Erica Finkelstein Parker lovingly planned her daughter’s 8th birthday party.
Because Emmalee loved airplanes, Finkelstein Parker chose the theme ‘Flying High with Emmalee’ and filled nearly two dozen brightly colored candy bags for the little girl’s friends, one for each child in her class, so no one would feel left out. .
Months later, the bags of candy remained unopened in Finkelstein Parker’s bedroom, a reminder of a birthday party that never took place.
Emmalee, who developed a rare complication of measles that can appear years after infection, spent her eighth birthday in hospice care at her family’s home. Her parents adopted Emmalee from an orphanage in India when she was 2 and a half years old. The orphanage staff did not tell them that she was infected with the disease.
“There are things a parent should never have to do,” said Finkelstein Parker of Littlestown, Pennsylvania. “I had to call the birthday party and explain that “We canceled the party because our daughter was dying.”
Emmalee died on January 2, 2011.
“People think these diseases are ancient history, but they still exist,” Finkelstein Parker said. “Measles is a stealthy virus. It may seem like it has left your body, but it is able to hide in your nervous system.”
The massive resurgence of measles around the world — attributed to pandemic-related declines in immunization and rising rates of vaccine hesitancy among parents — increases the risk of more serious complications and deaths, according to Dr. James Cherry , professor of pediatrics and infectious diseases expert at the David Geffen School of Medicine at UCLA.
In the past two months, American doctors have diagnosed dozens of measles cases linked to unvaccinated travelers who arrived at international airports and then exposed others in hospitals and day care centers. State health departments have reported cases of measles in California, Georgia, Missouri, New Jersey, Pennsylvania, Washington, Ohio, Maryland and Minnesota. The Centers for Disease Control and Prevention (CDC) has issued a warning to healthcare professionals, warning them to be alert for more cases.
“All it takes is one infected traveler to trigger an outbreak,” explained Dr. Amesh Adalja, a senior researcher at the Johns Hopkins Center for Health Security. “It comes from people getting off planes.”
Measles is so contagious that even a single case is considered an outbreak. Each measles patient infects an average of 12 to 18 people who lack immunity from vaccines or natural infection. By comparison, each COVID-19 patient infects about two more people, said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.
“Measles is much, much more contagious than COVID-19 or the flu,” Offit said.
(How the anti-vaccine movement minimizes the danger of measles)
Although two doses of the measles vaccine protect 97% of children, the airborne virus spreads so quickly that 95% of children in a community need to be vaccinated to stop outbreaks. About 93% of children were up to date on their measles vaccine in 2022-23, according to the CDC.
All states require children to be vaccinated in public schools, but more and more families are taking exemptions for religious, philosophical or medical reasons. Currently, around 3% of students are exempt from mandatory vaccination. In 10 states, more than 5% of schoolchildren are exempt, a percentage that makes it difficult to contain outbreaks.
People who refuse to vaccinate their children against measles are taking large and unnecessary risks, said Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital. Measles vaccines have been repeatedly shown to be safe.
Long-term effects of measles
For every 10,000 children infected with measles, 2,000 will be hospitalized; 1,000 will develop ear infections with the possibility of permanent hearing loss; 500 will develop pneumonia; and between 10 and 30 will die, Hotez said.
Ariel Loop was shocked when her 4-month-old son, who had received all recommended vaccines, fell ill with measles after visiting Disneyland in 2015. Babies are vulnerable to measles because they are not routinely vaccinated against the virus until the age of 12 to 15. months.
Loop took her son to the emergency room after he developed red spots, itchy eyes and a 38-degree fever that paracetamol did not relieve. Loop, a nurse, was especially worried about her son, who was born premature and suffered a stroke in utero.
“It was my first baby and I didn’t know how dangerous measles was,” said Loop, who lives in Pasadena, California.
Measles often leaves patients vulnerable to secondary bacterial infections, such as pneumonia, one of the most common causes of death in measles patients, said Patricia Stinchfield, president of the National Foundation for Infectious Diseases.
Measles also causes “immunoamnesia,” in which the immune system loses its ability to fight infections to which the patient was previously immune, Cherry explained. The virus eliminates between 11% and 73% of a person’s antibodies—both those acquired through infection and vaccination—which can leave patients at greater risk of contracting viruses such as the flu and bacteria that cause pneumonia and skin infections.
First symptoms of measles
In addition to the familiar red spots on the skin, measles often causes white spots in the mouth, which can make it painful for children to eat or drink, Stinchfield explained. Many children with measles become dehydrated and malnourished during the illness.
About 20% of measles patients are hospitalized, often because they need intravenous fluids, he said.
“These children arrive hanging from their parents’ shoulders, barely able to hold their heads up,” Stinchfield explained. “They are like rag dolls.”
In the days before children develop a red measles rash, symptoms include:
- Cough
- Lethargy
- runny nose
- Crying eyes
- Fever
Many become so sensitive to light that normal room lights hurt their eyes.
“It can look like the common cold, except for the degree of pain they suffer,” Offit explained.
People with measles can spread the virus for nine days — from four before they get spots to four after, Stinchfield said.
Since the virus spreads through aerosols, it can infect other people up to two hours after the sick person has left the room.
A deadly long-term complication
Although Emmalee was always very small for her size—her maximum weight was 39 pounds—she was otherwise in good health, according to Finkelstein Parker.
The first symptoms of a serious illness appeared when Emmalee was 7 years old and began stumbling over her feet, Finkelstein Parker said. At first, her mother recalled that she wondered if Emmalee’s new shoes were too big. The next day, Emmalee’s chin fell to her chest, as if she couldn’t hold her head up. When sitting in a chair, Emmalee leaned to one side, without enough muscle control to stay upright.
An Indian-trained pediatrician at Children’s Hospital of Philadelphia quickly recognized the early signs of a devastating long-term complication of measles called subacute sclerosing panencephalitis, more common in countries where the virus remains endemic. This deadly disease can cause memory loss, irritability, movement disorders, seizures and blindness, and can develop six to eight years after a child has apparently recovered from measles. Although anticonvulsant drugs can sometimes relieve symptoms, they do not cure the disease.
According to recent research, the complication is more common than previously believed, affecting 1 in every 600 children with measles.
Emmalee started having uncontrollable seizures. After four months, the little girl fell into a coma while at home, Finkelstein Parker said.
“My father didn’t understand why he wouldn’t wake up,” Finkelstein Parker recalled. “He tried everything, even playing his favorite music.”
Emmalee spent five weeks in hospice care and died five months after her symptoms began, Finkelstein Parker said.
After Emmalee’s death, Finkelstein Parker brought the candy bags to school as a gift for her daughter’s classmates. The children, who were also grieving, shared their favorite stories about her and made several drawings and notes.
“Their teacher said they needed closure,” Finkelstein Parker recalled. “They got through that day much better than I did.”
