Health

The Measles

The Pesach dishes are packed away and Chometz is now back. What is your pediatrician thinking about?

The measles.

Yes, the measles.

Unless you’ve been living under a rock, surely you’ve read or seen the news that there is a measles outbreak in the United States, Europe and Israel. Unfortunately, the Orthodox Jewish world is at its epicenter.

It’s unpleasant, to say the least.

It’s also scary because we Jews have been mobile and social during the recent Pesach holiday. Seminary and yeshiva students came home. Families traveled to be with families and others, whether in the continental United States or overseas. Does anyone have a ballpark idea of the final number of our brethren who descended on Orlando, Mexico, Italy, Spain, Morocco and other locations where Pesach programs abounded? Jews flocked for Chol HaMoed trips to Niagara Falls, Boston, Philadelphia, Washington and Virginia. And that’s just the East Coast.

We’re coming off a curve of mixing and mingling. And it takes just one cough or sneeze of someone whose nose and mucous is infected with the measles virus to spread this highly communicable disease that was all but eradicated nearly two decades ago.

I’m not here to judge. I am sharing my opinion that vaccines save lives and that no child should be left unvaccinated. I’m from South Africa and I saw the ravages of this disease firsthand. People can die from it. If one does not die, there can be nonetheless long-term medical consequences in some cases. It is tragic that in contemporary Madagascar, there have been over 1,000 preventible deaths from the measles.

Here is important information.

The MMR vaccine is safe and effective, even for people who have egg-related allergies. Perhaps you’ve declined this vaccine for your child until now. Then please reconsider the science and the risk to your child and the community if you choose to continue not vaccinating.

If your children are already immunized with the MMR, then you have less to worry about during this outbreak. The MMR is typically given after 12 months of age and triggers a 95% certainty for immunity for life. The second dose, which is classically administered at the 4-year well visit, boosts that immunity into the 98-99th percentile. According to the Centers for Disease Control and Prevention (CDC), a child who has had two MMR vaccines should not necessarily require a booster during their lifetime.

If you are living in a “MMR-at-risk” area and your child has not yet received the second MMR and is not yet 4 years old, then please pause reading this article and phone your pediatrician to schedule an appointment. It’s okay to have the second MMR as long as at least 30 days have passed since the first MMR.

The takeaway: An immunized child can go to school and shul during a measles outbreak because the MMR vaccine is effective. The MMR vaacine provides almost lifelong immunity. Look at how far medical science has brought us. Wow.    

Let’s now talk about infants who are too young to have received the MMR vaccine. While these little ones can be at risk during a measles outbreak, the good news is that most of us, depending on our ages (more on this later), have either had the measles or have been immunized against it so we are not spreading it.

For babies ages 6 months or younger, Moms are key. If Mommy has either had the measles or the vaccine, she has passed the antibodies during fetal development in utero or through breastfeeding. The antibodies are thought to provide protection to up to 6 months of age. Yet as a baby ages, immunity wanes and immunizing emerges as important. We don’t give the MMR earlier because it would be “wasted,” meaning Mom’s antibodies are active, present and doing their “gig.” If the MMR vaccine would be administered at this point, it is highly likely that any immunity it would offer would be absorbed by Mommy’s antibodies and the baby’s own immune system would not be stimulated.

The CDC recommends that if you are travelling internationally with your infant who is between 6-12 months of age or this infant is in a group babysitting situation, then make sure he receives a MMR vaccine. This vaccine will be given again after 12 months of age and at least 30 days after the first one.

Not every person has an immune response, even after two MMR vaccines. This is the exception and not the rule.

Let’s say there is a measles outbreak and you have a family Simcha. What should you do? If you have a young infant, it’s still best to put a wide berth between them and someone you know who is not immunized. As the adage goes, “An ounce of prevention is worth a pound of cure.” You can always photoshop them into a picture.

Is it safe for your child to be in school during a measles outbreak? Yes! As parents, you have every right to approach your children’s school district to find out the numbers of kids who are properly immunized. It is also your right to ask your school administration or school nurse for the same information. Now you can understand why schools are strict about having up-to-date immunization records for their students.

Adults who are living in or travelling to areas where there are measles outbreaks should check their vaccination status or get a second dose of the MMR vaccine. Knowing your vaccination status can be tricky for an adult because it can be nearly impossible to resurrect old vaccine records. It is most likely that people vaccinated in the United States since 1989 have had at least two MMR doses. Again, two doses are the standard for protection.

Anyone vaccinated between 1963 and 1989 most likely received only one dose of the inactivated vaccine. Americans born prior to 1957 are considered to be immune because it is most likely that they were exposed to measles during an outbreak.

If you are an adult who does not have ready access to your health records, it is recommended that you consult your physician about measuring your measles titers.  If this blood test shows that you lack immunity, then a MMR vaccine is in order for you.

There are people who should NOT receive the measles vaccine. They include:

  • Anyone who had a severe allergic reaction like generalized swelling of hives or swelling of lips or throat after the first vaccine;
  • Anyone knowing they are allergic to a component of the vaccine, i.e., gelatin;
  • A pregnant woman. Pregnancy should be avoided for four weeks post-vaccine;
  • Severely immunocompromised people, i.e., people with leukemia, lymphoma, congenital immunodeficiency, generalized malignancy.

Let’s say you or your child has been exposed to measles over the recent Pesach break.  What is there to do?

It takes about 10-12 days after exposure to measles for the first symptom, which is usually fever, to appear. The measles rash will appear about 2-3 days after the fever, meaning 12-15 days after the initial exposure. The rash usually begins at the hairline and then moves downwards on the face and neck and then the body. In addition to a fever, it is accompanied by a runny nose, pink eye, and loss of appetite. Measles is highly contagious and can be transmitted from four days before the rash appears to four days after it appears.

Because of this time lag and the socializing and traveling that transpired over Pesach, there is reason to be concerned (but not hysterical).

Notification of the exposure should be communicated immediately to your doctor. If you have not yet received the measles vaccine, it can be given within 72 hours of exposure although its efficacy is questionable.

It is likely that your physician’s office will have some kind of measles plan in place. In my office, one of my colleagues or I will speak with the parent to ascertain what, if any, exposure has taken place.

If we deem the child needs to be seen, we will come to the car to examine. Thank G-d, we wear our stethoscopes around our necks and in our ears and they are not attached to the wall. If we diagnose the measles, the poor sick child will be sent directly home and into bed, with Mommy and Tatty on alert. We will question and question you to ascertain where your child has been and exposed to whom. Please know that if we need to activate this step, we are doing so in order to contain the disease.

If your baby is 12 months or younger and has been exposed to the measles, time is of the essence in informing your pediatrician. An immunoglobulin shot may mitigate the consequences of the exposure.

We are here to prevent and, if necessary, to help.

As always, daven.


Dr. Hylton I. Lightman is a senior statesman among pediatricians, an internationally-recognized authority and diagnostician, a public speaker, expert witness and go-to resource for health issues in the Orthodox Jewish community and beyond. Originally from South Africa, he started his current practice, Total Family Care of the Five Towns and Far Rockaway, PC in 1987. Dr. Lightman is a board-certified pediatrician and fellow of the American Academy of Pediatrics (FAAP). Dr. Lightman is a clinical assistant professor of pediatrics at Hofstra Northwell School of Medicine. In addition, he is actively involved in teaching pediatric and family nurse practitioners through Columbia University, Pace University, Lehmann College, and Molloy College, as well as mentoring physician assistants through Touro College. Read more here.

 

The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.