When I was a medical student in the mid-1980s, I was called down to the emergency department by the head of the Department of Infectious Diseases. When I arrived, a group of fellow students were huddled around a fairly frightened and shivering little girl who may have been nine or ten years old. The girl and her mother spoke no English. In fact, they had just arrived in Chicago that very day from Mexico.

The girl was shivering not out of fear but because of fever, and a high one at that. She had a runny nose, a hacking cough, and her eyes were red and watery. Her skin was diffusely covered with slightly bumpy, reddish-pink spots that spread to her palms and soles — a giveaway clue that this was not the very common viral infection of childhood called roseola that causes a similar looking rash. Shining a flashlight into her mouth revealed small white patches dotting the inside portions of her cheeks near her molars.

“Get a good look, everyone,” the older and wiser Chief Attending told the eager medical students. “You will probably never see a case of this again.”

Three years of residency were followed by 26 years in a very busy pediatric practice. During those years, as you might imagine, I saw a lot of colds and coughs, and a lot of pink-eye, too. In children, rashes are a dime a dozen, and sometimes what you see on the skin (exanthem) can also be seen in the mouth (enanthem). But putting them all together — fever, the “3-Cs” (cough, coryza, conjunctivitis), the classic maculopapular (morbilliform) rash involving the palms and soles, and the fleeting “Koplik” spots in the mouth — the diagnosis was an easy one to make. Today, after more than 30 years of encouraging my patients to be immunized against it, I am happy to say that I never did see another case of measles again. Neither did my partners.

With so many cases of measles recently being reported around the country among children not immunized with the MMR vaccine or living in under-vaccinated communities where the unfounded fears propagated by the anti-vaccine crowd take hold, could a wise old pediatrician repeat the words to a group of young medical students today: “You will probably never see a case of this again”?

There was no telling on that day long ago how many persons that little girl may have inadvertently infected from the time she left Mexico on an airplane until the time she ended up with the diagnosis of measles in our emergency department in Chicago. Measles is one of the most contagious infectious diseases on the planet. Who else did she come in contact with who may not have been immunized or who may have lost their immunity to measles from another medical condition? An infant? A child who’s parent said “no” to vaccines? A young cancer patient also in the emergency room with fever and neutropenia from his chemotherapy? Her mother, who may not have been immunized herself?

It is important to remember that most of the unimmunized kids of today will become the unimmunized adults of tomorrow. I say “most” because not all kids grow up and follow the ideologies of their parents. Indeed, once old enough to legally give consent, some decide to get themselves immunized.  That’s a good thing because, as we will see tomorrow on The PediaBlog, children aren’t the only ones who get measles.


(Image: CDC)