Globally measles at an all time high

In the United States, the number of cases of vaccine-preventable viral disease measles is on a 25-year record high. According to the Centre for Disease Control and Prevention (CDC), the main reason behind this is inadequate vaccination of the general population. Spread of misinformation regarding vaccine safety is to be blamed for inadequate vaccination of the population says the agency.

15 months, held by her mother, being administered her first dose of mumps, measles and rubella (MMR) vaccine. Imaeg Credit: UNICEF/UN0201055/Krepkih
15 months, held by her mother, being administered her first dose of mumps, measles and rubella (MMR) vaccine. Image Credit: UNICEF/UN0201055/Krepkih

The report from the CDC says that most of the cases of measles encountered are among children who have not been vaccinated with the MMR vaccine (that covers against measles, mumps and rubella or German measles infection). According to US Health and Human Services Secretary Alex Azar this rise in number of cases was “completely avoidable”. Parents refusing to vaccinate their children with the MMR vaccine are termed as the anti-vaxxers and have been linked to over 390 cases of measles since October last year say the officials.

According to the latest report from the CDC, there have been 704 cases in the states since January this year (the number confirmed up until last Friday the 26th of April 2019). This makes 2019 the worst year for measles since 1994, they add. They speculate the numbers to be worse with eight more months to go this year. Secretary Alex Azar said in a statement, “The suffering we are seeing today is completely avoidable. We know vaccines are safe because they're among some of the most studied medical products we have.”

Dr Jonathan Fielding, former head of the Los Angeles County Department of Public Health explained, “Many parents are afraid. If you want to believe your kid doesn't need that many shots, there's plenty of places to find people who agree with you.” He added, “It's not so easy to discern what is real and what is not,” explaining the connections made on social media by antivaxxers between measles vaccine and autism.

At present over 390 cases of measles have been seen in New York City since last October and this has been concentrated among children in Orthodox Jewish Communities in Brooklyn that refuse to vaccinate their children. New York City health commissioner Dr Oxiris Barbot in a statement said, “This outbreak is being fuelled by a small group of anti-vaxxers in these neighbourhoods.”

Measles infection is also brought into the country by travellers say the officials. People with fever, runny noses, rash and cough travelling to the country bring in the infection that affects unvaccinated populations, they explain. In 2018 over 82 people brought in the measles infection while travelling from other countries. The number has crossed 40 this year in just 4 months, the CDC warns. Most common countries from where infections have reached the US include Ukraine, Israel and the Philippines.

CDC Vaccine Director Dr. Nancy Messonnier in her statement said, “Measles is imported when an unvaccinated traveller visits a country where there is widespread measles transmission, gets infected with measles and returns to the United States.  That traveller then exposes people in their community who are not vaccinated.  44 cases so far this year were directly imported from other countries. Among the 44 internationally imported measles cases over 90% were in people who are unvaccinated or whose vaccination status was unknown.” “The recent outbreak started through what we call importation,” she said.

Very few individuals with measles tend to develop complications such as pneumonias and other life threatening complications that require hospitalization. In the recent outbreaks of measles, there have been no deaths reported yet. However 3 percent of those infected have been hospitalized with pneumonia and a further 9 percent had to be hospitalized for other complications from measles explained the CDC director Robert Redfield. The CDC adds that at present around 10 percent of the patients in the present outbreak are adults who had received one or two doses of the vaccine. They explain that some adults may require a new dose especially when travelling to regions where outbreaks are taking place.

In a conversation Secretary Azar said, “Today’s the start of National Infant Immunization Week, an annual observance and opportunity for us to highlight the importance of protecting infants from vaccine-preventable diseases and to celebrate the achievements of immunization programs in promoting healthy communities throughout the United States.  This year, we’re celebrating 25 years of national infant immunization week.”

CDC director Robert Redfield added, “There are no treatment and no cure for measles and no way to predict how bad a case of measles will be.  Some children may have very mild symptoms.  Others may face serious complications.” He explained, “The United States has high rates of vaccination coverage among kindergartners entering school in 2017 about 94% had the recommended two doses of measles, mumps and rubella or the MMR vaccine.  That means the majority of parents are making sure their children get vaccinated according to CDC’s recommended immunization schedule.  Two doses of MMR vaccine are about 97% effective at preventing measles.  One dose is about 93% effective.”

On the issue of travel and importation of the infection Redfield said, “...normally we don’t recommend the measles vaccine to begin in infants until 12 months of age.  But because of the current situation globally, if infants were to travel, we recommend in their 6 months to 11 months before they would get their 12-month shot, we recommend those infants do get a dose of the MMR vaccine prior to travel.”

US President Donald Trump, last week also urged Americans to get vaccinated to prevent the spread of measles. “The vaccinations are so important. This is really going around now,” Trump said last Friday.

Measles in the news

In the UK last year there were 966 confirmed cases of measles. This is a fourfold rise since 2017. The numbers are at an all time high since the 1990s say officials. UNICEF research released last week shows that 2,5 million children in the U.S. did not receive MMR vaccine between 2010 and 2017, followed by France and the United Kingdom, with over 600,000 and 500,000 unvaccinated infants, respectively, during the same period.. The recommended vaccine coverage in the community is over 95 percent. Currently the vaccine coverage under the age of five in England is 88.6 per cent in 2014-15 and 87.2 per cent in 2017-18.

The CDC says that measles is a highly contagious disease. The recommendation is one dose at each of the following ages –

  • 12 through 15 months
  • 4 through 6 years

The recommendation states that before international travel:

  • Infants 6—11 months old need 1 dose of measles vaccine
  • Children 12 months and older need 2 doses separated by at least 28 days
  • Teenagers and adults who do not have evidence of immunity against measles should get 2 doses separated by at least 28 days

The recommendations also state that most health insurance plans cover the cost of vaccines.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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