Measles vaccination schedule for children has multiple doses

DEAR DR. ROACH » My daughter is 4 years old and has, in the past five days, developed measles. She was vaccinated at 9 months and has been treated with antibiotics, Tylenol and vitamin A supplements. What concerns me is that she is now experiencing seizures, even without a fever. They are not grand mal seizures, but simple ones. They have me worried. What can I do? DEAR READER » Measles remains a serious disease in many parts of the world, with 90,000 deaths reported in 2016. Even in industrialized nations, there have been outbreaks involving tens of thousands of people infected.

Vitamin A supplementation may be of value in those who are deficient, and Tylenol can help keep the fever down, reducing the risk of febrile seizures. The antiviral drug ribavirin sometimes is used, though without clear evidence of effectiveness. Otherwise, there are no effective antibiotics or other treatments for measles.

When seizures occur in a child with measles in absence of fever, it can indicate a complication called encephalitis — inflammation of the brain. Children also may experience nausea and vomiting, and they usually have a headache. Confusion and sleepiness are other common symptoms. The diagnosis can be confirmed by an evaluation of the fluid around the brain, the cerebrospinal fluid, which is sampled via a needle inserted into the lower back.

Confirmed encephalitis with measles is treated with steroids. This reduces the risk of permanent brain damage from the infection. Even so, 25 percent of children may be left with some impairment, including epilepsy.

Unfortunately, vaccination at 9 months is not adequate protection. Children’s immune systems may not be able to fully respond to the vaccine so early. Children are recommended to have the measles vaccine at 12-15 months and again at 4 to 6 years in the United States. In countries where risk of measles mortality remains high, children are vaccinated at 9 months, then again at 15-18 months. During an outbreak, a dose may be given as early as 6 months old, in addition to the other two doses.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.