By Thomas Sandora, MD, MPH
Thomas Sandora, MD, MPH, is the medical director of Infection Control at Children's Hospital Boston, and the hospital's
epidemiologist. His research focuses
on hand hygiene and patient safety.
Fifteen cases of measles and two of
rubella were reported in Boston as of
July 2006. In light of this recent rise,
Pediatric Views sat down with
epidemiologist Thomas Sandora, MD, MPH, medical director of Infection
Control at Children's Hospital Boston.
Why are we seeing a resurgence of measles, mumps and rubella?
Most measles, mumps and rubella cases in the United States are imported, meaning people come from other countries and bring in the infections. For example, the first case of the measles in Boston was a man who brought it from India. Because the United States has such good
vaccination rates overall, it's not as
common for these infections to occur
naturally in this country anymore. In
general, most people in this area are
immune because we have good
vaccination coverage.
There are some people who for various reasons might not be immune to measles. They might've been born before an
effective measles vaccine was developed in 1968, or they may have only had one dose of the vaccine, instead of two, which is the current standard for children. Even if you do get two doses, there are occasional
failures of the vaccine. But most people with two doses should be immune.
What special steps should primary care clinicians take if a child comes in with measles or mumps?
Measles is an airborne infection and is probably the most contagious infection there is, so containing it is very important. If you suspect a case—if someone comes in with a fever and a rash that's consistent with measles—you should put a mask on the patient right away and put him into a negative pressure room or airborne
isolation room, with the door closed. That
prevents the measles virus from getting out into the air and exposing other people in the clinic or waiting room.
Mumps is droplet—rather than an
airborne—spread, which means it's
usually spread at distances shorter than 3 feet, so not as many people will end up being exposed. If you recognize that someone has mumps, again, you want to put them into a single room with the door closed. Anyone who is going to be within 3 feet of the patient should wear a surgical mask while interacting with him.
What should parents do if they think their child has one of these infections?
Parents should call ahead and let the clinic know they're coming in, and that they're worried about measles, mumps or rubella. The clinicians could meet them outside and put a mask on the child before going into the waiting room.
What are the dangers of measles and mumps?
Both measles and mumps are viral
infections. Most people who get measles have a fever and a rash as the primary symptoms. With mumps, you get swelling of the salivary glands in the face. In
general, most people do pretty well and the illness resolves, but there are
complications for both. For measles, one dangerous potential complication is
encephalitis, which is an inflammation of the brain that can cause seizures. You can also develop pneumonia and ear
infections. For mumps, one of the most well-known complications is orchitis, which is swelling of the testes, and you can also develop more serious respiratory symptoms. But all of these complications are fairly rare.
What are the risks of rubella?
Rubella is not usually a very severe
infection. You get a fever and a rash, and it usually resolves. The biggest problem with rubella is when pregnant women transmit it to their children, which can cause
congenital rubella syndrome. This is an infection of the newborn infant that can cause severe problems, from deafness to eye and heart issues. That's why it's
important for all pregnant women to get tested for immunity against rubella.
What vaccinations should parents and pediatricians ensure children have in order to prevent these infections?
The vaccine we use now covers all three diseases—measles, mumps and rubella (MMR). The first dose should be given when the child reaches 12 months, and the second dose at 4 to 6 years of age.
Should primary care clinicians be more concerned than usual about their
patients contracting these infections?
I would say that if parents have been
vaccinating their children on the usual schedule, then there's not much reason to be concerned. But these illnesses could
occur if children didn't get the full
vaccination series. Also, kids under 12 months of age who are too young to get the MMR vaccine could get infected if they are exposed. I don't foresee a huge outbreak, because we have such good
vaccine coverage levels here. And the
Department of Public Health has been pretty active about trying to immunize everyone who gets exposed so it won't spread further.
