Let’s Talk Measles

Let’s Talk Measles

In medical school, I was taught how to recognize a viral illness essentially eradicated in the United States. The three “C”s – cough, coryza (inflamed and runny nose) and conjunctivitis – should make you think of measles. If this triad of symptoms is present, check the mouth for Koplik spots (small white spots on a reddened background on the inside of the cheeks) often presenting before the tell-tale maculopapular rash that starts on the head and works its way down the body to the lower extremities. This is the text-book presentation, which is all I have to go off of – as I have never seen a case of measles, despite being in hospital and outpatient clinical settings since 2000.

Over the last couple weeks, I have had parents ask me if measles is really that dangerous. Is it similar to the viruses we see regularly, like Roseola, the Flu and Hand Foot and Mouth disease? The answer is, of course, yes and no. In many affected persons it causes a week of miserable symptoms and then full recovery. In others, it is devastating. The catch is – it can kill you even if you were healthy and robust before infection. You can’t predict who will develop a secondary pneumonia or a debilitating encephalitis (brain swelling). You can’t prevent these sequelae and thus we can’t entirely prevent measles associated deaths.

So, why would someone choose not to vaccinate his or her child against measles? Potentially because of a discredited study in 1989 that evaluated twelve (TWELVE) children who developed an inflammatory bowel disorder and neurodevelopmental dysfunction apparently associated with administration of the MMR vaccine. The data reported was questioned and then pulled secondary to poor scientific method. What I found interesting in re-reading this retracted medical study was the report of high melthylmalonic acid in the urine of the affected children. Methylmalonic acidemia in its pure form is a genetic disorder of metabolism that occurs in persons who cannot break down certain fats and proteins and thus develop higher serum levels of this acid. This acidemia is associated with progressive brain dysfunction, developmental delays and failure to thrive among other things. What made the Wakefield study so poor is that all other potential confounders; such as environmental exposures, illness and familial and personal genetics were not examined. Normal physiologic processes that occur in children between the ages of 12-15 months that could account for changes in baseline constitution were simply not evaluated. So much data was ignored. Interestingly, the treatment for methylmalonic acidemia is cobalamin and carnitine supplements and a low-protein diet. Cobalamin is Vitamin B12! Both B12 and carnitine are available over the counter.

Maybe the parents that feel concern over the MMR vaccine, generated either by the Wakefield study or the anti-vaccine celebrity voices, should just supplement their kiddos diet with foods high in vitamin B12 and carnitine around the time of the vaccine, instead of avoiding the MMR vaccine altogether. Dr. Google has easily accessible and extensive lists of carnitine and B12 rich foods, and is certainly a safer topic to trust to Dr. Google than lists of reasons not to vaccinate. Best part is, there is no downside to the simple action of feeding our children vitamin rich foods. But the negative effects to skipping the MMR vaccine are easily quantified. Per Dr Pourmassina, internist and writer, “It’s a numbers game that affects all of us, so let’s do the math. One person with measles can infect 12-18 others who aren’t immune. If 1 person infects 18 people, and if each of those 18 go on to infect 18 more, who then go on to infect 18 more, we already have 5,832 people infected and around 17 of them will have died. This, with just 3 degrees of separation from the initial case.” Those are absolutely preventable deaths. Let’s prevent them as the science and even the speculation are in favor of vaccinating.