Written by Angela Grant
Measles And The Recent Outbreak In MN Somalian Community
A recent outbreak of measles in MN stirred the ongoing debate about measles vaccine as a cause of autism. As of today (May 9) there were 48 confirmed cases of measles with 46 of those cases affecting children 10 years or younger. The outbreak is largely confined to the Somalian community in MN, which is the largest in the country.
What exactly is Measles?
It is a highly contagious illness caused by a virus, known as the rubeola virus. It is transmitted largely through respiratory droplets, when affected patients cough or sneeze, and can also be airborne as droplets remaining in the air for up to 2 hours. Infected patients are contagious from four days before, through 4 days after the rash appears. Others contract the illness by breathing the air or touching contaminated surfaces. Measles is only spread from human to human; no animal species can infect humans.
These appear about 1-2 weeks after a person is exposed to the virus. Symptoms of fever, cough, runny nose and conjunctivitis (eyes) herald the infection, followed in 2-3 days by tiny clusters of white lesions called ‘Koplik spots’ inside the mouth. Three to five days after symptoms, a maculopapular rash starts on the face, then spreads downward to neck, trunk, arms, legs and feet. This rash is often associated with a high fever, which subsides in a few days.
Normally measles is self-limiting with most patients recovering without sequelae. But the risk of complications increase in children younger than 5 years old and adults older than 20 years. The most common severe complication is pneumonia, which occurs in as many as one out of every 20 children with measles. Pneumonia is also the most common cause of death from measles. One out of every 1,000 children with measles will develop encephalitis, which is swelling of the brain that can lead to neurologic deficits that result in deafness, seizures and cognitive disability.
So, can be very serious!
During pregnancy, a fetus exposed to the measles virus maybe born prematurely or with low birth weight.
While the CDC declared measles eradicated in 2000 (no continuous transmission for 12 months), sporadic outbreaks persist, particularly in unvaccinated children. According to the CDC, in 2014 there was a record number of cases, 667 reported from 27 states. There were 23 measles outbreaks including 383 cases among the unvaccinated Amish communities in Ohio. In 2015, there was another large multistate outbreak linked to a California amusement park. As of April 22, 2017, there have been 61 cases reported in 10 states (California, Florida, Michigan, Minnesota, Nebraska, New Jersey, Pennsylvania, Utah and Washington). Overwhelming the majority of cases were in unvaccinated people. In the rest of the world, measles is still a leading cause of death in children.
Researchers at Princeton’s Woodrow Wilson School of Public and International Affairs, et al, presented evidence that suggested the measles infection can suppress immunity for up to 3 years and not just a few months as previously thought. This study suggested people who contract measles could be relatively immunosuppressed for up to 3 years after their illness and would be at risk for a host of illnesses due to weakened ability to fight infections and increased risk of even cancer. Vaccines apparently eliminate this risk by preventing infection.
The CDC considers the following groups protected from measles if they show at least one of the following (Measles Signs and Symptoms ):
• Received two doses of measles vaccine and they are
o School-aged children (grades K-12)
o Adults in a high risk setting for measles transmission;
• Received one dose of measles vaccine and they are
o Preschool-aged children
o Adults in not in a high risk setting for measles transmission;
• Laboratory confirmation of past measles infection
• Laboratory confirmation of immunity to measles
• Anyone born before 1957.
The most recent outbreak in MN was first detected in April of 2017. Several reports indicated this problem was in the making in 2008 when a survey found a disproportionately high number of Somali children (about 2-7 times more Somalian children than non-Somalian children) in a preschool autism program. A study, The Minneapolis Somali Autism Spectrum Disorder (ASD) Prevalence Project showed Somali and White children in Minneapolis were equally likely to be identified as autistic than Black or Latino children.
The Somali estimate of 1 in 32 compared to 1 in 36 White children, 1 in 62 Black children and 1 in 80 Hispanic children. Overall, about 1 in 48 children aged 7-9 years in 2010 were identified as having autism spectrum disorder in Minneapolis.
The project did not find any reason for higher prevalence of ASD across certain ethnic and racial groups in Minneapolis (Whites and Somalians) and concluded more research was needed.
In 2004, the vaccination rate among children of Somali descent went from 92% to only 42% in 2014, as more Somalian parents became concerned about ASD. And that brings us to present day where Somalian parents fear ASD more than measles.
There is no cure for measles, only prevention with vaccinations, usually 2 doses. One given at 12-15 months and the other at 4-6 years old. With two doses the effectiveness is 97% at preventing measles.
A final piece of advice…
If you have been exposed to someone with measles, call you doctor immediately (to determine your immune status) and take precautions such as hand washing and covering your mouth and nose with a surgical mask to prevent putting others at risk.