儿科医生如何帮助家庭在麻疹疫情中保持冷静与知情

I’m a primary care pediatrician practicing in Pennsylvania. Nearly every day, I hear from parents who say: “I’m scared. How can I protect my baby from measles?”

With more than 1,300 reported cases in my state, 33% in children, the threat of measles in my community no longer feels hypothetical. It’s created a stark divide: Some parents are eager to get their child protected as early as possible, while others wonder if we are overly panicked. As a pediatrician, it is dizzying to have a family clamoring for the MMR vaccine in one room while the room next door adamantly opposes vaccination. During this measles outbreak, my colleagues and I find ourselves trying to avoid unnecessary panic about routine childhood illness, while keeping careful watch for real cases. As a result, health care and child care providers alike need to be re-educated on measles.

Some people have referred to my warnings of the danger of measles as “propaganda” or “fear porn,” perhaps reflecting a leftover pandemic-era skepticism. In early 2020, we did not know how severe Covid would be for children, and in being cautious, public health measures designed to help slow the spread of the virus created social isolation, education delays, and vaccine hesitancy.

While Covid was a novel illness, we have more experience with measles. That history is why public health organizations and pediatricians are concerned about this highly contagious and preventable infectious disease returning. Not only do health care providers worry about and need to communicate to patients the risk of hospitalization (1 in 5 cases, according to the Centers for Disease Control and Prevention) and death (1-3 in 1,000 cases) from measles, they also need to share that measles causes several complications including ear infections (1 in 10), diarrhea (1 in 10), pneumonia (1 in 20), and brain swelling (1 in 1,000).

In addition, measles can cause “immune amnesia,” where the immune system forgets its immunity to prior infections, leaving children vulnerable to all the infections they have already overcome. That could put our patients at additional risk and become a burden to the health care system.

I’m grateful that many in my area are taking this threat seriously. Day cares and school nurses send unimmunized children home with non-measles rashes because many are unsure what measles looks like. I understand: Even as a pediatrician of 18 years, I have never seen a case of measles outside a textbook. Many practicing pediatricians share this measles naivete because the measles, mumps, and rubella vaccine eradicated measles in the United States in 2000. We often need to grab the most senior physician around who saw measles years ago, or consult an infectious disease colleague to determine if a measles-like rash is something to investigate further with testing.

As we enter fall viral season, the number of “measles mimickers” will only increase. The symptoms of measles sound like every illness a child could bring home from day care: runny nose, cough, red eyes, fever, and rash. This may lead to confusion, worry, and overutilization of the health care system. Therefore, understanding what measles is, and isn’t, becomes even more important.

Pediatricians can reassure families that much of their daily life will remain unchanged. No public health organization suggests major lifestyle changes during the measles outbreak. Much of the decision-making about what activities are “safe” depends on a family’s own risk-taking tolerance. For example, taking an unimmunized infant to a large, indoor family wedding may be non-negotiable to some parents whereas others may seek alternative childcare.

Pediatricians can help families navigate these decisions and guide them on how to continue living healthy lives with minimal interruptions during a measles outbreak.

First, pediatricians should urge anyone who is eligible to get vaccinated against measles with the MMR vaccine. This vaccination routinely starts at 12-15 months of age, with a second dose between 4-6 years of age. But they don’t have to wait that long.

Patients can get their second dose of the MMR as early as 28 days after the first, to increase protection against measles. This is an effective way to ensure that children are prepared if exposed to measles and that we reach herd immunity.

Second, pediatricians should recommend avoiding traveling to outbreak areas if possible. While not all travel is avoidable, measles exposure risk may be a good reason to put off that family long weekend in Amish country.

Third, they can suggest that friends and family who have a cough or cold symptoms  stay away from unvaccinated children. The classic measles rash is one of the later symptoms, so sometimes measles is spread by someone who initially has a sniffle that they think is just a cold. This is a time to be more cautious about exposure to sick people.

Additionally, anyone who is unvaccinated and was exposed to measles should not consider themselves safe if they don’t get sick within a few days. Measles symptoms can appear seven to 21 days after exposure. This means that unprotected people need to stay home and away from others for 21 days after exposure.

Fourth, pediatricians should remind families to practice healthy habits with children. Nutritious meals, adequate sleep, regular exercise, and frequent handwashing can help keep germs away and immune systems strong.

Fortunately, most of my patients’ parents have expressed a desire to get their child an early second dose of the MMR vaccine during this outbreak. Children’s Hospital of Philadelphia has given over 16,000 such doses since the outbreak started. Many of these parents are looking to ensure their child is protected, but many are also vaccinating to protect the vulnerable around them: pregnant women, immunocompromised people, and infants.

The most at risk during this outbreak are the vulnerable people who can’t be vaccinated, and those who love them. When less than 95% of a community is vaccinated for measles, herd immunity is lost, meaning there aren’t enough immune people to prevent the spread of infection.

It’s also important that pediatricians’ offices make clear to families that if they are exposed to or have symptoms of measles, they need to call a health care provider first rather than showing up at a clinic. To minimize spread, health care teams need protocols to keep people with measles separate from vulnerable patients and expedite testing. Requesting patients call ahead helps ensure sick people get the right care in the right place at the right time, while protecting others.

The threat here is real. But parents don’t need to panic. We have the tools to end this outbreak. We have eradicated measles before, and through vaccination, we can do it again.

Katie Lockwood M.D., M.Ed., is a primary care pediatrician at the Children’s Hospital of Philadelphia. She and CHOP neonatologist Joanna Parga-Belinkie, M.D., are co-founders of Pediatric Health Chat, an online initiative providing resources for families looking for good information on the latest myths and misconceptions about children’s health.