As measles cases spread, doctors issue warning

By Maureen Gilmer, Riley Children’s Health senior writer, mgilmer1@iuhealth.org

Meghan Willey has two children under the age of 3, both healthy, and she wants to keep them that way.

Roslyn, 2½, and Tessa Willey, 15 months, have received all of their recommended vaccinations, including MMR, which protects against measles, mumps and rubella. Most parents today – and many doctors – have never seen measles because the vaccine, approved in the U.S. in 1963, effectively eliminated it – until recently.

“I think people need to get their kids vaccinated not only to protect their kids but also the other kids around them,” said the Indianapolis mom, who delivered both of her children at Riley Hospital for Children.

Dr. Jodie Meara has three kids, all under the age of 7. She’s also a pediatric hospitalist, caring for sick children who’ve been admitted to Riley Hospital and other IU Health hospitals.

If you ask her about the steady rise in measles cases around the country, she has a lot to say, but her most important words are: Vaccinate your children.

“I always want parents to know I want to work with them, and I know having a tiny human is a really big undertaking,” she said. “Part of my job is to enable parents to have truly informed consent … and to offer them good information on how their decision can affect their child.”

A similar message is shared by Dr. Shannon Dillon, a Riley pediatrician with offices in Zionsville, and mother to two teenagers.

“It’s a little frustrating that we have this really excellent vaccine that we’ve had since the 1960s, with a lot of data behind it, but because people haven’t gotten the vaccine, we are seeing this resurgence of a disease that we had gotten rid of in our country,” Dr. Dillon said.

Measles cases have climbed to nearly 1,300 in the United States this year (with three reported deaths), the largest outbreak since the disease was declared eradicated in the U.S. 25 years ago.

Measles is a highly contagious but preventable viral infection that is most serious for young children and can lead to pneumonia, encephalitis and permanent disabilities, according to Dr. John Christenson, pediatric infectious disease physician for Riley Children’s Health.

“When you’re dealing with a disease that is this contagious, if you have someone bring measles into a community where many are unvaccinated, it’s going to spread like wildfire. That’s what happened in Texas,” he said.

Indiana has had several reported cases (none yet in the Indianapolis area), but no deaths. Of the confirmed cases around the country, 29% were under the age of 5, and of those, 21% were hospitalized, according to the Centers for Disease Control. Ninety-two percent of the nearly 1,300 cases this year in the U.S. have been in people who were unvaccinated or their vaccination status was unknown.

“As the numbers increase,” Dr. Christenson added, “we’re going to see more deaths because that’s what happens, especially in children under the age of 5, who are at the highest risk of mortality.”

The percentage of children being vaccinated against the measles continues to decrease every year, he said, pointing to numbers the CDC has collected in the past.

“We are definitely under the 95 percent threshold we like to be to prevent outbreaks,” he said, noting that Indiana is at about 92-93% overall, but in some parts of the state the numbers dip into the 80s, particularly for children receiving the recommended second dose of the vaccine.

The recommended age for the first dose of the measles vaccine is 12 to 15 months, with the second dose generally given before a child enters kindergarten, but it can be given earlier. When both doses are given, the vaccine is 98% effective at protecting against the disease for life.

Dr. Meara, whose youngest son recently received his 1-year vaccines, including MMR, took her daughter in for her second MMR shot before she starts kindergarten this year.

Five-year-old Robin, affectionately known as “Birdie,” was showing off her Band-Aids from her shots at the pool last week.

“As a mom and a pediatrician, I want families to know I’m (we are) here for you. If your kiddo is healthy, sick, injured or struggling, in pediatrics we are here for you,” Dr. Meara said.

“Our goal is to work with you to keep your kiddo safe and healthy, so we use vaccines to remove diseases that are a huge risk to their health. The world of parenthood comes with so many wonderful worries, and concern about diseases that are preventable should not be at the top of your list,” she said.

“I don’t have a hidden agenda. “It’s just to try to keep kids alive.”

She has seen firsthand the effects of disease in South Africa, Haiti and Honduras during her travels with medical teams, diseases like measles that had been eliminated in the U.S.

“We have a whole generation of pediatric-trained physicians who didn’t see these diseases because they had been eradicated, and now you have a lot who are going to do some on-the-job learning, and that’s not always the best in healthcare,” Dr. Meara said.

Dr. Dillon, whose kids are fully vaccinated, said the decrease in vaccination rates in Indiana and around the country corresponds directly to the increase in misinformation about vaccines that has spread online, particularly in the past several years.

“People have a lot more concerns these days because they don’t know who to trust,” she said. “It’s something we continue to address and educate people on because it’s such an important part of what we do as pediatricians and providers for children.”

Her advice to parents who are unsure about any vaccine is to talk to their child’s physician first.

“I have this conversation multiple times a day about vaccines and vaccine safety, and it’s something I am happy to do,” she said. “We’re happy to help people sort out the information and misinformation. That’s why it's so important to have a regular pediatrician for your child so you have that trusted relationship and a resource you can go to.”

For people who are unvaccinated, measles can be quite dangerous, Dr. Dillon cautioned, putting it in stark terms.

“For every 1,000 children who get measles, one or two of them are going to die, and many more than that will wind up hospitalized and having complications.”

Symptoms of measles, which generally appear a few days after contracting the virus, include a high fever, cough, runny nose, red and watery eyes and a rash that usually starts on the face and spreads down the body. A person is contagious from four days before the rash appears until four days after.

The disease is spread through the air when a person coughs, sneezes or talks, and can also be spread through contact with contaminated surfaces.

There is no cure for measles; treatment is supportive only, Dr. Dillon said.

Dr. Christenson has four decades of experience in medicine, and he worries about the road ahead as more people put their faith in alternate sources of information and shy away from proven vaccines.

“I’ve been around long enough that I have seen measles, and I’ve seen death due to measles,” he said. “I have seen what measles used to do, and I have seen the benefits of vaccination. A lot of practitioners out there probably haven’t ever seen a case and there are adults with young children who have never heard of a case.”

He and his peers continue to try to educate people – both caregivers and healthcare workers.

“We’re trying our best, but there are still a lot of people who don’t think this is serious business. The greatest challenge we have is there are people in this country who have bigger microphones than we have, and they get all the attention. It is very frustrating. Nobody is listening.”

If you are interested in getting your child vaccinated, talk to your pediatrician or healthcare provider. You can also register for vaccines through the Indiana Immunization Coalition’s Vaccinate Indiana Clinic.