Personal reflections on measles outbreaks

Recent news of the US setting a 20-year high for cases of measles recorded brought back to me a chilling memory from when I was a pediatric emergency medicine fellow in Phildadelphia during the winter of 1990/91.A serious measles outbreak arose, leading to the deaths of at least two children from complications.   

I was working in the adult ER at Temple Hospital when a doctor on the staff approached me. “You’re a pediatrician, right? Wondering if you have any idea about the rash on a patient in one the ER rooms… we’re not sure what it is.” 

I walked into the room to find a man in his early 40s who was short of breath with pneumonia symptoms. He had a rash that was quite rare, but one I immediately had reason to suspect was measles.   

I asked him where he had been in the preceding weeks. He shared that on Christmas Eve, he had brought his son to the ER at St. Christopher’s Hospital for Children for treatment of an injury. That sealed the deal for me. I had been on duty in the St. Christopher’s ER that Christmas Eve, and we had triaged many cases of measles among children that day. We had taken great care to isolate anyone who came in with suspected measles. Yet now here was a man with measles 10 days later who likely was exposed to the measles virus via airborne.

Measles is very contagious. The virus can float in the air for a few hours after someone with measles sneezes or coughs. This man had been exposed to measles from virus that was floating in the air of triage room from a patient who was in that room a few hours earlier. The man’s time from exposure to symptoms of disease perfectly fit since it usually takes 8 to 12 days to get symptoms after exposure.  

It’s easy to forget how widespread and dangerous measles once were in this country. Mainly  through the efforts of the US Centers for Disease Prevention and Control (CDC), healthcare professionals and parents, cases of measles in this country largely went away.

The just-released CDC report is a cautionary tale regarding the importance of vaccination. The report notes that most of these new measles cases derived from travelers who literally flew the virus into the U.S. as they returned from countries where measles vaccination rates are much lower and cases of measles regularly occur. In 90 percent of the newly diagnosed U.S. cases, the afflicted individuals had not been vaccinated or their vaccination status could not be determined.

My St. Christopher’s experience taught me two important lessons. The first is that contracting measles can be devastating, particularly for young children. The second is that this is a virus that can spread rapidly, particularly among the unvaccinated. Remember that adult with measles and pneumonia complication I diagnosed at Temple Hospital, a few miles away from St. Christopher’s? He simply had the bad luck of coming to a place 10 days earlier where other individuals with measles recently had been.  

Dr. Leonard Friedland is Vice President/Director, Scientific Affairs & Public Health, Vaccines, North America, GSK