Measles: Who Should Be Worried & Why

RadioMD Presents:Healthy Children | Original Air Date: February 4, 2015
Host: Melanie Cole, MS
Guest: Corinn Cross, MD

MELANIE: If you’ve even looked at any of the media lately, you’ll see that the measles outbreak that started at Disneyland has become a huge hotbed issue. It’s controversial because there are people who choose not to vaccinate. The politicians have gotten involved. There are doctors on both sides of the aisles. It’s gotten rather crazy, but who really should be worried about measles and why?

My guest is Dr. Cori Cross. She’s a pediatrician spokesman for the American Academy of Pediatrics. So, Dr. Cross, first of all, measles is nasty, virulent, contagious as hell and it’s back. So, what do you want to say right off the bat to the people that are saying, “I’m afraid of the MMR vaccine?”

DR. CROSS: Well, I think that what we need to think about is really, you have to weight your pros and cons. So, every parent wants to do what is absolutely best for their kid. No parent wants to be the one to say, “Wow. I wish I’d made a better or a different decision because now I’m seeing these consequences and I didn’t realize what they would be.” And so, people—parents—feel that way whether they’re weighing whether or not they should give a vaccine and they feel that way when their child gets sick. I mean, that’s basically what a parent does. They juggle the pros and cons. And so, I think that we need to put those pros and cons in a context that makes sense for parents.

So, I live in Los Angeles which is being hit by this epidemic very strongly, but it also is a place where lots of people choose to either have a delayed or alternate vaccine schedule or choose not to vaccinate at all, which is probably why, or is definitely why, this has spiraled out of control so quickly.

So, vaccine side effects for the MMR. I mean, we all—hopefully most of us—can realize that the paper that was published years ago was fraudulent. It’s been retracted. We now know, as a medical community, very certainly that the MMR does not cause autism. Something else causes autism and we should definitely figure out what that is. If we keep wasting our time trying to figure out if it’s a vaccine, we’re not really going to tackle autism, but that’s a whole other topic. But, we can definitely say that the MMR vaccine doesn’t cause autism. You do have people who say, “Well, vaccines are unnatural. I don’t want to put them in my child. You know, they have unnatural things. They have other consequences, even if it’s not autism.” And to them, what I usually say is, “Yes. A vaccine has side effects but the side effects are fever.” So, for the MMR—for the measles, mumps, rubella vaccine—one in six kids get a fever. That’s not so bad. One in 20 kids gets a rash. Again, not so bad. One in 75 kids will have swollen glands. The one that people are most worried about is one in 3,000 will get a fever and with that fever will have a seizure. So, that means you have a 0.0003% chance of having a seizure. When you put that up against your 90% chance of getting measles if you’re exposed, I think it makes it really clear.

MELANIE: And, what about getting measles? What’s the big deal about measles anyway?

DR. CROSS: Well, measles is one of the most infectious diseases out there. It is not like other things where you can really just hand wash, make sure nobody coughs on you and you’ll probably be fine. Measles lingers in the air and on surfaces for an incredible amount of time. If you walk into an area where somebody has been in the last two hours and they had measles and they coughed and you are unvaccinated, nine out of 10 people who walk through that area unvaccinated will get the measles. That’s how contagious it is.

MELANIE: Yikes.

DR. CROSS: So, if you think about boarding an airplane, going through security in an airport, going to the school cafeteria, going to get your groceries, going to the shopping mall—think about how many people walk through the same airspace as you within two hours and you can understand how this can absolutely spiral. So, if you’re not vaccinated and you’re in an area where the measles is, you can almost guarantee that if you’re leaving your house and going to public places, you will probably get the measles.

MELANIE: And, you have some statistics for us. One in four who get the measles will be hospitalized.

DR. CROSS: Right.

MELANIE: One in one thousand can get encephalitis or an inflammation of the brain and one in 500 will die from the measles. It used to be thousands of people before the vaccination. So, if you got the vaccination, Dr. Cross, are you protected? Do you have the antibody? Is there a booster needed? What about our teenagers and our adults? Did we all get two or just the children recently?

DR. CROSS: So, basically, if you get one dose of the vaccine, it’s 93% effective. So that means for every 100 people who get just one dose, seven of them don’t develop a proper immunity to that. After the second dose, that number decreases to about 97%, or only three people would it make a natural immunity. For people who are unsure, they have two choices: they can get vaccinated again; they can try to find their records or they can look at their titers. So, the doctor can pull your blood, look at it and tell you whether or not you have immunity to the measles. People born before 1957, when it was sort of rampant, have a natural immunity. We consider them immune. So, children who are less than four or five, unfortunately, they usually don’t have two shots, so they have, still, that 7% chance of getting the measles. Children under a year of age, they have not been vaccinated yet. Typically, we do that first dose between 12 and 15 months and we do that second dose between four and five years of age. A lot of these kids are still going to pre-school and nursery school, so they’re still being exposed. Right now, we have an infant who may have exposed about 14 other infants and children in a daycare. So, you have to think about when a little kid gets this and they’re contagious for about eight days. Four days before they get that high fever and the rash that doctors are like, “Wait a second. This is measles,” four days before that, they’re still infectious. So, they’ll have a little bit of a runny nose, a dry cough, a low-grade fever. You still send them to daycare. Now, they’ve exposed the whole daycare. So, that’s the problem.

MELANIE: With such a contagious disease, what do you, as a parent and a pediatrician, recommend? This is so controversial now. We don’t have a lot of time left, but what do you recommend to parents to avoid this heated debate? I mean, the politicians out there are going crazy. They’re backtracking on themselves. “Oh, well. It should be a choice.” Or, “No. It shouldn’t be a choice.” Or, “Yes. Get vaccinated. It’s all in the good of public health and safety,” which is the American Academy of Pediatrics’ absolute line on this. What do parents do if their kids are friends with unvaccinated children?

DR. CROSS: Well, as long as your child has been vaccinated, you’re probably fine. What it comes down to is the people who are pregnant who could get measles and have miscarriages. It is the young children who can’t get vaccinated. The immune-compromised; the people who are on chemotherapy. Those people don’t have the choice and so it really comes down to protecting those people. For your children, if your children are able to be vaccinated and you vaccinate them, what everybody else chooses to do doesn’t actually affect you because you should be fine. But I would say, talk to your school. Make a big stink in your community because some of our schools, depending on what their rates are for some of these schools, the rates are so low that they’re saying that if somebody gets measles in our school, everybody who’s not vaccinated will have to stay home for 21 days. There’s a 21-day quarantine or ban from the school because they don’t one person passing it through the entire community. So, they’re trying to slow the progression of the disease.

MELANIE: Wow. So, you know, as a parent, this is certainly a decision you have to make just like letting your children go to someone’s house with a gun on them. It’s really kind of a real hot issue right now.

What do you see is going to happen in this last minute here, Dr. Cross, with this measles outbreak and the whole controversy that’s going on with the unvaccinated? You know, parents that are choosing not vaccinate or changing their schedule.

DR. CROSS: I think this is going to be a very big year for the measles. Measles was almost eradicated before. In 2004, for the entire year, we only had 30 something cases. Last year, we had the highest rate ever at like 640 something cases. This year, in one month, we’ve had 102 cases. So, if you think about how contagious it is and the low rate of vaccinations in some of these communities, it is going to spread. When you think of one in 500 kids die, we’re going to have some deaths this year, most likely, from this and we’re not a small community. It’s not an area of small communities like it used to be. People jet set across this country. People are out and about in a way that they weren’t when we didn’t have the measles vaccine. So, if it comes back and it comes back in full force, we are going to have a lot more people getting it and a lot more people getting very, very sick.

MELANIE: Very scary.

DR. CROSS: I know that some of the doctors here are just staying open very late just to try to get those kids in and vaccinate them.

MELANIE: Absolutely. Vaccinate your kids. Read up. The science is there. This is not a scary vaccine. It’s a much scarier disease than it is a vaccine and you’ve just heard it here on Healthy Children on RadioMD.

This is Melanie Cole. Thanks so much for listening and stay well.