A little more than a month ago, the City of New York made a startling announcement -- one that we thought we would never again hear in this country – a public health emergency was declared over a measles outbreak. Measles, declared eradicated in the year 2000, was mounting a comeback in the Williamsburg community of the Big Apple.
Three weeks later, the Centers for Disease Control (CDC) reported over 700 cases in the United States of the disease. According to officials, this most recent outbreak has been traced to overseas travelers who have contracted the virus and returned to this country spreading it to those who may not have been vaccinated.
But since we focus on seniors in this blog, there is good news about the return of measles – those boomers born before 1957 and usually at the highest risk for such viral infections, are home free this time around -- something we will discuss later. But for those boomers born after that date, the risk of contracting the measles begins to rise the later you were born.
Those considered most vulnerable to the virus at this time are:
Infants who have not yet been vaccinated
Those with weakened immune systems as a result of diabetes, cancer or AIDS
Those on certain medications and or treatments, including individuals undergoing cancer treatment, stem cell or organ transplants
The elderly whose vaccine immunity may have worn off
And, as we just stated, those born between the years of 1957 and 1985
So why are those we consider to be at high risk for nearly every viral and bacterial outbreak considered to be among the least vulnerable this time around? The answer exists in the fact that they were exposed to multiple measles epidemics before 1957 and have developed a natural immunity.
Those born after that year and even middle age adults are the ones who may be at risk. And those born after 1968 have lived their lives with virtually no exposure or discussion about measles and are in the group that should have concerns.
But, before we become too gleeful about measles not affecting seniors, in a recent measles outbreak that occurred at Disneyland, over 121 people were diagnosed with the virus including adults up to the age of 70.
Although us “older folks” talk about measles and chicken pox like they were rites of passage when we were children, they were actually extremely dangerous infections that killed and left many with lifelong disabilities. Those were the days before the internet, 24/7 news channels and Facebook could provide the horrific images of the ravages of these "childhood" maladies.
So here’s the truth -- before the measles vaccine, 3 to 4 million people contracted the virus annually and by the age of fifteen, nearly every child got it and luckily, most survived. That’s the good news. But the bad news was that the permanent complications and deaths disproportionately affected kids. As the saying goes, how soon we forget.
As with many things in 2019, most of us have forgotten what it was like to live in a world where young children regularly contracted serious diseases resulting in deaths. And again, without the drumbeat of daily news cycles driving coverage, these deaths mostly went unheralded, unless, of course, it was your child.
In an excerpt from a story published on the website of the Dittrick Medical History Center, the story of measles is indeed an ugly one ... measles does not, perhaps, sound as terrifying as small pox and polio. However, this highly contagious disease had a much higher mortality rate. Affected children were contagious both before and after the appearance of measles, and worse–it could survive in the air for over an hour just waiting for the next victim. Children got diarrhea and vomited, had a vivid red rash and watery eyes. It hospitalized an average of 48,000 Americans each year through the 1960s, leaving the survivors compromised sometimes with brain damage or deafness. With over 4000 cases of encephalitis, many children became wards of the state. In other, poorer, countries, millions died every year. Alexander Langmuir, chief CDC epidemiologist in 1961, stated emphatically: “Any parent who has seen his small child suffer even for a few days with a persistent fever of 105, hacking cough and delirium, wants to see this disease prevented.”
A visit to some of New England’s most historic cemeteries tell some very grim tales. Waves of influenza, measles and other diseases would wipe out entire families in just a few months. The gravestones tell a story of life before vaccines, medications and social media.
In a Mystic, Connecticut cemetery, there are several family plots where siblings are buried, all dying the same year with ages ranging from infancy to teenagers. In one section, a mother is also buried, perhaps dying during childbirth, but given that multiple children died at the same time, chances are it was an epidemic that hit the area.
And now a century later, we thought that we would never see this again, so why is it on the way back? Earlier we discussed that a current infection can be traced to overseas travel, but there is another reason, a big reason – children who have not been vaccinated.
Because of social media and a range of conditions blamed on childhood inoculations, fewer people vaccinating their children. As a result, we are losing the herd immunity that has protected this country for decades.
Although school districts and other public health agencies require vaccines for the public good, there are a number of religious and non-medical exemptions that have been granted to those who object to these vaccines.
In the last decade, whenever a measles infection occurred, we could usually trace it back to a traveler who was exposed to it overseas. However, when it began showing up in certain communities around the country, the common thread was the refusal to have children vaccinated.
These groups include;
Amish communities in Ohio who rejected vaccinations based on religious grounds;
In New York, the occurrence in Williamsburg is among the ultra-orthodox Jewish communities;
A recent outbreak in Washington state was traced back to a tight knit community of Slavic immigrants;
An outbreak in Minnesota was found among Somali Americans.
And when measles strike in these communities, they hit with a vengeance and soon becomes difficult to control. The real problem is that their decision to not get vaccinated doesn’t only affect them, but affects all those they come into contact with.
Measles are an extremely contagious disease, in fact, among the most contagious diseases that exists on this planet, along with cholera and tuberculosis. Let’s put this into context by looking at a workplace.
If you are working in a nursing home where no one has been vaccinated and one resident has contracted the
measles, it will spread like wildfire. For every 10 people who encounter that resident, 9 of them will get the measles. If 30 people encountered the resident, only 3 would remain healthy - pretty contagious, right? And just how does this compare with other diseases we feared over the past decades? You may be surprised.
A few years ago, we were in high alert about the Ebola virus. Yet, one Ebola case usually leads to two others. And what about HIV and SARS? Well, research shows that with these viruses, one case usually leads to another four. Pale as contagions when compared to measles. So why is this virus so hearty and able to infect so many?
Because Measles is an airborne virus that is transmitted by respiratory droplets from the nose, mouth, or throat of an infected person, in most cases through coughing or sneezing. Once coughed or sneezed out, measles can stay suspended in air for long periods of time after the person has left a room, and the virus can live on surfaces for up to two hours.
There is also another insidious thing about this virus - it can spread rapidly before the rash we all associate with it appears, so what may seem like a cold could be the super contagious measles virus (by the way, the person infected stops being contagious about four days after the rash appears).
People with measles may have initial symptoms that are typical of many viral illnesses such as irritability, cough, runny nose and conjunctivitis. They are already highly infectious to others at this time. The rash people generally associate with the disease starts on the head and spreads down through the trunk of the body, usually at the peak of respiratory symptoms (two weeks after exposure)
But it is the complications of the measles virus that is of most concern. Research shows that nearly 4 out of 10 develop a complication from the virus. The most common is pneumonia, which accounts for most measles-related deaths. Less frequently, measles can lead to blindness, croup, mouth ulcers, ear infections, or severe diarrhea. Some children develop encephalitis (swelling of the brain), which can lead to convulsions, loss of hearing, and intellectual disabilities.
One particularly disturbing consequence of contracting measles at a young age can be the development of subacute sclerosing panencephalitis (SSPE). This progressive neurological disorder of children and young adults affects the central nervous system. Patients develop a severe brain infection six to 10 years after having measles, which can lead to profound mental and physical deterioration and eventually coma and death. It is estimated that 1 in 500 to 1 in 1,000 children who had measles will develop SSPE.
These complications mostly arise in people whose immune systems are already weakened because of their age, preexisting diseases, or malnutrition. These usually occur in the very young (children under 5), in adults over 20, and in anybody else who is undernourished or otherwise immunocompromised. Children under 5 have the highest probability of death.
So the vaccine will keep you safe, right? In most cases, yes. However in exceptionally rare cases, even if you are vaccinated, you can still get measles. In less than 5 percent of vaccinated people, their immune systems just don’t kick in even with the shots and researchers still don not know why.
And here’s another piece of good news, even if you have been exposed, if you get the vaccine quickly, you may be able to avoid coming down with measles. But you should call your doctor first – don’t just show up at the office or at an urgent care facility – because you could end up exposing everyone in the waiting room.
So now back to seniors and those who work with them. To reiterate, most seniors are immune to this virus. But, as we age, we can
actually lose the original protection we had from vaccines. The cells in which once created antibodies, may no longer be able to attack the measles virus.
And although seniors are low-risk candidates, if caught, measles can most certainly be life threatening. This is especially true if an individual has a low immune system especially given the high rate of pneumonia associated with measles.
If you are a caregiver or work with seniors, the best way to deal with this is to prevent illness on a day to day basis. It is normal to be concerned when there’s an outbreak, especially when you’re caring for a senior. You can protect your loved one and yourself from the measles. Simply make sure that everyone is vaccinated, talk to your doctors, and maintain a healthy lifestyle.
But since we are talking about vaccines, there are some that the CDC recommends for all adults over the age of 50. These include:
Shingles: The CDC estimates that one in three people in the United States will develop shingles in their lifetime, and the risk of shingles is higher later in life. The vaccine not only protects against the infection itself, but also against complications that may arise from shingles.
Flu: Flu season arrives each year, putting those over the age of 65 at greatest risk. The CDC has found that over 60 percent of flu-related hospitalizations occur in people aged 65 and over each season.
TDaP: This is a combined vaccine for tetanus, diphtheria and pertussis (a disease also known as “whooping cough”); the vaccine can help keep these two infections and this disease at bay.
Pneumococcal: This vaccine protects against pneumococcal disease, which can result in infections in the lungs and/or bloodstream, leading to fatalities in adults over the age of 65.
In addition to those recommended above, additional vaccines may be required for those with chronic health issues that include:
Type 1 and type 2 diabetes: People with diabetes are more prone to infections and are at higher risks for serious complications from vaccine-preventable diseases; the CDC recommends that they receive the flu, hepatitis B, pneumococcal and shingles vaccines.
Liver disease: If you’re living with liver disease, the CDC also recommends that you get vaccinated for hepatitis A and B; human papillomavirus (HPV); measles, mumps and rubella (MMR); and varicella (chicken pox).
Kidney disease: For those with kidney disease or any sort of renal failure, the CDC suggests that you should also be vaccinated for hepatitis B, HPV, MMR and varicella.
One of the concerns we have heard from our senior clients is the cost of some vaccines. The good news is that Medicare Part B covers the flu, pneumococcal and hepatitis B vaccines. Medicare Part B will also cover a tetanus shot after an injury; however, it does not cover the TDaP or shingles vaccines.
Medicare Part D plans, on the other hand, provide more extensive coverage for vaccines. Depending on the type of Medicare Part D plan you have, you still may incur some out-of-pocket expenses for the vaccines you need but the costs that may occur if you get sick could be even more expensive. Review your plan to see what immunizations your's may cover.
By educating yourself, you’re already taking a proactive approach. If you have any concerns, please make an appointment with your healthcare professional. if you click on the photo below, you can download and print the CDC's Recommended Adult Immunization Chart.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.