• Eric Tyler, MD

Red or German?

Anyone born before 1957 will have heard that question posed from one worried Mother to another. In that span of time, childhood vaccines were not available so children encountered illnesses that were considered a rite of passage. Sometimes, the news of a child with an ailment resulted in his being confined to home under “quarantine” by a doctor. We didn’t know what that meant but he always was a bad kid so he had it coming or at least that was what we thought. Sometimes children were all invited over to contract a highly contagious disease just to get it over with all at once. “Chicken pox parties” did occur. Within two weeks, all the attendees suffered through those itchy blisters for about six days. Some illnesses put fear in the voices of the adults. Having a Mother that was on an “Iron Lung” a negative pressure thoracic ventilator to manage her Bulbar Paralysis from polio and seeing beautiful women having to walk with a bulky metal brace because of Polio meant that when the Sabin vaccine for Polio was given to entire communities in 1963, we lined up in the Highlands Elementary School and got the sugar cube with three drops of the live attenuated virus on it.

There were three that we were concerned about Measles, Mumps and Rubella. The way to know if the swollen mass on the side of your jaw was Mumps was to eat a Dill Pickle. If it hurt like rip, you had the Mumps. If it didn’t, your brother’s right hook landed when you didn’t believe it had. My neighbor had a bad case that caused his testicle to swell really big. If but for the pain, he was proud to announce that to us. It’s a guy thing.

There were then the two that caused rashes associated with fever. The German Measles (Rubella) and the Red Measles (Rubeolla). The German Measles had a brownish rash. The Red Measles was much more serious. The Red Measles cases usually got the quarantine. Moms upon hearing of the Measles would always ask, “German or Red?” The German Measles was considered a minor nuisance unless a woman was pregnant. The baby in the womb paid a heavy price if infected as heart diseases and cataracts were the norm. The Red Measles is a different animal.

The virus causing Red Measles (now just Measles) is highly contagious. It is spread by aerosol and droplet methodology. The aerosol produced by normal exhaling of air can be suspended in the air and considered infectious for two hours. Eight to 12 days after exposure (the incubation period), the “Three C’s” show up. Cough, Coryza and Conjunctivitis. On day 2 to four, a fever begins with levels as high as 104-105 degrees attained by the fourth to fifth day. The RED rash begins on the face, head, and neck on day four. It spreads down the trunk in the later phase of the process. The patient is contagious from day one until day four after the rash appears. This virus is hard on the respiratory system. Ear infections, Measles Pneumonia and bacterial pneumonia are very frequently encountered. In 1963 with the USA at 1/3 of the current population size, there were 500 deaths from Measles, 1,000 cases of brain infections and 48,000 hospitalizations. There is a rare complication called, ”Subacute Sclerosis Pan encephalitis” that could show up as far out as thirty years after a case of Measles which resulted in significant debilitation.

At present, the USA has reported 704 cases of Measles in many states. This is a twenty year high level of Measles activity. The variables in this situation include more unimmunized people travelling with a population that now has less than 95 percent protected by the vaccine. Ninety-five percent is the magic number to have for “cohort” protection. The disease is clustered in populations where for various reasons, the children have not been vaccinated.

Alabama has just reported the first case. The baby is 5 months of age and in St. Clair County. ALABAMA is not in a panic, emergency, everybody is going to die mode despite what social media might proclaim. The Health Department is in high gear and has issued the following guidelines:

1. Make sure the population is fully protected with two MMR vaccines. One at 12 months and a second at four to five years of age.

2. Know the signs and symptoms as outlined above.

3. Making a lab confirmed diagnosis is essential.

4. If quarantined, then stay at home for the prescribed time period and not go the see “The Avengers” on opening night like one woman in another state did.

PAAC is in almost daily contact with the Alabama Department of Public Health. We will keep you posted should any recommendations change. For now remember “Vaccines save lives.”

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