January 30, 2024 – It might be comforting to think that severe measles outbreaks are a problem we’ve outgrown in the future or a problem that only affects other people there, like in Europe, which reported 42,200 cases last year. But complacency here in the U. S. can also come at a price, experts say.
While measles was considered officially wiped out here in 2000, sporadic, clustered outbreaks continue to pop up. Most notably, measles hit New York City in 2019, central Ohio just 2 years ago, and Philadelphia starting this past December.
In early January, public health experts warned travelers who passed through two Washington, DC-area airports that they may have been exposed. That highlights just how easy it is for an infected person to pass measles along to other, unvaccinated people.
The number of cases in the U. S. The U. S. Department of Health prompted the CDC to consider a national measles alert last week.
COVID Lowered Measles Vaccinations
Measles is a “major concern,” said Dr. Gregory A. Poland, founder and director of the Vaccine Research Group at the Mayo Clinic in Rochester, Minn. , and editor-in-chief of the journal Vaccine. He described measles as the “canary in the coal mine” of vaccine-preventable diseases.
Measles is so contagious, he added, that a user who shows up at the emergency room 12 hours after a user with measles can get the infection (if they are not vaccinated).
“If SARS-CoV-2 were that transmissible, we’d have millions of more deaths in the U.S. by now,” Poland said.
And speaking of COVID-19, the pandemic has led to major delays in measles vaccination.
“WHO [World Health Organization] data showed that in the year to November 2022, almost 40 million children worldwide had received one dose of the measles vaccine. The largest 25 million children of all time did not receive their first dose, and another 14. 7 million did not receive their second,” according to a March 2023 report in Annals of Medicine and Surgery (London).
COVID also has delayed vaccinations in the U. S. According to U. S. data from the U. S. , and CDC data as of Jan. 12 suggest that more than 61 million doses of the MMR vaccine, which comprises the measles vaccine, were delayed or lost entirely between 2020 and 2022 due to COVID. “This increases the threat of major outbreaks around the world, including in the United States,” the firm said.
At least 8,500 schools nationwide are at risk of a measles outbreak, according to a CBS News investigation that analyzed vaccination rates in public and private schools in 19 states. In those cases, the vaccination rate for kindergartners falls below 95%. that the CDC considers mandatory to achieve herd immunity and entire communities.
“Even if we give babies two doses, which can be up to 97% effective, some other people are still vulnerable,” said Adam Ratner, MD, director of the department of pediatric infectious diseases at New York University’s Hassenfeld Children’s Hospital. Langone in New York, York City and a member of the American Academy of Pediatrics’ Committee on Infectious Diseases. “The measles vaccine is incredible. ” Two doses in the formative years last a lifetime, this needs no update and the formula has been pretty much the same since the 1960s.
Ways to get more people to take the measles vaccine and other vaccines are “really trying to engage with other communities about their concerns, simplifying vaccination and educating the public,” said Array, Krutika Kuppalli, MD, vice chair of the Infectious Diseases Society’s Global Health Committee.
“Measles is called the inequity virus for good reason. It is the disease that will find and attack those who aren’t protected,” Kate O’Brien, director of the World Health Organization’s Department of Immunization, Vaccines and Biologicals, said in a November 2023 WHO news release. “Children everywhere have the right to be protected by the lifesaving measles vaccine, no matter where they live.”
“The increase in measles outbreaks and deaths is staggering, but unfortunately, not unexpected given the declining vaccination rates we’ve seen in the past few years,” John Vertefeuille, director of CDC’s Global Immunization Division, said in the same release. “Measles cases anywhere pose a risk to all countries and communities where people are under-vaccinated.
“Urgent and targeted efforts must be made to prevent measles and death,” Vertefeuille added.
According to a joint report by the CDC and WHO, there were more than 136,200 measles deaths worldwide in 2022. You have to go back to 2015 to see a measles-related death in the United States.
Another challenge similar to measles outbreaks is the incubation period. Usually, other people can get measles for 10 to 14 days before they know it.
An Expert’s Perspective
Throughout the COVID-19 pandemic, what happened in Europe predicted what we might expect here in the United States. Is it the same with measles? We asked experts how concerned we are, and if so, why measles helps keep them awake at night.
“I’m concerned. It is the most contagious virus we know of,” said William Schaffner, MD, an infectious disease specialist at Vanderbilt University Medical Center in Nashville. “It is the number one, Olympic gold virus in terms of transmission.”
After eradicating measles from the Western Hemisphere, “we were negligent,” said Schaffner, who is also a professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine. “We’re now two or three generations away from when measles is not unusual in the United States. A lot of other people know that name,” he said, but they’ve never noticed measles in their lives, young doctors added.
Back in the 1950s and early 1960s, so many children got measles that “it was familiar to parents, pediatricians, and everyone else,” Ratner said. “It’s a different story now. “We had a big outbreak in New York right before the pandemic, and for a lot of people I work with, it was their first clinical exposure to measles.”
Measles, polio and diphtheria “are things we see less often. It’s vital to remind other people how serious they can be,” Kuppalli said. “We want to tell other people, not in an alarmist way but in an educational way. “
“People do not have to panic, but every time there is a [measles] case in the U.S. or elsewhere, it is a warning sign,” Ratner added. “People should vaccinate their kids.”
It’s not just measles either. Globally, there is a resurgence in other vaccine-preventable diseases, like diphtheria and pertussis.
“It’s not just a challenge in the U. S. , it’s a challenge around the world,” added Kuppalli, who is also the physician in charge of COVID-19 fitness operations at the Department of Epidemic and Pandemic Preparedness and Prevention under the state’s fitness emergency. program. World Health Organization.
Two points are contributing to the resurgence of those diseases, in addition to COVID-related vaccination delays.
“There’s also been a buildup of vaccine hesitancy due to misinformation and misinformation similar to COVID vaccines, and that’s impacting the uptake of other vaccines,” Kuppalli said. “During COVID, other people were socially distanced. Today, other people travel more than ever and mingle again.
A Growing Global Threat
Measles cases are occurring all over the world, they are becoming more and more frequent. The virus poses a developing threat, especially to young children, in 37 countries around the world, according to 2022 figures from the World Health Organization and the CDC. These case numbers have increased by 18% since 2021.
Measles deaths also increased by 43% globally between 2021 and 2022, the same report notes. The 136,000 deaths reported in 2022 were mostly children.
In the US, we have been luckier in recent years in terms of measles deaths. For example, measles caused an outbreak in another 649 people in New York City in 2018-2019 and caused severe illness, but no deaths were reported. Public health officials attributed the cases in New York to an unvaccinated child returning from Israel, which at the time was experiencing its own outbreak.
And no deaths have been reported from measles in recent months. That means the 85 people infected in the U.S. since late 2023 survived, although 36 of them had to be hospitalized.
Although our luck has held up when it comes to deaths, “the number of times we can throw the bucket is limited,” Ratner said. “At the moment there is a big outbreak in the UK. It’s heartbreaking because there’s so many things we can’t help it, but it’s all we can do. “
Globally, measles kills mostly children in one of two ways: they get measles pneumonia, “which is very difficult to treat,” Schaffner said. “We don’t have anti-measles, antiviral medications for this.”
The leading cause of death is rarer: measles encephalitis.
Complacency Not the Only Cause
Negative attitudes towards vaccination in general could also contribute to declining measles vaccination rates. Although the cases are imported and spreading among unvaccinated people, Schaffner said, “However, what happens more often is that young people who are denied the vaccine through their parents come by and bring it home, exposing other unvaccinated youth.
There are political and cultural issues involved in vaccine hesitancy, said Polonia, who said he and many of his friends had measles as children. He has secured investments for more than 30 years in measles.
About one or two people die for every 1,000 cases of measles. “It’s not something that most parents think about,” Poland said. “Do they need to take that threat or vaccinate their children?
Occasional outbreaks in communities across the U. S. “remind us once again that this pathogen is still alive and kicking,” said Jon Woltmann, MD, an infectious disease pediatrician at Children’s Hospital in Dayton, Ohio.
People making plans abroad may also need to talk to their doctor about the most productive course of action, he said.
When asked what helps him stay awake at night, Ratner replied, “I’m worried. As a society, we are complacent about measles.
Overall vaccination rates in the US are quite high and contribute to herd immunity. For example, among school-age youth in New York City, at the time of the 2019 outbreak, the vaccination rate was 95 to 96 percent, “which is enough to cause an outbreak,” she added.
“But what matters is the overall rate, even though the vaccination rate is 60 to 70 percent,” Ratner said. “Measles spreads incredibly well, especially during lockdowns, which can put larger communities at risk. “
SOURCES:
William Schaffner, MD, Infectious Disease Specialist, Vanderbilt University Medical Center, Nashville.
Adam Ratner, MD, Director, Division of Pediatric Infectious Diseases, Hassenfeld Children’s Hospital at NYU Langone, New York.
Gregory A. Polonia, MD, founder and director of the Mayo Clinic Vaccine Research Group, Rochester, MN; Editor-in-Chief, Vaccine.
Jon Woltmann, MD, Pediatric Infectious Disease Specialist, Dayton Children’s Hospital, Dayton, OH.
Krutika Kuppalli, MD, vice chair of the Global Health Committee of the Infectious Diseases Society of America; Medical Advisor, COVID-19 Health Operations, World Health Organization.
World Health Organization and CDC, “Progress Toward Measles Elimination: Worldwide, 2000-2022, MMWR, November 17, 2023. “
CBS News: “Data shows at least 8,500 Americans are at increased risk of a measles outbreak as vaccination rates decline. “
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