Measles causes brain damage in 1 out of 1000?

[DevaMajka]

Is this true? It doesn't seem like it could be- didn't nearly everyone used to get measles?

Ds's school sent home a letter saying that there's a measles outbreak- about 20 cases reported. They included that stat.
In BC, if there's a measles outbreak in the school, unvaxed kids must stay home for a few weeks. Ds had 1 dose as a baby, but would need 2 doses to stay in school IF it shows up in his school.

I was perfectly content with one dose. (last I read, 1 dose makes 95% of people immune, 2 doses 98%). Now I'm wondering how these 2 points should/will affect my decision.

[MeepyCat]

One of the potential complications of measles is encephalitis (looking at the available data, there's actually a couple of types of measles-related encephalitis), so yes, brain damage can happen.

Yeah, nearly everyone used to get measles, and some people used to die of it.

[DevaMajka]

I knew that brain damage could happen (as a complication of measles, or less often as a complication of the vax). It was just the frequency that seemed off to me. Does it really happen in 1 out of 1000 people who are infected with measles?

[Pirogi]

From the CDC's measles pink book:

Acute encephalitis occurs in approximately 0.1% of reported cases. Onset generally occurs 6 days after rash onset (range 1–15 days) and is characterized by fever, headache, vomiting, stiff neck, meningeal irritation, drowsiness, convulsions, and coma. Cerebrospinal fluid shows pleocytosis and elevated protein. The case-fatality rate is approximately 15%. Some form of residual neurologic damage occurs in as many as 25% of cases. Seizures (with or without fever) are reported in 0.6%–0.7% of cases.

1 in 1000 get acute encephalitis. Of those, 25% may have residual neurological damage. So no, 1 in 1000 do not have brain damage. The stat is actually .25 per 1000 or 25 per 100000, or 2-3 per 10000. The pink book doesn't give any more specifics on the range that "some form" of residual neurological damage may take, and I don't have any information on that.

To put things in perspective, the pink book quote above says that 15% of the 1 in 1000 who get acute encephalitis will die. This is 0.015% of those who get the measles. The government's Fatality Analysis Reporting System estimates that in 2008, there were 12.25 fatalities due to vehicle accidents per 100,000 population, which is equivalent to a 0.012% chance of dying in a car accident.

It should also be pointed out that that acute encephalitis is not the same as SSPE:

Subacute sclerosing panencephalitis (SSPE) is a rare degenerative central nervous system disease believed to be due to persistent measles virus infection of the brain. Onset occurs an average of 7 years after measles (range 1 month–27 years), and occurs in five to ten cases per million reported measles cases. The onset is insidious, with progressive deterioration of behavior and intellect, followed by ataxia (awkwardness), myoclonic seizures, and eventually death. SSPE has been extremely rare since the early 1980s.

[ammiga]

Does that stat refer to people worldwide or only in the US? Or Canada? Usually when I read really scary stats, I find that they include third world countries or places without access to good medical care.

[DevaMajka]

Ah, now I understand where they came up with the stat. I didn't think it was possible to cause that much brain damage- we'd have a lot more brain damage in older generations, yk?

I also didn't think of where the stat was including. That could be it too- perhaps the outcome is different in 3rd world countries?

[anjii]

I'm in Abbotsford, and I came here looking to answer the exact same question about that stat... thanks for the clarification

[Deborah]

measles becomes, oddly, more dangerous once you have a vaccinated population--all other things remaining equal. Why?

Because mothers who have had measles as children can provide babies with immunity. Measles used to commonly occur in children between 5 and 9 years old (probably spread at school) and very rarely in infants, when it is a more dangerous illness.

Once you have had measles you've got long-lasting, probably lifelong immunity. The vaccine, however, does not give the same results, leaving adults vulnerable to measles. It is a very rough sickness to go through as teen and very dangerous for adults with significantly more deaths.

So the measles outbreak in...was it the 90s? had a higher death rate. The other reason the stats from that epidemic looked particularly awful was that there was a discrepancy between the reported cases and the actual cases. Reported cases included all of the serious cases and all of the deaths, of course. Anyone who got through measles without a hitch was less likely to be counted.

I'm a measles survivor. Had it when I was 8. My younger brother and sister, even though they were in the same tiny apartment, were spared. I'm sure they had measles later on. Everyone did.

[Emmeline II]

Anecdotally, my mother (child of the '30s and '40s) said that she had it, everyone she knew had it and no one died or was injured.

Measles "is generally looked upon as one of the most harmless diseases"according to Kurt Elsner, M.D. in 1908

http://query.nytimes.com/mem/archive...619C946997D6CF
__________________________________________________

Here is the information on the Switzerland Measles outbreak:

http://www.eurosurveillance.org/ew/2007/070726.asp

483 cases total for November 2006- July 2007.

Six percent of the 445 cases for whom a detailed questionnaire had been submitted were vaccinated against measles (18 with one dose and nine with two doses), 87% were unvaccinated, and the vaccination status of the remaining 7% was unknown. There were 43 cases (10%) requiring hospitalization. Among 445 cases for whom information about complications was available, four cases were reported with encephalitis (1%), all among children, 29 cases with pneumonia (7%, median age 10 years), and 31 cases with otitis media [earache](7%).

No deaths were reported.

http://www.eurosurveillance.org/edit...8/080221_1.asp

Switzerland Measles Outbreak - From Nov 2006 to Feb 2008:

"1405 cases 1319 cases for which detailed information available**

Hospitalizations** 104 -- 7.9%
Pneumonia** 63 -- 4.8%
Otitis Media (ear aches)** 62 -- 4.7%
Encephalitis** 6 -- 0.5%

The proportion of vaccinated patients has been low for all ages (Figure 4). There were 104 cases (8% of 1,319 cases for whom information about hospitalisation and complications were available) who required hospitalisation. Six cases were reported with encephalitis or suspicion of encephalitis (0.5%), all among children. No deaths have been reported." The average age is eleven.

_________________________________________________
Measles outbreak in Gibraltar, August–October 2008
http://www.eurosurveillance.org/View...rticleId=19034
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[laohaire]

Originally Posted by Pirogi

To put things in perspective, the pink book quote above says that 15% of the 1 in 1000 who get acute encephalitis will die. This is 0.015% of those who get the measles. The government's Fatality Analysis Reporting System estimates that in 2008, there were 12.25 fatalities due to vehicle accidents per 100,000 population, which is equivalent to a 0.012% chance of dying in a car accident.

I just wanted to point out a little difference, in case somebody reads this and says "omg, you are more likely to die of the measles than a car accident!"

The difference is that 0.015% OF THOSE WHO GET THE MEASLES - already a limited population - will die of complications.

Versus 0.012% OF THE ENTIRE US POPULATION OVERALL will die of a car accident.

Once you've got the measles - sure, you've got as much risk of dying of it as in a car accident. But until you actually have the measles, the risk is significantly lower.

[Tracy]

i'm so old that I remember (in the 1960's) being a kid and having classmates get measles. They missed a week of school watched too much tv and then returned to school. the end. sigh.

[WantRice]

Thanks for asking this question. I had to send that very notice home with my students and thought the 1 in 1000 thing sounded odd too. They were also sure to mention in the notice that almost all of the people involved in the outbreak were unvaccinated or didn't receive the second dose.

[nicolebeth]

Are titres not accepted during an outbreak?

I'm curious--they won't accept positive titres to go to school? True, we have no outbreak here, but where we live, they accept one measles vaccination + titres in lieu of the second vaccination. I could imagine that, in an outbreak, we'd have to prove the titres were ok. Or, do outbreaks change the scenario, regardless of the rules that previously applied?

It just doesn't make sense to insist on a vaccine that won't actually start working until after the outbreak is over anyway.

[Sileree]

That is also the supposed death rate of measles too, isn't it? 1 in 1,000, I mean. I found a medical article from 1954 that put the death rate at 1 in 10,000. So maybe when measles was more benign and the younger ages got it, there were less complications also?

[Pirogi]

Originally Posted by Sileree

That is also the supposed death rate of measles too, isn't it? 1 in 1,000, I mean. I found a medical article from 1954 that put the death rate at 1 in 10,000. So maybe when measles was more benign and the younger ages got it, there were less complications also?

Says the pink book:

Death from measles was reported in approximately 0.2% of the cases in the United States from 1985 through 1992. As with other complications of measles, the risk of death is higher among young children and adults. Pneumonia accounts for about 60% of deaths. The most common causes of death are pneumonia in children and acute encephalitis in adults. Since 1995, an average of 1 measles-related death per year has been reported.

So as I understand it, these days about 2 in 1000 who get measles will die. 0.015% will die of encephalitis, about 0.12% (60% of 0.2%) will die of pneumonia, and the other 0.065% will die of something else?

Would you mind sharing or PMing me with your older reference showing 1 in 10000? I would like to have it for my own folder.

[Deborah]

the statistics from 1985 to 1992 are based on reported cases. Reasonably, mild cases resulting in no problems were considerably less likely to be reported. The CDC did not have the structure they have today to try to capture every single case of measles (although...I bet there are some homeschooling parents and other alternative lifestyle folk who still slip under the radar) so...if you don't have the complete universe of cases the proportion of problems won't be correct.

[caned & able]

Originally Posted by MeepyCat

One of the potential complications of measles is encephalitis (looking at the available data, there's actually a couple of types of measles-related encephalitis), so yes, brain damage can happen.

The same with the vaccine

Yeah, nearly everyone used to get measles, and some people used to die of it.

The same with the vaccine.

[Deborah]

The numbers from the 1950s, also based on the Pink Book from the CDC was about 4 million cases, 28,000 hospitalizations and 400 to 500 deaths. Some of the deaths were probably adults.

[SunshineJ]

In 1989 the measles vaccine failed and many children got measles. (I was discussing this with a former doctor about how my cousin had it sometime around then and she pinpointed the year and passed on the tidbit about the vax failing that year.) My cousin was completely fine, recovered without an issue, and when my aunt called the dr he not only refused to accept that it could be measles since my cousin had just been vaxxed for it but refused to see him as well. So yeah, take the numbers as you will. I'd suspect the actual percentages are lower than reported simply because cases do go unreported.

[caned & able]

Originally Posted by SunshineJ

In 1989 the measles vaccine failed and many children got measles. ...

The vaccine fails some every year, it is simply not reported nor are the cases correctly diagnosed.