger and did receive the measles vaccine.

The issue is that about 1 in 1,000 people who contract measles are not so lucky and go on to develop complications that can lead to brain damage or even death. And a subset of this group develops subacute sclerosing panencephalitis (SSPE), a nerve-damaging complication that happens seven to 11 years after infection. SSPE is much rarer, but it seems more real if you know someone whose child contracted it, as happened with the child of a pediatrician I knew early in my training. Thus, it’s not necessarily a “phew, the measles is over, now we’re done” phenomenon after a few days of illness; people who develop SSPE seem healthy for years before evidence of brain damage surfaces.

We’ve been fortunate that reports of severe complications and deaths from these measles epidemics have been few and far between. But if you’ve been putting off the MMR vaccine, thisis the year to have that talk with your provider about getting it, as many in Washington state now are doing.

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