Ask The Expert, Featuring Dr. Christina Rafiei and her take on the recent Measles Outbreak in Houston

 

Christina Rafiei, MD, FAAP is trained & board specialized in both internal medicine and pediatrics and is affiliated with Texas Children’s Pediatrics.

When the news broke a few weeks ago about cases of the measles in Houston, we saw immediate questions and concern from moms. So we reached out to Dr. Christina to help us put together an informative blog aimed to give you mamas all the facts and tools you need to protect your family.

Even yesterday, you couldn’t open social media or the news without seeing ‘Recent Study Finds MMR Vaccine Does Not Cause Autism.’

So this feature seems timely and important. However, we want to preface this post with this: THIS IS NOT meant to open up the debate about pro-vaccine or pro-no vaccine and we definitely don’t have a dog in the vaccination debate. We choose to vaccinate our children, but never want a mom to feel judged for making the decision NOT to vaccinate. We understand that each parent feels they’re doing the very best for their child and we never want to force feed an opinion on anyone or make anyone feel judged for making a decision that’s different than ours.
With that said, Dr. Christina gives us facts and advice and reminds us that there is reason to remain cautious of what’s going on.
It’s her belief that the six confirmed cases in the Houston area might just the beginning because of the growing trend to skip the MMR vaccine.
Our Ask The Expert series aims to inform mamas and give the facts from experts in our community. So, here’s everything you need to know about the measles, the recent outbreak in Houston, and how you can protect your family.

 

In the simplest of terms, what is the Measles?

  • Measles is a viral infection. The infection most commonly causes high fever, cough, runny nose, conjunctivitis (red eye) and rash. It can cause many complications such as ear infections, diarrhea, pneumonia, encephalitis (inflammation of the brain) and death. 
  • Measles is one of the most contagious infections. Approximately 9 out of 10 susceptible (not immune) people with close contact to a measles patient will get measles. The virus can stay in the air up to 2 hours after the infected person leaves a room.1

We haven’t heard much about this virus in a long time. Why is it coming back up now? 

  • Measles was eradicated (no longer constantly present and spreading) from the United States in 2000 thanks to vaccination.2
  • Since measles eradication in the US, US cases contracted in other countries did not lead to outbreaks because of the protection of herd immunity. Herd immunity comes from large vaccination rates in the population.
  • Measles is not eradicated worldwide. Around the world, measles still kills more than 100,000 people per year, most under the age of 5.3
  • Measles is coming back to the US now because of the high number of unvaccinated people in the country.

Do you think the trend of anti vaccines is a contributing factor to the outbreak in Harris county? 

  • Absolutely. Groups of unvaccinated people without a doubt contribute to outbreaks. If an infected and contagious person is surrounded by vaccinated/protected people, the virus does not spread beyond that one infected person. If an infected and contagious person is surrounded by unvaccinated people, then a much larger group is exposed and infected. This leads to further spreading of infection from these individuals to other susceptible people. 
  • Herd immunity is the protection offered to others by vaccinated individuals. This is particularly important for those that are NOT able to get the vaccination. As a community, our vaccinated people help to protect those vulnerable groups – small babies, elderly, those with history of cancer, those with immunodeficiency, etc.

 

 

What should parents know about this disease and how to prevent it? 

  • The best thing to protect our families is to have everyone vaccinated. If you have someone at home that is UNABLE to get the vaccination, either because of age or other vulnerability such as cancer or immune deficiency, make sure everyone that has regular contact with that person is vaccinated.
  • One dose of MMR is about 93% effective at preventing measles infection. Two doses are about 97% effective.1

Besides getting the vaccine, what can we do to ensure our families are safe from this?

  • Talk to your schools and daycares about their vaccination rates.
  • Always practice good hand hygiene.
  • Avoid anyone that is ill with measles.
  • Make sure you are up to date with vaccination if you plan to get pregnant.

Should parents be worried? 

  • As a parent and as a physician, I am very worried. I have a 5-month old that is too young for the vaccination and a 3-year-old that is too young for the booster vaccination. I think of measles almost every time I leave the house with my infant. As a physician, I see infants, children recovering from cancer, children born with HIV and other immunodeficiencies. I worry for my children and my patients that these outbreaks will spread further.

What are the initial symptoms, and what should a parent do if they fear their child has been infected?

  • Measles typically begins with fever, cough, runny nose and red, watery eyes. There are very characteristic tiny white spots that appear in the mouth a few days later (called Koplik spots). 3-5 days after symptoms begin, a red, blotchy rash breaks out, usually starting on the face and head and then spreading to the rest of the body. The rash may merge together as it spreads.5,6
  • Symptoms usually appear 7-14 days after exposure to measles. 
  • If your child has fever and rash or if he/she has fever with exposure to a case of measles, they need to be evaluated immediately. CALL YOUR PHYSICIAN’S OFFICE FIRST so that they can be expecting you and minimize exposing others to the illness.
  • A person with measles is usually contagious for about 8 days – from 4 days before to about 4 days after the rash breaks out.

There are now 6 confirmed cases in the greater Houston/Galveston area, what is the medical community doing to be sure this doesn’t get worse? 

  • Currently, there are no recommendations for early vaccination (before 12 months) or early booster vaccination (typically done at the 4 year check up).
  • The medical community and health department looking for potentially exposed people and monitoring for further infections.
  • The medical community is making algorithms to handle concerns from physicians and parents.
  • We are working to increase vaccination rates and educate families.
  • We are re-educating ourselves about measles infection and complications. Since measles was eradicated in 2000, the majority of US doctors under about 45 years of age have never personally seen or treated measles.

What are some of the complications of measles? 

  • More common complications are ear infections, diarrhea and pneumonia. Measles can also lead to encephalitis (inflammation of the brain) and death.
  • Pneumonia occurs in as many as 1 in 20 children and is the most common cause of death from measles in young children.
  • About 1 child out of every 1,000 will develop an encephalitis. This can lead to seizures and can leave the child permanently disabled and/or deaf.
  • Complications can occur in any age group, but most commonly occur in those < 5 years old and adults >20 years old.
  • Those at high risk for complications:
    • Infants and children <5 years
    • Adults >20 years
    • Pregnant women
    • People with weak immune systems – i.e. leukemia, HIV1

What are some of the barriers to vaccination with MMR?

  • Worry about side effects
    • The CDC website clearly lists any possible side effects8, no matter how rare, and they lay it all out on the table. As a physician, I often look up possible side effects of medications, including common medications, and the lists are pretty horrifying.It’s important to realize how often the side effects are seen. I still took my prenatal vitamin despite the listed rare possibilities of vomiting blood/gastrointestinal bleed and iron overdose. As an experiment, I’d challenge people to ask their pharmacist for a list of ALL possible side effects from any medication they take; it can appear very frightening.
    • Most people that get the vaccination do not have any problems with it. Side effects from vaccination are almost always minor and go away within a few days.7
    • MMR vaccination is much safer than getting the measles, mumps or rubella disease.7
  • Worry about ingredients in the vaccination
    • Thimerosal is NOT in MMR vaccination, so I will not discuss it except to say that it is found in trace amounts in multi-dose influenza vaccination.It is considered safe. For more information, please read the differences in ethylmercury (formed when the body breaks down thimerosal) and methylmercury (found in the environment when mercury is present). A link can be found below.7,9
  • Worry that MMR vaccination causes autism
    • This worry came about after an article published by Andrew Wakefield in 1998. This article was found to be fraudulent and was retracted.10, 11
    • After this article, however, the medical community began further investigations.
    • Madsen and colleagues published an article in the New England Journal of Medicine in 2002 which looked at 537,303 children, 82% of which had received the MMR vaccination. It found that the risk of autism in the vaccinated group was the same as that of the unvaccinated children.It found no association between the age at vaccination, time since vaccination or date of vaccination with the development of autism.12
    • Children’s Hospital of Philadelphia has a nice, brief overview of some of the research that has been done in this area. Please click the following link for more information.12https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-conditions/vaccines-autism

Is there anything else that you would like to add?

  • As an internist/pediatrician, I have seen patients die from vaccine preventable disease, and it is heart breaking. 
  • In the US, we are so fortunate to have eradicated measles and to have vaccinations against life threatening and debilitating diseases. Because these diseases are eradicated, we often forget why we vaccinate. 
  • I think that the best testimony I can give to my belief in vaccinations and their safety is that my 4 children are vaccinated on time, every time. I do it for their health. I do it for the health of their grandparents, their friends at school, pregnant family members and friends, my young patients and my immunocompromised patients.
  • Moms and dads want to keep their children safe. They are constantly searching for the right answers to these and other questions. It is good to question the norm and to think outside of the box. We are all just trying to do the best for our kids. We need the correct information to be able to make good choices for ourselves and our children.
  • We need to keep communication open. I hope that families with vaccination concerns will look through these links, discuss their concerns with their physicians and make the decision to have their children vaccinated.

 

 

ONLINE REFERENCES

1 https://www.cdc.gov/measles/hcp/index.html

2 https://www.cdc.gov/measles/about/history.html

3 https://www.mayoclinic.org/diseases-conditions/measles/symptoms-causes/syc-20374857

4 https://www.cdc.gov/vaccines/vac-gen/whatifstop.htm

5 https://www.cdc.gov/measles/about/signs-symptoms.html

6 https://www.mayoclinic.org/diseases-conditions/measles/multimedia/measles/img-20007237

7 https://www.cdc.gov/vaccines/parents/vaccine-decision/index.html

8 https://www.cdc.gov/vaccines/vac-gen/side-effects.htm#mmr

9 https://www.cdc.gov/vaccines/hcp/conversations/downloads/vacsafe-thimerosal-color-office.pdf

10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136032/

11 https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-conditions/vaccines-autism

12 https://www.nejm.org/doi/full/10.1056/nejmoa021134

13 https://www.cdc.gov/vaccinesafety/concerns/autism.html

14 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908915/

15 https://www.texaschildrens.org/blog/measles-here%E2%80%99s-what-you-need-know?fbclid=IwAR2v6p3-VJLzYkz9UOE_CFTaECNDKDbR48Ios2mecI10sZwB8IsiKUiZCCc

16 https://www.npr.org/sections/goatsandsoda/2015/05/07/404963436/scientists-crack-a-50-year-old-mystery-about-the-measles-vaccine

 

 

Feature provided by Dr. Christina Rafiei, MD, FAAP, Internal Medicine-Pediatrics, Texas Children’s Pediatrics Locum 

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