Eleven-month-old baby Amy was brought to the office because of a rash. Her mom was concerned that it might be measles. Amy had had four days of fever, reaching as high as 104 degrees. There had been no office visit during the fever because there were absolutely no other symptoms. She had no cough or runny nose, nor did she have vomiting or diarrhea. In fact, when given Tylenol, her fever came down. She was playful and looked pretty good, according to mom. Then, on the fifth day after the fever had broken, she was covered in little red spots all over her body. This alarmed mom who asked the grandmother for her thoughts. “I think she has measles,” the grandmother said, sending Amy’s mom into a panic.
“I have heard on the news about a measles outbreak in San Diego and Arizona. I’m worried that my baby has the disease and I’ve waited too long to bring her in,” she said in a trembling voice. “Will she be all right?”
Taking one look at Amy I knew that she did not have measles. With no signs of a fever she was playful and engaging, and her exam was completely normal with the exception of small red spots scattered over her trunk and face. I assured mom that Amy would be fine.
She had roseola, which is a common childhood virus that almost all young children get. Roseola is caused by a type of herpes virus, Herpes-6. The hallmark of roseola is a high fever lasting from four-to-six days. During that time there are typically no symptoms other than the fever. This is also the period of time in which the child is most contagious to other children. The fever breaks suddenly and then the rash appears. From this point on the child seems and acts perfectly normal. The peak age for roseola is 10-to-11 months. Most children will get the virus before entering preschool. Antibodies are normally produced in the body after getting roseola. Thus, a child should get the virus only once, and be protected for life. Aside from the high fever, roseola is a relatively benign illness.
Measles, on the other hand, is a serious illness with many potential complications. Because of the immunization practices in this country it is no longer endemic in the United States. However, from 2003 to 2006 up to 66 cases were reported annually. These cases were imported from other countries. There were recent outbreaks of measles in San Diego, Arizona and New York. The people who contracted measles were those who had not been immunized, or infants under the age of one year who had not yet been immunized.
Many parents are fearful of the alleged association of the MMR vaccine and autism. This theory has not been proven and actually has shown to not be the case. As a result, some of these parents are electing to forego the MMR vaccine; henceforth putting the child at risk to get the measles.
Measles is also a virus that is spread through the nasal droplets of an infected individual. It is highly contagious. There is an incubation period of approximately 8-to-12 days after exposure whereby there are no symptoms. The child then will enter the prodrome phase which lasts from three-to-five days. This is characterized by fever, hacking cough, conjunctivitis, runny eyes and nose. During this phase, the child is obviously ill and looks sick. Then the fever rises rapidly, reaching as high as 104 degrees at about the same time that the rash appears. The rash starts on the upper part of the neck, behind the ears and hairline, and along the cheeks. It then spreads over the neck, chest and upper body within the next 24 hours. Following the next 24-to-48 hours it will extend down the entire body, finally reaching the feet. By the time it reaches the feet, it will start to disappear on the face. It will fade away in the same order in which it appeared.
During this time the child appears very ill, and has markedly swollen lymph nodes behind the ears and in the neck. Complications of measles include ear infections, pneumonia, croup and diarrhea. Encephalitis occurs in one of every 1000 cases of measles, which may lead to permanent brain damage. The mortality rate for measles is 1-to-3 per 1000 cases. Death is usually from pneumonia or neurological complications. The standard of care is to immunize children at one year of age with the MMR (measles, mumps and rubella) vaccine and again at five years. Measles IS preventable!
I assured Amy’s mom that the baby had roseola. She would be perfectly fine and should not get it again. She definitely did not have measles. On her next well-check at a year of age Amy would be getting the MMR which should protect her from getting measles. She was greatly relieved.