Measles is having a field day across the world, including the United States. This devastating and potentially deadly disease is so contagious that any small opening we give it to spread has overwhelming consequences.
Where Is Measles Resurging?
The United States has several recent hot spots of spread that have raised public health alarm bells. As of February 22, there were 35 cases across 15 states. The numbers are currently on track to exceed those reported each year since the last major surge in 2019.
Why Do We Care About Measles?
Since the discovery of effective vaccines decades ago, many developed countries have been successful in containing measles. Because of this success, though, there may be a perception that measles is a benign illness that merely causes a rash, runny nose and fever. Unfortunately, this is not the case. Measles can lead to death or damaging infection of the brain in one to three children per 1,000 infected. It can also cause severe consequences in pregnancy and in the growing number of individuals with compromised immune systems, such as organ transplant recipients, patients with cancer or HIV or other diseases requiring immune suppressing medications. In impoverished areas with poor nutrition, it can lead to devastating and deadly diarrhea, especially in children under five years old. Around the world, over 100,000 children still die from measles each year.
What Is Driving The Resurgence?
There are several factors that have led to the rise in measles cases. We can assess the impact of different infectious diseases by how many follow-on cases occur after a single case of disease. This value is called the “basic reproductive number,” R0 (pronounced R naught). Measles just happens to be the most contagious infection there is, with an R0 of 12 to 18. That means, for a single person who has measles, they can spread it to 12 to 18 others, on average. With such a high number, it is not hard to see how things can get out of control very quickly.
Second, because it is so contagious, in order to keep measles under control, immunity among the population has to be maintained at extremely high levels, at a minimum of 95%. People can gain immunity from either natural infection or vaccination. The United States used to achieve this level; however, due to several factors, including religious exemptions, increased numbers of individuals with immune-related disease who can’t be vaccinated and most importantly, growing mistrust of vaccines, the U.S. measles vaccination level has dropped. Recent estimates show a decline in measles vaccine coverage from the 2019-2020 school year of 95% to around 93% in the 2022-2023 school year. Vaccine exemptions exceeded 5% in ten states and increased in 41 states. With such exemption rates, it is no surprise to anyone involved in public health why we are seeing a measles resurgence.
Third, although we had several years with a significant decline in travel due to Covid-19, we are now seeing a record number of travelers. Not every country has the resources to vaccinate their populations against measles, and many routine vaccinations were disrupted due to the pandemic. This provides an opportunity for individuals infected with diseases that occur more commonly outside the U.S. to arrive already infected and to initiate spread inside the U.S.
Fourth, after the Covid-19 hiatus, children are back in school and daycare. Every virus takes advantage of human behavior to perpetuate itself. For the measles virus to thrive, there is no better place to find susceptible new hosts than in a crowded school, where mixing occurs constantly inside classrooms, in the hallways and on buses.
How Does Measles Spread?
Measles spreads by respiratory droplets. After exposure, the prodrome of high fever begins about 10 to 12 days later and the rash appears around 14 days later. An individual can spread the virus from four days before through four days after appearance of the rash. If you have ever seen a picture of a child with measles, it is easy to perceive how miserable they feel. In addition to the obvious rash, their eyes are red and dripping, and their nose is running. They are basically sputtering and spewing out respiratory droplets constantly. You don’t need a rocket science degree to understand that all those fluids help potentiate measles’s efficient spread.
Public health measures have developed over decades for a simple reason: they work. They also require leadership, a consistent message and the population needs to be part of the solution. Broward County, Florida is in the midst of a measles outbreak in an elementary school. Rather than mandating restriction of children without prior infection or vaccination from attending school temporarily, as is standard public health practice, the Florida Surgeon General wrote a letter to parents on February 20 giving them the option of still sending their children to school. Such a decision could potentially backfire, because measles is so contagious.
Usually public health authorities prefer to shut down any opportunity for spread as quickly as possible, lest it get out of control. The United Kingdom provides an important example, where low levels of cases percolated for most of 2023, then exploded in November. The UK Health Security Agency has reported 581 laboratory confirmed cases just since October 1, 2023. Once the genie gets out of the bottle, if that genie is measles, it is very difficult to put it back in.
What Can You Do To Protect Yourself And Your Family?
Anyone who has seen the 1960s movie, “The Graduate,” will remember the famous advice Roger Brooke (as Mr. McGuire) gave to a nervous Dustin Hoffman (as Benjamin Braddock), “I just want to say one word to you. Just one word.” The word is “Plastics.”
In the same vein, protecting yourself and your family is simple. I just want to say one word to you, just one word. Vaccinate. The measles vaccine is one of the best there is. The vaccine shields us from becoming infected ourselves and from spreading measles to others. There is no simpler, more effective means to protect you and those you care about than to get vaccinated and ensure your children are vaccinated on the recommended schedule.
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