Sea Sick: by Keith Murray
It seems like you can’t turn on the news these days without someone talking about the measles outbreak. But what does it mean to have the measles, why the sudden interest, and is this a threat to captains and crew?
Measles is a very contagious disease caused by a virus. Measles spreads through the air when an infected person coughs or sneezes. Typically, the first sign of measles is a fever. Soon after, it causes coughing, a runny nose and red eyes. Next, a rash of tiny red spots breaks out. Typically, the rash begins at the head and spreads to the rest of the body.
Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.
Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit.
Measles can be prevented with MMR vaccine. The vaccine protects against three diseases: measles, mumps and rubella. The U.S. Centers for Disease Control and Prevention (CDC) recommends children get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 to 6 years of age. Teens and adults should also be up to date on their MMR vaccination.
The MMR vaccine is very safe and effective. Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.
Before the measles vaccination program started in the U.S. in 1963, an estimated 3 to 4 million people got measles each year. Of these, approximately 500,000 cases were reported each year to the CDC; of these, 400 to 500 died, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) from measles.
Since then, widespread use of the measles vaccine has led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. However, measles is still common in other countries. Unvaccinated people continue to get measles while abroad and bring the disease into the U.S. and spread it to others.
The sudden interest in measles this year is due to the large number of reported cases. From Jan. 1 to April 26, 704 individual cases of measles have been confirmed in 22 states. This is an increase of 78 cases from the previous year. It is the greatest number of cases reported in the U.S. since 1994 – and since measles was declared eliminated in 2000. Health officials say a trend in recent years among some parents to opt out of vaccinating their children has contributed to the outbreak.
The states that have reported cases to the CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, Tennessee, and Washington.
If you are not sure whether you need a booster for measles, you should first try to find your vaccination records or documentation of measles immunity. If you do not have written documentation of measles immunity, you should get vaccinated with the measles-mumps-rubella (MMR) vaccine.
Another option is to have a doctor test your blood to determine whether you’re immune, but this option will take two doctor’s visits. There is no harm in getting another dose of MMR vaccine if you may already be immune to measles or mumps or rubella.
HOW TO HANDLE A CASE OF MEASLES ON BOARD
A passenger has measles. What should I do?
If a passenger or crew member has the measles, you need to contact a doctor quickly.
The infected person should be quarantined on board and should not move around for four days after developing the rash.
Staying in quarters is an important way to not spread measles to other people. Ask the doctor when it is safe for the infected person to be around other people again.
A crew member with measles is confined to quarters. What else can we do to limit exposure?
The sick person should cover mouth and nose with a tissue when coughing or sneezing. Place used tissue in the trash can away from others.
Wash hands often with soap and water for at least 30 seconds.
Avoid sharing drinks or eating utensils.
Disinfect frequently touched surfaces, such as doorknobs, railings, tables, counters, faucets, refrigerator door handles and other frequently touched surfaces. Standard household disinfectants will readily kill the measles virus.
I’ve been exposed to someone who has measles. What should I do?
Immediately call your doctor and let them know that you have been exposed to someone who has measles. Your doctor can make special arrangements to evaluate you, if needed, without putting other patients and medical office staff at risk, and determine if you are immune to measles based on your vaccination record, age, or laboratory evidence.
If you are not immune to measles, the MMR vaccine or a medicine called immune globulin may help reduce your risk of developing measles. Your doctor can advise you, and monitor you for signs and symptoms of measles.
If you are not immune and do not get MMR or immune globulin, you should stay away from settings where there are susceptible people (such as schools, hospitals, or childcare centers) until your doctor says it’s okay to return. This will help ensure that you do not spread it to others.
Could I still get measles if I am fully vaccinated?
Yes, but it is not likely. Very few people – about 3% – who get two doses of measles vaccine will still get measles if exposed to the virus.
However – and this is another reason to get vaccinated – fully vaccinated people who get measles are much more likely to have a milder illness. And fully vaccinated people are also less likely to spread the disease to other people, including people who can’t get vaccinated because they are too young or have weakened immune systems.
EMT Keith Murray provides onboard CPR, AED and first-aid training as well as AED sales and service. His company can be found at TheCPRSchool.com. Comments are welcome below.