Message to Anti-vaxxers: Measles is More Than Just a Fever and a Rash

The vaccination debate is probably one of the hottest topics in medicine today. I’m not going to elaborate on the different issues at length, but two recent articles in lay media (USAToday and The New York Times) reminded me of a post I’ve always wanted to share.

One of the most common arguments against vaccinations is that the diseases that vaccines prevent have minor, non-life threatening symptoms. Frequently this argument is applied to measles, and most parents think measles is just a fever and a rash. If that were true, then yes, maybe being vaccinated for a disease that just causes a little fever and a rash is overkill. But its not true. Its a lie.

Many viruses have diseases that arise many years after the initial infection. For example, shingles arises from the chickenpox virus, herpes zoster. When one is infected with chickenpox as a child, the virus will lie dormant in the nerve roots of your spine. Later in life as an adult you may have a cold or other cause of immune suppression at which point the virus reactivates and causes an excruciatingly painful rash.

Well, measles also has a disease that arises many years after the initial infection, although its much more serious and nearly always fatal. Its called subacute slerosing panencephalitis (SSPE).  This disease is a fatal neurodegenerative disorder associated with the measles virus which arises from 1 month to 27 years after the initial infection. The first signs of SSPE may be changes in personality, a gradual onset of mental deterioration and myoclonia (muscle spasms or jerks). In advanced stages of the disease, individuals may lose the ability to walk, as their muscles stiffen or spasm. There is progressive deterioration to a comatose state, and then to a persistent vegetative state. Death is usually the result of fever, heart failure, or the brain’s inability to continue controlling the autonomic nervous system.

Some studies show that up to 18 in 100,000 patients infected with measles will get SSPE. The average survival rates are 1 to 2 years. All of the genetic analyses of viral material derived from brain tissue of SSPE patients have revealed sequences of wild-type measles virus, never vaccine virus. There is no evidence that measles vaccine can cause SSPE.

Subacute sclerosing panencephalitis. Figure 1. MRI scans of the brain at the time of presentation in the neurology clinic (A and B) and 3 months later (C and D). Panels A and C are T1-weighted images; B and D are T2-weighted images. The initial MRI scan (A and B) reveals a focal abnormality in the subcortical white matter of the left frontal lobe, consisting of a hypointense signal on the T1-weighted image (arrow in A) and a hyperintense signal on the T2-weighted image (arrow in B). In the follow-up scan, the focal abnormality in the left frontal lobe is less obvious than previously (arrow in D), but advanced and diffuse cortical atrophy is present, signified by the ventriculomegaly and markedly enlarged sulci (arrowheads in C).