Sunday, June 9, 2013

Measles: Common, yes; Mild, no


Maureen does not remember much from her experience with measles. She remembers “being in a huge room all by myself. And I remember the nurse with the blue eye shadow who gave me needles. I hated her.” Maureen was four, and the year was 1960, before the measles vaccine. She had a very bad case of measles. Her mother told Maureen that she “even had spots on the soles of my feet”. The measles turned into pneumonia; Maureen was hospitalized and in an oxygen tent. She spent a week in the hospital. The doctors thought, initially, that she had scarlet fever because she was having so much trouble breathing. Then they confirmed it was measles. 

Measles in history:
Measles was documented at least as far back as 900 BC. Here is a short summary of its history, courtesy of Refutations to Anti-Vaccine Memes:



Here is an example of what it can do to a population, from the same source:



Measles did not only affect the poor or malnourished. In 1711, the son and heir of Louis XIV, the French Dauphin, succumbed to smallpox, and his son became the dauphin. On February 5, 1712, the new Dauphin’s young wife – princess Adelaide, then 26, and the joy of the aging monarch – developed a fever. Two days later, her condition worsened: “A piercing pain, worse than anything she had ever endured, then laid her low and continued for twenty-four hours despite the best (or worst) efforts of doctors… At last some spots emerged and fever was announced; hope was felt that she would recover when the rash had broken completely. It did not happen. … by daybreak on Friday 12 February the Princess was in extremis. Her fever continued to rise, and eventually she died.” The young woman knew she was dying, and accepted her fate.  “Six days later, her husband followed her to the grave. Their 5-year-old son died on March 8. All that was left was the younger son, only two years old… (Antonia Fraser, Love and Louis XIV).

Measles in the pre-vaccine 20th Century:
In 1916 measles killed nearly 12,000 people in the United States – most of them under the age of five (Note also the video in the link, describing the complications).
Measles is extremely contagious; in the pre-vaccine days, pretty much everybody got it – between 1953-1962, there were over 500,000 cases a year in the United States, with 440 deaths a year on average.
Even in regular, uncomplicated cases, measles can be painful and miserable. Meleese remembers when she and her brother caught it: “My brother hallucinated from the fever. I was kept in a darkened room and not allowed to read - for 2 weeks - pure torture as I was a bookworm and an early reader. I was about 7-8 and could read before I started school.”
Says Robin: “I was 5, I think. I remember mum worrying that my sisters, who were tiny babies, would get it. I was so sick I didn't eat for a few days, and had a huge fever and vomiting. I remember I had never felt so sick in my life. I had been vaccinated, and was lucky that it was comparatively mild.”
Alice says: “I was 8, in third grade. I was so sick I don't really remember much of it. I do know that I spent days in my room with the window shade down, alone, and I must have been very sick because I don't remember being bored or asking if I could have something to read. That alone should tell the tale. The other thing I remember is the look on my mother's face when I got better. She was never one to let us see if she was worried when we got hurt or were sick. There was a lot of, "Shall I call an ambulance?" if we cried over a skinned knee, even while she made sure it was well taken care of. But the day she allowed me to come downstairs and lie on the couch, with her sunglasses on (Her sunglasses, which none of us were allowed to wear and which always stayed in their case), she asked me if I was hungry and what I might want to eat. The look on her face when I asked for a hamburger is still in my mind. She didn't say anything but, "Oh, you must be feeling better!" and went right out to the kitchen to get it, but I could tell how very relieved she was.”

Here are some examples of the measles rash on children:


Courtesy of the CDC/Dr. Lyle Conrad, provided through the Public Health Image Library, found at: http://phil.cdc.gov/phil/details.asp?pid=6887


Courtesy of the CDC/Dr. Barbara Rice, provided through the Public Health Image Library, found at: http://phil.cdc.gov/phil/details.asp?pid=990


The complications were estimated at about 30%, and the complications could be really bad. They included pneumonia, encephalitis, ear infection that could lead to deafness or hearing loss and other problems. Says Alex: “My mom had it as a kid, as did all my aunts and uncles. My uncle went blind in one eye, and my mom ended up with impaired vision and hearing loss. My uncle really took the blindness hard, not at the time, but later in his teen years.  He wanted to play sports, but vision in one eye only ruined that.”

And even without malnutrition, at a rate of about 1 or 2 in a thousand, measles killed. Author Roald Dahl’s daughter, Olivia, was one of the victims. Olivia was seven when she got the disease. Initially, it looked like all would be well. But, tells us Dahl, “Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything. 

'Are you feeling all right?' I asked her.
'I feel all sleepy,' she said.
In an hour, she was unconscious. In twelve hours she was dead.
The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.” The vaccine was not yet available for Olivia; in his moving story, Dahl called on parents to protect their children from Olivia’s fate and vaccinate.

Then there is the latent killer. SSPE, subacute sclerosing panencephalitis. If a child got measles while young (typically under the age of two), they could develop this rare but incurable complication. Some years after the disease – 5 or more – the measles virus would start destroying the child’s brain cells. It is unpredictable how SSPE would develop – but it leads to slow deterioration of the child’s skills, and eventually, death.
This is what happened to a little girl in Germany named Angelina, as told by Just theVax and SkepticalraptorAngelina had measles as a 7 months old baby, before she was to be vaccinated, and seemed to recover. Then, a little before the age of 6, her mother says ""In February of this year, we noticed pronounced problems with our daughter. She kept falling off her bike, and had speech blockades. When this was getting worse, we went to the clinic. The diagnosis SSPE was a shock for us. Our child became dependent on care within 8 weeks. She cannot walk nor speak and needs to be tube fed. She would have entered school this year. This blow of fate is very hard for us all."” All that is left for the parents who raised her lovingly for six years to do is watch her deteriorate and die.

Measles today:
We have an extremely effective (though, of course, not 100% effective) vaccine against measles today. The MMR provides long term, maybe lifelong immunity to 99% of people who receive two doses. Still, measles kills over a hundred thousand people, most in the third world. According to the World Health OrganizationIn 2011, there were 158 000 measles deaths globally – about 430 deaths every day or 18 deaths every hour.”  That’s a decrease fromover 500,000 in 2000. Most of the deaths are in children under the age of five. Lack of access to the vaccine costs life; and malnutrition and vitamin A deficiency make measles much more dangerous.
Consider, for example, the recent epidemic in Pakistan. In one of the hospitals:
The ward is so packed with babies and young children that they are sharing beds. At one stage, up to 70 new patients were arriving at the hospital every day. They are covered in rashes and burning with high temperatures, some fighting for life.
In one corner, a boy lies motionless on his back, his eyes rolled back as flies crawl across his face.
At least 40 children have died in this hospital since the epidemic spread from southern Pakistan to Lahore and other parts of Punjab province at the beginning of the year.”
A family whose children were not vaccinated is watching their daughter struggle.
“Mohammed is cradling his daughter Yasmeen, who will be two this summer. She is covered in the measles rash and has had an alarmingly high temperature.
Just a few days ago, her brother Ehsan died at the Lahore Children's hospital from complications arising from measles. He was nine months old.
'I didn't get him vaccinated because I was on my own at home with so many children,' says Nasara. [the mother] 'And we had to go out to get the vaccinations, so it was difficult because they were small.'”
In the first world too, outbreaks increased in recent years, affecting primarily the unvaccinated, including children too young to vaccinate. And they came with complications – not as many deaths as in the third world, but still, preventable deaths and disabilities. In 2011, Europe saw 28,868 cases. Over 80% of cases were in unvaccinated individuals. The largest infected group were children under one year old whose parents will only know many years after the fact whether or not they will develop SSPE. The known complications included 8 deaths, 26 cases of encephalitis, 1040 cases of pneumonia, and over a thousand others.
Outbreaks were also seen in the UK, concentrated in Wales.
The United States had so far seen lower numbers of cases, though outbreaks seem to be increasing recently. 2013 has so seen outbreaks in North Carolina, in Colorado, and in an Orthodox Jewish community in New York, among unvaccinated individuals. Several outbreaks started with an unvaccinated individual traveling abroad and coming back with the disease.


Measles does not have diphtheria’s mortality rate of 10% or polio’s scary paralysis. But it is not an easy disease by any means, and it can cause very nasty complications in substantial percentages of those who get it. It is also very contagious, and can come back easily as vaccination rates drop. And it is preventable: we have an extremely effective vaccine. Given this background, allowing measles to come back, bring certain pain and suffering and potential complications, even death, seems, well, just wrong. 

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