There have been six confirmed cases of measles in Ellis County so far this year, all in unvaccinated individuals. The first case had a history of international travel during the incubation period.
There have been six confirmed cases of measles in Ellis County so far this year, all in unvaccinated individuals. The first case had a history of international travel during the incubation period. One of the six went to the movies while they were contagious, on January 9 at the ShowBiz Cinemas in Waxahachie. The incubation period is about 2 weeks, and health officials say that it takes 21 days (until January 30) to know whether the disease was transmitted in the visit to ShowBiz Cinemas.
Not only is measles highly contagious, it does not require contact with a diseased individual; simply being in the same large room is enough, as it is spread by airborne microscopic droplets. The disease begins like a cold, with runny nose and cough, but the fever is usually higher (101 degrees F or higher) and there is often conjunctivitis (like pink eye). Then the rash starts, and this lasts for more than three days. The sick individual is contagious beginning four days before the onset of the rash, and continues to be contagious for four days after the appearance of the rash. Besides vaccination, symptomatic treatment is about the only useful intervention. A single vaccination, even shortly after exposure, may be effective in preventing the disease. Two vaccinations are required to be confident of long-term immunity, however. During an outbreak susceptible persons (those who have not had at least two measles vaccinations) should be isolated from anyone who might be ill with measles. This not only prevents them from getting the disease, it helps to prevent spread of the disease.
Measles is a real nuisance for everyone who gets it or must care for someone sick with the disease, but it can have serious--even fatal--complications. Pneumonia is the most serious common complication and occurs in about 6% of cases. Pneumonia accounts for most of the measles-associated deaths. Respiratory tract infections occur most frequently in those less than 5 years of age, or more than 20 years old. In connection with this fact, it should be mentioned that measles in the pre-vaccine era had a different natural history than it does in today's outbreaks. Then it was a disease that affected children of primary school age, almost exclusively. Now, it is more likely to have severe complications because it is more likely to strike those who are more than 20 years old or less than 5 years old.
The most feared complications of measles are neurological. Encephalitis occurs in about one of every 1000 cases, and typically appears within a few days of the rash. The symptoms are new onset fever, headache, stiff neck, vomiting, seizures and coma. About 15% of these cases die, and another 25% of children suffer neurodevelopmental consequences. Acute disseminated encephalomyelitis (ADEM) occurs in about one in every 1,000 measles cases. ADEM is a demyelinating disorder, like multiple sclerosis (MS), that comes on after the rash has resolved. This has life-long effects and is fatal in 10 to 20% of cases. Finally, there is Subacute sclerosing panencephalitis (SSPE) which is a fatal, progressive degenerative disease of the central nervous system that usually occurs 7 to 10 years after measles illness. We used to think that SSPE occurred at a rate of about eight per million cases of natural measles, but based on the cases caused by the resurgence of measles in the US during 1989-1991 the risk of SSPE among children less than 5 years old at the time of illness, may be higher than one in 1,000.
Measles is a bad disease that is preventable, but only if we each do our part. Everyone who does not have a firm contraindication should be immunized. Ellis County isn't very far away from Runnels County, less than 200 miles.
This article is intended to provide general information only, and is not to be taken as medical advice. For advice about a particular case or situation, consult your own physician or other trusted health professional.
Dr. Bundrant is the chief of staff at Ballinger Memorial Hospital. He is a member of the Health and Wellness Coalition of Runnels County which is comprised of health care professionals throughout the county. Members meet on the first Thursday of the first full week of the month.