As of April 24, 2019, there have been 695 confirmed measles cases in the United States, the highest number reported in 25 years. The US declared measles eliminated from the country in 2000, but with more parents choosing not to vaccinate their healthy children, there is a concern this recently rare disease will return permanently in the US. Globally, the World Health Organization reported the number of cases has nearly quadrupled in the first quarter of 2019, putting the most vulnerable populations around the world and at home in jeopardy.
This week in Brooklyn, NY, a judge ruled against a group of parents who challenged the mandatory vaccine order imposed by the local health department. The parents argued that the city’s public health officials had exceeded their authority when imposing the mandatory vaccination instead of recommending quarantine for families with unvaccinated children. The city won, arguing that people are infectious before they become ill. Therefore, a quarantine would be inadequate to control one of the most contagious viruses on the planet. It only required one infected unvaccinated child to travel to Michigan to cause 39 people to become ill, demonstrating the potential of the measles virus to infect 9 out of 10 people who encounter an infected individual.
The measles virus causes infection through direct contact with an infected person, through the air and lives on surfaces for up to two hours, making it very easy to spread through a community and across the globe. The most vulnerable people in our population that are most likely to develop complications are infants and children under the age of 5, adults over the age of 20, pregnant women, and children and adults with weak immune systems. Complications include permanent hearing loss, pneumonia, encephalitis (swelling of the brain), permanent brain damage and subacute sclerosing panencephalitis (SSPE). SSPE is a rare fatal disease of the central nervous system that results from a measles virus infection. SSPE generally does not cause symptoms until 7-10 years after the initial infection. During recent US outbreaks, 4-7 out of 100,000 developed SSPE, with the highest risk in those younger than 2 years of age. Most of these infants and toddlers died before they reached their teens.
The only way to prevent the disease from spreading further and becoming a permanent fixture in the US is to vaccinate everyone who eligible for the vaccine. For herd immunity to protect the vulnerable people in a community, 90 percent of the population must be immune to a disease. Without this layer of protection, adults and children with compromised immune systems inevitably become a statistic with 1 out of 4 people requiring hospitalization and 1 to 2 people out of 1000 dying from complications of the illness, most from pneumonia.
Whether to vaccinate your children can be a difficult decision. After all, we are driven to protect our children at all cost. However, there is overwhelming scientific data that demonstrate the MMR vaccine is effective and much safer than contracting measles naturally. As physicians, one of the most challenging things we face is the death or disability of those in our care. Our emotional pain is a thousand times worse when permanent disability or death could have been prevented by a safe and readily available intervention.
Most adults believe they are immune to the disease because they were vaccinated or became ill with the virus during childhood, however many are not. A simple and inexpensive blood test can confirm if you are immune.