While health officials continue to monitor and treat those affected by a measles outbreak in Texas that has led to the death of one child, clinicians also are addressing misinformation regarding how to prevent infection and the cause of the outbreak.
As of Feb. 24, the Texas Department of State Health Services (DSHS) has reported 124 confirmed cases of measles in the South Plains and Panhandle regions of the state. A majority of those infected are unvaccinated children. On Wednesday, DSHS reported an unvaccinated school-age child died after being hospitalized with measles.
Families hoping to protect their children from measles are encouraged to speak with their pediatrician to receive a measles-mumps-rubella (MMR) vaccine, if needed. Two doses of MMR are 97% effective against measles. With more infections expected to be reported, health care officials are reminding families that vaccination is the best way to prevent spread of measles.
While there is no specific antiviral treatment for measles, the World Health Organization recommends two doses of vitamin A be administered by a health care professional 24 hours apart for children and adults with measles. The supplement restores low vitamin A levels that can occur even in well-nourished children and can help prevent eye damage and blindness.
Many U.S. experts concur with administering vitamin A to all children in the United States with measles, regardless of hospitalization status, according to the AAP Red Book.
Clinicians, however, are working to debunk claims that vitamin A can prevent measles.
“Vitamin A is recommended for children diagnosed with measles to help prevent complications, particularly in children who are hospitalized,” said Sean T. O’Leary, M.D., M.P.H., FAAP, chair of the AAP Committee on Infectious Diseases (COID). “It should not be used to try to prevent measles, and high doses of vitamin A are potentially very harmful. The only effective way to prevent measles is the MMR vaccine.”
Larger, prolonged doses of vitamin A can cause nausea and vomiting, headache and fatigue, joint and bone pain, blurry vision and skin and hair problems. They also can lead to dangerously high pressures inside the skull that push on the brain, liver damage, confusion, coma and other problems.
“Vitamin A, at any dose, does not protect you from measles,” said James D. Campbell, M.D., M.S., FAAP, vice chair of COID. “No one should take, and no parent should give to their child, vitamin A in hopes of preventing measles. It will not do that.”
According to Dr. Campbell, vitamin A is a micronutrient, meaning only small amounts are needed to stay healthy.
“Those small amounts are what is found in a healthy diet and in recommended doses of over-the-counter multivitamin supplements,” Dr. Campbell said. “Larger doses, especially larger doses given over prolonged periods, are very dangerous. In summary, MMR vaccine prevents measles. Vitamin A does not.”
Additional misinformation claims the outbreak was caused by the MMR vaccine, which public health officials have debunked. According to the Centers for Disease Control and Prevention (CDC) and DSHS, genotype testing has linked the outbreak to a genotype of measles virus called D8 that is circulating in Europe.
The AAP and CDC recommend children receive the measles-mumps-rubella (MMR) vaccine at age 12-15 months and again at 4-6 years. Children can receive the second dose earlier if it is at least 28 days after the first dose. Each dose of MMR lowers the risk of infection and severity of illness, if infected.
Families in an outbreak area also can talk to their pediatrician about whether the vaccine can be given to children ages 6-12 months, said Lara W. Johnson, M.D., FAAP, chief medical officer at Covenant Children’s Hospital in Lubbock, Texas, where the child died from measles.
Immunization has been used starting at 6 months of age with good efficacy in previous measles epidemics in the United States, according to the AAP Red Book.
The measles virus is transmitted by contact with infectious droplets or by airborne spread when an infected person breathes, coughs or sneezes. Measles virus can remain infectious in the air up to two hours after an infected person leaves an area.
Illness onset (high fever, cough, runny nose and red, watery eyes) begins a week or two after someone is exposed. A few days later, a rash breaks out as flat, red spots on the face and then spreads down the neck and trunk to the rest of the body. A person is contagious about four days before the rash appears to four days after.
Other measles symptoms may include small spots in the cheek area inside the mouth, diarrhea and ear infection. Measles can lead to pneumonia, swelling of the brain, deafness, intellectual disability and death.
Most children who get measles are not up to date on recommended vaccines or are not old enough to get measles vaccine.
Resources
- AAP resource Think Measles: Recognizing and Addressing Measles in Pediatric Practice
- Red Book Online on-demand webinar “Identifying Measles in the Pediatric Setting”
- AAP Red Book chapter on measles
- Information for health care providers from the CDC on measles
- Information for families from HealthyChildren.org on how to protect children during a measles outbreak
- FAQs on how to protect babies from a measles outbreak from HealthyChildren.org
