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Prevention of Measles

Measles is a highly contagious respiratory disease caused by a virus. The


disease of measles and the virus that causes it share the same name. The
disease is also called rubeola.

The best prevention of measles is the measles vaccine. A second dose of the
vaccine is recommended to protect the 5 percent of people who did not
develop immunity with the first dose, and to give a "booster" effect to those
who did develop an immune response. Widespread use of the measles
vaccine has led to a greater than 99 percent reduction in measles cases in the
United States.

An Introduction to the Prevention of Measles
Prior to 1963, almost everyone got measles; it was an expected life event.
Each year in the United States, there were approximately 3 to 4 million cases,
and an average of 450 deaths. Epidemic cycles occurred every 2 to 3 years.
More than half the population had measles by the time they were 6 years old,
and 90 percent had the disease by the time they were 15 years old.

However, after the measles vaccine became available, the number of
measles cases dropped by 99 percent, and the epidemic cycles diminished
drastically. Therefore, the best prevention of measles is the measles vaccine.

Measles Vaccine as Prevention of Measles (Primary Prevention)
Prevention of measles begins with the measles vaccine (contained in MMR,
MR, and measles vaccines).

The MMR vaccine is a live, attenuated (weakened), combination vaccine that
protects against the measles, mumps, and rubella viruses. It was first licensed
in the combined form in 1971, and contains the safest and most effective
forms of each vaccine.

It is made by taking the measles virus from the throat of an infected person,
and adapting it to grow in chick embryo cells, in a laboratory. As the measles
virus becomes better able to grow in the chick embryo cells, it becomes less
able to grow in a child's skin or lungs. When this vaccine virus is given to a
child, it replicates only a little before it is eliminated from the body. This
replication causes the body to develop an immunity that, in 95 percent of
children, lasts for a lifetime.

A second dose of the vaccine is recommended to protect the 5 percent who
did not develop immunity in the first dose, and to give "booster" effect to those
who did develop an immune response.

Widespread use of the measles vaccine has led to a greater than 99 percent
reduction in measles cases in the United States, compared to the pre-vaccine
era; however, measles is common in other countries where it spreads rapidly,
and can be easily brought into the United States. If measles vaccinations
were stopped, measles would return to pre-vaccine levels in the United
States, and hundreds of people would die from measles-related illnesses.

Preventing the Spread of Measles (Secondary Prevention)
People who have a generalized rash and fever (as well as people who have
fever and respiratory symptoms) following exposure to a person with measles
may be infected with the measles virus. People who are potentially infectious
with measles should minimize the risk of transmission by limiting contact with
other people who may be susceptible to the disease. Contact should be
limited until:

A medical diagnosis, excluding measles, has been established
The symptoms have resolved completely
4 days have passed since the onset of the rash.

People who are potentially infectious with measles should especially avoid
public transportation (including commercial airlines) and crowded indoor
areas. Patients who suspect they may have measles should call ahead before
visiting a clinic or hospital, so that arrangements may be made for the
healthcare provider to attend to the patient without exposing others in the
facility to measles.

Tertiary Prevention
Usually, the progression of measles is fairly predictable. After two to three
days of fever, a whole-body rash breaks out, the cough worsens and the fever
pushes higher, into the 103 to 104 range. The fine red spots on the body
may join together to form larger splotches. But the rash, which lasts from
five to eight days, is not itchy.

Sometimes children with measles develop an ear infection, pneumonia or
neurological complications. Most of the time, though, kids with measles just
feel really sick for seven to ten days. There's not really much you can do
about it, except to try to relieve some of the symptoms.

Ease the fever with medication. Give your child a nonaspirin pain reliever
such as Children's Tylenol or Tempra to help reduce fever and irritability, says
Blair M. Eig, M.D., a pediatrician in private practice in Silver Spring, Maryland.
Check the directions on the package for the correct dosage for your child's
age and weight. If your child is under age two, consult your physician. 'If your
child has a high fever that is really debilitating, your pediatrician may prescribe
some ibuprofen,' adds Dr. Eig. ( But ibuprofen should not be given to children
unless you have a doctor's recommendation.)

Measles can be complicated by a bacterial infection such as pneumonia or by
an ear infection. If your child develops either of these infections, he needs to
be treated with doctor-prescribed antibiotics. You should call the doctor
immediately if your child complains of an earache, if he has yellow discharge
in the eyes or if he develops a nasal discharge which becomes yellow and
stays yellow for more than 24 hours, say Betti Hertzberg, M.D., a pediatrician
and head of the Continuing Care Clinic at Miami Children's Hopital.
'If your child has fever after the fifth day of the rash, or any symptoms of
pneumonia such as labored breathing, wheezing, chest pain or severe
coughing, you need to contact your child's pediatrician as soon as possible,'
she says.

Your child will need immediate medical attention if he has any neurological
symptoms such as a seizure, delirium or weakness or spasm of an arm or a
leg, adds Blair M. Eig, M.D., a pediatrician in private practice in Silver Spring,
Maryland. And if you can't wake him from a nap or from sound sleep, you
should call for emergency assistance.

Control the cough when necessary. You can try a mild cough
suppressant that contains dextromethorphan to relieve the cough, especially if
it's interfering with your child's sleep, suggests Dr. Eig. Over-the-counter
products such as Triaminic-DM contain dextromethorphan. Be sure to read
package directions--or check with your physician--for the correct dosage for
your child.
Make the most of mist. 'A cool-mist vaporizer will put some humidity in the
room air and make it easier for your child to breathe freely,' Dr. Garcia says. If
you do use a vaporizer, though, you must clean it often, following the
manufacturer's instructions. 'Otherwise, bacteria and mold could grow in
the still water,' he cautions.
Keep the lights low. With measles, the eyes can become very irritated and
sensitive to light. 'Keep the lights dim in your child's room, or give
him sunglasses to wear,' advises Dr. Hertzberg.
Flush and wipe the eyes. 'Rinsing the eyes with plain saline solution--
available at drugstores--may be soothing,' says Dr. Eig. Use an eyedropper to
put several drops in the corner of each eye.
If your child's eyes get crusty, wipe them with cotton balls that have been
wrung out with boiled water, says Dr. Hertzberg. 'Be sure to wipe from the
inside corner of the eye to the outside, and use a different cotton ball for
each eye,' she says.
Restrict activity. Be sure that your child stays indoors, preferably in
bed, says Dr. Hertzberg. 'With the measles, he'll probably feel too sick to do
much else,' she says.