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Saturday, September 3, 2011

One missed measles vaccine, one new outbreak

Mahi Abdallah nearly died of measles after his family traveled to Kenya. Two others got sick.

Twelve-month-old, Mahi Abdallah was hospitalized with a severe case of the measles, soon after he and the family returned from a trip to Kenya. The boy was not vaccinated before the overseas visit to the country where measles is endemic.

Twelve-month-old, Mahi Abdallah was hospitalized with a severe case of the measles, soon after he and the family returned from a trip to Kenya. The boy was not vaccinated before the overseas visit to the country where measles is endemic.

Nuria Koto hasn't been home since Aug. 10 -- the day she brought her 12-month-old son to the emergency room with an out-of-control fever.

Within days the baby, Mahi Abdallah, was on life support. And for the second time this year, measles was on the loose in Minnesota.

Mahi, who was infected during a family trip to Kenya, is recovering in the pediatric intensive care unit at Children's Hospital in Minneapolis. "I didn't think I'd be able to hold him again," his mother said Friday, as she cuddled him in her lap.

So far, only two infants and one adult have been sickened in the state's latest outbreak. But with the outbreak last winter that sickened 23 people, Minnesota has seen more measles cases this year than in the last 10 years combined.

Against that backdrop, Mahi's story should be a cautionary tale for anyone who may be tempted to shrug off vaccinations, said Patsy Stinchfield, the infectious disease director at Children's.

"We were very concerned that he would not survive," Stinchfield said. "This could have been anyone's child," she added. "This could have been any of us."

Koto, an Ethiopian immigrant who works as a nursing assistant, said she and her husband always intended to have their son vaccinated, just like his three older sisters, ages 3 to 7.

But when the Dakota County family left for Kenya in late spring, Mahi was just nine months old -- below the recommended age of 12 months. She didn't know, she said, that experts now recommend shots as early as 6 months old for children traveling out of the country.

Shortly before they left Minnesota, the whole family visited a travel clinic to update their shots. But at the last minute, his mother decided that Mahi could wait for the measles shot until he returned in August.

They arrived back in Minnesota on Mahi's first birthday, Aug. 4.

The fever began the next day, his mother said. A few days later, she took him to the doctor, who sent him home with Tylenol. And then he landed in the hospital with pneumonia.

At first, says Stinchfield, Mahi "did not look like a child with measles." There was no sign of the classic rash, which typically starts at the hairline and travels down the body. His mother had spotted "a bit of a rash" on his arms and chest. But measles, she said, "didn't even cross my mind." In the hospital, tests confirmed the diagnosis.

Potentially fatal

Thanks to vaccines, measles -- one of the most contagious diseases in history -- is rare in the United States. But it's still widespread in parts of Europe, Africa and Asia, and it can turn fatal. Around the world, the death toll is estimated at 1 in 1,000.

On his fifth day in the hospital, Mahi took a dangerous turn. He was transferred to intensive care, hooked up to a breathing machine and given antibiotics to battle the pneumonia. For days, he was sedated and barely moved.

"It was really hard," said his mother. "It was like watching a dead body."

The medical experts were equally worried. Mahi, said Stinchfield, was "teetering near death."

After nearly two weeks in intensive care, Mahi started to wake up, as doctors eased up on the sedation.

On Tuesday, they took off his breathing tube. "He opened his eyes and looked at me," said his mother, and he squeezed her hand. "Look at this!" she thought. "I couldn't believe he could be that strong." When he started crying when she stepped away, she was thrilled. "Wow, my son knows me," she said.

Meanwhile, the Minnesota Department of Health was watching the case closely. While Mahi was at Children's, a cousin who had visited the family earlier that month was hospitalized with a less severe case of measles. The cousin is now doing well, Koto said. A third person, an adult woman, also caught the virus, apparently when she was exposed to one of the children in a health care setting, according to state health officials. But she was not hospitalized, and so far, there are no other confirmed or suspected cases, says Dr. Ruth Lynfield, the state epidemiologist.

'My son is back'

By Friday morning, Mahi was sitting up on a mat beside his mother in his hospital room. He was still tethered to an oxygen tube, with machines monitoring his vital signs. But Jessica Ovans, a physical therapist, was able to coax him to turn his head and press the buttons on a musical toy. "He's going to get much better, so we have to start working, challenging him," Ovans told his mother. "He is so precious."

Stinchfield says he will probably remain in the hospital another week.

"He's definitely taken a turn for the better and it looks like he's going to survive, so we're all very happy about that," she said. At the same time, she said, such severe cases of measles can cause lung and neurological damage as well, so he'll have to be monitored carefully.

Koto knows it's not over, but she's grateful and relieved. This week, she heard Mahi speak one of his first words - "Abo," an uncle's name. "My son is back," she said. "He's totally back."

By Maura Lerner • 612-673-7384

Source: The Star Tribune

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