It seems that our children need to be vaccinated for measles earlier in life. In just the first two months of the year, 13 people in the U.S. contracted measles as a result of international travel, many of them young children according to the Center for Disease Control and Prevention, or CDC. Although measles was declared eliminated in the U.S. in 2000, imported cases continue to occur among travelers returning from parts of the world where the disease is endemic.
The CDC report states:
“Young children are at greater risk for severe measles, death, or sequelae such as subacute sclerosing panencephalitis. Although all seven children had been eligible for vaccination before travel, none had received measles, mumps, and rubella (MMR) vaccine, the only measles-containing vaccine currently available in the United States….Of the 29 measles cases reported during January and February, 2011, a total of 28 were import-associated, of which 16 (57%) were classified as imported cases; 13 of the imported cases (81%) were among U.S. residents. Of these 13 cases, seven (54%) occurred in children aged 6 to 23 months. All seven patients had recently traveled internationally; they were residents of Massachusetts (two patients), Texas (one), New York (one), Pennsylvania (one), Washington (one), and California (one).”
In the first two months of the year, there were 692 cases of measles, and 87% of which were associated with cases contracted outside the U.S., they found. Of these, 292 were directly contracted outside the U.S., and 159 of them were in U.S. residents. Of the 159 cases, 30% were in children ages 6 months to 23 months and 30% of those needed to hospitalized.
Four of these youngest cases required hospitalization, two for diarrhea and dehydration, one with persistent fever, one with pneumonia. The median hospital stay was 3.5 days, the researchers said, but all seven recovered.
Researchers noted that children ages 12 months and over who are traveling internationally should get two doses of MMR vaccine, separated by at least 28 days. Children ages 6 to 11 months should get one dose. They also note that doctors should maintain a high level of suspicion for measles in patients with febrile rash illness and recent travel outside the U.S.
While measles is probably best known for the full-body rash it causes, the first symptoms of the infection are usually a hacking cough, runny nose, high fever, and red eyes. A characteristic marker of measles are Koplik’s spots, small red spots with blue-white centers that appear inside the mouth.
The measles rash typically has a red or reddish brown blotchy appearance, and first usually shows up on the forehead, then spreads downward over the face, neck, and body, then down to the arms and feet.
In developed countries, most children are immunized against measles by the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because children younger than 18 months usually retain anti-measles immunoglobulins (antibodies) transmitted from the mother during pregnancy. A second dose is usually given to children between the ages of four and five, in order to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune.
On the other hand, in still developing countries where measles is highly endemic, the WHO recommend that two doses of vaccine be given at six months and at nine months of age. The vaccine should be given whether the child is HIV-infected or not. The vaccine is less effective in HIV-infected infants, but the risk of adverse reactions is low. Measles vaccination programs are often used to deliver other child health interventions as well, such as bed nets to protect against malaria, de-worming medicine and vitamin A supplements, and so contribute to the reduction of child deaths from other causes.
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Written by Sy Kraft