Measles: Are You Prepared?

I have a thing for diseases, especially communicable diseases that have historically killed millions of people.  As an genealogist, I've spent hours going through parochial and government death and burial records looking for information on my ancestors.  A measles epidemic always spiked the death rate in any community it reached.  

In 2000, the World Health Organization declared that the US had eradicated measles from the country and that the risk of measles infection here is low.   And that is true.  Right now.  Especially during post-COVID.  In 2019 there were nearly 1300 cases of measles in 31 states.  In 2020, 13 cases of measles were reported in the US, with 49 cases in 2021.  As of the end of October 2022, the US had 33 cases reported.

The CDC states that all these cases were imported--travelers brought them here from their home countries, and then spread the disease to unvaccinated or immunocompromised people in this country.  

If you and your family are immunized, your risk of contracting measles is incredibly low.  You basically have nothing to worry about.  

But what happens when our society collapses?  What happens when young children and newborns can't be immunized?  What happens as increasing numbers of parents opt out of vaccines for their children?  (And this isn't an anti-vaxxer rant--some people have legitimate objections--it's just to raise awareness about the possibilities.)

We already have increasing numbers of children who are unvaccinated.  Sometimes immigrants are less concerned with personal hygiene, which may also happen with our neighbors in a societal collapse. In a fragile society, there is increasing malnutrition as food becomes difficult to obtain.  Measles is always a concern in war-torn countries.  And it most definitely could happen here.

The majority of physicians in this country have never even seen, let alone treated, a case of measles.  Older people who have seen it and cared for people with it are very few and far between.  Most of the off-grid medicine books I normally consult have either nothing or next-to-nothing on treating measles.  The extent of advice is limited to making sure you are vaccinated. 

The guide coming to our rescue today is The Ship's Medicine Chest and Medical Aid at Sea, a book reviewed here on the blog a couple of years ago.  As it is a government publication and may be copied, I've elected to reproduce the information here rather than reword everything.  

Measles (Rubeola)

Incubation period: 8-13 days

Isolation Period: From diagnosis until 7 days after the rash appears.

Measles, an acute viral disease, is the most contagious of all communicable diseases.  The virus is found in the secretions of the nose, mouth, throat, and lungs of infected persons.  Most adults in childhood have had the disease [note--this edition was published in 1978], and one attack provides lifelong immunity.  However, measles must be feared because of complications, mainly to the eyes, kidneys, and brain; and secondary infections as bronchitis, bronchial pneumonia, and inflammation of the middle ear.

Symptoms begin about ten days after exposure.  The onset is sudden with a general overall feeling of not being well, sneezing, runny nose, headache, sore throat, cough, soreness of the eyes, dislike of bright light, and a rise in temperature to about 102 degrees F (38.8 degrees C).  Symptoms are apt to be severe with copious tears, swollen lids, and bloodshot eyes.  During this stage the disease is most contagious.  On the second and third day of the disease the symptoms become more marked and the face gets a puffy look.  On the inner side of the cheeks, near the junction of the upper and lower jaws, where the back teeth meet, tiny whitish spots (Koplik's spots) may be seen.  These spots confirm the diagnosis of measles.  The patient now should be isolated, if not already done.  After three to five days of the disease the temperature rises to about 104 degrees F (40 degrees C) and the typical measles rash appears.  The rash of a reddish hue with slightly raised irregular blotch patches starts on the forehead and behind the ears, and gradually spreads to the face, body, and limbs.  The rash remains about four or five days, then fades from the body regions in the same sequence that it appeared.  This is followed by a fine peeling of the skin.  As the rash disappears, the temperature drops to normal.  

Because of its extremely infectious nature, measles usually cannot be kept from spreading to crewmen who have not had it.  However, a measles patient should be isolated to protect him from exposure to germs of other communicable diseases, as the common cold or pneumonia, that are carried by many apparently healthy individuals.  Secondary respiratory infections are so dangerous to a measles patient that masks should be worn by the patient and everyone attending to his needs. 

Treatment

Treatment is symptomatic as there is no specific medicine that will cure measles.  Medical advice by radio should be obtained.  

The patient should be cared for in strict isolation (see p. 321) and in a well-ventilated cabin screened from bright light, comfortably warm, and without drafts.  Close attention should be paid to cleanliness of the mouth and teeth.  To protect the eyes, the patient should wear dark colored glasses.  The room should be darkened by not completely blacked out.  The eyelids and margins should be cleansed several times a day with cotton balls moistened with sterile isotonic eye irrigating solution.

If the rash causes irritation or itching, calamine lotion should be applied freely three times a day.  If the patient develops a troublesome cough, 5 ml or one teaspoonful of dextromethorphan hydrobromide syrup 15 mg/5 ml, with glyceryl guaiacolate should be given every four to six hours, as needed.  For headache, aspirin 600 mg should be given by mouth every three to four hours.  If aspirin is not well tolerated by the patient, acetaminophen may be tried at the same dosage and frequency.

The patient should be kept in bed at all times.  Exercise, even such slight exertion as going to the head while fever or malaise is present, may encourage kidney and other complications.  The patient should drink plenty of fluids and the diet should be liquid or soft foods.  

During convalescence one should watch for complications and secondary infections and try to avoid them.  The patient should not engage in anything but the lightest tasks for two or three weeks after the attack.    At the first convenient port, he should be referred to a physician for a medical checkup.

That concludes the Ship's Medicine Chest information.  While details on medications to use may be dated, the identification, course of the disease, and basic treatment are the same, and the information is much more thorough than anything provided in any of the sources commonly available to us.  

However, there are a few tidbits to add in:

• In first world countries, with first world sanitation, hygiene, nutrition, and medical care, the death rate is 0.2%.  The serious brain injury rate is 2%.  In a malnourished population, the death rate is 10%.[1]  In a third world situation with poor conditions, such as societal collapse, the situation could become quite serious.  
• Those most at risk are children under the age of 5 years.
• Secondary infections are quite dangerous and occur in about 30% of patients.[2]
• Administer vitamin A, or rich sources of it, if possible, especially to children to prevent eye damage.[3]
• Administer antibiotics if earache develops.[4]
• Administer oral rehydration solution for diarrhea.
  
• Offer aspirin or acetaminophen for headache.
• Patient must be confined to bed at all times, especially while fever is present.  Use a bedpan.  Even going to the bathroom may be too much exertion and may bring on complications.  

Herbs historically used for treating measles include the following.  However, note that most of these have not been researched in modern medicine.

• Chinese skullcap[5]
• Elder[6]
• Ginger[7]
• Houttuynia[8]
• Isatis[9]
• Licorice[10]
• Coconut oil[11]
• Juniper (infusion, as a skin wash)[12]

Measles is an incredibly easily transmitted disease.  While it has been eradicated in the US, that doesn't mean it won't make a comeback, and it will do so among the most vulnerable populations--our children.  We have to be prepared to identify it and properly treat it.

References:

The Ship's Medicine Chest and Medical Aid at Sea, 1978, 180-181.

[1] Survival and Austere Medicine, 3rd Edition, 294. 

[2] Ibid. 

[3]  David Werner, Where There Is No Doctor, 311.

[4].  Ibid.

[5] David Buhner, Herbal Antivirals, 133.

[6] Ibid, 160-64.

[7] Ibid, 172.

[8] Ibid, 189.

[9]  Ibid, 200-206. 

[10]  Ibid, 218.

[11].  Ibid, 253.

[12] Kimball Chatfield, Medicine from the Mountains, 67.