Suspected case of measles stirs up worry

One recent Thursday afternoon, a family called the office because their daughter’s daycare center had notified the family that one of the children there was suspect for having measles. Naturally the parents of this young child were concerned. Their child was still too young to have received the vaccine, and they didn’t know what to do. At the time of the call, the parents reported that she had just a mild cough but no fever or other symptoms. She was advised to come to the office later that day for assessment and to receive the measles mumps rubella (MMR) vaccine in the hopes of minimizing her chances of contracting the illness.

Measles is a viral illness that is highly contagious. It has a cousin the German Measles (“rubella” of the measles mumps rubella vaccine) which is milder. Both illnesses have an incubation period of 6-12 days where the infected person exhibits no symptoms of illness but is contagious nonetheless. Once the illness begins, fever, cough, sore throat and red eyes are typical.

The fever in measles is quite high (up to 104 or higher) and somewhat lower in rubella, but either one will make the sick child really unhappy. The cough, sore throat and red eyes last for a couple of days and then the characteristic rash appears usually starting at the head and working its way down. What helps differentiate measles or rubella from other viruses that cause rash and similar symptoms is that with measles or rubella the fever will often worsen as the rash appears. Many of the other winter viruses, the fever comes first and then just as it ends the rash appears. Once the measles rash appears, it will spread for several days and the child remains contagious during this time.

 Measles will make you miserable but it is the potential complications that are most concerning. Pneumonia and a brain infection called encephalitis are the most serious and either can cause permanent changes to the lung or brain and death is a common complication with these manifestations of measles.

When the patient arrived, her condition had changed and she was now feverish and had a reddish look to her eyes. She was very cranky, too, but it wasn’t clear if that was just because she was in the office or because she felt so sick. Because she had developed fever and was sick, we weren’t sure if she should receive the MMR vaccine and called a specialist who was aware of the possible measles case at the daycare and advised us not to give the vaccine given her current symptoms. The girl and her parents then went home to wait and see if more symptoms of measles evolved.

After she left, we understood too that every patient in the office at the same time was potentially exposed if she turned out to have measles, and so we compiled a list of all the families there at the time, along with their vaccine status regarding the MMR vaccine. We hoped to never have to call the families and would know within a day or two if this patient was truly exposed to measles or not and if so, we would also know by the next Monday if she had gone on to have the illness herself.

It turned out that the child in our office was not exposed to measles, but rather a different more benign winter virus and so we didn’t have to call the families in the office that day or worry that this little girl would get sicker. It was a wake-up call, though, to remind me that these infectious illnesses we rarely see are indeed still on the radar and the complications both medical and logistical are widespread.

The MMR vaccine is available routinely starting on a child’s first birthday and is recommended to be given by 15 months. Now that the association between the vaccine and autism has been debunked, receiving the vaccine on time should be an easier decision for most families.