Measles is back in the news again, as approximately 70 cases in 6 different states have been documented with links to the Disneyland outbreak. Measles is a pernicious respiratory disease that was declared eliminated in the United States in 2000. However, because more and more parents are choosing not to vaccinate their kids, herd immunity has declined and measles transmission has been on the rise.
The reason why measles is particularly ugly is because infected individuals typically infect anywhere from 12 to 18 others (for ebola, the number is closer to 2). The virus is airborne, can incubate up to 21 days in a host (typically 10 days), and can be transmitted several days before the characteristic rash appears. You can fact-check me with these helpful links to the CDC and WHO measles pages, or you can briefly wonder why I even know all this shit off the top of my head.
Because about this time last year, I got a phone call from our pediatrician with some very bad news: my daughter may have been inadvertently exposed to measles. The fact that she called me to explain the situation directly, rather than through her nurses or an impersonal letter, made me appreciate her all the more. Our daughter was at that point skimming along the bottom of the growth chart, not to mention vulnerable to the complications of a respiratory infection (most preemies are), and a virus like the measles would almost certainly be a one-way ticket back to NICU care, a scenario our pede was anxious about. It took me a moment or two to process what she had said.
Although our pediatrician was reassuring on the phone, I could definitely hear the strain in her voice. It was after-hours, on a Friday no less, and it couldn’t have been an easy call to make. After the initial shock of the news wore off, she gave me a quick and dirty rundown of everything measles. 90% was my biggest takeaway, as in 90% of unvaccinated individuals exposed to the measles virus will become infected with it.
Then, she gave me more specific details about how my daughter may have been exposed, just up to the point where patient confidentiality would have been an issue. An infant, also a sub-1, had visited her office that morning while we were there, with a runny nose and slight fever. At the time, she didn’t think measles, she hadn’t seen it since her residency, but took a culture just in case, since the infant had a family member who had recently traveled abroad. So when the culture came back, something like seven days later, measles. She called county, and then she called the parents.
After that, I think I asked her questions for something like thirty minutes. She was as patient as always, as if the weekend wouldn’t be for another two hours yet. What was our exposure? We had not spent time with the other patient in the waiting room, had not even been seen in a room next to their’s, but had been in a room which was downwind from the other, so to say. Was there an emergency booster for sub-1s? Yes, but it was only efficacious if administered a few days after initial exposure–and we had already passed out of that window, before the culture had even come back.
And so on and so forth. As our conversation began to wind down, she reminded me to monitor and isolate–to avoid our library’s Rhyme Time and limit our play dates to children who had already been vaccinated. Which in turn reminded me that if DC were to suddenly become symptomatic over the weekend, we would have potentially exposed her cousin (a sub-1), her bestie (a sub-1), my best friend’s two preschool aged children (vaccinated but still a few years away from the booster), and three library friends (all sub-1s).
I asked our pede if I should notify these other parents. She wasn’t sure, since Daphne was only maybe-exposed and wasn’t showing signs of a fever. It was my call. So I demurred, reasoning that I didn’t want to worry my friends unnecessarily. Besides, could presymptomatic individuals transmit the virus, even before the onset of a fever?
Apparently it was up to seven days possible, according to our county epidemiologist, who called first thing Monday morning. Seven days possible, but more like one or two days probable.
And so our watch began. We were already about 10 days in, but had another 2 weeks to go–and our pediatrician recommended monitoring and isolation for an additional week, based off the advice of her friend and colleague, an epidemiologist in the children’s hospital network.
During that time, very little changed in our daily routines, besides the fact that we were socially isolated–which definitely took a greater toll on me, since, as a stay-at-home-mom, I relished any and all contact with the outside world, but was now having to decline play dates and coffee mornings. It was too cold to spend a lot of time outdoors, so a couple of times I bundled her into the car seat and drove around out in the sticks. I programmed the information for the three closest hospitals into my phone, as well as the contact info for county health services and everyone I had spoken with on the phone. And into my husband’s phone. I even revisited an old friend from grad school. I was bored. I was prepared. And I was very, very nervous.
I couldn’t help but wonder, if she was admitted to the hospital again, would the nurses let me sleep in an armchair next to her crib? They were gonna have to. Would they take blood draws from the heel of her foot, or was she now large enough to have it taken from her arm? Would she have to be intubated if she developed pneumonia? What if she slid off the growth chart again? How could they possibly stabilize her weight if she also had chronic diarrhea?
We were very lucky that we never had to find out. She never came down with the measles. It had been a near miss (not to mention an anticlimatic end to a story, thank God). But it seemed those seventy-seven days she had spent in the hospital after she was born still loomed large in my rear-view mirror–and maybe that time always will. She had had fought so hard for every breath of air from the get-go; it would break my heart if she ever had to do it again.