With one measles outbreak after another across the country, many people are worried about what they thought was an old-fashioned disease that was no longer a threat. As of May 10th 2019 the CDC has reported a measles outbreak of three or more people in 23 states, with 839 confirmed cases. This is the greatest number of cases since 1994. How did a disease that was declared eliminated in the United States come roaring back to sicken so many people?
Due to a robust vaccination plan measles was declared eliminated in the United States in 2000. Unfortunately just because measles was no longer present within US borders, doesn’t mean it was eliminated from other countries. There have been outbreaks of this highly contagious disease in several European countries with low levels of vaccination rates, including France, Germany, Switzerland, Poland, Italy, and perhaps most importantly the Ukraine. Scientists speculate that the large outbreak in the Ukraine is fueling the spread of the virus throughout the rest of Europe, which has reported 100,000 cases and 35 deaths since 2017. Health officials in that country are working feverishly to increase rates of vaccination, which had declined due to government corruption, war, a lack of political commitment to vaccination, and anti-vaccine sentiment.
A measles outbreak in the U.S. usually begins with contaminated travelers returning to or visiting from countries where the disease is less controlled. These outbreaks can become more severe if they occur in close-knit communities with low vaccination rates. This is currently happening in the New York Metropolitan area where the disease is spreading in orthodox Jewish communities where there is a strong anti-vaccination sentiment and many parents have chosen not to vaccinate their children. In an attempt to keep the virus from spreading, New York public health officials are currently working to combat misinformation about the risks of vaccination and announced a $1,000 fine for anyone who cannot show proof of vaccination. Similar measures are also being taken in Europe, where Germany is considering fining parents with unvaccinated children up to €2,500 Euros ($2,790 U.S.).
These areas with low vaccination rates, which tend to occur in clusters of people that share values or viewpoints, have reduced levels of herd immunity and made the spread of measles in the U.S. possible. Herd immunity refers to a level of vaccination among the population high enough to protect vulnerable populations, such as infants who have not yet received the vaccination and immunocompromised adults. Because measles is so highly contagious for herd immunity to be effective, at least 90-95% of the population needs to be vaccinated. A disease like polio is less contagious, and 80-85% of the population would need to be vaccinated for herd immunity to work. Interestingly, the success of the vaccination program in the U.S. may be one of the reasons the disease is making a comeback. Before the 1960’s—when almost all children got the measles and about 500 people a year died of the disease—the vaccination was a welcome relief. Today very few people have experienced the virus firsthand or know someone else who has, so it has become an abstract problem—an old-fashioned disease that people don’t think will happen to them. Globalization and increased international air travel is also contributing to contagious diseases, such as measles, being spread.
A measles outbreak can also occur when an infected and contagious person goes to a place with a lot of people in close contact such as church, school, or sporting event. Places where large numbers of people congregate—including international travelers who might have the virus and not know it yet—are especially prone to measles outbreaks. This happened in 2015 at Disneyland where over 50 people were infected, including several babies who were too young to be vaccinated. The measles virus can linger in the air for up to two hours after the infected person is gone, making further outbreaks possible.
In 1989, a measles outbreak at Siena College and the University of Hartford led officials to ban spectators from the conference’s postseason basketball tournament. After a player came down with measles, Siena played its final nine games of the regular season in empty stadiums to eliminate the risk of transmission. There was a similar concern when a contagious person recently attended a Portland Blazers basketball game.
Measles symptoms start with a high fever—up to 105°F —followed by cold-like symptoms such as a cough and runny nose. The telltale measles rash usually follows, covering the face, upper neck, and finally torso in irritated red spots. Infected people can spread measles to others from four days before through four days after the rash appears. Measles can be a very serious, even fatal condition, especially for young children. An outbreak in Philadelphia in 1991 killed 6 children, all unvaccinated members of a religious community. Children with the condition are susceptible to pneumonia and encephalitis. Those who survive may also face long-term consequences such as deafness, blindness, and brain damage. The disease can spread very rapidly in pockets of unvaccinated individuals. Research shows parents who choose not to vaccinate their children tend to live in clusters, making risk of infection even greater due to close proximity of other unvaccinated children.
How to stay safe and reduce the spread of measles:
Take steps to find out your and your family’s vaccination history. This may be challenging as there is no national registry of vaccination records and doctor’s records from many years past can be difficult or impossible to locate. If you are unsure about your vaccination status, its best to get vaccinated again, as being vaccinated twice is considered safe.
The CDC recommends that adults or teenagers without proof of vaccination get a least one dose, with the exception of adults born before 1957 who do not require the vaccination. For the most comprehensive protection, the CDC recommends children get two doses, one between 12 and 15 months and another between 4 and 6 years of age. There should be at least 28 days between the two doses. It is especially important to be vaccinated if you live in or near an area with low rates of vaccination, will be around international travelers, or will be traveling yourself internationally.
Though most people can safely get the MMR vaccination, there are a few exceptions including children under 12 months of age, pregnant women, and people with compromised immunities, or vaccination allergies, those who’ve received another vaccination within the past 4 weeks, or people with bleeding disorders. Talk to your doctor if you are concerned about the safety of receiving the MMR vaccination.
Keep children too young to be vaccinated and vulnerable adults away from potentially risky venues, such as amusement parks and large sporting events. If you suspect you have been exposed to the virus and are unsure of your vaccination status, getting vaccinated within 72 hours of exposure may offer some protection.
If you suspect you or a member or your family may have contracted measles, call your doctor first and stay home. Immediately going to the doctor’s office, urgent care or ER could spread this highly contagious virus to other people. Follow your doctor’s instructions on how to best take care of yourself, while not further spreading the virus.
There is no cure for measles, but seek supportive care if symptoms become severe including breathing problems, headache, confusion, seizures, etc. In rare cases, measles can be fatal, so call your doctor if concerned about symptoms.
Only 55% of quiz takers knew what action to take if they might be infected with measles. To find out if you know the right answer, try taking our featured measles quiz.