Measles: Highly Contagious Disease Reaches New Epidemic Levels

Measles is Back and it’s Entirely Our Fault

If you haven’t heard by now, the measles virus is on the rise in the United States. As of May 23, 2014, 288 cases have been reported in 18 states with 15 distinct outbreaks making up 79% of the reported cases this year.

CDC Measles Cases and Outbreaks 2014

Of these cases, over half are ages 20 or older and 43 have been hospitalized, mostly because of pneumonia. Additionally, 85% of this year’s cases are occurring in people who were not vaccinated because of religious, philosophical or personal objections, according Dr. Anne Schuchat, director of Immunization and Respiratory Diseases at the US Centers for Disease Control (CDC). Major outbreaks have occurred in Amish communities in Ohio, in the San Francisco Bay Area and Orange County and in Upper Manhattan .

Reasons for not receiving measles vaccine in current outbreak

US Measles Cases 2014, graph by Mother Jones

Why should you care? Measles is no joke – it is extremely contagious (9 of 10 susceptible people with close contact to a patient will develop measles) and can lead to ear infection, diarrhea, pneumonia, miscarriage, meningitis and death even in people who were previously healthy. Measles is spread through airborne droplets and remains in the air even 2 hours after a person has left the room.

Measles Review courtesy of The Washington Post

How do you prevent getting this potentially devastating disease? Vaccination, pure and simple. In 2005, a measles outbreak occurred in Indiana after a non-immunized teen traveled to Romania with a church group. Unknowingly infected, she returned home and attended a church gathering the next day of about 500 people. Of those 500, 450 had evidence of immunity and less than 1% came down with measles. Of the 50 who were not immunized, 32% became infected. Of the 35 children whose parents had declined immunization, 31 eventually caught the virus – 16 were infected that very day.

Child receiving vaccine, picture courtesy of NY Times Parenting Blog

Once rare, now often unrecognized

In the decades after the vaccine was introduced in 1963, cases of measles dropped significantly until it was finally declared eliminated in the US in 2000. As such, many clinicians have never seen a case of measles outside of textbooks. In the midst of this resurgence in the disease, it’s important that clinicians can recognize the signs and symptoms of the virus.

Estimated measles mortality and measles deaths prevented by vaccination, courtesy of the CDC

Measles is characterized by a prodrome of fever (up to 105F) with malaise and the three Cs: cough, coryza and conjunctivitis. Blue-white Koplik spots in the patient’s mouth are pathognomonic and are followed by a maculopapular rash that appears 2 weeks after a person is exposed and that spreads from the head to the trunk and then to the lower extremities. Patients should be considered contagious from 4 days before to 4 days after the rash appears.

A measles case is considered confirmed if it is laboratory confirmed (detect serum IgM to measles or detect measles virus nucleic acid from specimen) or meets the clinical case definition:

  • Generalized rash lasting > 3 days
  • Temperature of > 101F / 38.3 C
  • Cough, coryza and/or conjunctivitis
  • Is linked epidemiologically to a confirmed case

Characteristic rash of measles.
(C) American Academy of Pediatrics

More pictures can be found here.

While complications such as otitis media, bronchopneumonia, and laryngotracheobronchitis are common, serious, though rare, complications can occur . Approximately 1/1000 will develop acute encephalitis, 1-2/1000 will die from respiratory and neurologic complications and subacute scleorsing panencephalitis, a fatal degenerative disease of the central nervous system can develop 7-10 years after measles infection occurs.

The CDC has an excellent resource for physicians on vaccinating, recognizing and treating measles infections. The American Academy of Pediatrics has many resources which can be accessed here, and the MMR Vaccine Information sheet can be accessed here.

Children should receive the MMR vaccine, which covers the measles virus, starting with the first dose between 12 and 15 months, and the 2nd dose at 4-6 years of age. College students, international travelers, and healthcare personnel are encouraged to get vaccinated if they do not have evidence of immunity. A comprehensive vaccine schedule for parents can be downloaded here.

The World Health Organization has also put together a helpful infographic about the disease for the general public.

WHO fact sheet

Hysteria, Vaccines, and Epidemics

Prominent figures like Jenny McCarthy have made false claims about dangers associated with vaccine administration, including supposed links to autism, which have led to a decline in the percentage of children receiving full immunizations in this country.  These tables track vaccination from 1995-2012 by race and income  and by state.

Omer and colleagues published an article in the New England Journal of Medicine in 2012 which showed rates of non-medical immunization exemptions made in 2006-2011. The number of children not getting vaccinated for non-medical reasons in on the rise.

Rates of NonMedical Exemptions from School Immunizations, S Omer N Eng J Med 2012

Rates of NonMedical Exemptions from School Immunizations, S Omer N Eng J Med 2012

The website Mother Jones took this and other data and made some pretty impressive infographics highlighting the anti-vaccine problem in the United States.


Rate of NonMedical Vaccine by State - MJ

How Hard to get Vax Exemption

Laws for and against vax exemptions

Why are people refusing to vaccinate their children even though physicians and scientists continue to push and advocate for immunization? A study published in the Lancet in 2011 attempted to address the ‘vaccine-confidence gap’ by asking people who they trusted for advice on immunization Even though most answered a healthcare provider, only 54% ‘strongly agreed’ that they would trust a medical professional.

New Decade of Vaccines 5: Addressing the vaccine confidence gap. Heidi J Larson et al. Lancet 2011; 378: 526-35

New Decade of Vaccines 5: Addressing the vaccine confidence gap. Heidi J Larson et al. Lancet 2011; 378: 526-35

This video by PhD Comics explains how vaccines work in a way that the lay person can understand.


And if you still can’t convince someone to get their children vaccinated, perhaps this PSA from WHO will do the trick.

Report written by Vidya Eswaran


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