Erica Finkelstein Parker planned her daughter's 8th birthday party with love.
Emmarie loved airplanes, so Finkelstein-Parker chose the theme “Flying with Emmarie.” Finkelstein-Parker packed nearly 20 brightly colored candy bags for Emmalee's friends. He has one for every child in the class so that no one feels left out.
Months later, the snack bag remained unopened in Finkelstein-Parker's bedroom, a reminder of a birthday party that never took place.
Emmalee spent her eighth birthday in hospice care at her parents' home after developing a rare complication of measles that can take years after infection. Her parents adopted Emmalee from an orphanage in India when she was two and a half years old. The orphanage staff did not tell her that she had contracted measles.
“There are some things that parents should never do,” said Finkelstein Parker of Littlestown, Pennsylvania. She said: “I had to call her birthday venue and explain that the party was canceled because her daughter was dying.”
Emmalee passed away on January 2, 2011.
“People think these diseases are ancient, but they still exist,” Finkelstein-Parker says. “Measles is a stealth virus. It may appear to be cleansed from the body, but it can hide in the nervous system.”
Dr. James Cherry, professor of pediatrics and infectious diseases, said pandemic-related immunization declines and rising rates of parental vaccine hesitancy are causing a major resurgence of measles around the world. He said there was an increased risk of more serious complications and death. Expert at the David Geffen School of Medicine at the University of California, Los Angeles.
In the past two months, U.S. doctors have diagnosed dozens of measles cases linked to unvaccinated travelers who arrived at international airports and became infected at hospitals and day care centers. State health departments have reported measles cases in California, Georgia, Missouri, New Jersey, Pennsylvania, Washington, Ohio, Maryland and Minnesota. The Centers for Disease Control and Prevention has issued a warning to health care providers to be on guard against additional cases.
“It only takes one infected traveler to cause an outbreak,” said Dr. Amesh Adalja, a senior researcher at the Johns Hopkins Center for Health Security. “This is from people getting off the plane.”
Measles is highly contagious, so even one person is considered infected. Each measles patient infects an average of 12 to 18 people who have no immunity from vaccination or natural infection. In contrast, Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia, said each patient infected with COVID-19 infects about two other people.
“Measles is much more contagious than COVID-19 or influenza,” Offit said.
Two doses of measles vaccine protects 97% of children, but airborne viruses spread so quickly that 95% of children in a community need to be vaccinated to stop an outbreak. About 93% of children were up to date on measles vaccines in 2022-2023, according to the CDC.
All states require vaccinations for public school children, but a growing number of families are taking advantage of exemptions for religious, philosophical or medical reasons. Currently, about 3% of students are exempt from the vaccine requirement. In 10 states, more than 5% of school children are exempt, making it difficult to contain the spread of the virus.
Dr. Peter Hotez, co-director of the Vaccine Development Center at Texas Children's Hospital, said people who refuse to vaccinate their children against measles are taking a huge and unnecessary risk. Measles vaccines have been repeatedly proven to be safe.
Long-term effects of measles
For every 10,000 children infected with measles, 2,000 will be hospitalized. 1,000 people develop ear infections that can cause permanent hearing loss. 500 people develop pneumonia. And 10 to 30 people will die, Hotez said.
Ariel Roop was shocked to learn that her 4-month-old son, who had received all recommended vaccines, contracted measles after visiting Disneyland in 2015. Infants are more susceptible to measles because they are not regularly vaccinated against the virus until they are 12 to 15 years old. A few months.
Roop took her son to the emergency room after he developed red spots, itchy eyes and a 102-degree fever that didn't respond to acetaminophen. Roop, a nurse, was especially worried about her son because he was born prematurely and suffered a stroke in the womb.
“He was my first baby, so I didn't know how dangerous measles was,” said Roop, who lives in Pasadena, California.
Patricia Stinchfield, president of the National Foundation for Infectious Diseases, said measles often leaves patients vulnerable to secondary bacterial infections such as pneumonia, which is one of the most common causes of death for measles patients. .
Measles also causes “immune amnesia,” where patients lose the immune system's ability to fight infections to which they were previously immune, Cherry said. The virus erases 11% to 73% of a person's antibodies acquired through infection and vaccination, potentially putting patients at increased risk for viruses such as influenza and bacteria that cause pneumonia and skin infections. .
Early symptoms of measles
In addition to the well-known red patches on the skin, measles usually causes white spots inside the mouth that can make children feel painful when eating and drinking, Stinchfield said. Ta. Many children infected with measles become dehydrated and malnourished during their illness.
About 20% of measles patients are hospitalized, often because they require IV fluids, she said.
“These children come in on their parents' shoulders, barely able to lift their heads,” Stinchfield said. “They're like little rag dolls. They won't even take a popsicle.”
A few days before the red rash of measles appears in children, the following symptoms appear:
- cough
- lethargy
- snot
- pink eyes
- heat
Many people become so sensitive to light that indoor lighting can hurt their eyes.
“It might look like a common cold, except for how miserable they are,” Offit said.
Stinchfield said a person infected with measles can spread the virus for nine days, from four days before spots appear to four days after symptoms appear.
The virus spreads through aerosols, so it can infect people up to two hours after a sick person leaves the room.
fatal long-term complications
Emmalee had always been small for her size, peaking at 39 pounds, but was otherwise healthy, Finkelstein-Parker said.
Finkelstein-Parker said the first signs of serious illness appeared when Emmarie started stumbling over her feet at age 7. At first, she said, her mother thought Emmalee's new shoes were too big. The next day, Emmalie's chin fell onto her chest, as if she could not support her head. She was leaning to her side without enough muscle control to keep her upright while Emmarie was sitting in her chair.
Pediatricians at Children's Hospital of Philadelphia, trained in India, quickly recognized early signs of a devastating long-term complication of measles called subacute sclerosing panencephalitis. Subacute sclerosing panencephalitis is more common in countries where the virus is still endemic. This fatal condition can cause memory loss, irritability, movement disorders, seizures, and blindness, and can develop six to eight years after a child appears to have recovered from measles. Antiepileptic drugs may relieve symptoms, but they do not cure the disease.
Recent studies have shown that this complication is more common than previously thought, with approximately 1 in 600 infants affected by measles.
Emmalee began having uncontrollable seizures. Four months later, while Emmalie was at her home, she fell into a coma, Finkelstein-Parker said.
“My father couldn't understand why she wouldn't wake up,” Finkelstein-Parker said. “He tried everything for her, including playing music from her favorite music box.”
Emmalie spent five weeks in home hospice care and died five months after symptoms began, Finkelstein-Parker said.
After Emmalee died, Finkelstein-Parker took the gift bag to school as a gift for her daughter's classmates. Children who were also grieving shared their favorite stories about Emmalee and created hanging mobiles with pictures and notes on them.
“The teacher said we needed closure,” Finkelstein-Parker said. “They handled it much better than I did that day.”
