What The Heck Is Measles Anyway?

It was 5 o'clock, July 2, 1991.  I know the date and time because it was the end of my first 36 hour shift as Chief Resident.  And it was a true 36 hour shift, not a wink of sleep, with sick kids piling into the hospital like we were having a sale.  But finally it was time to sign out to my fellow residents and go home for a quiet supper and some sleep.  Then the Emergency Department called- has anyone up there seen Measles before? I had.  Two years before, in medical school, I had gone to the Philippines for a month for a course in third-world medicine.  In the Philippines vaccinations are a luxury few can afford and I saw lots of diseases we seldom see in the States-measles included.  I went downstairs to the ED, saw the child, and when he opened his mouth, I saw the blue-white spots on the roof of his mouth that clinch it: he had measles.  I didn't feel sorry for myself that my well-earned break was put off by one more patient; I was elated.  I made a diagnosis no one else could! Measles is in the news a lot lately.  We are having an epidemic- lots of kids are getting the disease this year.  Many parents are refusing to get their kids vaccinated because of fears of injury from the vaccine.  Those unvaccinated kids are vulnerable and when they come in contact with someone infected, often someone who has been in another country, they get infected too. What is the measles?  Measles is a virus that has been with mankind for centuries.  It is a virus that starts off like many cold and flu viruses.  The child starts with a cough, runny nose, and fever.  He might have some red eyes, sore throat, and maybe some vomiting.   Then in about 2 to 3 days a spotty rash develops, and those white spots in the mouth.  The rash starts on the face, then spreads to the torso and then the arms and legs. The whole thing lasts about 10 days before it goes away. So what is so bad about the measles?  Why all the news, why a vaccine in the first place? Well, the bad news is that the measles can be deadly.  Before the late 20th century, measles was a terror for families.  Lots of kids with measles developed bad complications- pneumonia or encephalitis (brain infection).  Many children died. It was common and terrible scene in many households.  The parents and doctors could do little for a badly infected child.  There were no IV fluids, no respiratory support, no antibiotics for pneumonia.  All anyone could do was hold the child's hand and watch helplessly as he slipped away, comatose and struggling to breathe. As the century progressed, improved nutrition, hygiene, and medical care helped more kids survive. Then in 1963 a vaccine was invented and the world rejoiced- finally children were safe from measles!  But in the span of my lifetime, we in medicine became victims of our own success.  With the near-eradication of measles, the next generations did not learn to fear it.  People began to question- what's in those shots that you're putting into my kid? Then in 1998 there was a study that suggested the measles vaccine caused autism. Since then mountains of evidence have refuted that, and the study itself was found to have fraudulent data.  However, the seeds of doubt were planted.  Some parents won't get their kids vaccinated and that makes for a chink in the armor of our population's immunity. Pockets of unvaccinated kids are vulnerable to the measles.  And measles is highly contagious- viral particles can hang in the air up to an hour after the infected, coughing patient has left the room. Now we doctors are having to re-learn what measles looks like.  We are having to explain over and over the safety of vaccines, and the threat of disease that history has forgotten. So help us, and help your own kids- keep them vaccinated.  Enjoy one of the benefits of modern science and technology- safety from one of the world's worst illnesses, once thought gone for good, now threatening to come back.