Measles in Iowa

We've had pertussis and mumps, so it was only a matter of time.

State health officials declared a "public health emergency" Tuesday after a test confirmed a case of measles in an unvaccinated Dallas County baby who apparently picked up the disease in India.

They said people who might have been exposed included passengers on an Americans Airline flight from Chicago to Des Moines May 11 and people who were at Mercy Medical Center or a Mercy pediatric clinic in downtown Des Moines May 14.

Dr. Patricia Quinlisk, medical director for the Iowa Department of Public Health, said many Americans falsely recall measles as a benign childhood illness. "I get asked by medical students, 'Which disease are you most afraid of?' And they expect me to say Ebola or SARS or something like that - but, it's measles," she said. "I don't think people understand how bad it can be, how many people can get seriously ill and, unfortunately, how many people can die from this disease. It's bad and it's probably the most spreadable disease we have in our society."


Dr. Asha Madia, a Mercy pediatrician, said the patient is an 8-month-old boy who had a fever, a rash and a mild eye infection. He has recovered. She said the boy was not vaccinated because such vaccinations generally are not given before age 1. But she said his family believes in vaccinations and had immunized the boy's older sibling.

So this is unique in that the index case isn't from a family who has eschewed vaccination (unlike this case in 2004), but in a child who was unvaccinated nevertheless due to his age. This is one reason the CDC just last month recommended the MMR vaccine in infants who would be traveling abroad, even if they are below the traditionally recommended age.

Story still developing, but for now it appears that this is the only case recognized. However, as Maryn recently pointed out, *any* measles outbreak isn't cheap, due to the diligent surveillance that must be undertaken to make sure no one else comes down with the infection. Full information available here from the Iowa Department of Public Health.


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"Conscientious[sic] objector" parents of unvaccinated children should pay a levy to cover the costs of dealing with outbreaks such as these.

By Vince whirlwind (not verified) on 24 May 2011 #permalink

So, I'm confused (ignorant). I seem to remember that, as a kid (I'm 42 years old now) measles was fairly common, and I don't remember it being considered all that big a deal. I mean it wasn't good, but people didn't talk about measles like it was cancer. But, I was a kid at the time, so maybe my memory/understanding of the situation wasn't that good. From Dr. Patricia Quinlisk's response, I suspect I'm not alone in my ignorance.

SteveC, forty years ago, people accepted a much higher rate of child mortality as normal and unavoidable. Since there wasn't much they could do about it, they accepted the risk of death or brain-damage in much the same light as we accept the risk of falling down stairs: i.e. We now try to keep our stairs reasonably tidy, and families back in the day tried to ensure kids with measles were well nursed. Now we actually have an effective way of stopping measles transmission (vaccination), any death, maiming or suffering as a result of measles infection is entirely needless. So people get worked up, because children die or suffer despite us being able to prevent it.

In fact, measles kills something around one patient in every thousand, even with the best of care (and more like 10% in poor countries, rising to 20-30% in crisis conditions). This sounds quite low (at least if you have access to a good hospital), but measles is *incredibly* infectious. As in, probably more infectious than smallpox was. Before vaccination, you got outbreaks where literally every single person who'd not had it previously caught the disease. Once you start multiplying 0.1%, by the 5% or so unvaccinated that you need to allow transmission, by population of whole countries, you're getting into very scary territory. Also, you run into the flu epidemic problem of hospital capacity. If you start to run out of beds and healthy staff your death rate will rise. Even if only a small proportion of cases need hospitalisation, that's still a load that, on top of your normal patient load, may well be more than your systems can handle.

And then you have the chance of permanent disability. Measles causes encephalitis in a significant % of patients, which can in turn cause brain damage, deafness or blindness. High fever itself is dangerous. Also, especially if you're looking at patients with other health conditions, you get things like pneumonia rearing their ugly heads. Imagine a major measles outbreak in an area with high rates of HIV+ children. Definitely something to get worked up over.

By stripey_cat (not verified) on 25 May 2011 #permalink

My mother-in-law works with the local health department and she has some serious scares that have come up in the past with measles in Florida. Luckily it was never classified as an outbreak.

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- David

There was nothing people could do about viral diseases except keep their children away from crowds and nurse them through the symptoms. If you'll recall, though, Alexander Graham Bell taught at a school for deaf children, from complications of measles.

I had forgotten until recently, when my daughters asked me to read "The King's Stilts" to them, that measles was used as a major bogeyman in the story. Not the major threat, of course -- the major threat to the kingdom is flooding if its protective line of dike trees is breached. But the boy who could save the day is removed from the picture by the false claim that he's got measles -- he is immediately tossed into an abandoned house on the edge of town, with armed guards posted outside. And the armed guards don't know the reason why the bad guy wants him out of the way -- they just think he has measles. That's how seriously the disease is taken in the book. A draconian quarantine was the only way to prevent a measles epidemic in those days. (The book was written in the 40s, I believe.)

The infant in Iowa is very lucky; measles could have cost him his sight.

By Calli Arcale (not verified) on 31 May 2011 #permalink