Dr. Raffin: Those Measly Measles!

by Celeste Raffin
Member, Los Alamos County Health Council

Courtesy of the Los Alamos Reporter
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I remember very little of my early childhood, but will never forget having the Measles. Even though it was over 60 years ago, I remember how sick I was with astonishing clarity.

Measles, aka Rubeola, is an infectious disease caused by the Measles virus. It was first described in Persia in the late 800’s AD. By 1200 AD it had developed into a human only disease that was prevalent throughout Asia and Europe. Whether intentional or not, Measles became one of the first bioterror weapons. Asian and European explorers, followed by North American missionaries brought Measles with them to North and South America, Hawaii, the South Pacific Islands, Indonesia, and the Caribbean, wiping out 20 – 50% of the indigenous populations who had never seen the disease before. As time passed, populations grew, exploration continued, and Measles spread worldwide. And as infectious diseases go, Measles was a doozy, causing well over a million deaths a year and leaving many millions with lifelong disabilities.

​Viruses are fascinating. They are not living organisms but rather protein sacks filled with genetic material.  The only way a virus can persist is to infect a living organism. Once in an organism, the virus hijacks the cell’s reproductive machinery, forcing it to make thousands of copies of the virus. Eventually the cell ruptures, killing the cell, and spreading the virus to the rest of the organism. Survival of the infected organism depends on its immune system. If the immune system can recognize, corral, and destroy the replicating virus in time, the organism lives, if not the virus wins and the organism dies.

In order for the virus to persist, it must be passed on to another living organism. Measles spreads from one human to another via respiratory droplets and saliva. Every time an infected human breathes, talks, sings, coughs or sneezes, kisses, or uses a cup or utensil they leave droplets teaming with Measles virus waiting for their next victim who will inoculate themselves by unwittingly inhaling the infected droplets floating in the air, touching a contaminated surface and then bringing their hand to their mouth, nose, or eyes, or sharing that grubby dish or cutlery.

Measles is one of the most contagious diseases known to man. If you have not had the disease or been vaccinated, and you encounter one of those Measles infected droplets, you have a 90% chance of contracting the disease. And those measly droplets can survive for about 2 hours, so even though the Measles patient has left the area you can still be infected. The incubation period for Measles (time from infection to onset of symptoms) is 10 days to two weeks. But once infected, one starts shedding measles virus 4 days BEFORE the onset of symptoms.

It started like a regular cold: cough, sore throat, runny nose, and sneezing. But each day I felt worse. By day four I was spiking fevers to 105 degrees, couldn’t eat or drink, hurt everywhere and my head ached so badly I thought it was going to explode. My eyes were bloodshot and burning. I had funny white spots in my mouth. Then the rash appeared, starting at my hairline and then descending down my face to my neck, shoulders, trunk, arms, and legs. My Dad took me to the pediatrician. When his nurse saw me, she immediately evacuated the entire waiting room. Diagnosis was Measles, “take her home, keep her comfortable, and hope for the best.”

Measles patients experience a spectrum of severity. A few lucky ones will be infected but remain asymptomatic though still contagious. Some squeak by with just cold and flu symptoms. Most will become very ill like I was but recover. However, a significant number of measles patients will suffer complications:  virulent Otitis media, corneal ulcerations, severe diarrhea, pneumonia, encephalitis, and panencephalitis.  These complications can result in hearing loss, blindness, life threatening dehydration, respiratory failure, brain damage, and death. Measles can also cause an “immune system amnesia”. After the Measles has resolved the patient’s immune system “forgets” how to work. This can last for weeks to years leaving the patient highly susceptible to other infectious diseases. Tragically, children have the highest incidence of complications and death.

There is no cure for Measles. Treatment is supportive: hydration, fever control, pain medication, antibiotics (only in the case of bacterial superinfection), and treatment of complications as they arise.

Much has been made lately of Vitamin A. Vitamin A (which is found in Cod Liver Oil) is important for a healthy immune system. In the third world, where Measles is still endemic, malnutrition is prevalent and Vitamin A deficiency is common. Vitamin A is given to Measles patients thinking that it can help boost their immune systems and help them fight the disease. In the US vitamin A deficiency is very rare, but Measles patients are given two doses of Vitamin A 24 hours apart because it “might be helpful”. BUT Vitamin A has a very narrow therapeutic index. It is easy to overdose causing vitamin A toxicity, resulting in vision loss, liver damage and death. Vitamin A is NOT a panacea for the measles, does NOT prevent Measles, and definitely does NOT CURE MEASLES. Post exposure prophylaxis of one MMR (Measles-Mumps-Rubella) shot can be given within 72 hours of Measles exposure and measles immune globulin can be given to the severely immunocompromised (chemotherapy and HIV patients) and pregnant patients up to seven days after Measles exposure with some success in preventing the illness or mitigating the severity of the illness and its complications.
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The best way to treat Measles is not to get it in the first place. The MMR vaccine was first synthesized in 1963 and the modified 1968. It has been spectacularly successful achieving 93% immunity from Measles after the first dose and 97% immunity after the second. Almost nothing in medicine works this effectively. Because of the US vaccination program, Measles was declared eradicated from the US in 2000. But we continue to have outbreaks of Measles throughout the US. The majority (2/3) of Measles cases are brought in by unvaccinated US citizens who travel to endemic areas and bring the virus back with them. Remember, once infected, patients can shed the virus up to four days before experiencing symptoms providing ample opportunity to spread the disease.

The vaccination rate in the US has been declining. Part of this is due to the success of the MMR. Most people in the US, including Health Care Providers, have never seen a case of the Measles. It is hard to fear what you don’t see. Add in anti-vaccine propaganda, my belief that most people really hate shots, a culture that is largely reactionary instead of proactive, and it is easy to see how we are becoming increasingly complacent towards vaccines. People who have either been vaccinated or survived a prior measles infection are considered immune to the Measles.

Herd Immunity occurs when you are surrounded by enough Measles immune folk that the disease just can’t get to you. Since we have no naturally occurring Measles infections (all cases are imported) our immunity is driven by vaccination. Because Measles is so contagious, it takes a vaccination rate of 95% to achieve herd immunity. Herd immunity is a great thing, because it protects people who cannot be vaccinated, children under the age of 12 months, pregnant women, and people with severe immune deficiencies.

While our overall vaccination rate is declining, Measles has NOT become less contagious. So, we can expect to see more frequent and widespread outbreaks. And if our vaccination rate continues to drop there will be enough people infected that measles will once again become endemic in the US.

NOTHING in medicine is 100% safe. But our 60 plus years of experience with the MMR vaccine shows that the MMR is about as safe as you can get. Worldwide, the MMR has shown a severe adverse reaction rate of less than one in one million vaccinations (0.0001%). Measles infections have 0.1 to almost 1% severe complication rate. I agree that everyone has the right to refuse vaccination. But you do NOT have the right to infect others; and children, under 12 months of age (except in very special circumstances) cannot have the vaccine. Perhaps the most precious segment of our population is vulnerable while the unvaccinated exercise their rights.

I survived the Measles with no complications. But I missed two weeks of school, my dad missed two weeks of work, and I was quarantined from the rest of my family while I was ill. I contracted the measles in 1963, the year the vaccine was developed.
For up-to-date information on Measles, vaccines, guidance on exposure, or reporting measles cases, call the Department of Health Helpline at 833-796-8773.

For the most up-to-date data on the 2025 measles outbreak, visit tinyurl.com/3kje24t3. The MMR vaccine is available at both Smith’s Pharmacy locations (Los Alamos and White Rock) and Nambe Drugs. You can also contact your local healthcare provider for vaccine information.

Editor’s note: Dr. Raffin is a retired, board-certified Emergency Medicine physician who practiced for 30 years in emergency departments in Los Angeles, Calif., Salt Lake City, Utah, and Park City, Utah.