Ask the Pharmacist

Q) I have been hearing a lot about the measles outbreaks. What can you tell me about all of this?

A) Measles is a highly infectious virus associated with a characteristic skin rash most often seen in children. It was not so long ago that virtually every child born in Canada contracted this illness leaving a small but not insignificant number left with life-long complications and some families mourning the loss of a loved one.

However, two changes occurred to reverse these numbers. The first was just better overall healthcare that greatly decreased the mortality rates in the multitude of kids who became infected. Secondly, starting in the 1970’s, was the use of the measles vaccine which almost eliminated the local spread of the disease due to both its effectiveness and its widespread use.

Without the measles vaccine, experts estimate Canada would see about 350,000 cases a year rather than the few dozen we expect to see. It’s hard to say where our death rates would be without the vaccine given the massive improvements in our overall health care but historically measles claimed 892 lives in 1926 in Canada and the total number of deaths attributed to it between 1969 & 1979 was 129.

Taking into account modern medical practises, experts predict that one out of every 1,000-5,000 kids who came down with measles would die, a catastrophic figure given the predicted number of cases. Clearly prevention is needed.

Measles is back in the news due to a number of outbreaks in a number of places throughout the world, with the one in Vancouver being of particular concern to Canadians. Vancouver/ B.C. currently has had 20 cases confirmed which makes it a small outbreak when compared to other countries with modern health care systems such as Italy (165 cases in January) , France (124 cases) & Japan (170 in the 1st two months) .

The reasons behind this surge in measles seems to be a small but notable decrease in the number of people getting their children vaccinated along with the continued trend to travel to areas of the world where vaccination rates are much lower thereby making exposure more likely. There’s not much we can do about the latter but it is hard to make a convincing argument in support of forgoing the vaccine.

The vaccine is highly effective (it’s about 95% effective, there will always be some people who do not respond to a particular vaccine and these people, along with those that cannot be given the vaccine, are protected by the rest of us who do respond, a concept called herd immunity and one of the most important social obligations we owe to each other in my opinion) and has decades of data supporting its safety.

There are numerous studies showing that the MMR vaccine does not cause autism (nor do any others) conducted not only by Big Pharma (for whom there is a deserved amount of skepticism about some of its track record) but also by many independent scientists and doctors all of whom have friends and relatives that would be affected by any falsifications in their data. This is a conspiracy theory that has no basis in truth.

Measles is extremely contagious. A number that puts the risk in perspective is that if you were in a room with a person who has measles, you would have a 90% of catching it. The reason it is so infectious is that the virus lives in the mucous of your nose and throat. When an infected person sneezes, coughs or even breathes the virus is spread throughout the room. It can also live on in droplets on surfaces or circulating in the air for 2 hours afterwards.

To confound matters further, people can be contagious a full 4 days before they present with the telltale rash causing them to expose others unwittingly. A high fever is usually the first symptom to emerge starting 10-12 days after being exposed to the virus and usually lasting from 4 to 7 days in length.

During this time other symptoms that might develop include the infamous rash (it begins as flat, red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs and feet. Small, raised bumps may appear on top of the flat spots), a runny nose, red eyes that might be sensitive to light, a sore throat and tiny white bumps in the mouth. For most, you’ll be sick for a couple of weeks and make a full recovery.

Possible complications are what make measles such a serious disease. These complications are seen more frequently in those younger than 5 and adults past the age of 20 and can include ear infections (which occur in 10% of kids and may result in permanent hearing loss), diarrhea (also quite common), pneumonia (5% will acquire this and this is the most common cause of death from measles), encephalitis (a swelling of the brain that can lead to deafness or a cognitive deficit) and in those who are pregnant a greater chance of premature birth and/ or delivering a low birth-weight baby.

There are no specific treatments for measles other than controlling the symptoms with such measures as acetaminophen or ibuprofen.

Prevention, as I cannot stress enough is the key. The vaccine is recommended to be given to kids in 2 doses, the first between 12-15 months old and the second dose between 4 and 6 years old. Adults born after 1970 who missed the childhood regimen should get the standard 2 dose regimen (any adult born before 1970 is assumed to have had measles as a child and therefore have natural immunity). Booster shots are not necessary for those who have both doses of the vaccine or who had the virus as a child.