All the pediatric rooms in the hospital except those used for patients with damaged immune systems have been converted to negative pressure, she said, with the airflow directed out of the hospital. Visitation to the newborn intensive care unit has been restricted to parents, since premature infants are particularly vulnerable, and parents who live in one of the high-risk ZIP codes have to show immunity in order to visit.
“There’s almost this guilty feeling because I recognize the real suffering that measles inflicts, these children who are truly sick and are in the intensive care unit with pneumonia and without that support would certainly be in danger of dying,” Dr. Ratner said. And yet, “this is an incredible chance to learn for our trainees and for me,” he said. “I will never forget what I’m seeing now.”
The baby in our clinic had no evidence of measles, and in fact, the original rash was almost gone. The resident was able to get in touch with the shelter and verify that there were not in fact any cases of measles there, and we were therefore able to reassure the mother.
But we talked all afternoon, on and off, about what to do to keep children safe. Dr. Arthur Fierman, chief of pediatric ambulatory care at Bellevue and a professor of pediatrics at N.Y.U., said that may mean reviewing all the children cared for in the clinic who live in the four ZIP codes of the outbreak.
“I have a spreadsheet on my desktop right now with the names, addresses, phone numbers, of about 700 kids less than 4,” he said. It may be necessary to contact them all, offering protection through early initial or second vaccination and also telling them how to get help if they think they’ve been exposed (come in but call ahead so they don’t expose everyone in the waiting room).
The first MMR vaccine is usually due at the age of a year, but we can give it as early as 6 months if children are in danger of being exposed. That means giving an extra dose of vaccine, since they’ll need to get it again at a year. And there’s also the possibility of moving the usual second dose forward; we normally give it at 4, but could do it earlier. Babies under 6 months who are exposed and are too young for vaccine can be given immune globulin as protection.
The New York Department of Health has advised medical providers serving the Orthodox community in those ZIP codes that all babies 6 to 11 months should be given the first dose of vaccine early, and that children under 4 can receive the second dose early as well.