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{"id":6221,"date":"2015-03-10T11:00:14","date_gmt":"2015-03-10T15:00:14","guid":{"rendered":"http:\/\/circulatingnow.nlm.nih.gov\/?p=6221"},"modified":"2024-11-13T13:58:06","modified_gmt":"2024-11-13T18:58:06","slug":"measles","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2015\/03\/10\/measles\/","title":{"rendered":"Measles"},"content":{"rendered":"<p>Circulating Now <em>welcomes guest blogger David Morens, Senior Associate at the <a title=\"Johns Hopkins Bloomberg School of Public Health \" href=\"http:\/\/www.jhsph.edu\/\" target=\"_blank\" rel=\"noopener noreferrer\">Johns Hopkins Bloomberg School of Public Health<\/a> and<\/em> <em>Senior Advisor to the <a title=\"National Institute of Allergy and Infectious Diseases (NIAID)\" href=\"http:\/\/www.niaid.nih.gov\/\" target=\"_blank\" rel=\"noopener noreferrer\">Director of the National Institute of Allergy and Infectious Diseases<\/a> (NIAID). Dr. Morens is an epidemiologist with a long-standing interest in emerging infectious diseases, virology, tropical medicine, and medical history.<\/em><\/p>\n<p>Since mid-December 2014, epidemic <a title=\"NLM's MedlinePlus\" href=\"http:\/\/www.nlm.nih.gov\/medlineplus\/measles.html\">measles<\/a> has spread from Disneyland to infect 170 Americans in 17 states\/jurisdictions. People who remember life in the 1950s, when Disneyland was built, also <a title=\"American Association for the History of Medicine Newsletter\" href=\"https:\/\/web.archive.org\/web\/20230603084520\/https:\/\/histmed.org\/newsletters\/February2015web.pdf?_ga=1.162373308.1616661711.1423238469\" target=\"_blank\" rel=\"noopener noreferrer\">remember measles<\/a>. In those days, almost every kid got it: the fever, the cough and runny nose, the awful red blotches that kept you out of school and home in bed. Some kids even died from it, or got encephalitis, or eye damage. But beginning in 1963, measles vaccines ended all that. The nation-wide measles epidemics that swept the U.S. every 2\u20133 years were stopped cold. Why then do we still have measles in 2015?<\/p>\n<figure id=\"attachment_6222\" aria-describedby=\"caption-attachment-6222\" style=\"width: 650px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1front.png?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"6222\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2015\/03\/10\/measles\/card1front\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1front.png?fit=1600%2C1128&ssl=1\" data-orig-size=\"1600,1128\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Measles Diagnostic Stereoscope Card\" data-image-description=\"<p>\u201cA young girl with the typical diffuse red maculopapular rash of measles,\u201d stereoscope card, from Selden Irwin Rainforth, The stereoscopic skin clinic; an atlas of diseases of the skin, consisting of colored stereoscopic illustrations and a text in the form of clinical lectures, designed for the use of practitioners and students of medicine (New York: Medical Art Publishing Co., 1914). <\/p>\n\" data-image-caption=\"<p>\u201cA young girl with the typical diffuse red maculopapular rash of measles,\u201d stereoscope card, 1914.<br \/>\nAfter a 10-12 day incubation period, illness begins with prodromal symptoms of fever, runny nose, conjunctivitis and cough, often accompanied by red macules, having bluish-white centers, on the buccal mucosa. By about the 14th day, the full blown disease appears with onset of the characteristic rash, which begins on the head and neck, along the hairline, and then proceeds downward to involve most of the body except the palms and soles. It remains more pronounced on the trunk than the extremities. When seen by experts, the clinical course of measles is considered pathognomonic, meaning that it can be confused with very few other diseases, except rubella (Rotheln, or \u201cGerman measles\u201d), which was clinically distinguished from measles in the 1880s and is caused by an unrelated virus.<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1front.png?fit=300%2C212&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1front.png?fit=840%2C592&ssl=1\" class=\"size-large wp-image-6222\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1front.png?resize=650%2C458&ssl=1\" alt=\"A card with two side by side images meant to be viewed through a sterioscope for 3D effect, a young child covered in a find spotted red rash.\" width=\"650\" height=\"458\" \/><\/a><figcaption id=\"caption-attachment-6222\" class=\"wp-caption-text\">\u201cA young girl with the typical diffuse red maculopapular rash of measles,\u201d <a title=\"NLM's LocatorPlus Catalog record\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/nlmcatalog\/?term=48220650R\">stereoscope card<\/a>, 1914.<\/figcaption><\/figure>\n<figure id=\"attachment_6223\" aria-describedby=\"caption-attachment-6223\" style=\"width: 650px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1back.png?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"6223\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2015\/03\/10\/measles\/card1back\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1back.png?fit=1600%2C1147&ssl=1\" data-orig-size=\"1600,1147\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Measles Diagnostic Stereoscope Card Reverse\" data-image-description=\"<p>\u201cA young girl with the typical diffuse red maculopapular rash of measles,\u201d stereoscope card, from Selden Irwin Rainforth, The stereoscopic skin clinic; an atlas of diseases of the skin, consisting of colored stereoscopic illustrations and a text in the form of clinical lectures, designed for the use of practitioners and students of medicine (New York: Medical Art Publishing Co., 1914). <\/p>\n<p>MORBILLI<br \/>\nSynonyms: Rubeola; Measles.<br \/>\nMeasles is a contagious disease common among children of which one attack generally confers immunity. Its incubation time is ten days to the onset of the fever and prodromata, thirteen to fifteen days to the appearance of the rash. The onset is with fever, about 103\u00b0 or 104\u00b0 F., cough, severe corynza and conjunctivitis. There may be the symptoms so commonly associated with oncoming fever, –nausea vomiting and headache. The pharynx is hyperemic on the first day and Koplik\u2019s spots soon appear on the buccal and labial mucous membranes. Usually on the fourth day, when the fever and general symptoms have reached their height, the trash begins on the face, usually on the cheeks and forehead, and spreads within the next twenty-four hours, downward over the neck and trunk and lastly upon the extremities, with no preference for the flexor or extensor surfaces. The palms and soles may be involved. The distribution is invariably symmetrical. When the eruption is well developed the face is swollen and covered with reddish blotches. On the trunk occur numerous, red, pin-head to small finger-nail sized, round or oval macules, which are fairly well defined and may be slightly elevated above the surface of the skin. Occasionally on the upper part of the trunk some of the lesions may have an indefinite crescentic arrangement. The macules may be very closely aggregated, but they do not coalesce to form an uninterrupted sheet of eruption over the entire skin, although at times large patches may be found, particularly on the face, in which the individual lesions are almost indistinguishable. The macules disappear at first under pressure, but after a couple of days a light yellow pigmentation persists. This pigmentation may give the skin a blotchy appearance after the rash has subsided. During the outbreak the temperature remains near 103\u00b0 or 104\u00b0 F., and descends either by crisis or lysis about the fifth day, together with the abatement of all the symptoms. The disappearance of the rash is followed by a fine branny scaling which seldom lasts more than a week. While the rash is present there may be more or less itching. The prognosis is good in vigorous children. In very young, debilitated or neglected infants, fatal pulmonary complications are not rare. DIAGNOSIS: The length of the prodromal period, the catarrhal symptoms, the presence of Koplik\u2019s spots, the swollen, blotchy appearance of the face, the macular character and crescentic arrangement of the lesions, the prevalence of an epidemic and the nature of the disease from which the contagion arose, are the points to be considered in a differential diagnosis from other exanthemata, drug rashes or syphilis. TREATMENT: The patient should be put on a light diet, confined to bed, and isolated in a darkened but well ventilated room. The severe symptoms are to be mitigated by appropriate symptomatic treatment and the patient is to be guarded against exposure, especially during convalescence.<\/p>\n\" data-image-caption=\"<p>\u201cA young girl with the typical diffuse red maculopapular rash of measles,\u201d stereoscope card, 1914.<br \/>\nAfter a 10-12 day incubation period, illness begins with prodromal symptoms of fever, runny nose, conjunctivitis and cough, often accompanied by red macules, having bluish-white centers, on the buccal mucosa. By about the 14th day, the full blown disease appears with onset of the characteristic rash, which begins on the head and neck, along the hairline, and then proceeds downward to involve most of the body except the palms and soles. It remains more pronounced on the trunk than the extremities. When seen by experts, the clinical course of measles is considered pathognomonic, meaning that it can be confused with very few other diseases, except rubella (Rotheln, or \u201cGerman measles\u201d), which was clinically distinguished from measles in the 1880s and is caused by an unrelated virus.<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1back.png?fit=300%2C215&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1back.png?fit=840%2C602&ssl=1\" class=\"size-large wp-image-6223\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1back.png?resize=650%2C466&ssl=1\" alt=\"Descriptive text about Measles\" width=\"650\" height=\"466\" \/><\/a><figcaption id=\"caption-attachment-6223\" class=\"wp-caption-text\">\u201cA young girl with the typical diffuse red maculopapular rash of measles,\u201d reverse, <a title=\"NLM's LocatorPlus Catalog record\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/nlmcatalog\/?term=48220650R\">stereoscope card<\/a>, 1914.<br \/>After a 10-12 day incubation period, illness begins with prodromal symptoms of fever, runny nose, <a title=\"NLM's MedlinePlus \" href=\"http:\/\/www.nlm.nih.gov\/medlineplus\/pinkeye.html\">conjunctivitis<\/a> and cough, often accompanied by red macules, having bluish-white centers, on the buccal mucosa. By about the 14th day, the full blown disease appears with onset of the characteristic maculopapular rash, which begins on the head and neck, along the hairline, and then proceeds downward to involve most of the body except the palms and soles. It remains more pronounced on the trunk than the extremities. When seen by experts, the clinical course of measles is considered pathognomonic, meaning that it can be confused with very few other diseases, except rubella (Rotheln, or \u201cGerman measles\u201d), which was clinically distinguished from measles in the 1880s and is caused by an unrelated virus.<\/figcaption><\/figure>\n<p>First, some history. The initial advance against measles occurred over 1,000 years ago, when Persian physician Mohammad-e Zakari\u0101-ye R\u0101zi (\u0627\u0628\u0648 \u0628\u0643\u0631 \u0645\u062d\u0645\u062f \u0627\u0628\u0646 \u0632\u0643\u0631\u064a\u0627\u0621 \u0627\u0644\u0631\u0627\u0632\u0649, or \u201cRhazes\u201d) wrote <em>al-Judari wa al-Hasbah (<\/em><em>On Smallpox and Measles<\/em>), describing and distinguishing these two diseases. Before the development of germ theory, there was little appreciation that one disease differed from another. Full clarification of this important distinction awaited discovery of viruses and microbes, centuries later. But Rhazes helped lay the groundwork for its appreciation and acceptance.<\/p>\n<p>Beginning in the Renaissance, measles (also called <em>Masern<\/em>, <em>morbilli<\/em>, <em>rubeola<\/em>,<em> rougeole<\/em>, and many other names) became known to parents as one of the deadliest of the childhood fevers. In 1713, for example, measles killed 45% of persons infected in the household of Puritan minister Cotton Mather, including Mather\u2019s wife and three of their children, roughly the same fatality rate as the 2014\u20132015 Ebola epidemic, and almost as terrifying.<\/p>\n<p>Mather was then the New England colonies\u2019 foremost medical authority. Sometime before 1714 he had learned from an African-born slave that smallpox could be prevented by inoculating fluid from the blisters of infected persons into the skins of persons who had not yet been infected. Similar stories reached Europe from Turkey and elsewhere, among the most astonishing medical stories anyone had ever heard. When a smallpox epidemic came to Boston in 1721, Mather, along with the young Benjamin Franklin, Franklin\u2019s brother, and others, campaigned successfully in favor of smallpox inoculation. Inoculation saved many lives between then and 1798, when it was replaced by an even more radical, but safer procedure: vaccination.<\/p>\n<p>The prevention of smallpox by inoculation had no scientific explanation: it just worked. But that got people thinking. In 1758, Scottish physician Francis Home (1719\u20131813) reasoned that if inoculation worked to prevent one of the pair of diseases described by Rhazes, the same method might work against the other. And in a 1759 publication, Home showed that measles could also be prevented. Whether by insight or blind luck, he chose, as the inoculum, blood from children at the height of their illnesses. In retrospect, those early smallpox and measles inoculation studies, and Jenner\u2019s later vaccination studies, were the first experimental demonstrations of what we now understand as active immunity. Just like natural diseases, fluids from infected people or animals, inoculated into others, can confer long-lasting protection. And that is the basis of modern disease prevention via inoculation, vaccination, passive immunotherapy, and protection of newborns by maternal antibody.<\/p>\n<figure id=\"attachment_6229\" aria-describedby=\"caption-attachment-6229\" style=\"width: 650px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/book-2045_001.png?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"6229\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2015\/03\/10\/measles\/book-2045_001\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/book-2045_001.png?fit=1600%2C1258&ssl=1\" data-orig-size=\"1600,1258\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Book-2045_001\" data-image-description=\"<p>SECT. IV.<br \/>\nOf the measles as they appeared 1758 at Edinburgh, and of their inoculation.<br \/>\nThe measles appeared in Edinburgh about the beginning of December, and were very epidemic all the winter. In general they were of a mild fort; and not above the twelfth part died of those who were attacked. In general, the cough was very severe, even in the gentlest fort, from the first or second day of their being seized; continued, like a hooping-cough, to harass the patient till the turn of the meafles, and then, in the favourable kind, abated very much, a looseness generally coming on about that time.<\/p>\n\" data-image-caption=\"<p>Francis Home\u2019s 1759 publication Medical Facts and Experiments contains the first description of the prevention of measles by inoculation of blood into skin incisions.<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/book-2045_001.png?fit=300%2C236&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/book-2045_001.png?fit=840%2C660&ssl=1\" class=\"size-large wp-image-6229\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/book-2045_001.png?resize=650%2C511&ssl=1\" alt=\"Book open to section IV "Of the measles as they appeared in 1738 at Edinburg, and of thier innoculation.\" width=\"650\" height=\"511\" \/><\/a><figcaption id=\"caption-attachment-6229\" class=\"wp-caption-text\">Francis Home\u2019s 1759 publication <a title=\"NLM's LocatorPlus Catalog record\" href=\"https:\/\/catalog.nlm.nih.gov\/permalink\/01NLM_INST\/1o1phhn\/alma992762383406676\"><em>Medical Facts and Experiments<\/em><\/a> contains the first description of the prevention of measles by inoculation of blood into skin incisions.<\/figcaption><\/figure>\n<p>Home\u2019s method was never widely adopted, perhaps because of the expense and difficulty getting blood from sick children for the inocula (parents often refused). Control of measles by immunization had to wait two centuries, until the era of modern virology. Tissue-culture propagation of viruses\u2014for which Enders, Weller, and Robbins were awarded the 1954 Nobel Prize\u2014led to the development of the first measles vaccines, which were introduced in the U.S. between 1963 and 1967. In recent decades, these vaccines, brought to every country of the world, have saved millions of lives. There has been a five- to ten-fold drop in annual global measles deaths in the past 15 years, a tremendous achievement that brings us to the doorstep of measles eradication.<\/p>\n<p>However, measles does not go quietly. Politics, superstition, and irrational fears prevent some parents from vaccinating their children. Some believe that measles itself is relatively harmless, and that the vaccine causes diseases like autism\u2014despite overwhelming <a title=\"Centers for Disease Control and Prevention\" href=\"https:\/\/www.cdc.gov\/autism\/faq\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/ncbddd\/autism\/topics.html\" target=\"_blank\" rel=\"noopener noreferrer\">evidence<\/a> to the contrary. Some parents even take their children to \u201cmeasles parties\u201d to purposely expose them to measles-infected children, putting their children at risk of severe or fatal disease\u2014a risk that is, by rough calculation, over a hundred million-times greater than any complication arising from measles vaccination. All of which goes to explain why we are now having an American measles epidemic. If <a title=\"Centers for Disease Control and Prevention\" href=\"http:\/\/www.cdc.gov\/measles\/\" target=\"_blank\" rel=\"noopener noreferrer\">current public health campaigns<\/a> can persuade parents to have their children vaccinated, one day measles can be eradicated, just like <a title=\"NLM's MedlinePlus\" href=\"http:\/\/www.nlm.nih.gov\/medlineplus\/smallpox.html\">smallpox<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Circulating Now welcomes Dr. Morens, Senior Advisor to the Director of the NIAID and an epidemiologist with a long-standing interest in emerging infectious diseases, virology, tropical medicine, and medical history.<\/p>\n","protected":false},"author":19605840,"featured_media":6298,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"Measles - Dr. David Morens from NIAID shares some history about Measles in a guest blog on Circulating Now. http:\/\/wp.me\/p3xcDk-1Cl","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[12763,51014],"tags":[1343,136219,25639,604852,591803,52877],"class_list":["post-6221","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-collections","category-guests","tag-children","tag-epidemic","tag-epidemiology","tag-immunization","tag-measles","tag-vaccine"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2015\/03\/card1front_feature2.png?fit=932%2C360&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/s3xcDk-measles","jetpack-related-posts":[],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/6221","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/users\/19605840"}],"replies":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/comments?post=6221"}],"version-history":[{"count":23,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/6221\/revisions"}],"predecessor-version":[{"id":45708,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/6221\/revisions\/45708"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media\/6298"}],"wp:attachment":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media?parent=6221"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/categories?post=6221"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/tags?post=6221"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}} |