The Measles Outbreak: What Parents Need to Know
Pediatrician Dr. Steve Silvestro breaks down what’s happening with measles right now & how much you really need to worry
by Steve Silvestro, MD @zendocsteve
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I had an interesting interaction with a new dad the other day.
He had a two-week-old son and was asking about how risky it would be if they met up with unvaccinated cousins in the midst of the current measles outbreak in the U.S.
He said: “Look, we’re fine with vaccines. But to play devil’s advocate, isn’t all this worry about a measles outbreak just hype? I mean, it’s only a few hundred people around the country.”
His question gave me pause. He’s right—at the time I’m writing this, the current measles outbreak in the U.S. consists of just 626 infected people in a country of 327 million.
Why all the fuss?
The answer lies in how insanely contagious measles is, and how easy it is to reach a tipping point at which those few hundred quickly turn into thousands and more.
To better understand why we care, let’s dig into what the U.S. outbreak currently looks like, what measles can do, how easily it spreads, and what you need to know about it.
The 2019 Measles Outbreak in the U.S.
As I mentioned, at the moment I’m writing this, there are currently 626 people across 22 states whose measles infection has been reported to the Centers for Disease Control (CDC). [UPDATE: Within 12 hours of me writing this article, the number jumped to 681. By the time you read this, the number will likely be much higher still.]
Seventy-one of those people were reported in the last week alone—a 13% jump in just a week.
The United States has seen outbreaks before. The biggest outbreak—after we officially declared measles eradicated in the U.S. in 2000—was in 2014. That year saw 667 cases of measles in the whole year. If we keep at a rate of 13% more cases every week, we’ll beat 2014’s year-long record by the end of April—just a few days from now. [UPDATE: Yeah, that happened.]
In the U.S., most measles outbreaks are the result of people who’ve traveled to places where there are currently larger measles outbreaks—places like Israel, Ukraine, or the Philippines—and then bring it back to the United States.
Many of these people also happen to live in communities in the U.S. where there are lower than ideal vaccination rates, and so the disease then spreads in their community. That’s why initially, many of the early cases tend to be family members of the originally infected person.
The risk, of course, is that if enough people contract measles in these communities, it can spread to people in other communities—and this is what we’re seeing now.
How does this happen?
To say that measles spreads like wildfire would be an understatement. More on that in a moment. First, let’s get a sense of what measles is and what it can do.
What Is Measles?
Measles is a virus that is spread through the air. When someone with measles coughs, sneezes, etc., the virus lingers in the air and also lands on surfaces.
In fact, the measles virus can remain in the air for up to 2 hours.
This fact, combined with how easily a susceptible person will catch the disease and what can happen if they do, is part of why we fuss about it.
The Common Signs of Measles
Symptoms tend to appear 1-2 weeks after a person is first exposed to measles. The common signs & symptoms include:
- Fever—sometimes as high as 105 (see here for what to do with high fevers)
- “The 3 Cs”—Cough, Coryza (runny nose), and Conjunctivitis (pinkeye)
- Koplik spots—many tiny white spots on the inside of inflamed cheeks, poetically described as “grains of rice on a red base.” These Koplik spots can appear 2-3 days after the 3 Cs develop.
- Rash—This is what usually clues most people in to the fact that they have measles. It is a flat to slightly raised, red rash that spreads from the head down the trunk and limbs—think of it as someone pouring red paint on your head & it slowly oozes down the body. That’s the measles rash. It appears 3-5 days after symptoms started.
The Complications of Measles
Now we’re beginning to get to why we make a fuss about measles…
For your average person, measles is just a bad fever and cold with a rash. Most people will simply get the common symptoms mentioned above, feel pretty miserable for a few days, and then get better.
About 1 in 10 kids, however, will develop ear infections or pneumonia. Again, not necessarily good, but usually treatable, right? Not quite—ear infections caused by measles have a much higher chance of causing permanent hearing loss than run-of-the-mill ear infections kids commonly get.
1 in 1,000 people with measles will develop encephalitis—essentially, an infection of the brain. Should a person with measles encephalitis survive, she is quite likely to suffer lifelong neurologic complications as a result.
And, unfortunately, about 1-2 in 1,000 children with measles will die from respiratory or neurologic complications.
Because numbers and statistics can feel so cold and removed, beloved children’s author Roald Dahl put a name and a face to the perils of measles—his own daughter, Olivia. In this short article, Dahl writes that Olivia contracted measles when she was seven. He treated it as the routine illness it was in that day—until Olivia developed encephalitis and died within hours. It’s a heartbreaking story that reminds us that, yes, that 1 in 1,000 is indeed somebody’s son or daughter.
How Contagious Is It?
Here’s the kicker with measles—it’s EXTREMELY contagious, far more so than a common cold.
If you put 100 unvaccinated or immunocompromised people in a room with 1 person with measles and that person coughs or sneezes, 90 of those 100 susceptible people will develop measles.
To make matters worse, people are contagious beginning 4 days before the rash develops. Remember those early signs of measles—fever, cough, runny nose, and pinkeye? Before the rash develops, a person with measles will most likely think they have a common cold, thus being less likely to isolate themselves or their child as strictly as they might if they knew they had measles.
The result is that a person with measles can walk around and infect 90% of susceptible people they encounter for days before they get the telltale rash that lets them know they have more than just a cold.
So Why Do We Care?
Let’s get back to that dad’s original question:
If we only have 626 cases of measles in a country of 325 million people, why all the fuss?
After all, 1 in 1,000 will get encephalitis and 1-2 in 1,000 will die—but we haven’t even hit 1,000 infected people yet.
Well, let’s put all the pieces together:
- A person with measles is contagious 4 days before they likely know they have measles
- The virus lingers in the air for 2 hours after an infected person coughs or sneezes
- 9 out of every 10 susceptible people exposed to measles will get it
We can see how what starts off as a very low number of infected people can very quickly snowball into exponentially bigger numbers.
Add to this the fact that “susceptible” doesn’t just mean families who choose not to vaccinate, but also the 4 million new infants born in the U.S. every year (as the first measles vaccine isn’t given until 12 months of age) and the roughly 10 million Americans believed to be immunocompromised, and it becomes clear why we make such a fuss about measles outbreaks.
We have a highly contagious disease with the potential for deadly or life-altering complications, and a relatively large pool of people who are susceptible to getting sick.
In essence, it’s a perfect storm—and every additional person who contracts the illness magnifies the odds that the storm will hit.
What Should You Do In This Outbreak?
Now I’m not one to try and incite fear and worry in parents. We all know there’s far too much of that already—in fact, the whole reason I started The Child Repair Guide Podcast was to try and combat the anxieties we all face as modern day parents as it is.
So here’s what parents need to know:
- Stepping out of your house is not likely to put you or your child at risk. This outbreak is not necessarily something that should cause you much anxiety.
- However, if you live in an area of the country where there is a known outbreak or will be traveling to such an area, you should contact your pediatrician to double check that your kids are up-to-date on their vaccines.
- If you live in an outbreak area or will be traveling to one and your child is under 12 months of age—and therefore hasn’t had the first measles vaccine yet—check with your pediatrician or local health department to see whether it is recommended that your infant get the first dose early. This will depend on how big the outbreak is in your area. For example, I practice in Maryland—we currently have four confirmed cases in the state, but there is not a sweeping recommendation to give all infants an early measles vaccine yet. If the number of infected people were to skyrocket here, that may change.
- The vaccine is effective. In the decade prior to the release of the vaccine in 1963, 3-4 million Americans contracted measles each year, with nearly 50,000 people hospitalized annually. One dose of the vaccine is believed to give 93% immunity, with the second dose bringing you to 97%.
- If you believe that you or your child has been exposed to measles, contact your physician. If your child hasn’t been vaccinated yet, then getting a first dose of the measles vaccine close to the time of exposure may provide some partial protection against infection or make the illness less severe.
- People born before 1957 are considered immune—measles was so common back then, it’s assumed people born before 1957 got it. A second dose became standard in 1989—it’s possible parents born in the late ’70s and early ’80s may have been caught up with a second dose, but check your vaccine records to be sure. If you don’t have vaccine records, ask your doctor whether a blood test to check your immunity is worthwhile.
During our conversation, the new dad in my office tried to press further. He wanted to know what the specific risk would be if his 2-week-old baby got together with unvaccinated cousins.
I told him that if he were looking for a specific number—say, an 11.2% risk—I couldn’t give that to him. If the cousins lived in a community that hasn’t seen any measles infections yet, then the odds are extremely low that there is any significant risk to the baby when it comes to measles.
If, however, those cousins do live in an area where there is currently a measles outbreak, then that risk becomes much harder to assess. Remember, the first signs of measles look just like a common cold—yet the infected person would be highly contagious. We all know how young kids seem to constantly have runny noses and a cough—so depending on how many cousins there are, chances are good that at least one will have symptoms similar to early-stage measles…or just a common cold. So if they live in an area where measles has been detected, there really is no way to know exactly what the baby’s risk would be.
Ultimately, I told him, it comes down to trust. Could he trust his relative to be honest about whether or not one of the cousins was sick, even with mild symptoms? That’s complicated not just by the fact that experienced parents might downplay mild symptoms as not a big deal, but also by the notion that, to be realistic, someone who’s chosen not to vaccinate already has their own questions about trusting what others deem to be important.
The question of whether or not to visit that family is a tough one to answer, but one that this dad and his spouse will have to figure out together.
But the question of why we care so much about measles outbreaks—when it’s highly contagious, could have life-altering consequences, and should be preventable in the first place—that answer is crystal clear.
Dr. Steve Silvestro is a pediatrician and host of the award-winning Child Repair Guide Podcast. His mission is to give parents clear information so that they can feel more confident as they raise their kids.