Measles outbreaks in the USA are a public health problem – GWC Mag

Recent measles outbreaks in the USA have physicians and public health officials worried about protecting young children from infection, as well as about the role of misinformation in driving the spread. I know many people think that measles is nothing more than a minor rash and that’s about it, but if these outbreaks continue, it could be a public health issue very shortly.

As I’ve mentioned before, the cultural memory of measles outbreaks has been lost to modern society because of the measles vaccine. And that’s one of the downsides of successful vaccinations — people forget what it was like before mass vaccination programs.

I want to take a brief look at what is measles and some of the consequences of the disease. But I also want to look into why these small outbreaks could become something more consequential — vaccines are the key to stopping these outbreaks.

All about measles and the vaccine

Measles (rubeola, not to be confused with rubella or German measles) is a respiratory disease caused by the Measles morbillivirus. This virus normally grows in the cells that line the back of the throat and lungs. 

The virus is spread through respiration (contact with fluids from an infected person’s nose and mouth, either directly or through aerosol transmission). It is highly contagious — 90% of people without immunity sharing living space with an infected person will catch it.

Infected individuals can spread measles up to four days before and four days after a rash appears.

There are no specific treatments for the disease. And there are no miracle preventions, except, of course, the MMR vaccine (for measles, mumps, and rubella). The first dose is usually given at 12 to 15 months of age, and the second dose at 4 to 6 years of age. Teens and adults should also be up to date on their MMR vaccination. To be clear, children under 12 months are not vaccinated against measles and are the most susceptible to catching the disease.

In case you heard anti-vaccine claims about the MMR vaccine, there is no link between the vaccine and autism – this is settled science.

Also, I want to debunk the oft-repeated, and highly inaccurate, claim that vitamin A supplements can cure or prevent measles. It’s essential to supplement with vitamin A to prevent blindness as a result of measles, but it doesn’t reduce mortality or prevent some neurological issues unless there is chronic vitamin A deficiency. That’s why scientists are very supportive of golden rice, which supplements vitamin A through their rice.

According to the CDC, some of the many measles complications are:

• About 30% of measles cases develop one or more complications.
• Pneumonia is the complication that is most often the cause of death in young children.
• Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result.
• Diarrhea is reported in about 8% of cases.
• As many as 1 out of every 20 children with measles gets pneumonia.
• About 1 child in every 1,000 who get measles will develop encephalitis, an inflammation of the brain that can lead to convulsions, deafness, and other long-term neurological deficits.
• A measles infection can result in short- and long-term immune system dysfunction which can leave the child susceptible to other diseases early in life (which is in direct opposition to claims by anti-vaccine activists that it helps “boost” the immune system).
• About 1-2 children, out of 1000 who contract measles, may develop subacute sclerosing panencephalitis (SSPE), a rare chronic, progressive encephalitis that affects primarily children and young adults– it is caused by a persistent infection of the measles virus. The disease starts with measles infection, usually before the age of 2 years, followed by approximately 6-15 asymptomatic years. Some researchers think the asymptomatic period is around 5-8 years after the initial disease. The disease gradually progresses with psychological and neurological deterioration, including personality changes, seizures, and coma. It is always ultimately fatal.
• And sadly, for every 1,000 children who get measles, 1 or 2 will die from it.

As I wrote recently, measles is much more dangerous than most people think. I’m not here for fear-mongering – but real science tells us that measles is a dangerous, debilitating disease that has both short and long-term consequences.

Measles outbreaks and dangers to public health

There have been several small outbreaks of measles throughout the USA. I recently wrote about several outbreaks along the East Coast. Hundreds of people were exposed to measles at the University of California, Davis, medical center.

Furthermore, there is an ongoing outbreak in Florida, where Florida Surgeon General, Joseph Ladapo, whom I’ve discussed previously, has decided to ignore CDC guidelines by not recommending measles vaccines or keeping children home in response to a local outbreak of the disease.

There are several reasons why we need to be vigilant despite the small number of measles cases that we’ve seen so far.

1. The measles vaccine is not recommended for children under the age of 12 months. This cohort is the most susceptible to measles and may suffer the most complications. So, if a child with measles goes into a pediatric office and there are a few infants under the age of 12 months, all of those kids could catch the disease.
2. The measles vaccine is very effective. Two doses of measles vaccine (one at 12 months and the second at 4-6 years) are about 97% effective at preventing measles if exposed to the virus. One dose is about 93% effective. That means that approximately 3-7% of children may not have immunity to measles even though they have been vaccinated.
3. According to the most recent data from the CDC, only about 90.8% of 24-month-old children have received the MMR vaccine. And only about 91.9% of adolescents ages 13-17 have been vaccinated. And these numbers may have dropped dramatically — a report on Michigan childhood vaccinations during the pandemic appears to have dropped to around 50% (although many children may have caught up with their vaccinations as they enter school).

What do all of these numbers mean? We have to first understand the concept of herd immunity, where a sufficient percentage of a population has become immune to an infection, whether through previous infections or vaccination, thereby reducing the likelihood of infection spreading to individuals who lack immunity. For measles, the herd immunity level is estimated to be around 92-94%. In other words, outbreaks grow if the population around the initial cases has either a natural immunity to the disease or has been vaccinated falls below 92-94% — the USA is probably falling below that number.

A lot of children are susceptible to measles because they are not immune. Moreover, if the measles vaccination rate continues to drop, there will be more and more children will be susceptible to the disease during these outbreaks. A small outbreak of just a handful (or even one) of children could blossom into a large outbreak.

As we see more and more of these small outbreaks plus the anti-vaccine push against childhood vaccinations, these measles outbreaks are going to be a public health disaster.

We were so close to making measles extinct. But that’s not going to happen now.

Citations

• Bramer CA, Kimmins LM, Swanson R, Kuo J, Vranesich P, Jacques-Carroll LA, Shen AK. Decline in child vaccination coverage during the COVID-19 pandemic – Michigan Care Improvement Registry, May 2016-May 2020. Am J Transplant. 2020 Jul;20(7):1930-1931. doi: 10.1111/ajt.16112. PMID: 32596921; PMCID: PMC7361263.
• Delamater PL, Street EJ, Leslie TF, Yang YT, Jacobsen KH. Complexity of the Basic Reproduction Number (R₀). Emerg Infect Dis. 2019 Jan;25(1):1-4. doi: 10.3201/eid2501.171901. PMID: 30560777; PMCID: PMC6302597.