In the year 2000, measles was completely eliminated in the United States. As one of the most contagious pathogens in existence, the elimination of measles was a public health triumph decades in the making. Unfortunately, this victory has not lasted.
In 2019 alone, this country has seen over 700 measles cases. The majority have occurred in New York State. Complacency due to the lack of measles cases in the United States coupled with the recent anti-vaccine movement, has created a new public health problem. As fewer parents choose to vaccinate their children, the protection to which we have all become accustomed is eroding.
State of emergency
NYC Mayor Bill de Blasio recently declared a public health emergency covering certain parts of Brooklyn, where the outbreak has been most severe. It bans unvaccinated students from going to school and fines unvaccinated individuals for not having themselves or their children vaccinated. As of April 25, 2019, Rockland County, where another large outbreak has taken place, issued a 30-day state of emergency that excludes persons diagnosed with the measles or exposed to a person diagnosed with the measles from indoor and outdoor places of public assembly. The order also requires all students attending school to be vaccinated or have a medical or religious exemption on file with the school. The state of New York is currently considering a measure to prohibit any non-medical vaccine exemptions.
Safety myths drive drop in vaccination rates
While there is always a risk of allergic or other negative reaction to any vaccine or medication, the measles, MMR and MMRV vaccines are considered to be extremely safe. One study a number of years ago linked the MMR vaccine to autism; however, that study was discredited and retracted due to data misrepresentation. Numerous studies conducted prior to and after that study have shown no link between the MMR vaccine and autism.
Yet myths persist about vaccine safety that have led to decreased rates of vaccination in some communities. Parents believed their children would be safe because “herd immunity” from the rest of the population would keep measles from reappearing in the United States. Unfortunately, as numbers of unvaccinated persons has increased, herd immunity has decreased. This can have tragic consequences for those who, for medical reasons or because of age, cannot be vaccinated.
One of the most contagious pathogens
According to the CDC, measles is so contagious that if one person has it, up to 90 percent of the people close to that person who are not immune will also become infected.
Infected people can spread measles to others from four days before through four days after the rash appears. Measles transmission has been documented to have occurred even after a contagious person has left the room up to two hours before a susceptible person enters the room.
For many, measles infection means several days of high fever, cough, runny nose, rash and conjunctivitis. For those who experience more severe infection, however, complications can include permanent hearing loss, encephalitis, pneumonia, serious pregnancy complications and death.
The CDC recommends that children receive two doses of the MMR or MMRV vaccine—the first between the ages of 12-15 months and the second between the ages of 4-6 years. Adults who have only received one dose of the MMR should speak with their physician about getting a second booster vaccination. Adults vaccinated between the years 1963-1968 received the inactivated virus, which is considered significantly less protective over the long term than the attenuated live vaccine that has been in use since 1968. It is recommended that adults who were vaccinated during this period receive a second vaccination or have titers checked for immunity. Adults who were born prior to 1957 may be considered immune due to likely exposure to measles in childhood. It is recommended that they either get vaccinated now or have titers taken to measure immunity.
Even those who have previously had measles may still be at risk of infection and should consider getting vaccinated or having titers taken to confirm immunity.