In the vaccine fight, measles is winning
Why is measles making a comeback, especially in the U.S. almost 20 years after it was officially declared eradicated? Much media attention has focused on the erosion of herd immunity due to pockets of unimmunized children and deservedly so. But another important reason is the public perception that measles is a mild childhood disease — uncomfortable for a few days but not serious.
We have forgotten how terrible the measles can be. Many parents think it is mild, yet few have ever seen a child with the disease; neither have many practicing pediatricians, since the disease was rare in the U.S. for years before it was officially declared “eradicated.” Even in a “mild” case of measles (rubeola), the patient suffers from a variety of very uncomfortable symptoms, including a high fever up to 104 F, red, watery eyes, runny nose and cough, followed in three days by a red, itchy and bumpy rash over much of the body.
{mosads}Unvaccinated children and adults over 30 are more likely to have complications. Most common are diarrhea, ear infections and extreme dehydration. But measles can also cause very severe complications. As many as one of every 20 children gets pneumonia and that complication in turn accounts for 60 percent of measles-related deaths. And measles during pregnancy can cause premature births.
The recent news that a flight attendant was hospitalized in a coma resulting from measles reminds us just how virulent the disease can be, particularly in unimmunized adults. Encephalitis (swelling of the brain), as is the case of the flight attendant, occurs in one out of 1,000 measles cases. Symptoms include fever, headache, vomiting, stiff neck, drowsiness, convulsions, and coma. Fatal 15 percent of the time, encephalitis is the most common cause of death in adult measles cases. Even if the patient recovers, it can cause lasting neurological damage in up to 25 percent of cases; in children, it can cause seizures, deafness and intellectual disability.
Long after recovery from the acute illness, measles can continue to cause harm. Though rare, subacute sclerosing panencephalitis (SSPE), a fatal central nervous system disease, may develop seven to 10 years after a person appears to fully recover from measles. SSPE results in swelling of the brain, loss of cognitive abilities, and, finally, death.
There’s been an alarming 400 percent global increase in measles cases in the first three months of 2019 compared to 2018, according to the World Health Organization. The cases often occur in clusters where vaccination rates are poor. Yet, despite the proven effectiveness of vaccines, anti-vaccination sentiment has never been higher in the U.S. It’s a belief that is undermining public safety efforts and has helped measles establish itself in 22 states across the country, to date infecting over 626 people, mostly children.
The situation is so serious that lawmakers in six states — Colorado, Arizona, New Jersey, Washington, New York and Maine — have authored or co-sponsored bills to make it harder for parents to avoid vaccinating their school-age children. Many of these measures face opposition from other legislators who support parents’ rights to decide if and when their children are vaccinated. In West Virginia and Mississippi, states with some of the nation’s strictest vaccination laws, lawmakers have introduced measures to expand vaccine exemptions.
Culturally, we have short memories. Before the vaccine program began in 1963 and herd immunity was eventually established throughout the U.S., it is estimated there were three to four million measles cases every year. Approximately 500,000 cases were reported annually to the CDC, resulting in nearly 50,000 hospitalizations, 1,000 encephalitis cases, and 450 to 500 deaths. At the turn of the 20th century, the U.S. averaged 6,000 measles-related fatalities every year.
We don’t want to return to the old days. Vaccines are safe. They work. In addition to protecting your child from measles, the inoculation protects against mumps and German measles (rubella). These diseases also carry serious complications and can cause lifetime disabilities to individuals and developing fetuses that are particularly vulnerable to the impacts of rubella. One dose of the measles, mumps, rubella or MMR vaccine is 93 percent effective against measles, 78 percent effective against mumps and 97 percent effective against rubella. Two doses of MMR vaccine are 97 percent effective against measles and 88 percent effective against mumps.
Every day, measles gathers momentum. For families with children, this is especially bad news. In Rockland County, N.Y., where a state of emergency was declared this month, there are 193 confirmed cases this year as of April 18, 84 percent are children under 18 years old, and nearly 60 percent are young children — infant to age seven.
In the great debate over vaccinations, the clear winner has been the measles. While we bring this issue to the political stage, measles spreads. There have already been more U.S. measles cases in 2019 than in any of the last five years, and it’s only April. We are well on the way to the largest number of cases since the disease was officially eradicated 20 years ago, and based on the numbers, the human cost is predictable. We need to start treating the measles outbreak as the public-health emergency that it is. Without returning the rate of vaccination to pre-2000 levels, we are putting both adults and children at grave and needless risk of illness, disability and even death.
Jonathan Fielding, M.D. is currently a distinguished professor of health policy and management and of pediatrics in the schools of public health and medicine at UCLA.