Measles Makes a Comeback

BEFORE THE WIDESPREAD use of vaccines in the 1960s, most pediatricians were well-acquainted with the symptoms of measles. When patients presented with a fever and other flu-like symptoms, doctors knew to check their patients’ throats for the spray of telltale spots that indicated a measles infection. The disease was so commonplace that many people expected to get it, and according to the World Health Organization, 2.6 million deaths annually were attributed to measles in the years preceding the development of the vaccine.¹

Today, 145,000 people die of measles each year, most because they lack access to the vaccine, with only a small percentage of fatalities occurring in the United States. The recent measles outbreak that began in Southern California, however, has alarmed public health officials and serves as a reminder that if large segments of the population continue to avoid vaccination, a full-blown epidemic is not only possible but probable.

Measles Vaccine: A Brief History

The measles, mumps and rubella vaccine (MMR) was introduced in the United States in 1968. A decade later, the Centers for Disease Control and Prevention set a goal to eliminate measles from the United States by 1982. By 1981, the number of reported measles cases was 80 percent less compared with the previous year; however, a 1989 measles outbreak among vaccinated school-aged children prompted the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians to recommend a second dose of MMR vaccine for all children. Following the implementation of that initiative, reported measles cases declined even further. Measles was declared eliminated (absence of continuous disease transmission for greater than 12 months) from the United States in 2000.²

The recent measles outbreak that originated in Disneyland has health officials alarmed. Initial exposures at the park happened in December 2014, according to the California Department of Public Health, but an additional outbreak was linked to theme park attendees in January. From Jan. 1 to May 29, 173 people from 21 states and the District of Columbia were reported to have measles, 117 of whom were part of the outbreak linked to Disneyland.³

Measles: Recognizing the Signs

In the wake of recent outbreaks of measles, many physicians are being tasked with identifying symptoms of a disease they may have never seen outside of a textbook. The American Osteopathic Association offers the following tips to physicians who want to be prepared should a measles outbreak occur in their community:⁴

• Familiarize yourself with the signs and symptoms of measles, as well as vaccination recommendations for the disease. Measles symptoms include a bad cough, red eyes, a rash on the face and a fever of 102 or 103 degrees Fahrenheit. People who become infected are contagious for two to three days before they start showing symptoms.
• Train your front office staff to listen for mentions of potential measles symptoms. Patients who mention these symptoms should be asked appropriate follow-up questions and flagged so they can be given appropriate care when they visit your practice. While at home, measles patients should drink plenty of liquids and take ibuprofen as needed. Also remind staff of the necessity of vaccines in preventing disease. Whatever their personal beliefs, staff should not discourage vaccinations when interacting with patients.
• Because measles is highly contagious, it may be wise to bring patients who could be infected through the back door and straight into an exam room, rather than having them wait in the waiting room and risk exposing other patients. This practice is especially important in pediatric practices, since infants must be between 12 months and 15 months old before receiving the MMR vaccine. As an alternative, the patient and anyone accompanying them should be advised to wear a face mask in the waiting room and common areas.
• Secretions from measles patients, like a sneeze, remain active for two hours. After treating a patient with measles, clean the exam room with Lysol, and wait two hours before using the waiting room for other patients.