pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Numbered Diseases of Childhood: FIRST Disease – Measles

March 10, 2014

In 1905 pediatricians made a valiant attempt to simplify the medical nomenclature by giving the then known six diseases which caused rashes numbers instead of cumbersome, and sometimes embarrassing names. We spoke about the Numbered Diseases of Childhood in a previous article.

Facial rash of MeaslesIn this article we’ll talk about: “FIRST Disease”; which, not only was the first of the six diseases known and recorded, but has been involved in the worst medical hoax of our time and continues to put millions of people at risk. Measles!

FIRST Disease – Rubeola

This illness has been around causing rashes since before anyone can remember – eons, literally. Eventually it became known as Measles and was the first childhood disease on the numbered list – FIRST disease. When someone just says “measles” this is the one they mean.

You may have called it Rubeola (roo-bee-oh-la) or the “Hard Measles” or the “14-day Measles” or “Morbilli” or “English Measles” – they’re the same thing. (In Spanish it’s “sarampión.”) None of the six numbered diseases are a piece-of-cake but they call this one the “hard” measles for a reason.

Contagion and Spread

Like just about every other infectious disease, the “victim” is exposed to someone else who had it; and this is the “poster child” of diseases which are contagious. Over 90% of un-immunized people sharing the same living space will be inflicted with the disease from one person who is sick.

One of the reasons is that the virus in the mucus droplets from one persons cough in a room can hang in the air and be infectious for up to TWO hours! Another reason is that this “bug” is just plain nasty! If it decides to, it leaves the respiratory system, effects the skin and even the brain.

Fluids from an infected person’s nose and mouth (either directly or through aerosol transmission) carry the virus which attacks the unfortunate recipient’s respiratory system and quietly begins replicating for nine or so days until they’re so numerous that the person’s eyes turn red, nose starts running and they begin coughing and develop a fever.

Symptoms and Physical Findings

So far, your doctor would still be scratching his head because this is just like thousands of other “cold” viruses. We were taught to watch for: the “4-Ds and 3-Cs” – 4-day long fever (even up to 104°F) and cough, coryza (runny nose), and conjunctivitis (red eyes).

Photo: Koplik Spots of measlesIf you take your child in to see the doctor with only the “cold” he just might be able to see “Koplik Spots” (named after a real Dr. Koplik) on the inside of the cheek next to the back molars – tiny, raised, red dots with a bluish-white center, which are pathognomonic (proof) of measles. But, most likely he won’t because they come and go so fast.

One to 2 days after the spots, Ka-boom, the rash hits: maculopapular (raised bumps), erythematous (red) rash beginning on the back of the ears rapidly spreading to the head and neck then to most of the body – often pruritic (itching). Early on the splotches blanch with pressure but eventually become fixed and sometimes are so numerous that they join together.

It can last for over a week and “stains” as it is resolving – changes color from red to dark brown. That’s how long the child will be home from school – IF everything goes well – until the rash fades.

Complications

I say “If everything goes well” because, unfortunately, it frequently doesn’t – and by frequently I mean that complications in this disease are fairly common. They range from the less serious (like diarrhea) to otitis media, primary and secondary pneumonia, encephalitis (brain infection), corneal ulceration, subacute slcerosing panencephalitis (SSPE) and death.

The death rate can be as high as 30% for measles pneumonia and between 1987 and 2000, just fourteen years ago, the fatality rate in the United States was 3 per thousand cases. In underdeveloped countries death rates are 28% and in immunocompromised patients it’s a whopping 30 percent!

Prevention and Eradication

“FIRST disease” is extensively known. We know where it lives: only humans. We know what it looks like: a single-stranded, negative-sense RNA paramyxovirus. We know how it gets in: only coughing and sneezing via close personal contact or direct contact with secretions. And, we know how to prevent it: a simple, readily available vaccination – the MMR.

If we can once get to a state where no human is infected the disease would be GONE! Kaput! In fact it WAS CONSIDERED GONE, in the U.S. in 2000! There was no endemic measles noted, they were all contracted from foreign countries and were down to 60 cases per year. WHAT HAPPENED?!

Heinous Hoax

It was the most heinous medical hoax ever perpetrated on the world in recorded history. A crap-for-brains British doctor, Andrew Wakefield, completely falsified his research data in order to make money and gain “fame.” He make the false claim that there was a link between the MMR vaccine and autism – and the British journal Lancet published it without verifying all the facts.

Journalist Brian Deer who exposed Wakefield’s fraud (right)]That was in 1998 and it took until 2004 for the intrepid investigative reporter, Brian Deer, to uncover Wakefield’s lies and begin to make them public. Unfortunately, it wasn’t until 2010 that regulatory “officials” began to act and now have completely removed his license to practice medicine calling him “dishonest”, “unethical” and “callous.” Two other physicians were also implicated in wrong-doing, one was found to be “unknowing.”

Andrew Wakefield, scammer exposed by JournalistWakefield’s defense attempt to counter-sue Deer and the Times for liable also fell apart and made him responsible for all of their legal expenses as well. It seems to me that this so-called breech of ethics was so far-reaching and deliberate that I’m perplexed why he hasn’t yet faced criminal and civil penalties.

We now know that “scientific evidence provides no support for the hypothesis that MMR plays a role in causing autism.” However, even though Wakefield’s research was declared fraudulent in 2011 by the BMJ, the catastrophic damage done to the children of the world persists by the Wakefield-wannabe’s with hidden, monetary and notoriety agendas in the cult-papers and internet.

They continue to prey on the minds of the “intentionally unknowledgeable,” “habitually misinformed,” and “conspiracy theorists” to the hurt of the world’s health.

Hoax Results and Damage to World Health

Beginning in 2000 vaccination levels began to drop because of the false claims. It even created a “spin-off” hoax in Nigeria whose radical preachers used it to promote a rumor that polio vaccines were a Western plot to sterilize Muslims and infect them with HIV. As the vaccination levels decreased the infection and death rates rose!

In 2013 6,497 measles cases left 23 people dead in the Philippines. Last year 1,219 cases and 88 hospitalizations in the city of Swansea, Wales, UK rose to the declaration of an epidemic and government intervention.

The last reported data from France (2008-2011) revealed over 17,000 cases (over 1/3 in the last three months) and included 2 deaths in 2010 and 6 deaths in 2011. French cases led to an outbreak in Canada where 327 cases were reported over only 6 months in Quebec.

On an average day, 430 children – 18 every hour – die of measles worldwide. In 2011, there were an estimated 158,000 measles deaths according to CDC data.

The United States is no better off! In fact we should consider ourselves much worse off when considering our compulsory immunization programs, vaccine availability and the considerable amount of naivety it takes to create such a level of “immunization objectors.”

Before the vaccine was available, nearly all U.S. children got measles by their 15th birthday and epidemics cycled through the nation every two to three years — generally peaking in the late winter or spring. In those days, about 450 to 500 Americans died from measles each year!

Measles In The United States Today

In the U.S., 2011 was described by the press: “2011 was worst measles year in U.S. in 15 years.” There were 222 measles cases in 17 outbreaks reported to CDC, compared to 60 cases in four outbreaks reported during 2001–2010.

Facial rash of measlesIn 2013 the U.S. press claimed: “U.S. measles cases in 2013 may be most in 17 years.” The first 8 months of 2013 saw a total of 159 cases reported to the CDC. Ninety-one percent were in persons who were unvaccinated (or unknown status). Eight outbreaks accounted for 77% of the cases reported in 2013, including the largest outbreak reported in the United States since 1996 (58 cases).

Although as of February (2014) final statistics aren’t available for 2013, the estimate was 175 cases, nearly triple the 60 per year usually seen. The cases were linked to individuals who brought the infection home after foreign travel.

Among those who have been stricken with measles this year, 92% were not vaccinated or had unknown vaccination status. The largest outbreak was in New York, where 58 people contracted measles in a community where many refuse to be vaccinated.

Those who choose not to vaccinate put other people’s babies at risk, since babies cannot be vaccinated until their first birthday, and are therefore vulnerable to the disease.

And it’s expensive to the country to thwart the contagion. Containing just 107 of the 222 cases in 2011, “the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.” That’s NOT the cost of medical treatment, only government public health costs.

In contrast, the MMR vaccine only costs about $56.

What IS This Ornery Disease We’re Faced With?

Let me take you through just one specific case in order for you to get a better understanding about just what an ornery kind of disease measles is to the world we live in, and what we’re up against.

Body rash of measles]As I can piece together what its taken this long to uncover, a 2008 measles outbreak in San Diego was the result of a couple who had a “personal belief” exemption and took their unvaccinated 7-year-old to Switzerland where he was exposed. A week after returning he became ill then returned to school when he began to feel a bit better in 3 days. That was when the rash developed and he was taken first to a family physician and then to a pediatrician who made the diagnosis of measles.

Even though he was progressing along the classic measles course, he was taken to the emergency room because they were worried about a continued fever. Before he stopped exposing others, eleven other children became infected with measles – two siblings, five school mates and four children exposed in his pediatrician’s office!

None of the eleven children with secondary infections had been immunized: 7 with “personal belief” exemptions, 1 with “missed opportunity” and three were younger than 12 months of age and too young for the vaccination.

One of the infants was exposed at his 10-month Well Child Check and required critical hospitalization for three days. Another of the infants traveled to Hawaii exposing people on route and while there.

An additional seventy children were placed under voluntary quarantine for 21 days after their last exposure because they were exposed to one of the measles cases and either didn’t want to be vaccinated or were too young. In all, 839 people were exposed to the measles virus from this one un-immunized child in several states and costing health departments hundreds of thousands of dollars in addition to medical costs.

Did I say that MMR vaccination costs under $50?

The Rest Of The Story

Besides understanding that being unvaccinated leaves an individual vulnerable to measles and its complications of brain infections, deafness and infertility in addition to being responsible for passing it on to others who may not be able to be vaccinated, other aspects to consider are:

MMR vaccination has stopped world measles epidemics
• Two to 5% of people do not respond to their first dose of measles vaccine, which is why a booster dose is recommended. But more than 99% of people develop immunity to measles after two doses of a measles vaccine, like MMR.
• A booster dose of MMR was not first recommended in 1989, so many adults born before 1985 may not have had two doses of MMR.
• Measles is fatal in about 0.2% of cases.
• Respiratory droplets from a cough can stay in an area for up to two hours after a person with measles symptoms has left.
• People with measles are contagious from 3 or 4 days before they develop the first symptoms – perhaps up to a week before the rash – and until the rash has gone.
• Call your pediatrician BEFORE going to a “walk-in” situation if you think your child has measles so care can be arranged without exposing others – especially if he develops a high fever and/or rash during a local measles outbreak or after a trip out of the country.
• Not all doctors have actually seen measles in their training so actual diagnosis may be delayed until classic symptoms are obvious.

The bottom line: a measles vaccine (MMR) is the best way to protect your own child from measles and to protect those in your community as a whole who are either too young, medically frail or unable to yet receive vaccination. And it is especially important if there is a measles outbreak in your area or if you are traveling to an area with high rates of measles – which, unfortunately, even still today is just about EVERYWHERE – thanks to people like Wakefield.

Next on our nostalgic journey through the historic Numbered Diseases of Childhood is “SECOND disease” – Scarlet Fever.