Health NW: MMR and the chicken pox vaccine

<center>Kathryn B. Brown, FNP</center>

It has been 40 years since the vaccine against measles became available in 1963. Before then, there were millions of measles cases each year in the United States, which caused hundreds to thousands of deaths. Now, there are just a few dozen cases of measles each year, and deaths are rare. Sadly, this is not true in the rest of the world, particularly in countries where the measles vaccine is not routinely given. Worldwide, measles still kills 1 million people - mostly children - each year.

Most older people can remember having measles when they were young. For most, the symptoms were high fever, rash, cough, runny nose and pink eye. One out of 20 children with measles develops pneumonia, and one in 1,000 develops an inflammation of the brain called encephalitis. Encephalitis can cause deafness and brain damage. One or two out of every 1,000 infected people die from measles.

Measles is highly contagious, which is why more than 90 percent of people in the pre-vaccine era caught the disease. Measles epidemics were once common in this country, since the disease spreads by coughing and sneezing, just like the common cold.

Measles is especially dangerous for people who have weakened immune systems, such as those with cancer or AIDS, or who are taking chemotherapy or steroids for certain medical conditions. Infants are also at high risk.

The combined MMR (measles, mumps, rubella) vaccine became available in the 1970s. It is a very safe vaccine. Out of a million people who get the vaccine, only one or two will develop a severe allergic reaction or encephalitis, so it is much safer to get the vaccine than the disease. Most experts in the United States - including the American Academy of Pediatrics - have concluded that the MMR vaccine does not cause autism in children, as some people have claimed.

Mumps is a very common disease in the developing world, but it is now rare here due to the MMR vaccine. It is a disease with flu-like symptoms (fever, muscles aches, headache, fatigue) plus some patients also develop swelling of the salivary glands of the neck. Older boys and men with mumps frequently have inflammation of the testicles.

Rubella ("German measles") is a much milder form of disease than measles. The rash generally lasts just three days in children. It is more serious in adults. The most concerning complication of rubella occurs if pregnant women are infected. The disease then affects the unborn baby and can cause miscarriage, stillbirth and many types of birth defects, including blindness, deafness and mental retardation.

Although there were fewer than 1,000 cases of either mumps or rubella in the United States in the last few years, these are still very common diseases in the world. The only way to prevent an epidemic of either of these diseases is to assure that Americans all get the MMR vaccine.

The newest vaccine that is recommended for routine use in the states is the varicella vaccine, which protects against chicken pox. Though it is usually a mild disease, 10,000 people are hospitalized with chicken pox each year, and 100 die from the disease.

The varicella vaccine is between 85 and 90 percent effective. The 10 to 15 percent of people who do get chicken pox despite having been vaccinated have a very mild illness. Many schools in Oregon are requiring varicella vaccine for children; Washington state does not require this vaccine, although it is available for those who wish to have it.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to kbbrown@eastoregonian.com.

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