Measles

Measles, or rubeola, has been around for centuries and has travelled the globe.  In the 10th century, a Persian physician known as Rhazes was the first to document measles as a distinct disease in his book “The Book of Smallpox and Measles.”  Prior to that, societies from time to time had outbreaks of various diseases, including smallpox and measles, and often simply referred to them as “plague.” In 1757, a Scottish physician identified that there was a pathogen in the blood of patients suffering from measles; in 1954 physicians in Boston isolated the measles virus.

Measles is a highly contagious disease caused by a virus. It’s passed by infected patients’ respiration — coughing and sneezing. It remains airborne for a significant amount of time – it has been found in the air up to four hours after an infected person visited a room. 90% of people who are susceptible to measles and are exposed to it in an airborne environment will become infected.

Here’s what the CDC has to say about the symptoms of measles:

Measles causes fever, runny nose, cough and a rash all over the body. About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1,000 children who get measles, one or two will die.

There are other nasty complications too, such as corneal ulcers (which often leads to corneal scarring for life) and encephalitis.  According to the CDC, in the United States from 1954 to 1963 about 450-500 people died each year because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness.

Prior to the existence of a vaccine in 1963, it was assumed that everyone would get measles at some point in their lifetime. The good news is that once you had it and recovered, you were generally immune to it for the rest of your life.  The bad news is that if you were under 5 or over 65 when you caught it, the  odds of suffering complications went way up (as did the mortality rate). There still is no cure or treatment for measles; it just runs its course.

Measles was endemic (i.e. it would always be present) in any population that was large enough to have enough babies being born to have a constant supply of non-immune people. One study estimated that any city with a population of 250,000 or more would have endemic measles. Epidemics circulated every 2 or 3 years. 90 percent of the population had measles by the time they were 15.

When a vaccine was successfully developed in 1963, it changed everything. Over 19 million doses were delivered over the next 12 years in the United States, and eventually measles vaccination became widespread.  The incidence of measles dropped over 99%, and now there are only around 60 cases per year reported in the U.S.  In 2000, the CDC declared that measles was no longer endemic anywhere in the United States.

Unfortunately that doesn’t mean that there are no longer any cases here; measles remains endemic in many parts of the world, and global travel means that it continues to be re-introduced to the U.S. Because of this, it is critical that as many people as possible continue to get vaccinated.

One of the reasons for this is that there are some interesting nuances to successfully vaccinating young children with the measles vaccine, and to understand that, we need to discuss how vaccines work. A vaccine is either an inactive or “weakened” version of the virus; injecting it into the body causes our own immune system to learn to recognize it as a foreign invader so that a rapid defense can be summoned if it is ever seen again. Researchers discovered that babies often inherit antibodies (one of more than a dozen different immune systems active in our bodies) from their mother that can fight off the measles virus; in fact, they do it so effectively that if a baby is injected with the measles vaccine, the antibodies will destroy the vaccine before the baby’s own immune system can develop an immunity. So the medical community developed a recommendation that the first vaccine dose should be given after the baby’s first birthday, when the inherited antibodies have dissipated. Even so, many children did not build up a full immunity with that first dose, so a booster is now given a few years later and studies show that the combination does in fact give full immunity in nearly all children.

This seems a good point to point out that research shows overwhelmingly that the measles vaccine, both delivered alone and in the typical MMR (measles, mumps, and rubella) combination injection is safe.  In particular, there is no connection between the MMR vaccination and autism. A British researcher, Andrew Wakefield, started a health scare by publishing a paper in a reputable medical journal declaring that the MMR vaccination caused autism in some number of children. Since then, Wakefield has been shown to have considerable conflicts of interest, that he concocted fraudulent test results, and that his purported results could not be reproduced. His paper has been retracted and his work has been thoroughly discredited. Nevertheless, there are still people who believe that there is a connection between MMR and autism, and as such refuse to have their children immunized.

There are also people who believe that a “natural immunity” received by contracting the disease is preferable to immunity by vaccination.  There are numerous problems with this belief. First, as laid out in the statistics I showed above, measles can have significant health complications for the afflicted. In 2008, there were 164,000 measles deaths worldwide; make no mistake, measles can be a deadly disease, particularly for the very young, the very old, those whose immune systems have been compromised and those suffering from malnutrition. Second, there is a “herd immunity” effect from having the vast majority of the population immune; in particular, this protects young children in the first year of their life, when measles presents a greater risk of severe complications and before they can be effectively immunized. As we previously discussed, measles is endemic in large populations with moderate to high birth rates, specifically because very young children are susceptible; widespread vaccination is the key to preventing it from becoming endemic.

The pockets of anti-vaccination fervor has from time to time led to regular outbreaks of measles across the country. The last month has seen acute outbreaks of measles in several parts of the United States, including New York, California, and Washington State. These cases have been traced back to infected individuals travelling into the country. Because measles is airborne and highly contagious, it presents an enormous risk to very young children. Today we deal with it by publishing lists of exactly where the infected individuals have been.  We also need to deal with it by fighting the myths and misinformation about measles vaccination. In fact, measles is a prime candidate for systemically eradicating from the planet through a global vaccination program. Fortunately, organizations such as the Gates Foundation are partnering with other NGOs healthcare companies, and governments to expand vaccination programs and to develop new delivery methods that can dramatically reduce the expense and logistical overhead of attempting a global vaccination program.

The bottom line:  measles is very serious stuff. We could be making real progress in eradicating it from the planet, but instead at the moment we seem to be losing a little ground as unsubstantiated beliefs about the risks of MMR and other vaccines reduce the overall percentage of the population who are getting vaccinated. If this were only the problem of the people who are refusing vaccination that might be excusable, but measles is so contagious and so risky for very young children that it’s everyone’s problem and we all need to be pushing towards 100% vaccination among the eligible population.

 

 

 

 

1 Comment

  1. […] This isn’t just a tragedy. It’s a stupid, pointless, completely avoidable tragedy. I wrote recently about measles and the problems the anti-vaccination “movement” is causing through not […]

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