Last week New York City health officials announced that there was a measles outbreak in Manhattan and the Bronx. So far they have identified 16 cases of measles, representing the worst outbreak in the state in the past 17 years. While some childhood diseases have been virtually eradicated, some, like measles and whooping cough, are making a comeback.
Parents are delaying or refusing childhood immunizations for children over scares that side effects or reactions are connected to learning disabilities, autism, or education related concerns. Some parents refuse due to religious beliefs, and others just delay because of cost or lack of appropriate parenting.
People need to understand why outbreaks are a concern for everyone, even the vaccinated. Measles is certainly unpleasant, but it can also be quite dangerous. As many as one in three people with measles develop complications to include pneumonia, miscarriage, brain inflammation, hospitalization and even death. Infants under one year of age, people who have a weakened immune system and non-immune pregnant women are at highest risk of severe illness and complications. One out of 1,000 people with measles will develop inflammation of the brain, and about one out of 1,000 will die.
Another vulnerable group may be aging baby boomers, typically the grandparents of unvaccinated children, whose own childhood immunizations may be wearing out after 50 years. In some cases, doctors are recommending re-vaccination for people of this generation.
Even though the risk of disease may be low for a fully vaccinated child or adult, we must consider that there are still people who remain vulnerable. For example, children under a year old who haven’t been vaccinated as explained above, as well as children who haven’t had their second dose who may only remain at greater risk. And of course there are those, both children and adults, who can’t receive an MMR vaccine due to various medical reasons. They must rely on protection from those of us who can.
One of the most challenging things about containing the spread of measles is that it is highly contagious. The virus resides in the mucus of the nose and throat and once an infected person sneezes or coughs, droplets spray into the air and spread the disease to others. The most amazing part is that the droplets remain active and contagious on infected surfaces for hours. Therefore, you could be in the same place that an infected person once was, and still get sick even if you never encounter them face to face.
Fortunately, the measles vaccine (which is part of the MMR vaccine) is highly effective against the virus, especially after the recommended two doses. About 95 of every 100 children will develop immunity after one shot (typically administered between 12-15 months), and about 99 of 100 children will develop immunity to measles after two shots (with the second shot recommended between 4-6 years). Immunizing that additional 4 percent of children a second time is important when trying to protect against a disease as highly contagious as measles. However, with the challenges we’ve faced in obtaining global vaccine coverage, we see that measles is still quite common worldwide. There are an estimated 20 million cases each year and 164,000 deaths. (For more information on measles in the United States and worldwide, visit the Global Elimination page.)
Looking at the decade before the measles vaccination program began, one can see just that measles vaccination has been largely effective. For instance, there were about 3–4 million people in the U.S. infected each year, of which 400–500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis. Fortunately, widespread use of measles vaccine has led to over a 99% reduction in measles cases in the United States compared with the pre-vaccine era. In 2012 there were only 55 cases of measles reported in the United States.
Since measles was declared eliminated in the U.S. in 2000, cases that occur in this country are heavily monitored. Each year about 60 people in the U.S. are reported to have measles. However, in 2013 we recorded the second highest number of cases in a single year since elimination with 189 cases. About 28% of these cases came from patients who were infected in other countries and brought it back to the U.S. where they spread it to others. This caused 11 measles outbreaks in various U.S. communities, including the largest U.S. measles outbreak since 1996 (58 cases). (See Measles—United States, January 1-August 24, 2013 for more information.)
As the year progresses, we’ll have to wait and see just how 2014 will compare to previous years in regards to measles outbreaks. In the meantime, the best way for our readers to stay informed would be to follow your local public health department’s alerts and media announcements to ensure you are getting updated on infectious disease outbreaks in your local area. You can also visit Healthmap to track outbreaks of diseases near you.
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