musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

Measly measles?


Did you ever wonder about measles -I mean before the anti-vaxxers allowed its recrudescence with their ill-founded mistrust of scientific authorities?

I can’t pretend that it ever seemed that important to me when I was young; I was a child in Winnipeg, of course- we all got measles in those post WWII days. It was one of the only sure-fire excuses to skip school. There was no vaccine for measles then, and I lucked out, not only because I didn’t die or get encephalitis, but I was also able to extend my two-week vacation at home with a subsequent case of chicken pox. Some people just live charmed lives, I guess.

It must have had some sort of effect on me, though, because I remember going to the downtown library to find out more about it. In fact, I recall being delighted when I discovered that the name ‘measles’ itself was interesting: ‘Middle English maseles, probably from Middle Dutch masel ‘pustule’ (compare with modern Dutch mazelen ‘measles’). The spelling change was due to association with Middle English mesel ‘leprous, leprosy’.’ I had no idea what it meant, but I remember being relieved that it wasn’t leprosy that had been feverishly reddening my skin only a few months before. After all, it was just a childhood disease that you had to get so you wouldn’t get it again… Anyway, my mother was also quite relieved when I finally got it, I think.

Thinking about measles has changed a lot since then. A lot!!

I recently became rather worried about it again after hearing reports on local TV and radio that chronicled a measles recurrence in our area that was blamed on falling rates of vaccination. I’d known for years how dangerous that was and I just couldn’t understand why some people chose not to vaccinate their children. I mean this wasn’t 1950ies Winnipeg when we had no choice. No vaccines…

John Enders, a Nobel Laureate, and an American biomedical scientist studying a measles epidemic in Boston, only succeeded around 1954 in isolating measles in the  blood of a 13-year-old boy named David Edmonston, but he didn’t manage to create a measles vaccine until 1963. After that, we didn’t hear much about it until 1998 when Andrew Wakefield, a now discredited British doctor, published a study in the prestigious medical journal The Lancet claiming that the MMR vaccine (a commonly used combination containing Measles, Mumps, and Rubella vaccines) caused autism (among other things). Despite the fact that his contention was not only deeply flawed and parts of it were deceptive, some of the data were also discovered to have been falsified. That set the cat amongst the pigeons -even though The Lancet subsequently fully retracted the article and Wakefield was struck off the UK Medical Register a few months later.

The problem, of course, is that it is virtually impossible to prove a negative finding -there is always a lingering suspicion that you might have missed something. Remember the old saying: Absence of evidence isn’t evidence of absence. And anyway, the anti-vaxxers latched onto a new causal agent: thiomersal, a mercury compound used as a preservative in some vaccines. It was a desperate search for something to fall back on to refute the authorities’ denial of any significant measles vaccination risk -even if the evidence  about thiomersal was unable to find any of the bad stuff the antivaxxers seem to think it caused.

At any rate, measles has been known since antiquity, but, to quote the American CDC (Centers for Disease Control and Prevention) it was not until the 9th century that a Persian doctor published one of the first written accounts. We now know that ‘Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed. If other people breathed the contaminated air or touched the infected surface, then touched their eyes, noses, or mouths, they could become infected. Measles is so contagious that if one person has it, up to 90% of the people close to that person who are not immune will also become infected.’

But not only that, about 20% of unvaccinated people who get measles need to be hospitalized And, ‘As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.’ Of course this is not even mentioning the risk of encephalitis or various neurological complications.

So, despite the historical need for its relatively passive acceptance as just another milestone that had to be passed to successfully navigate childhood, it was an extremely dangerous, albeit necessary, way to gain immunity. I had no idea how lucky I was.

Paired with other genetic sequences, including a new set isolated from a virus dating to 1960, the data reconfigures the measles family tree. The virus’ hop into humans, the team’s analysis suggests, could have occurred as early as the fourth century B.C. In other words, this is when measles diverged from the rinderpest virus and was able to infect humans as a new host. And as it happens, this new timeline ‘happens to coincide with an important juncture in human history: the rise of large cities, home to populations of 250,000 or more. These swollen urban hubs, the researchers say, are about the minimum size a fast-spreading virus would need to sustain itself. Had measles tried to spread throughout smaller, more isolated groups, it probably wouldn’t have left enough survivors who were still susceptible to infection, thereby rapidly blipping back out of existence.’

I’m amazed at how much genomic studies are able to help us reconstruct past events. Smarter minds than mine have able to analyze things like genetic drift, mutation frequency, mitochondrial DNA (inherited exclusively from the mother) and non-recombining Y chromosome studies for some time now, but more recent technological improvements and genomic data from contemporary populations have been helpful in finding new clues which have been invisible to classical historical methods.

Me? I can only vaguely remember the advice the school nurse gave us at a primary school assembly in the gym one year. It was in the middle of a Winnipeg winter, and the gym was hot, even though we’d left our parkas and toques on the hooks on the back walls of our classrooms.

“Everybody gets measles,” I remember her saying. “And you’ve already got it even before you get sick… so that’s when you can give it to others.” We all looked around at the kids sitting near us and pretended to be repelled by their deceit.

“So when you feel hot, or your face seems flushed, be sure to tell your mother.” I remember we all felt hot sitting in the gym, so we shuffled nervously in our seats. “She’ll decide whether or not she needs to call the doctor or just keep you in bed for a while… Usually rest, and plenty of fluids are all we can do anyway. Oh, and it keeps you away from other people, of course -Isolation its called… It’s also known as keeping you home from school, eh?” she added with a little forced chuckle, knowing, I suspect, that we would all cheer. And we did.

How things have changed!

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gozzter

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