Remember measles’ past when talking to parents

Emily was a beautiful 19-year-old honors student attending Barnard College in New York, New York, who contracted measles and developed post-measles encephalitis with resulting severe brain damage. I met Emily when visiting with a group of fellow pediatricians at Letchworth Village in Thiells, New York, a former residential institution for the physically and mentally disabled. We soon realized that, unfortunately, Emily was now barely able to function at the developmental level of a child aged 4 to 5 years.

That encounter made an indelible impression that has stayed with me to this day. The year was 1959, 60 years ago, and shortly before the measles vaccine was available. At that time, measles was one of the most common childhood illnesses.

Vaccine success story

Since the approval and licensing of the vaccine in 1963, we have seen a dramatic decrease in the prevalence of measles. The vaccine has been shown to be safe and effective. My office participated in the field trials in 1961. My son was an uncooperative, unwilling participant in the trial as I drew his blood, as were many of my other patients. In those days every practicing pediatrician was quite familiar with measles that was, along with chicken pox, seen very frequently.

The diagnosis of measles at times could be challenging. We learned about the 4 k’s: koplik spots, kough, koryza, and konjunctivitis. However, there were cases that did not present with all these features. Finding the koplik spots, which appeared before the rash, was not easy. Prying the mouth open of a sick and screaming toddler was hard enough. Locating these 1-mm to 3-mm blue white lesions with an erythematous base on the buccal mucosa opposite the first molar was even harder.

During the 1989-1991 outbreak, the mortality rate was 2.2 deaths per 1000 cases.¹ Pneumonia was responsible for 60% of the deaths, mostly in children aged younger than 5 years.² As illustrated by Emily, measles can also cause severe neurologic complications. Post-measles encephalitis is seen in 1 to 2 cases per 1000, usually developing several days after the rash. The hope at that time was for the vaccine to not only protect against measles, but more importantly to prevent the serious complications, which is exactly what has happened.

The vaccine had been an incredible success, so much so that in 2000 the Centers for Disease Control and Prevention (CDC) declared that measles was officially eliminated in the United States, as a result of so few reported cases in each of the previous few years.

MMR: Victim of its own success

However, now we are suddenly witnessing a major outbreak of measles, and so I am again reminded of Emily. I watch, with increasing frustration and anger, more and more antivaccine parents refusing to immunize their children with the measles/mumps/rubella (MMR) vaccine. As of September 19 this year, 1241 cases of measles have been reported by the CDC, the highest number since 1992. Why is there no public outcry to mandate universal measles vaccination without exception for all children?

I am certain that every parent wants only the best for his/her child, and this includes the antivaccine group. When I am faced with a parent who is hesitant or refuses to immunize his or her child, I explain to them how safe and effective the vaccine has been for over 50 years, but I also tell them about Emily and who she was before and after she caught measles.

Many practicing pediatricians have little or no experience with measles and its complications, unless, like me, they started practicing pediatrics before the routine use of the measles vaccine in 1963 or before the last major outbreak of measles that occurred 25 years ago. (The MMR vaccine was licensed in 1971 and recommended to be administered in 2 doses in 1989.)

What we can do

For those community pediatricians who have little or no experience in diagnosing or treating measles, I implore you to emphasize to all your patients the absolute necessity to fully immunize every child on time and without delay, and explain to any reluctant parents that the group that questions the safety or effectiveness of the measles vaccine is not only wrong but is jeopardizing the health and well-being of their children. Tell them that the British physician who first reported that the MMR vaccine could cause autism was found to be a dangerous fraud and so lost his license to practice.

The antivaccine group must be made more aware of the terrible complications of measles. In my opinion, not vaccinating a child against measles is not only idiotic, it is immoral and dangerous.

Please remember Emily.