Box Butte General Hospital Emergency Department physician Bruce Forney, MD, is urging the public to take seriously the recent news stories about the measles outbreak. “We (providers and health care facilities) are receiving constant updates and recommendations from a variety of sources, including the Nebraska Department of Health and Human Services, the Centers of Disease Control (CDC) and the American College of Emergency Physicians (ACEP),” he said. “All point to the potential of a serious outbreak occurring.” According to the CDC, the United States experienced a record number of measles cases in 2014 (more than 600) and from January 1, 2015 to January 30, 2015, a total of 102 cases have been reported in 14 states, including Nebraska, Colorado and South Dakota (see accompanying graphic).
Many people may be surprised by the possibility of a severe measles outbreak. “Measles had been largely eliminated from the US and developed countries through effective Measles, Mumps & Rubella (MMR) vaccination programs,” Dr. Forney said. “Through most of my career, I’ve hardly seen any cases. The reason for that was that over the years the effective vaccination program in the United States had produced what we call ‘herd immunity.’ That’s where so many people had been vaccinated, it created a kind of firewall that protected those individuals who may not have been immune. That’s breaking down for a couple of reasons.”
The rise in measles outbreaks in the U.S. is due to two primary factors according to the ACEP: 1) importation of cases from other countries with lower immunization rates, and 2) lack of immunization among certain segments of the childhood population.
Dr. Forney said the second factor concerns him and many other health care providers. “For more than a decade, some parents with children have been convinced that vaccinations can cause other problems in children, so they didn’t have their kids vaccinated,” he said. According to the ACEP, more affluent, educated families comprise the majority of the anti-vaccination movement.
“We’re seeing the results of that kind of thinking by this latest outbreak of measles,” Dr. Forney stated. “Studies have shown that such fears about measles vaccinations are groundless. If you haven’t vaccinated your children, or have never received a vaccination yourself, do so. I can’t stress enough how important that is. Complications that can arise from measles make immunization a must; with benefits far out weighing any perceived risk.”
The ACEP reports that up to 3 in 10 (30%) of measles patients may develop complications such as ear infections and diarrhea. More serious complications include pneumonia and encephalitis (inflammation of the brain, which can cause permanent injury to the brain or death).
Again, according ACEP, those who are most at risk of complications are infants younger than 12 months (too young to be vaccinated); children older than 12 months who have not had at least one MMR vaccination; and children over four years who have not had a second MMR vaccination.
The fact sheet goes on to say that measles (Rubeola – “Red Measles”) is a very contagious, potentially severe and deadly viral infectious disease that is spread via the airborne route (sneezing, with airborne droplets either directly inhaled or airborne droplets landing on surfaces). The measles virus remains infectious on surfaces and in the air for up to two hours after an infectious person leaves the area. “What makes containing this especially problematic is the fact that patients are infectious up to four days before the typical measles rash shows up,” Dr. Forney said.
Prior to the rash presenting, a person might experience fever, malaise, cough, runny nose or conjunctivitis (pink eye). The rash itself usually presents around 14 days after a person is exposed, however the incubation period ranges from seven to 12 days. The rash will usually start in the oral cavity, then on the face and spreading from there to the rest of the body. “In addition to being contagious 4 days prior to rash developing, patients who have developed the rash are considered to be contagious up to four days after the rash appears,” Dr. Forney said.
He concluded by urging area residents to contact their primary care clinics if they have questions about vaccinations or to schedule an appointment if it is determined one is needed. For those who do not have insurance options, a twice a month immunization clinic is held at BBGH.
Box Butte General Hospital is an equal opportunity provider and employer.