U.S. Narrowly Escapes Losing Measles Elimination Status

U.S. Narrowly Escapes Losing Measles Elimination Status

Americans urged to vaccinate as cases of the disease hit 28-year high in 2019.

For the first time in two decades, the United States nearly lost its measles elimination status as cases of the highly contagious disease hit a 28-year high in 2019, according to the Centers for Disease Control and Prevention (CDC).

Overall in the U.S., there were 1,282 confirmed cases of measles in 31 states—Alaska, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Virginia, and Washington—as of December 31, 2019.

There were a total of 372 confirmed cases of measles across the country in 2018. Between 2015 and 2017, there were between 86 and 188 confirmed cases each year. In 2014 however, the number of diagnosed measles cases spiked to 667.

Why measles outbreaks happen
Before the vaccine that protects against measles was licensed back in 1963, the CDC estimates that three to four million people were infected annually, and hundreds of people died from the infection.

Outbreaks of this magnitude don’t happen anymore thanks to the MMR (measles, mumps, rubella) vaccine. Once people are vaccinated against a disease and become immune to it and they can’t pass it on to others. So, as more people have been vaccinated against measles over the past several decades, the disease has had fewer opportunities to spread.

The CDC points out however, that measles is making a comeback as the infection may still spread among U.S. communities with “pockets of unvaccinated people.” Americans who travel to countries where measles outbreaks are happening are also bringing the disease back to the United States.

In Europe, there were roughly 84,000 measles cases in 2018. In the first half of 2019, about 90,000 children and adults in Europe were diagnosed with measles, according to a report from the World Health Organization. In June 2019, federal health officials urged Americans to protect themselves and ensure they are fully vaccinated at least one month before traveling outside the United States.

Complicating matters, here in the U.S., a growing number of parents are choosing not to vaccinate their children as recommended by health experts. This may be due in large part to prevailing myths and misconceptions about vaccine safety. Some forego immunizations simply for personal reasons, such as their religious views. The fact that most Americans alive today don’t have firsthand knowledge of devastating diseases, like polio and smallpox, may also contribute to lagging vaccination rates in some parts of the country.

“The problem with measles is that it’s so contagious,” says Darria Long Gillespie, MD, an ER doctor at Emory University Hospital in Atlanta. “If you have not been vaccinated fully and you’re exposed to someone with measles, you have a 75 to 90 percent chance of getting measles yourself.”

One of the most recent U.S. outbreaks of measles originated in Washington state, prompting the governor to declare a public health emergency in January 2019. As of March 24, 2019, there were 72 confirmed cases near Portland, Oregon–a known anti-vaccine “hotspot.” Nearly all of those infected are children who had not been immunized against the disease.

On January 29, 2019, New York health officials also confirmed that 64 children from Brooklyn’s Orthodox Jewish community were diagnosed with measles. The outbreak was triggered when unvaccinated children traveled to Israel where there is a large outbreak of the disease. When the young people returned home, the disease spread to other members of the community.

How you can protect your family
The good news: You can protect yourself and your family. Here's what you need to know.

What is measles? Measles (rubeola) is a serious and sometimes fatal respiratory disease that’s caused by a virus. Worldwide, it is still one of the leading causes of death in children.

How does it spread? An infected person can pass the virus, usually by coughing or sneezing, up to four days before and after the trademark red rash appears. “Measles droplets can remain in the air for hours after a person has coughed and left the room,” Dr. Gillespie says. By breathing that air or touching an infected surface and then touching your own nose or mouth, you can become infected.

Who’s at risk? Any child or adult who is not vaccinated is at risk, especially if they travel internationally in countries where measles is still common or if they visit areas in the U.S. where outbreaks have been reported. “If your child is not fully vaccinated, you have to keep her away from someone who has it, and that’s almost impossible to do if someone with measles is in your neighborhood or community,” notes Gillespie.

What are the signs and symptoms? Measles symptoms occur in stages, beginning with a high fever accompanied by a runny nose, cough and watery eyes. Tiny white spots may appear in the mouth a couple of days later. An itchy red rash follows in three to five days, starting at the hairline and spreading down toward the feet.

Is getting measles dangerous? There is no cure for the virus or treatment that can shorten the length of the infection. Once a person becomes infected, complications may include pneumonia, severe diarrhea and even swelling of the brain. A doctor may order fluids for dehydration or, if needed, prescribe antibiotics.

How can you avoid infection? Early vaccination is key. The CDC recommends all children get two doses of MMR vaccine by age 6; adults who aren’t immune should get at least one dose. The risks of not doing so are high. “As an ER doctor I see children come in with many illnesses, many of which can be prevented,” Gillespie says. “This goes from being a personal decision to a public hazard if you’re not vaccinating your child.”

Medically reviewed in February 2020.

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