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General · 1st July 2014
Pat Peterson
JUNE ARTICLE (Please excuse the lateness of this article: I had technical difficulties loading it. My apologies)

With the most recent outbreak of measles in the Fraser Valley, along with several cases of pertussis on Vancouver Island, including Quadra, I thought it would be timely to discuss both these contagious diseases. Although both are considered childhood diseases, adults are also susceptible. The incidence of both has decreased with the use of preventative immunizations; however, outbreaks continue to occur in pockets where there are low immunization rates.

MEASLES
Measles, or rubeola, is an infection caused by a virus of the paromyxovirodae family. It is highly contagious, either through direct contact with or inhalation of secretions from an affected individual. The virus can also be passed through contact with material soiled with secretions from an affected individual, such as on tissues, linen or shared utensils. The contagious period occurs for about 4 days prior to and 4 days following the appearance of the rash.

NATURAL HISTORY
According to the World Health Organization (WHO), measles occurs in all countries in the world and is still one of the leading causes of vaccine preventable death in children. Prior to the introduction of vaccination, measles occurred in cycles every 2-3 years, with the number of cases reaching 3-400,000 annually in Canada. The measles vaccine was initially offered in 1963; by 2002 outbreaks had been eliminated in North America. In 1996, the two-dose schedule for measles was introduced to provide better coverage. However, in recent years small isolated outbreaks have occurred, chiefly in areas where the vaccination rate is low.

SYMPTOMS
Once the virus has been contracted, the incubation period ranges from 8-14 days with an average of 10. Individuals are initially asymptomatic, but about 8 days into incubation, symptoms of fever, malaise, runny nose, cough, and red, runny eyes (which are light sensitive) can occur. Teens and adults may report joint pain. One may notice Koplik spots, or white to grey spots with a red base that appear on the inner lining of the mouth, often resembling grains of sand. 3-7 days following the initial symptoms, the red blotchy rash occurs, starting on the face and moving downward. Individuals can be lightly or totally covered with the rash. Most individuals recover within 2-3 weeks.
Diagnosis of measles is chiefly done by symptoms though confirmation can be obtained through blood testing and/or nasopharyngeal swabbing.
Complications of measles include diarrhea, pneumonia and infections of the brain. In developed countries 1-2 cases/1,000 result in death. In developing nations, this increases to 3-5/1,000.

TREATMENT
There is no treatment for measles. Symptom management includes treatment of fever, rest and encouraging a healthy diet with plenty of fluids.
Fever should never be treated with aspirin in children under the age of 20, due to the risk of Reyes syndrome.
Individuals with measles need to be isolated until 4 days after the rash appears.

PREVENTION
Vaccination is the best prevention. In British Columbia, it is recommended that children receive one dose of measles, mumps and rubella vaccine (MMR), or one with the addition of varicella (MMRV) at 12-15 months of age, followed by a second dose (booster) between ages 4-5.
Any individual who did not receive two doses of the vaccine should do so. Any adult who has not been vaccinated should receive the vaccine. This is particularly important for those who travel, or women desiring pregnancy.
There are very few people who should not receive the MMR. Those with a previous life threatening reaction to a previous MMR, those whose immune system has been compromised by disease or medications, and those who have received blood or blood products within the last year should not be vaccinated.
The vaccine is very safe, and does not contain thermosel.
Side effects of the vaccine can include redness at the injection site, fever, fussiness, rash, and/or swollen glands. These can occur up to 12-24 hours following vaccination and disappear within a few days.

PERTUSSIS (WHOOPING COUGH)

This is a highly contagious bacterial infection that affects the lungs and airways, caused by the bacterium bordetella pertussis. It is spread by droplet infection when the affected individual coughs or sneezes, or when an individual touches a toy or article contaminated by the bacterium. The pertussis bacterium can live for 2-5 days on dry surfaces. Toxins produced by the bacterium cause the majority of the symptoms.

NATURAL HISTORY
Pertussis occurs world wide in cycles that peak every 3-5 years. WHO estimates there are between 20-40 million cases per year, chiefly in developing countries and in those who are under/un-immunized. There are approximately 400,000 deaths per year attributed to pertussis. By far the most vulnerable are infants under 6 month of age.
In Canada, pertussis vaccine was introduced in 1943. Scheduling and vaccine changes have resulted in decreased infection rates but there are still outbreaks, with the last in 2012. Infection rates are greatest in infants and children, less so with adolescents and adults. There are still 1-4 pertussis related deaths in Canada per year.

SYMPTOMS
There are three distinct stages to pertussis: catarrhal, paroxysmal and convalescent. In the catarrhal stage, symptoms similar to a cold (fever, runny nose, sneezing and a mild cough) appear 7-28 days following infection. The cough gradually worsens and becomes more violent, with bursts of coughing ending in a whoop as individuals try to get their breath. Vomiting is not uncommon. It is this paroxysmal stage (lasting 2-8 weeks) that gives pertussis the name ‘whooping cough’. The convalescent stage lasts weeks to months as the individual recovers.
Younger individuals may not have typical symptoms and the only sign could be apnea or periods where the infant does not breath.
Serious complications, which are greater in the younger age groups, include pneumonia, seizures, brain infections, hernias and death.
Older individuals, with larger airways, are at lesser risk of serious complications, but rib fractures, urinary incontinence; rectal prolapse or subconjunctival hemorrhage is not uncommon. Older individuals with mild symptoms are often those who pass on the infection to infants and children.
Individuals are most contagious in the catarrhal stage, often when the infection is mild and thus unrecognized.

TREATMENT
Diagnosis of pertussis is by clinical symptoms and laboratory testing (nasopharyngeal swab). The usual treatment is antibiotics, started before laboratory confirmation if there is high suspicion of infection.
Comfort care for younger children includes keeping children calm to prevent coughing spells, avoiding things that may trigger a coughing spell, small frequent meals and fluids, and use of humidified air if soothing.
An individual is considered contagious from early symptoms to 3 weeks after the cough begins.
One is no longer considered contagious following 5 days of antibiotics.
It is common to treat all immediate family members or those in close contact with the affected individual.

PREVENTION
Prevention begins with suspicion of infection and isolation of the suspected individual. If you suspect you may be ill, it is very important to seek medical care for confirmation along with keeping away from young children and infants, who are most at risk for serious complications.
Vaccination for pertussis is given as part of the immunizations series for infants beginning at 2 mos. They receive at total of 5 vaccinations for pertussis by age 5, with a booster in grade 9.
It is very important to receive boosters at the recommended timeframes as immunization wanes over time.
The vaccine is free to any adult who has not previously been immunized for pertussis.
The pertussis vaccine can be given to pregnant women after 26 weeks if needed.
The vaccine is very safe. Side effects are mild, most commonly with a local reaction of redness, tenderness and/or swelling at the injection site.
The vaccine is 85% effective with full immunization.

SUMMARY
Both measles and pertussis are preventable through vaccination.
Vaccination helps protect those at most risk of serious complications, the very young.
Vaccinations are free for most individuals.
One can receive vaccinations through most primary health care clinics or through public health. Call your local clinic or the public health unit (250-850-2110) for further information or times the public health nurse is on Quadra Island.
Contact my self for further information: 250-285-3540 or patricia.petersonviha.ca I am happy to answer any questions.


*NEW* Immunization Canada has a free downloadable app to help you store and keep track of you and your families immunizations. Go to immunizecpha.ca to download the app. *NEW*