Measles report card for 2011 shows too many cases

By Dr. Ananya Mandal, MDApr 22 2012

According to the CDC in its Morbidity and Mortality Weekly Report, last year was the worst year for measles in the U.S. in 15 years. They report that there were 222 cases of measles, a large jump from the 60 or so seen in a typical year. Most of the cases last year were imported — either by foreign visitors or by U.S. residents who picked up the virus overseas.

U.S. children have been getting vaccinated against the measles for about 50 years. But low vaccination rates in Europe and other places resulted in large outbreaks overseas last year authorities speculate.

So far this year, 27 U.S. cases have been reported and it's too early to gauge whether 2012 will be as bad as last year. But with large international events like the London Olympics coming up, health officials are urging everyone — particularly international travellers — to make sure they're fully vaccinated. “For those of you travelling abroad, bring back memories and not measles,” said Dr. Anne Schuchat of the Centers for Disease Control and Prevention.

Of the 196 U.S. residents who had measles in 2011, 166 were unvaccinated or didn't know if they'd been vaccinated, although 141 were eligible to be vaccinated, the CDC report found. Sixty-six percent of the 141 who were eligible for vaccination were between the ages of 16 months through 19 years, the time span a person is most likely to be vaccinated. Three-quarters had not received the vaccine because of a philosophical, religious or personal exemption. The vaccine is considered very effective but a few vaccinated people still get infected.

Although no cases of measles death were reported in the U.S, about a third were hospitalized, and one child was touch-and-go for about a week before finally recovering, one CDC official said. Officials traced 200 of last year's 222 cases to measles in another country, said Schuchat, director of the CDC's Office of Infectious Diseases. The largest outbreak was in the Minneapolis area where 21 cases were traced to a child who got sick after a trip to Kenya. The last time the United States had more measles was in 1996, when 508 cases were reported.

The highly infectious illness seems to be making an unexpected comeback. Measles was declared eliminated in 2000 after public health measures successfully interrupted the transmission of disease from person-to-person in the United States. The disease is still endemic in many other parts of the world, however.

Measles is highly contagious. The virus spreads easily through the air, and in closed rooms, infected droplets can linger for up to two hours after the sick person leaves. It causes a fever, runny nose, cough and a rash all over the body. In rare cases, measles can be deadly, and is particularly dangerous for children. Infection can also cause pregnant women to have a miscarriage or premature birth.

“Measles is preventable and unvaccinated people put themselves and others at risk for measles and its complications, particularly those who are too young to be vaccinated who can sometimes have the worst complications,” Schuchat said.

Doctors should be on the lookout for patients with measles, who typically seek medical care for the condition, the CDC said. Those who are infected should be immediately isolated to prevent transmission of the disease to those who aren’t vaccinated against it, the agency said.

“The clinicians in the country, paediatricians, internists, and family physicians, many of them have never seen measles,” she said. “In some of these outbreaks, the families went to doctors multiple times, visited emergency rooms, it took awhile for the cases to be diagnosed. During that period, measles was spread to other people.”

Two doses of a measles-mumps-rubella vaccine are recommended for all children, including a first dose given around a child's first birthday and a second dose around the time of preschool. These vaccinations are believed to last for a lifetime. Children as young as 6 months can get a first dose if they're going to a country with measles outbreaks, health officials say.