A big bugaboo about measles

When the Y2K bug threatened to cripple computer systems worldwide last year, one frequently cited obstacle in fixing the problem was that few young computer programmers knew how to work with the older code.

If the measles virus - unseen in Allegheny County in the last 10 years - ever makes a comeback, a similar problem will face the medical profession as many young doctors will have book knowledge of the disease, but no hands-on experience with it.

Michael Hepler-Smith, a 22-year pediatrician in McCandless Township, has not seen a case of measles in the past 21 years, and that was in Philadelphia. He said there are two sides to the inexperience of the newer doctors.

'It's good because it means the obvious: that measles is not around anymore,' Hepler-Smith said. 'But it would be bad if there were a reoccurrence or if there were an epidemic.'

But with increased immunization efforts nationwide, the once-common measles virus comes ever closer to joining smallpox in eradication.

While children in the United States have long been required to get a combination measles-mumps-rubella vaccination before entering school, the Allegheny County Health Department is reminding parents that all students, kindergarten through grade 12, will soon be required to have a second dose of the measles vaccination under new state and county laws.

The law took effect in August, and the deadline for getting the shot is April 30. In some districts, half the students have not had a booster shot, health officials say.

Guillermo Cole, spokesman for the Allegheny County Health Department, said if parents miss the April 30 deadline, their children should be removed from school, although that decision might be handled on a case-by-case basis.

Cole said booster shots are necessary because in about 5 percent of children the initial vaccination does not provide enough protection.

Receiving a second dose practically guarantees lifelong protection. Those who do not receive a second dose are at higher risk should a measles outbreak occur.

Before the 1997-1998 school year, having two measles vaccinations was not a requirement, although a booster was strongly recommended.

In 1997, a law was enacted that required any new students to have both shots, but those enrolled before 1997 were exempt.

Cole said part of the reason for the new law is a statistic showing a low vaccination rate among Allegheny County students.

'We have found schools spread throughout the county where rates have been seen as low as 50 percent (of students),' he said. 'We feel it's important to get this notice out now.'

He added that the majority of the under-immunized students are older students in the junior and senior high grades who entered the school system before students were required to be double-vaccinated.

Hepler-Smith said many people's perceptions of how common measles is may be skewed because they confuse common rashes and ailments with the actual disease.

'In the past five years, from time to time, parents have come in with (children who have) rashes and they wonder what it is,' Hepler-Smith said. 'Some parents are just so unfamiliar with measles.'

The unfamiliarity stands to increase as newer generations who have never had measles begin to have children.

Despite the disease's rarity in the United States, Hepler-Smith said receiving both immunizations is still necessary.

'Years ago, people who were getting the single immunization were getting (infected) from exposure to imported cases,' he said. 'You can never say it's absolutely necessary for you (to get immunized), but for the population as whole, we're far safer.'

It has been more than 10 years since a measles outbreak in the United States, Cole said. When that occurred, Allegheny County had few cases.

Richard McGarvey, spokesman for the state Department of Health, said only one case of the measles has been recorded in Pennsylvania this year and no cases were recorded last year.

The patient with measles lived in Franklin County in the south-central part of the state but contracted the virus while overseas, McGarvey said.

The goal of any immunization effort is eradication of the virus and someday measles may join the ranks of smallpox as a virtually extinct disease.

Currently only two specimens of the smallpox virus exist, stored in freezers at medical facilities in Moscow and Atlanta.

Other diseases that were commonplace half-a-century ago but nearing eradication are polio and mumps. A vaccine has been developed for chicken pox, and that disease may one day disappear as well.

Cole said that with increased vaccinations, the U.S. medical profession gets closer to eradicating measles.

'We're getting close to it. We haven't quite eradicated it from the United States, but the incidence is dropping,' he said, adding that in 1998 only 100 cases of the measles were recorded nationwide.

'That's the lowest number ever recorded and most were brought in from abroad,' Cole said.

Cibie Felice, a pediatrician at Children's Community Care in Pleasant Hills, said that with the new state law in effect, 95 percent to 99 percent of the population will be protected against measles.

With that level of protection, he said, even if a case of measles were to crop up, the chances of it spreading would be low.

'It's good for the patient. Measles is a bad disease. Don't forget that. It's really good that nobody gets it,' Felice said. 'As long as our immunization practices stay good, we shouldn't have a problem with it.'

Ed Kairis, a pediatrician at Allegheny General Hospital, said that while he has received reports of children with measles, he has never seen an actual case in his more than five years of experience, including three years residency at a pediatric hospital.

He said with the common practice of double-vaccination, most reported cases are simply misdiagnoses by parents and family members.

'People call us all the time (when they see a rash) and think their kids have the measles,' Kairis said. 'But when kids get rashes, for the most part, it's not measles.'

Joseph J. McCallister can be reached at jmccallister@tribweb.com or at (412) 380-8536.