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Outcomes for children with measles in current epidemic

(17 Posts)
PJM18 Wed 15-May-13 00:25:59

Hi. Not looking for a debate as there are plenty around but want to make an informed decision about whether to give my children mmr or not. I'm a bit disappointed that all the stories in the press are using scare tactics and report how dangerous measles is. I'm not doubting that it can't be dangerous but it's annoying that we can't make informed choices by hearing both sides ie children who had measles and were ok.
Anyway I just wondered if there were any statistics out yet about outcomes for the hundreds of children recently affected, ie how many have developed serious complications. May be too early but wonder if we will ever know.

sashh Wed 15-May-13 08:17:57

But you can't get that data until after the outbreak. A child could contract measles today and next week be in hospital, or be fine.

At the moment it seems to be about 10% of cases that are hospitalised. But that doesn't mean they are all complications.

Long term effects such as hearing loss won't be known yet. SSPE may not occur for 15 years, so that data will not be available until/unless it happens. I don't think the numbers of deaths include deaths from SSPE.

According to this US website 30% of cases develop one or more complications.

www.cdc.gov/measles/about/complications.html

CatherinaJTV Wed 15-May-13 08:18:56

I have asked PHW that. They are collating numbers at the moment, but won't publish them for another couple of months and severe complications, like SSPE, might not develop for some years. I am not sure they are going to report the details of complications, because they don't usually do that very well.

CatherinaJTV Wed 15-May-13 08:27:08

sashh and my answers crossed ;)

The Swiss, in a similar sized (464 reported cases) outbreak in 2003 observed 11% complications, ranging from about 7% in young children to 18% in adults. Three cases of encephalitis occurred (pointing to some under reporting) in children aged 10, 10 and 16 years, one of whom was hospitalised for 6 weeks. There were 14 cases of Pneumonia, 3 with suspected pneumonia, 11 cases of otitis, 1 delirium, 1 myocarditis, 1 case of generalised tonic convulsions, 1 gingivostomatitis, 1 hepatitis with suspected appendicitis, 1 otitis with hepatitis and 14 hospitalisations without specified complications. I think 30% is too high for "complications", certainly many will get high fever, but will not have a complicated course. Proper "complications" (i.e. where further medication/treatment is necessary) probably range in the 10% and complications with lasting effects will be under 1% (but nasty, as encephalitis or SSPE). There is absolutely no doubt that measles is the most severe of childhood infectious diseases. I will try and see whether I can find whether there has been a case of SSPE associated with the 2003/4 Swiss outbreak and post if I find it.

PJM18 Fri 17-May-13 00:45:24

Hi. Thanks for answers, they were very helpful. I find it a difficult decision. I know that SSPE is a very rare side effect of measles that can occur years later but it has also been reported as a side effect of the mmr.

My oldest son was in hospital with gingivostomatitis a week after his mmr so it's interesting to see it in the swiss report as one of the measles side effects, although I suppose this makes sense.

CatherinaJTV Fri 17-May-13 07:29:07

MMR does NOT cause SSPE.

sashh Fri 17-May-13 07:49:56

Not only does MMR not cause SSPE, it can't cause it.

PJM18 Sat 18-May-13 13:30:42

Hi. SSPE is listed on the Merck website (who manufacture vaccines) under adverse neurological reactions to mmr. It has also been discussed in the British Medical Journal. It is obviously very very rare however so I don't think is a reason not to get the mmr at all or to worry about it as a side effect of measles. I'm more worried about the side effect my son had and weighing up risks and benefits for my other two children, which is why I'm interested in how many serious outcomes there have been for the hundreds of children who have had measles in Swansea.
Catherine, what is PHW, I'm assuming related to public health?

scaevola Sat 18-May-13 13:37:30

PHW is Public Heath Wales.

The CDC overview is probably a better guide to overall rate of complications though, as it covers so meant more cases. But no amount of research will tell you whether your DC will be one of the 30% with complications.

CatherinaJTV Sat 18-May-13 16:31:18

PJM18 - SSPE has been thought to be associated with MMR for a while, but it is now clear that MMR has never (and probably cannot) cause(d) SSPE.

Every SSPE biopsy sample submitted for molecular sequencing has always been wild-type virus and never vaccine strain measles virus. (from www.ncbi.nlm.nih.gov/pubmed/15893837)

6.4. Only wild-type virus sequences have been found in SSPE
The description of specific clades and genotypes of MV has allowed the evaluation of mutations found in the MV RNA sequences from SSPE brain material against wild-type (clades B–G) viruses. All the vaccine viruses are derived from the Edmonston strain (clade A) but no clade A virus has been found in SSPE brain material. The sequences found in SSPE brain are related to the wild-type viruses circulating at the time of initial infection of the child and not to those circulating at the time of onset of symptoms. Hence, the virus which initially infected the child, appears to persist and SSPE is not due to a super-infection by viruses circulating during the onset of symptoms (Jin et al., 2002) (Rima et al., 1995); Rota, personal communication). To the best of the authors’ knowledge no vaccine virus, genotype A, sequences have been obtained from SSPE cases. SSPE has been vastly reduced in incidence after successful control of measles by vaccination (Dyken et al., 1989). In contrast, vaccine strains have been identified in MV infections in immuno-compromised patients who died from MIBE (Bitnun et al., 1999) and giant cell pneumonia (Mawhinney et al., 1971).

Even in SSPE cases who did not have any reported measles disease but had measles vaccination, only wild-type measles strains were identified (http://jid.oxfordjournals.org/content/192/10/1686.long):

Although measles is a monotypic virus, 22 genotypes of wild-type virus are recognized; many genotypes have been associated with endemic circulation of measles virus in certain geographic regions or have been documented in connection with an outbreak or epidemic in an area [4, 5]. The measles vaccine virus strains belong to genotype A and can be distinguished from wild-type virus of the same genotype by means of sequence analysis [6 –8]. Analyses of measles virus sequences in brain tissue samples obtained from patients with SSPE have identified only wild-type measles virus, and the virus genotypes identified have been consistent with the genotype of measles virus that circulated in the area where the patients lived and to which the patients had been exposed ⩾10 years before the onset of symptoms of SSPE [6, 9 –13]. Genetic studies have supported epidemiologic evidence that measles vaccine virus does not cause SSPE [6, 14, 15]. In cases of SSPE that developed in children or adults who had no history of measles but who did have a history of vaccination against measles virus, analysis of measles virus sequences derived from the patients confirmed the presence of the wild-type genome, indicating that the individuals had an undiagnosed measles virus infection [6, 7, 9]

MMR does not cause SSPE.

PJM18 Sat 18-May-13 19:30:11

Hi thanks for the info, I suppose it depends what you read. I would have thought Merck would not have this in their information if it had been completely ruled out. Anyway it's so rare and hopefully not something for anyone to worry about.

sashh Mon 20-May-13 06:50:41

Hi thanks for the info, I suppose it depends what you read. I would have thought Merck would not have this in their information if it had been completely ruled out.

They have to list things that could be an outcome, no matter how unlikely if there is even a theoretical risk.

PJM18 Mon 20-May-13 23:02:40

Hi. I'm more interested in the numbers of children who ended up in hospital with pneumonia or who have been left with hearing loss etc. I think that we need up to date statistics to be able to allow people to make informed choices and weigh up the pros and cons. As I said my oldest son was hospitalised due to the mmr vaccine so I am having to think seriously about what to do with my younger two sons.

beedles17 Wed 26-Jun-13 21:20:10

fact is the vaccine will not kill you. measles can kill you.SSPE has a 100% fatality rate even if it is rare. therehave been so many cases in this outbreak that were will get at least one case of sspe Iin a few years time

Crumbledwalnuts Thu 27-Jun-13 07:17:20

SSPE reported as an adverse event on the package insert of MMR.

bruffin Thu 27-Jun-13 08:18:35

Crumbled - it may be included as a VAERs reaction but it doesnt mean that it was a result of mmr(there is evidence of over reporting of more serious side effects on VAERS to create to create a basis for litigation)

SSPE is usually to having asymptomatic measles probably as a baby. Every single case of SSPE that has been investigated has found to be caused by wild measles. That is even if the child has had mmr and in others who were thought not to have had measles at all.

epidemiology sspe

sspe and mmr
includes another case of asymptomatic measles and sspe

CatherinaJTV Thu 27-Jun-13 12:00:25

Crumbled, read the thread upwards - SSPE is not caused by the MMR.

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