By Dr. Anthony Policastro
We know that second hand smoke puts others at risk. Driving under the influence of alcohol puts others at serious risk. There are other behaviors like that that can affect the health of those around us.
One example of this can be found in the South Carolina measles epidemic. Many younger physicians have not seen measles very often. However, in my early years as a pediatrician, I saw it quite frequently. I often talked about them having a “measly” appearance. I could literally walk in the door of a room, look at a child and make the diagnosis of measles without an exam.
Some individuals have chosen to not have their children get the measles vaccine. They are choosing to have their own children get naturally occurring measles. That choice affects only their child at that point in time.
We already know that the way to prevent a measles epidemic is by having over 95 percent of the population vaccinated. Therefore, if more than five percent of the population makes this decision, they are subjecting the community to a measles outbreak. That puts the entire community at additional risk.
Another problem occurs if their child becomes infected with measles. They may decide to take their child to the doctor. They will sit in a waiting area with a child who is very infectious.
Also in that office are well babies or sick infants under the age of one year. We do not give the measles vaccine to children under 12 months of age except in certain circumstances. The reasons are immunologic in nature.
The mother’s antibodies to measles are carried across the placenta before birth to the infant. It offers partial protection for a few months. However, we know that if you cannot give the vaccine before those antibodies disappear.
If you do that, then any response to a vaccine will be blunted. The infant will not have the full effect of the vaccine. Therefore, the first dose needs to wait until at least 12 months of age.
A problem occurs when the infant is exposed to measles before they reach 12 months. Those antibodies are still present from the mother. However, they are too low to protect the infant. Therefore, the infant will likely get measles.
Measles infection under one year of age is dangerous. The mortality rate is somewhere between one in 10 and one in 20 infants. Fortunately, in a society where measles is rare (like it has been for the last 26 years in the United States), this is not often an issue.
However, in a situation like the one that occurred last year in Texas and is now occurring in South Carolina, the story is different.
Doctors in offices and emergency departments often have to make a decision about exposing well infants to a potential case of measles. They often leave the office to go out to the parking lot to make sure a child does not have measles before letting them indoors. Some parents object to that approach.
Therefore, screening in a parking lot is not that farfetched. But it is interesting that over 50 years since we have had a vaccine, we are now going back to the old days of medical practice.
We need to realize that we live in a society where sometimes our decisions can impact others. If the doctor asks us to wait in a parking lot, that might make perfect sense. We should welcome that and not get upset. We do not want the infants in the office unnecessarily exposed to a serious illness.
Addendum: After I wrote this article, there was news about a 14 year-old girl from North Dakota. She was exposed to measles in school. She was vaccinated but immune compromised because of medication that she was taking. She developed measles symptoms on Feb 10. She wound up with pneumonia and had to be placed in a medical coma with ultimate hospital discharge on March 3. It is not only well infants that are put at increased risk.