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USA Measles Cases Continue. Is Ohio Next?
by Clyde E. Henderson, M.D.
Cincinnati Medical Association
Measles is one of the most contagious diseases known to man. This viral illness is preventable by proper vaccination. A person who is not vaccinated has a 9 in 10 chance of becoming ill if they are exposed to measles. This dreadful disease was declared eliminated from the United States in 2000. Like most infectious diseases, measles has no respect for geographical borders due to the extensive international travel which occurs. According to the CDC "measles anywhere is a threat everywhere." There were 10.3 million worldwide cases in 2023. There have been small yearly outbreaks in the USA including one in Central Ohio in November and December of 2022. There were 85 children infected, 36 hospitalizations, and no deaths. None of the affected children had been fully vaccinated. This lack-of- vaccination is fueling the current outbreak in Texas. There have been 198 cases with twenty-three hospitalizations and one probably preventable death. This dead child and another in New Mexico were both unvaccinated, along with most of those infected. Cases are currently being reported in eight other states, including our neighboring Kentucky.
Measles can be deadly and is more than just a rash. It can spread four days before and four days after the appearance of the rash. Whitish lesions surrounded by a red halo (Koplik spots) can appear inside of the mouth. These can occur two days before the classic skin rash and these lesions are said to be a hallmark (pathognomonic) sign of measles. Temperature elevation to105 degrees can occur along with tiredness, runny nose, watery red eyes, cough, and sore throat. The rash, which usually starts 10-14 days after exposure, generally first appears on the head and face, spreads to the trunk, and then to the lower extremities. The rash is referred to as maculopapular as it combines flat, discolored lesions (macules) with small, raised areas (papules). The sore throat and mouth lesions can make it difficult to swallow which can lead to dehydration, particularly in the face of a high fever. Common complications include middle ear infections, pneumonia, bronchitis, and diarrhea (also contributing to dehydration). Measles is one of the leading causes of childhood blindness, particularly in areas with malnutrition and vitamin A deficiency. Brain inflammation (encephalitis) occurs in 1 of 1000 infected children and can lead to permanent brain damage. The death rate from measles infection in 1 to 3 per 1000!
The management of measles, once a person is infected, is directed at the specific symptoms present. One in five people with the measles require hospitalization because of more severe complications. Children younger than five, adults over the age of 20, pregnant women, and individuals who are immunocompromised are at the highest risk of severe complications. Proper nutrition, hydration, and over-the-counter medications are appropriate for mild cases. Two doses of weight-appropriate vitamin A, given 24 hours apart, are recommended by the WHO (World Health Organization) to prevent eye damage or blindness. Note that too much vitamin A or D can cause toxicity, thus avoid the indiscriminate use of either supplements containing these vitamins or cod liver oil. Measles is spread by tiny droplets generated by cough, sneeze, or talk. These droplets can survive on surfaces. Thus, isolation and masking of the infected and thorough handwashing after contact with contaminated objects is necessary.
The most important measure for preventing measles is vaccination. There is solid scientific evidence that demonstrates the benefit of vaccination against measles. There is no vaccination for measles alone but protection against measles is safely provided by the MMR (measles, mumps, and rubella) or the MMRV (measles, mumps, rubella, varicella (chickenpox)) vaccine. The recommended two dose regimen of the MMR is 97% effective at preventing a measles infection. Unfortunately, our country is plagued by vaccine misinformation and skepticism. People are understandably fatigued by the pressures around the lifesaving COVID-19 vaccine. Yet we are better off following the science and not the skeptics as our failure to vaccinate can have fatal consequences for our children. According to the Ohio Department of Health, the MMR vaccination rate for Ohio 2-year-olds in 2023 was 91.5%. The CDC’s target rate is 95%. Our state’s low level of vaccination leaves Ohio’s children under-protected and needlessly subject to illness and possibly death from a preventable disease. It is just a matter of time before measles revisits the Buckeye State.
Please get your children and unvaccinated adults, vaccinated!
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