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Posts for category: Infectious Disease

February 10, 2019
Category: Infectious Disease
Tags: Autism   vaccine   measles   Contagious   Complications  

4 things everyone needs to know about measles

Claire McCarthy, MD

Faculty Editor, Harvard Health Publishing

We are in the midst of a measles outbreak here in the US, with cases being reported in New York City, New York state, and Washington state. In 2018, preliminary numbers indicate that there were 372 cases of measles — more than triple the 120 cases in all of 2017 — and already 79 cases in the first month of 2019 alone. Here are four things that everyone needs to know about measles.

Measles is highly contagious

This is a point that can’t be stressed enough. A full 90% of unvaccinated people exposed to the virus will catch it. And if you think that just staying away from sick people will do the trick, think again. Not only are people with measles infectious for four days before they break out with the rash, the virus can live in the air for up to two hours after an infectious person coughs or sneezes. Just imagine: if an infectious person sneezes in an elevator, everyone riding that elevator for the next two hours could be exposed.

It’s hard to know that a person has measles when they first get sick

The first symptoms of measles are a high fever, cough, runny nose, and red, watery eyes (conjunctivitis), which could be confused with any number of other viruses, especially during cold and flu season. After two or three days people develop spots in the mouth called Koplik spots, but we don’t always go looking in our family members’ mouths. The characteristic rash develops three to five days after the symptoms begin, as flat red spots that start on the face at the hairline and spread downward all over the body. At that point you might realize that it isn’t a garden-variety virus — and at that point, the person would have been spreading germs for four days.

Measles can be dangerous

Most of the time, as with other childhood viruses, people weather it fine, but there can be complications. Children less than 5 years old and adults older than 20 are at highest risk of complications. Common and milder complications include diarrhea and ear infections (although the ear infections can lead to hearing loss), and one out of four will need to be hospitalized, but there also can be serious complications:

  • Five percent of people with measles get pneumonia. This is the most common cause of death from the illness.
  • One out of 1,000 get encephalitis, an inflammation of the brain, that can lead to seizures, deafness, or even brain damage.
  • One to two out of 1,000 will die.
  • There is another possible complication that can occur seven to 10 years after infection, more commonly when people get the infection as infants. It’s called subacute sclerosing panencephalitis or SSPE. While it is rare (four to 11 out of 100,000 infections), it is fatal.

Vaccination prevents measles

The measles vaccine, usually given as part of the MMR (measles-mumps-rubella) vaccine, can make all the difference. One dose is 93% effective in preventing illness, and two doses gets that number up to 97%. In general the first dose is usually given at 12 to 15 months and the second dose at 4 to 6 years, but it can be given as early as 6 months if there is a risk of exposure (as an extra dose — it doesn’t count as the first of two doses and has to be given after 12 months), and the second dose can be given as soon as 28 days after the first.

The MMR is overall a very safe vaccine. Most side effects are mild, and it does not cause autism. Most children in the US are vaccinated, with 91% of 19-to-35 month-olds having at least one dose and about 94% of those entering kindergarten having two doses. To create “herd immunity” that helps protect those who can’t get the vaccine (such as young infants or those with weak immune systems), you need about 95% vaccination, so the 94% isn’t perfect — and in some states and communities, that number is even lower. Most of the outbreaks we have seen over the years have started in areas where there are high numbers of unvaccinated children.

If you have questions about measles or the measles vaccine, talk to your doctor. The most important thing is that we keep every child, every family, and every community safe.

February 01, 2019
Category: Infectious Disease
Tags: Influenza   Flu   immunizations   Vaccines   flu shot   update   Urgent Care   ER  


Note: 2018-19 Flu Season Update
As the flu season continues, please review these reminders and updates below:

  • It is not too late to get a flu shot if you have not received a flu immunization during the current flu season.
  • Receiving a flu vaccine every year offers the best available protection against flu and has been shown to reduce illnesses, hospitalizations and deaths in people of all ages. 
  • If you or someone in your family are diagnosed with a respiratory illness even though you've had a flu shot, flu test confirmed or not, the flu vaccine was effective, especially if they are  seen by a doctor and sent home with minimal treatment.
  • If you or someone in your family have flu-like symptoms that unless instructed by a physician to be given for other medical reasons, you should avoid aspirin and aspirin-containing products (such as Pepto- Bismol, Kaopectate and Alka-Seltzer, for example), which have been associated with rare but severe complications when taken by children and adolescents with flu.
  • If your child needs evaluation at a Children's Healthcare of Atlanta facility when your routine office is closed, it is better to seek care at Children’s urgent care locations as an alternative to the Emergency departments. Families can visit for more specifics regarding the Urgent Care centers or use the Children’s app on their mobile phones to check wait times at the different locations.
  • Please visit these resources at to learn more about influenza.


Dr. T

January 17, 2019
Category: Infectious Disease
Tags: immunizations   Vaccines   measles   MMR   Atlanta   ATL  
  1. Confirmed Measles Cases in 2 Metro Atlanta Residents!

    The GA Public Health Dept has confirmed measles in 2 residents of metro Atlanta who visited several metro Atlanta locations Jan. 7-14 & may have exposed others. Best protection is to be sure ur family is properly immunized.

    Go to to learn more about Measles & to to learn what U need to know about the vaccine.t

September 02, 2018
Category: Infectious Disease
Tags: measles   Rubeola   Outbreaks   Hotspots   CDC NME   Exemptions  


CDC Reports 107 Measles Cases Already This Year, Here Are Potential Outbreak Hotspots


Will signs like this become more and more common? (AP Photo/Amy Forliti, file)

Harrison Ford once said in the movie Six Days and Seven Nights, "I decided my life is too simple, I wanna complicate the hell out of it." Here's one way to do that. Go against established medical advice. Stop using vaccines that have been preventing a potentially deadly disease and watch the disease return. 

A study published in the journal PLOS Medicine found that over the past decade more and more parents have been opting out of school requirements to get their kids vaccinated in the 18 states that allow such non-medical exemptions (NME).  In other words, more and more parents are taking the option to increase their kids' (and other kids') risk for getting measles, a highly contagious and potential deadly disease.

That's because there is nothing even close to the measles vaccine in preventing the measles. No supplement, food, oil, body position, app, or chant is going to be able to replace the vaccine.

Keep in mind that NMEs are not medical exemptions, otherwise they'd be called medical exemptions. In other words, parents seeking NMEs aren't doing so because a real doctor said that their kids shouldn't get the vaccine because of an immune system disorder or a severe allergy to vaccine components. They are "opting out" because of their beliefs.



Nikki Craven from Grass Valley joins protestors during a rally in opposition to a bill mandating that California schoolchildren be vaccinated. (AP Photo/Steve Yeater)

If you've pushed for your state to allow NME's, take a look at the PLOS Medicine study to find out what you would be causing. For the study, a research team from the National School of Tropical Medicine (Jacqueline K. Olive, Peter J. Hotez, MD, PhD , Ashish Damania, and Melissa S. Nolan, PhD, MPH) analyzed data from these 18 states and the Centers for Disease Control and Prevention (CDC).  The study found that in 12 of the states that allow NMEs (Arkansas, Arizona, Idaho, Maine, Minnesota, Missouri, North Dakota, Ohio, Oklahoma, Oregon, Texas, and Utah) the number of NMEs has been steadily increasing since 2009. (Colorado, Louisiana, Michigan, Pennsylvania, Washington, and Wisconsin round out the rest of the 18 states that allow NMEs).

The research team also found that that higher NME rates correlated with lower measles-mumps-rubella (MMR) vaccination rate. In other words, MMR vaccination rates tended to be lower, the higher the number of NMEs. This is concerning because scientific studies (and common sense) have showed how locations with lower measles vaccination rates are more likely to have measles outbreaks.

And this week, as this ABC15 news segment reports, health officials are warning about potential measles exposure in Arizona, one of the states that has NMEs:

As Hotez explained, "while national immunization rates may not have changed much over the years, we are seeing a rise in non-medical vaccine exemptions in 18 states that still allow them for reasons of personal belief. These hotspots of antivaccine activity are at risk for breakthrough measles and other childhood infectious diseases."

This study essentially showed the consequences of states offering NMEs. And declining vaccination rates are going against what has been one of the biggest successes in the history of public health and has saved millions upon millions of lives and prevented lots upon lots of suffering. Typically schools will require kids to have the full set of routine vaccinations before entering. That's because schools can be germ buffets. You may think that your kid can stay clear of others and others' bacteria and viruses, but in schools it's "snot" reality. Little kids are constantly smearing things such as snot on themselves, their things, their classmates, and everything else.

Requiring kids to get routine vaccinations has helped control of number of diseases that used to be a lot more commonplace up to the earlier part of the 1900's. It helped eradicate smallpox, control polio, and make measles practically non-existent in the United States, at least at the beginning of this century. When it came to vaccine -preventable infectious diseases such as measles, mumps, and pertussis, life by the end of 1990's had become simple. Just keep the population vaccinated to prevent outbreaks.

Enter the Harrison Ford quote. In 1998, British gastroenterologist Andrew Wakefield claimed that measles, mumps, and rubella (MMR) vaccine may be linked to autism and in 2004 published a study in the Lancet in support of his claims. Wakefield sparked an anti-vaccination movement in England that subsequently spread to the United States. However, when investigations revealed evidence that he may have had a financial motive for making such claims and falsified data, the Lancet subsequently retracted the paper and Wakefield lost his license to practice medicine.

Despite these revelations and lack of scientific evidence connecting vaccines with autism, the anti-vaccination movement has continued. So has Wakefield, as he continues to speak at conferences such as the International Chiropractors Association's Annual Conference on Chiropractic and Pediatrics as I described previously for Forbes. The growing number of NMEs has suggested that the anti-vaccination movement has been picking up steam over the past decade.

This steam has included a lot of hot air because many of the anti-vaccination movement's claims have lacked scientific backing. Plus, the anti-vaccination movement has offered no viable alternative to vaccines to protect people against life-threatening diseases such as the measles. Some anti-vaccination proponents have offered supplements and alternative medicine methods as options (without providing adequate scientific evidence), which makes you wonder what the motivations may be behind attempts to discredit vaccines.

So what does a more complicated life look like compared to the late 1990's when measles was virtually non-existent in the U.S? According to the Centers for Disease Control and Prevention (CDC), as of July 14, 2018, at least 107 people from 21 states (Arkansas, California, Connecticut, Florida, Illinois, Indiana, Kansas, Louisiana, Maryland, Michigan, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, and Washington) and the District of Colombia had measles since the start of this year. The majority were unvaccinated. Here are the numbers of reported cases by year so far in this decade:

Year Cases
2010 63
2011 220
2012 55
2013 187
2014 667
2015 188
2016 86
2017* 118
2018** 107

Still want to complicate the heck out of life?


August 23, 2018
Category: Infectious Disease
Tags: immunizations   measles   MMR   rash   Europe  

Measles Cases Hit Record High in Europe & Outbreaks in the Americas


Source: World Health Organization Regional Office for Europe [edited]

Over 41 000 children and adults in the WHO European region have been infected with measles in the first 6 months of 2018. The total number for this period far exceeds the 12-month totals reported for every other year this decade. So far, the highest annual total for measles cases between 2010 and 2017 was 23,927 for 2017, and the lowest was 5,273 for 2016. Monthly country reports also indicate that at least 37 people have died due to measles so far this year [2018].


"Following the decade's lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks," says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. "We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease. Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our Sustainable Development Goal commitments."


Of the countries in the region, 7 have seen over 1000 infections in children and adults this year [2018] (France, Georgia, Greece, Italy, the Russian Federation, Serbia, and Ukraine). Ukraine has been the hardest hit, with

over 23,000 people affected; this accounts for over half of the regional total. Measles-related deaths have been reported in all of these countries, with Serbia reporting the highest number of 14.


"This partial setback demonstrates that every person who is not immune remains vulnerable no matter where they live, and every country must keep pushing to increase coverage and close immunity gaps, even after achieving interrupted or eliminated status," says Dr Nedret Emiroglu, Director of the Division of Health Emerge

ncies and Communicable Diseases at the WHO Regional Office for Europe.



Measles Can Be Stopped


The measles virus is exceptionally contagious and spreads easily among susceptible individuals. To prevent outbreaks, at least 95 percent immunization coverage with 2 doses of measles-containing vaccine is needed every year in every community, as well as efforts to reach children, adolescents and adults who missed routine vaccination in the past.


While immunization coverage with 2 doses of measles-containing vaccine increased from 88 percent of eligible children in the region in 2016 to 90 percent in 2017, large disparities at the local level persist: some communities report over 95 percent coverage, and others below 70 percent.


WHO is working closely with Member States currently facing outbreaks to implement response measures, including enhanced routine and supplemental immunization as well as heightened surveillance to quickly detect cases. WHO is also working with other countries to attain the 95 percent threshold.


"At this midterm juncture for the European Vaccine Action Plan, we must celebrate our achievements while not losing sight of those who are still vulnerable and whose protection requires our urgent and ongoing attention," concludes Dr Jakab. "We can stop this deadly disease. But we will not succeed unless everyone plays their part: to immunize their children, themselves, their patients, their populations -- and also to remind others that vaccination saves lives."


Source: Mirror [edited]


Measles cases have hit a record high across Europe with more than 41,000 children and adults infected in the 1st 6 months of this year [2018]. That figure is nearly double the highest number of yearly cases recorded since 2010.


At least 37 people are thought to have died due to the highly contagious disease so far this year [2018], although there have been no fatalities in the UK.


Between July 2017 and June 2018, there were just under 1000 cases of measles in Britain, compared to 531 confirmed cases for the whole of 2016. Meanwhile, there have been 760 cases in the 1st 6 months of this year [2018] in the UK alone compared to 187 in the last half of 2017.

"Following the decade's lowest number of cases in 2016, we are seeing a dramatic increase in infections and extended outbreaks" said Dr Zsuzsanna Jakab, World Health Organization (WHO) Regional Director for Europe.


"We call on all countries to immediately implement broad, context-appropriate measures to stop further spread of this disease.


"Good health for all starts with immunization, and as long as this disease is not eliminated we are failing to live up to our Sustainable Development Goal commitments."


In May [2018], it was reported that the UK was facing unprecedented cases of measles.


Anyone who has not received 2 doses of the MMR [measles, mumps, rubella] vaccine is at risk, while young people mixing in close proximity, for example at festivals or at University, are more vulnerable.


Last year [2017], measles cases rocketed by 300 percent across Europe as some parents refused to vaccinate their children. That led to more than 20,000 people being infected causing 35 deaths, according to figures from the WHO.


Before the introduction of a measles vaccine in 1963, there were serious epidemics every 2-3 years, causing an estimated 2.6 million deaths globally each year.


Measles had virtually been eradicated in Britain before confidence in the MMR vaccine collapsed in the late 1990s after now-discredited Dr Andrew Wakefield wrongly claimed the measles, mumps, and rubella jab was linked to autism.


The best way to prevent outbreaks is to ensure that at least 95 percent of the population is immunized with 2 doses of the measles vaccine. High rates of vaccination allow for "[community] immunity" that can protect vulnerable people such as infants who are too young to be vaccinated and those who can't be vaccinated because of medical reasons.


But vaccine skepticism remains high in many parts of Europe. A 2016 global survey of vaccine confidence led by researchers at the London School of Hygiene and Tropical Medicine found Europe to be the region that was least confident in vaccine safety.


In Italy, for example, a loud anti-vaccination movement has been bolstered by populist, anti-establishment politicians, reported the Associated Press. In Romania, superstitions abound, such as using cabbage juice to ward off the disease, while celebrities such as TV star Olivia Steer have publicly promoted anti-vaccine stances.


While immunization rates increased among eligible children in Europe in 2016, there are still some communities that report below 70 percent coverage.


WHO says it is working closely with those countries currently facing outbreaks to implement enhanced immunization as well as heightened surveillance to quickly detect cases.


"We can stop this deadly disease," said Jakab. "But we will not succeed unless everyone plays their part: to immunize their children, themselves, their patients, their populations -- and also to remind others that vaccination saves lives."


Source: Forbes [edited]

Being purists, the CDC is not calling the current upswing in measles cases an "outbreak" -- defined as 3 cases in an area within a month -- but any "reasonable person" would likely do so.


In 2000, we said that measles had been eliminated in the US. In 2016, there were 86 cases, and in 2017, 118 cases. The year is only half over, yet we already have 107 cases across 21 states and DC, including 8 clusters that meet the CDC definition.

Hopefully, we won't have a repeat of some of the larger recent outbreaks --like Disneyland in the winter of 2014-15, which resulted in 145 cases in 7 states and 2 other countries, or the 383 cases, mostly among unvaccinated Amish in Ohio, but there is a growing threat of larger outbreaks due, in large part, to changes in immunization patterns and lower rates of vaccination.

Many dismiss measles almost as a rite of passage. We have been so successful, that most people have never seen a case nor understand how serious it can be, with high fevers. One in 10 get ear infections; this may lead to life-long complications, like the deafness of one of my friends. One out of every 20 children with measles gets pneumonia, and this is a common cause of death. One child of 1000 will get encephalitis, a brain inflammation and swelling that can leave seizures, blindness, deafness, or learning disabilities. Worst, measles kills 1-2 per 1000 infected kids.


Roald Dahl's description of his 7-year-old daughter's death [The Washington Post <>] is heartbreaking.


All of this is readily avoided by a series of 2 immunizations.

Measles is transmitted through the air, or by droplets, so just being near someone is enough to get infected. The virus can remain in the air and be transmitted even after the infected person has left the room. It is highly

contagious -- if one person has measles, 90 percent of those close to the index person will also become ill. Making measles even more easily transmitted is that people are contagious for up to 4 days before the rash appears.


Infection may easily be missed, as most physicians have never seen a case, and it won't be high on their radar. It can look similar to an allergic drug rash, but measles is often accompanied by fever, cough, runny nose, and conjunctivitis, where a drug rash is more likely itchy and without these other symptoms.


More than 10 percent of those infected require hospitalization.


Communicated by:

ProMED-mail Rapporteur Mary Marshall


Measles is easily controlled with a safe and efficacious vaccine, MMR (measles, mumps, rubella). There is no reason children have to suffer severe disease from measles and in some cases die due to this disease. It is irresponsible of parents not to have their children vaccinated; the link between vaccination and autism has been disproved, yet parents continue to cling to it. The consequences are clearly evident from the global increase in disease following measles infection. And it is particularly important to protect children who cannot be immunized due to immunological issues, such as children receiving chemotherapy to treat cancer and other conditions. Furthermore, it is far more costly to treat individuals following infection because they have not been vaccinated.


It is not only measles that one can easily protect against by vaccination, but also other vaccine-preventable diseases. There was recently a case of varicella (chicken pox) in an 11-month baby causing a stroke after infection, the virus

having been transmitted from unvaccinated older siblings , demonstrating why chickenpox vaccine is so important.

"The case highlights the dangers -- both to one's own children and to those of others -- that are associated with skipping vaccinations. Widespread vaccination protects kids who can't get vaccinated either because they are younger than 1 year, like the boy in the report, or because they have immune system problems. In recent months, there have been numerous chickenpox outbreaks around the country, a result of pockets of parents who have opted not to vaccinate, assuming either that their kids won't get the disease or will simply tough it out if they do."


A confirmed case of measles prompted Contra Costa County, California public health officials on Wed [22 Aug 2018] to warn residents and visitors they may have been exposed to the highly contagious airborne illness. The infected person visited several popular indoor venues in Contra Costa County, Los Angeles County, and Arizona, and officials in the latter areas have issued their own advisories.


This serves as a reminder that even though the USA is considered free of measles, i.e., no endemic transmission except through introduced cases, measles can be brought into the country by tourists and following travel by citizens to regions where there still are a high number of measles casesAccording to the WHO, measles cases have reached a record high in Europe this year [2018], with more cases recorded in the first 6 months of 2018 than any other 12-month period this decade. Therefore, parents must maintain vaccination of their children


[2] PAHO / WHO Epidemiological Update 20 Aug 2018
Source: PAHO / WHO [edited]

Between epidemiological week (EW) 1 and EW 33 of 2018, a total of 5,004 confirmed measles cases, including 68 deaths, were reported in 11 countries in the Americas:

Antigua and Barbuda (one case),

Argentina (8 cases),

Brazil (1237 cases, including 6 deaths),

Canada (19 cases),
Colombia (60 cases),

Ecuador (17 cases), Guatemala (one case),

Mexico (5 cases),

Peru (4 cases),

the USA (107 cases),

and the Bolivarian Republic of Venezuela (3545 cases, including 62 deaths).


Commentary by Dr. T:

The world gets smaller every year. We live in an international city. We go to Europe and Europe comes to us as do other parts of the Americas and the rest of the world as well. Maintaining our community protected by safe and effective immunizations for adults and children is everyone's responsibility. We are our brothers' keepers. Talk to your doctors about your immunization status and that of your families.