"The groundwork of all happiness is health." - Leigh Hunt

How nervous should we be?

January 30, 2024 – It could also be reassuring to do not forget that severe measles outbreaks are an issue now we have overcome prior to now, or something that only affects humans over there – like in Europe, where 42,200 cases were reported last 12 months. But complacency here within the United States may come at a price, experts say.

While measles was officially eradicated here in 2000, sporadic, frequent outbreaks proceed to occur. New York City specifically was hit by measles in 2019, central Ohio just two years ago and, since December of last 12 months, Philadelphia.

At the start of January, health experts warned travelers in transit two airports within the Washington, DC area that they could have been exposed. This illustrates how easy it's for an infected person to pass measles on to other unvaccinated people.

Recent case numbers within the US prompted the CDC to issue a Nationwide measles warning last week.

COVID lowered measles vaccinations

Measles is an “immense problem,” said Gregory A. Poland, MD, founder and director of the Mayo Clinic Vaccine Research Group in Rochester, MN, and editor-in-chief of the journal Vaccine. He described measles because the “canary in the coal mine” for vaccine-preventable diseases.

Measles is so contagious, he added, that a one that involves the emergency room 12 hours after seeing one other person with measles could contract the infection (in the event that they should not vaccinated).

“If SARS-CoV-2 were so transmissible, we would have millions more deaths in the U.S. by now,” Poland said.

Speaking of COVID-19, the pandemic has caused significant delays in measles vaccinations.

“WHO [World Health Organization] Data showed that in the year ending November 2022 almost 40 million children A vaccine dose against measles had been missed worldwide. A historic high of 25 million children missed the first dose and another 14.7 million missed the second,” a March 2023 report said Annals of Medicine and Surgery (London).

COVID also delayed vaccinations in the USA. CDC data updated Jan. 12 shows more than 61 million doses of it have been administered MMR vaccine, which contains the measles vaccine, were delayed from 2020 to 2022 or skipped altogether due to COVID. “This increases the risk of major outbreaks around the world, including the United States,” the agency noted.

At least 8,500 schools across the country There is a risk of a measles outbreak, according to a CBS News investigation that examined vaccination rates in public and private schools in 19 states. In these cases, the vaccination rate for kindergarten children falls below the 95% that the CDC says is necessary to achieve herd immunity and protect entire communities.

“Even though we give infants two doses that could be as much as 97% effective, there are still individuals who remain in danger,” said Adam Ratner, MD, director of the Division of Pediatric Infectious Diseases at Hassenfeld Children's Hospital at NYU Langone in New York City and a member of the American Academy of Pediatrics Committee on Infectious Diseases. “The measles vaccine is amazing.” Two doses in childhood generally last a lifetime, it doesn’t need to be updated, and the formula has been largely the same since the 1960s.

Getting more people to get vaccinated against measles and other vaccines is “really about understanding different communities and interesting with them about their concerns, making vaccination easier and educating the general public,” said Dr. Krutika Kuppalli, vice chair of the Immunization Global Health Committee of the Infectious Diseases Society of America.

“Measles is called the inequality virus for a reason. It is the disease that finds and afflicts those who are not protected,” Kate O'Brien, director of the World Health Organization's Division of Immunization, Vaccines and Biologics, said in a November 2023 WHO statement Press release. “Children everywhere have the right to be protected by the life-saving measles vaccine, no matter where they live.”

“The increase in measles outbreaks and deaths is alarming, but unfortunately not unexpected given the declining vaccination rates we have experienced in recent years.” John Vertefeuille, director of the CDC's Global Immunization Division, said in the same press release. “Measles cases everywhere pose a risk to all countries and communities where people are not adequately vaccinated.

“Urgent, targeted efforts are critical to preventing measles illnesses and deaths,” Vertefeuille added.

According to a joint report from the CDC and WHO, there were more than 136,200 deaths from measles worldwide in 2022. You have to go back to 2015 to find one Measles-related deaths in the United States.

Another challenge in combating measles outbreaks is that Incubation period. Typically, people can have measles for 10 to 14 days before they notice it.

Expert perspective

What happened in Europe during the COVID-19 pandemic was a foretaste of what we could expect here in the United States. Does this also apply to measles? We asked experts how worried we should be and what, if anything, about measles is keeping them up at night.

“I'm concerned. It's essentially the most contagious virus we all know,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville. “It's the primary Olympic gold virus when it comes to transmission.”

After we eradicated measles in the Western Hemisphere, “we became lax,” said Schaffner, who is also a professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine. “We are now two to three generations removed from the time when measles was widespread in the United States. “A lot of people know the name,” he said, but have never seen measles in their lives, including younger doctors.

In the 1950s and early 1960s, so many children got measles that “parents, pediatricians and everyone else were familiar with it,” Ratner said. “That’s a different story now. “We had a large outbreak in New York just before the pandemic, and for many people I work with, it was their first clinical exposure to measles.”

Measles, polio and diphtheria “are things we don’t see as much. “It’s really important to remind people how serious they can be,” Kuppalli said. “We should inform people, not in a fear-mongering way, but in an educational way.”

“People don't need to panic, but every time there is [measles] “In the United States or elsewhere, this is a warning sign,” Ratner added. “People should have their children vaccinated.”

It's not just measles either. There is a global resurgence of other vaccine-preventable diseases such as diphtheria and whooping cough.

“This is not just a problem in the United States, it is a problem around the world,” added Kuppalli, who also serves as a medical officer for COVID-19 health operations in the Epidemic and Pandemic Preparedness and Prevention Division in the Program for The World Health Organization is active in health emergencies in the USA.

In addition to COVID-related vaccination delays, two other aspects are contributing to the resurgence of those diseases.

“In addition, vaccine hesitancy has increased due to misinformation and disinformation surrounding COVID vaccines – and that is impacting the acceptance of other vaccines,” Kuppalli said. “During COVID, people were social distancing. Now more than ever, people are traveling and mingling again.

A growing global threat

Cases of measles not only occur all over the world, they are even more common. Accordingly, the virus poses a growing threat in 37 countries worldwide, especially for young children Figures for 2022 from the World Health Organization and the CDC. These case numbers have increased by 18% compared to 2021.

The number of deaths from measles worldwide also increased by 43% from 2021 to 2022, the same report said. The 136,000 deaths reported in 2022 were mostly children.

In the United States, we've had better luck recently when it comes to deaths from measles. For example, measles infected 649 people in New York City in a 2018-2019 outbreak and caused severe illness, but no deaths were reported. Public health officials traced the New York City cases to an unvaccinated child who returned home from Israel, which was experiencing its own outbreak at the time.

And no deaths from measles have been reported in recent months. That means the 85 people infected in the U.S. since the end of 2023 have survived, although 36 of them required hospitalization.

Even if our luck holds up when it comes to deaths, “we can only roll the dice so many times,” Ratner said. “There is currently a major outbreak in the UK. It’s heartbreaking because there are so many things we can’t prevent, but this is something we can.”

Worldwide, measles primarily kills children in one in all two ways: They get measles pneumonia, “which may be very difficult to treat,” Schaffner said. “We don’t have anti-measles and antiviral drugs for that.”

The second cause of death is less common: measles encephalitis.

Complacency is not the only cause

Overall negative attitudes toward vaccination could also lead to lower measles vaccination rates. Although cases are imported and spread among the unvaccinated, Schaffner said, “What is becoming more common, nevertheless, is that children who're deprived of the vaccine by their parents go abroad and produce it home, putting other unvaccinated children in danger. “

There are political and cultural factors that play a role in vaccine hesitancy, said Poland, who said he and many of his friends had measles as children. He has received funding for measles research for the past 30 years.

About one to two people die for every 1,000 cases of measles. “Most parents don’t think about that,” Poland said. “Do you want to take that risk or have your child vaccinated?”

The occasional outbreaks in communities across the U.S. “remind us once again that this pathogen is still very much alive and well,” said Jon Woltmann, MD, a pediatric infectious disease physician at Dayton Children's Hospital in Ohio.

People planning international travel may additionally wish to discuss the very best plan of action with their doctor, he said.

When asked what keeps him up at night, Ratner said, “I’m really worried. We are complacent as a society about measles.”

Overall vaccination rates within the US are quite high, contributing to herd immunity. For example, the vaccination rate amongst school-age children in New York on the time of the 2019 outbreak was 95% to 96%, “which should be good enough to control an outbreak,” he added.

“But what matters is not the overall rate, but the small areas where the vaccination rate is 60 to 70%,” Ratner said. “Measles spreads incredibly well, particularly in remote neighborhoods, which can then endanger larger communities.”