Measles 2014: New Reminders of Old Lessons 


By: Amy Movius MD

This year is shaping up to be the worst for measles cases in the US for many, many years. In fact, measles was declared effectively eradicated from the United States in the year 2000 as it did not circulate within our population. This was because of the high vaccination rates of Americans.
Before the measles vaccine was available in the 1960s, there were 3 to 4 MILLION cases/year in our country resulting in 500-600 deaths and many more survivors who suffered pulmonary and neurologic injuries because of infection. In the early 2000s, the few cases still reported each year were “imported” from individuals traveling from other countries where measles still circulates. In recent years, however, more cases are being seen. 2011 was the worst with 220 cases. This also coincides with more people choosing not to vaccinate. With at least 80 cases already confirmed this year, 2014 is likely to exceed this with well- publicized out breaks in NYC and other parts of the country. Hopefully a silver lining of this unfortunate state of affairs will be a reminder of why vaccinations are so important and how much illness and suffering they prevent.
Measles is one of the most contagious infections known. 90% of unimmunized people exposed to measles will develop the illness. It spreads through the air, leaving a room “infected” for up to 2hours after the person with measles has left!! Also, an individual with measles can spread the disease 4 days before they develop the tell-tale rash – and for 4 days after the rash has disappeared. For this reason, unimmunized people exposed to measles should self- quarantine for 21 days.
Measles is also a very nasty disease. Even in developed countries like ours, 1 in 4 people who develop measles require hospitalization. Pneumonia and encephalitis (brain inflammation/swelling) are well known dangerous and potentially fatal consequences. Unfortunately, children are overrepresented in the US measles cases because the first immunization is given at 12 -15 months. The second is given around 4 years of age.
The current outbreak in our country started with measles brought in from unvaccinated persons who were traveling abroad. It has been a public health nightmare, with a domino effect of secondary cases. Some of the ways this outbreak has been found to be spread has been to other family members in unvaccinated households, hospitals and health clinics where ill individuals have presented as well as doctor’s offices, classrooms, buses and other public transportation. Potential sites of further spread also include airport and other large public places. One person the CDC has tracked may have exposed up to 100 cancer patients.
This robust spread of measles is completely avoidable. Receiving the recommended 2 doses of measles vaccine confers 99% immunity. The risk of the vaccine is minor and certainly much less than contracting the disease. THE MEASLES VACCINE DOES NOT CAUSE AUTISM. Multiple, rigorous studies from different countries have extensively evaluated this. Misinformation remains common however. Spreading of these myths can result in more unimmunized people, which can result in more measles cases as we see in NYC now. This potentially puts all children at danger. A mother of a 10 month old boy who nearly died from measles he contracted from unimmunized children put it best. “People who chose not to vaccinate their children actually make a choice for other children and put them at risk.”
I hope against hope the current outbreak of this highly contagious disease fades quickly. Meanwhile, I also hope Americans will take advantage of the lessons learned from history – before vaccinations were widely available – and get their families immunized. Vaccinations like the one for measles protect our children.