The measles virus has been rearing its ugly head in the past year, with an unprecedented rise in cases all over the developed world, including Israel. According to the most recent Ministry of Health data, there have been more than 2,000 cases throughout Israel since the beginning of the outbreak, most of them in Jerusalem.
In this article, we have asked Mayanei Hayeshua’s Professor Somekh to provide information about the disease, its symptoms, its treatment, and most importantly, how to prevent further spread.
What is measles?
Measles is a serious and sometimes fatal viral infection most often occurring in children. Its symptoms include fever, dry cough, runny nose, sore throat, conjunctivitis (inflamed eyes), and characteristic rashes.
Measles has several stages that unfold over the course of two to three weeks. For the first 10-14 days after infection, the patient has no signs or symptoms; this is called the incubation period. Then the patient normally contracts a mild to moderate fever, often with a cough, runny nose, inflamed eyes and sore throat—symptoms that seem typical of most other viral infections. This stage lasts two to three days, and is called the prodrome.
Next, a rash begins to appear, normally starting on the face: small red spots in tight clusters that make the skin look splotchy. The rash spreads over the course of the next few days throughout the whole body. During this time, the fever rises significantly, often reaching 40 or 41 °C. Finally, the rash begins to recede, fading first from the face and lastly from the lower extremities.
In most cases, children will recover from the disease naturally. But the fatality rate, even in developed countries, is somewhere around 1:1000 —higher when complications develop or when the child has other “common” health issues.
Some of the complications of the measles virus include: ear infections, laryngitis, croup, bronchitis, pneumonia, encephalitis, and pregnancy complications including preterm labor, low birth weight and maternal death. An additional severe complication that may develop 7-10 years after having measles is SSPE, a terminal neurological disease.
How is measles treated?
Because measles is a viral—rather than bacterial—infection it cannot be treated directly once it’s been contracted. Treatment of measles normally involves managing the symptoms and treating secondary infections and other complications as they arise. This treatment is suitable for immune-compromised patients.
Vitamin A deficiency has been found to increase the severity of measles, and therefore children who are found to have low levels of the vitamin and/or patients with a severe illness are treated with high doses of vitamin A.
The best treatment for measles is prevention—that is, the vaccine. The measles vaccine is extremely effective with a 97% success rate, and involves minimal risk: extensive medical research has shown that there are no long-term side effects. The vaccine is normally administered at one years of age, with a second shot given in first grade.
If you have not been vaccinated and you’ve been exposed to measles, your doctor may recommend a post-exposure vaccination. If the vaccine is given within 72 hours of exposure to the virus, it may prevent the disease, and if not, it can make the symptoms milder and decrease the duration of the illness. Another option is an injection of antibodies, called immune serum globulin, which can have a similar effect if given within six days of exposure. This option is particularly suitable for people with a compromised immune system who cannot get the live measles vaccine.
If most people recover naturally, and my child is healthy, why should I bother with the vaccine?
First of all, even when measles isn’t fatal and no complications develop, it is still an extremely unpleasant illness. Why force your child to endure that suffering when you can prevent it from happening in the first place?
Second of all, and most importantly, while your child may not be severely affected by measles, he may infect others who are not as fortunate. Measles is an extremely contagious disease—90% of unvaccinated people exposed to it will contract it. It is the only virus that can be contracted from a carrier who is no longer in the room (up to two hours after the infected individual has left the room). The period during which measles is contagious lasts about eight days, starting four days before the rash appears and ending when the rash has been present for about four days. That means that your child will be contagious even before you know that she is sick—and by the time you realize that she has measles, she will already have exposed others to the illness. Children who have been vaccinated will probably not contract the disease, but there are plenty of children who can’t be vaccinated, such as infants who are too young, and children undergoing treatment for cancer, whose immune systems are compromised. Measles can be fatal to these children.
Vaccination is a shared social responsibility. We vaccinate our healthy children to protect our unhealthy children who are unable to receive the vaccine. When lots of healthy children are not vaccinated, the disease is able to spread and infect people who are more vulnerable.
But isn’t the vaccine risky?
No. The measles vaccine is extremely safe. There is a vast amount of high-quality research documenting this, and not a single credible study has found a link between the vaccine and autism or any other serious condition. You may have seen articles online calling this fact into question; every single one of them is based on faulty science and a conspiracy-theory mindset. Vaccines are safe, effective, and crucial for public health.
Some parents may be concerned about the fact that the vaccine contains preservatives or other chemicals that may be harmful to humans in large amounts. What’s important to understand is that toxicity is not a question of the substance itself, but of dosage. Even the most benign substance, such as water, can be fatal when consumed in large quantities. The vaccine contains these substances in amounts that are completely safe for human consumption and some of these preservatives, such as mercury, are no longer added to vaccines. In fact, you are naturally exposed to some of these chemicals in your regular food and drink. There is 10-60 times more formaldehyde in an average pear than in a vaccine. Your body knows how to process these chemicals and get rid of them in reasonable amounts.
Why is this outbreak happening?
After the introduction of the measles vaccine, infection rates dropped dramatically—almost to the point of eradication—in developed countries such as Israel. In recent years, though, unfounded concerns about vaccines, such as those mentioned above, have led some parents to choose not to vaccinate their children.
As mentioned above, in order to protect those who cannot be vaccinated against viruses like measles, a certain percentage of the population must be immune. We call this herd immunity. The fewer children vaccinated, the more the disease is able to spread.
What do Rabbanim say on this issue?
Gedolei Torah from all over the world have spoken out very clearly on this matter and their opinion is one and the same: vaccinate your children.
In fact, it was Rav Dr. Menachem Brayer, deputy medical director of Mayanei Hayeshua Medical Center, who initiated the joint call from a group of highly respected rabbanim urging parents and communities to vaccinate against measles. Among the rabbanim who joined the initiative are the head of the Eida HaHaredit Beit Din, Rabbi Moshe Sternbauch; Rabbi Yitzchak Zilberstein, known for his expertise on medicine and halacha; Rabbi Moshe Klein, rabbi of the Hadassah Ein Kerem Hospital; Rabbi Shimon Baadani and others. Their joint declaration states that “the Torah granted doctors the power to heal, and it is a mitzvah, even pikuach nefesh. And if one refuses [to vaccinate], it is though he has spilled blood.”
Similar statements have been made by such eminent personalities as the Rosh Yeshiva of Ponevezh, HaRav HaGaon Rabbi Baruch Dov Povarsky and the head of the “Tiferet HaTorah” yeshiva in Williamsburg, Rabbi Yoel Roth.
It is extremely unfortunate to note that the majority of cases of measles in Israel were discovered among the charedi communities in Jerusalem. Those who claim to avoid vaccination in the name of Torah are, as the above statements unequivocally declare, in severe violation of it.
Where can I get my child vaccinated?
If you or your child missed the MMRV vaccine at one and/or six years of age, it is still not too late. Contact your physician or Tipat Chalav staff immediately. The Talmud teaches that anyone who saves one life is as if he has saved the entire world; vaccinating your child means saving not just one, but thousands and thousands of lives.