The return of the measles: are we going backward?

In 2000, the USA achieved a milestone public health victory by eliminating measles, a disease characterized by fever, coryza (catarrh), conjunctivitis, coughing, and a rash. However, the CDC recorded 555 reported measles cases between January and April 2019 across 20 states in the USA. Several other countries have also reported a resurgence in the disease, some have even banned unvaccinated children from schools. Thus, the question must be asked, are we going backward?

Measles is a contagious disease that is highly infectiousKaspars Grinvalds | Shutterstock

Measles is transmitted by respiratory droplets that can be viable in the air for 2 hours. It is a highly contagious disease that typically spreads from one person to 9-18 other people. The risk of contracting the disease if you are unvaccinated is 90%. Whilst most patients recover from the disease after a few weeks, around 1 in 1000 patients experience serious and fatal complications that affect the CNS.

Devastatingly, around 70,000 people still die from measles every year, despite the widespread availability of highly effective vaccines that can provide up to 97% protection with two doses.

Vaccination rates plummeted after a paper described a link between the vaccine and autism, and numbers have been slow to recover, despite several large cohort studies proving that there is no link between the diseases. Minor side effects include a sore arm and fever, and in rare cases (5%), a reduction in platelet count.

Although the measles vaccine has prevented 21 million deaths over the world since 2000, there has been a resurgence in cases, with a 31% increase between 2016 and 2017. In several European countries, the virus has re-established itself where previously its transmission was stopped.

Herd immunity: Protection in numbers

Herd immunity refers to a population wherein a sufficient number of persons have been vaccinated, providing protection for unvaccinated individuals. In the case of measles, 95% of the population is required to be effectively protected for preventing the resurgence of measles. The UK is close to this number, with 91.2% children receiving the MMR (measles, mumps, and rubella) vaccine between 2017-2018, but the threshold is clear, at 95%.

The absence of herd immunity can put an entire community at risk. For example, a single child in Shanghai in 2015 led to the infection of 23 other children. Fifty percent of those infected children ended up with severe complications and it was fatal in 21% of children.

The risk of complication is highest in people whose immunity has been compromised. In such cases, measles may cause more severe complications that have not yet been documented, including giant-cell pneumonia and measles inclusion body encephalitis.

Patients most at risk of such extreme responses are those with HIV, cancer, organ transplants, and patients receiving high-dose glucocorticoids and immunomodulators. These people cannot be protected safely using live-attenuated vaccines and have to depend on herd immunity to protect themselves against the measles infection.

Are we going backward?

Despite the availability of an effective vaccine, measles is fast emerging as a large public health issue. The growing anti-vaccine movement threatens to derail the progress made to eradicate measles and puts the world behind by a decade in its efforts to combat this disease.


Measles in 2019 — Going Backward. 2019. NJEM. DOI: 10.1056/NEJMp1905099.

Dr. Surat P

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Dr. Surat P

Dr. Surat graduated with a Ph.D. in Cell Biology and Mechanobiology from the Tata Institute of Fundamental Research (Mumbai, India) in 2016. Prior to her Ph.D., Surat studied for a Bachelor of Science (B.Sc.) degree in Zoology, during which she was the recipient of an Indian Academy of Sciences Summer Fellowship to study the proteins involved in AIDs. She produces feature articles on a wide range of topics, such as medical ethics, data manipulation, pseudoscience and superstition, education, and human evolution. She is passionate about science communication and writes articles covering all areas of the life sciences.  


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  1. Mel Paul Mel Paul Australia says:

    There have been a lot of "science" documents that have been proved false, all in the name of profits.
    People do not easily believe anymore. Which is good from a false news perspective but bad for any organisations who want to legitimately inform people of truth.
    Perhaps the virus has mutated?
    Do scientists use the latest virus to manufacture the vaccine? Its a live vaccine. Is it in time before another mutation?
    Herd immunity is a myth. Everybody's immune system is different. It works on some but not others. You can never immunise 100% of the population, especially world wide. In a multipolar world where in a few short hours you can travel to a different continent. There are no checks to see if you have been vaccinated at the entry gates.

  2. roslyn ross roslyn ross Australia says:

    Measles was never eradicated. Vaccines do not immunise. Whatever effect they have does not happen in a percentage of people who are therefore not vaccinated. The vaccinated can still get the diseases against which they have been vaccinated and they had and they do.

    As someone lucky enough to be old enough to have had all the minor childhood diseases, including Measles, and to have real immunity, I can only look at the paranoia today surrounding Measles and think, but, hang on, in the Fifties and Sixties they made comedy shows about kids getting Measles. How has it become the Black Death?

    Even when I had kids in the early Seventies my GP advised me to expose my children so they could get the disease, get over it and have lifelong immunity. The same advice doctors gave my parents.

    If Measles is a problem today it is because for some reason, and not necessarily vaccination, Measles in childhood has been delayed and, as with the other minor childhood diseases, is major in Adults. Now that is a problem.

    How any science or medical professional could believe that tricking the immune system, an immature immune system, into acting against a non-threat, i.e. acting irrationally or in confusion, could EVER lead to good health is the real question.

  3. Siegfried Schmauder Siegfried Schmauder Germany says:

    Within a period of 10 years nobody died in the US by measles but more than 100 died by the MMR vaccination. Those who still advise to vaccinate must be unaware of the facts. Thus: vaccination is fake!


    In Greece, beetween 1 April 2018 and 31 March, reported 870 cases of measles and 1 death of measles. Futhermore, it is devastating, that despite Greek coverage of first dose of measles- containing vaccine in 2017 was beetween 95%-99%, the coverage of second dose maesles-containing vaccine in 2017 was under 85%. (European Centre for Disease Prevention and Control, 2019).

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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