To party or not to party, that is the question this Chanukah. In the face of the measles outbreak that has recently spread from Williamsburg, Monsey, and Lakewood to Flatbush and Passaic, what can we do to keep our Queens families safe? Quarantining our Queens communities is the only way to keep the measles out of Queens.
Why do we care if the measles comes to Queens? Measles is one of the most contagious airborne diseases: 90 percent of susceptible people exposed to it will get it. Following exposure to someone with the virus, there is an incubation period of 10-12 days with few if any symptoms. (You may be contagious during this period, even without symptoms.) Then, patients experience low-grade fever, cold symptoms, inflammation of the eyes, a hacking and increasingly severe cough, and possibly “Koplik spots,” grayish white dots with surrounding redness opposite the lower molars. These spots are diagnostic of measles, but disappear within 12-18 hours. Finally, their temperature rises abruptly to 104-105° F, they appear desperately ill, and the rash begins, usually as red dots in the facial area, and becoming larger and joining as the rash spreads down the neck, arms, upper chest, and abdomen. Over three days, it finally reaches the feet, and begins to fade on the face. The rash fades downwards as the patient recovers, and there can be skin peeling during recovery. People are contagious from a week after exposure to two days after the rash has disappeared.
About 30 percent of people with measles have complications, ranging from ear infections, diarrhea, and pneumonia, to inflammation of the brain and blindness, even death. In 2014, there were 73,000 cases worldwide, and the death rate was up to ten percent, with most under five years of age. Even scarier is the fact that people who recover from measles can get progressive neurological deterioration, including memory loss and seizures, six to eight years after having the measles. This subacute sclerosing panencephalitis (SSPE) leads patients to deteriorate to a persistent vegetative state and death within three years of developing symptoms. The risk of developing SSPE is about one in 2,000 cases of measles. (No one has ever gotten SSPE from the measles vaccine.)
Unfortunately, we do not have antibiotics to treat measles. And even if you had the recommended two doses of the measles vaccine, three out of 100 people are still not immune, and could catch the measles if exposed. I have two patients in my practice who received the recommended vaccines, but are not immune. In 1989, the last time we had a measles epidemic in Queens (brought to Queens over Yom Tov from a hotel in New Jersey), a four-year-old patient of mine who had received one shot was hospitalized for five days with the measles. The only guarantee of immunity is a blood test documenting immunity!
So, since patients with measles are contagious before they are sick, and even people who are fully vaccinated can be susceptible, I believe the only safe strategy this Chanukah is to keep Queens quarantined: Do not go out, and do not invite those from outside. To party or not to party? I’m staying home.
Rachelle H. Meth, MD, has a private practice in pediatric and adolescent medicine in Kew Gardens Hills.