So how do we treat the measles?
And this is often what patients ask me when I'm checking them for measles.
They'll say, 'What are you gonna give me if this ends up being measles?'
And my response is nothing. Antivirals don't work and antibiotics don't work.
There are severe complications and these can be reduced
through supportive care so staying hydrated and resting.
You can use antibiotics only if the patient has a secondary bacterial infection
and these can develop after the measles virus.
And this includes bacterial ear infections, bacterial eye infections, and bacterial pneumonia.
You can supplement your patient with vitamin A
and you can have acetaminophen to lower their fever,
and remember, children older than 6 months can also have ibuprofen.
You need to avoid aspirin therapy in the pediatric population
because of the risk for Reye syndrome which is a rare
but serious condition that causes swelling in the liver and brain.
We can also manage measles by ensuring our patient has proper nutrition,
they are well hydrated, and they're able to rest.
So we need to prevent the spread of measles and this happens with isolation.
Remember, this is a very, very contagious disorder.
It's contagious from the 4 days before to 4 days after the rash breaks out.
These patients need to stay completely out of the community.
They have strict isolation and you need to keep unvaccinated people away from infected people.
So we can also prevent this by vaccination and this is done after 12 months
and then again around kindergarten.
How do we prevent the spread passively?
So mothers who are immune will pass these antibodies to their children in utero
and these antibodies are gonna protect newborns and infants with some immunity.
But through time, this protection fades, usually over the first 6 months.
So this provides some short-term protection.
The maternal anti-measles antibodies will disappear and once they're gone,
this infant is susceptible to measles infection.
Here we see a graph of the annual measles cases in the United States through time.
You can see it used to be pretty high and then there was the development of the vaccine.
You can see a rapid drop off and then the MMR was developed.
Next, the CDC got on board and started recommending a booster
which is a second dose of the MMR and through time after the second dose of MMR was given,
it was declared that measles was eliminated.
We've been trending very, very low but lately, there's been an uptick.
Now let's talk about the measles vaccine, the MMR.
In developed countries, this is given at 12 months of age through the MMR vaccine
and then again around kindergarten.
Adverse reactions are rare but children may get pain at the injection site and fever.
These are the most common.
Vaccination rates are high enough to make measles a relatively uncommon infection.
In developing countries, measles is common and they give the MMR vaccine sooner.
This is given around 6 months of age and around 9 months of age regardless of HIV co-infective status.
So how do we get protection against measles?
It's through herd immunity and this is where you promote and preserve widespread immunity.
Since the introduction of the measles vaccine, measles has virtually been eliminated
in the United States even though not everyone has been vaccinated.
This is what we called herd immunity.
But herd immunity may now be weakening a bit due to the drop in vaccination rates.
The incidents of measles in the United States has recently increased significantly.
Here you can see on the left, if a patient has measles and no one is immunized,
this contagious disease is gonna spread through the population.
Here's where we have a little bit of coverage.
If some people are immunized, a contagious disease is still going to spread through the population.
Then, there's a threshold and this is our herd immunity.
And this is where most of the population is immunized
and this is how we control the spread of contagious disease.
So complications of measles.
These are more likely in young children less than 5 and adults greater than 20 years old.
These include ear infections, bronchitis, laryngitis, or croup.
Pneumonia and this can be a fatal complication.
Encephalitis, this can cause deafness and brain damage.
And then pregnancy, the complications include preterm labor, low birth weight, and maternal death.
Measles can be serious. 1 out of 4 people with measles will be hospitalized.
1 out of every 1,000 will develop brain swelling due to the infection called encephalitis
and that can lead to brain damage and 1 or 2 out of a thousand people
will die even with the best care.