Measles can kill

The current resurgence of measles in the United States is greatly alarming. The Center for Disease Control and Prevention (CDC) reported that, as of April 11, 2019, there were 555 new cases in 20 States, 359 of which were in New York. This is the second highest (667 cases in 2014) since it was “eradicated” in 2000, almost 2 decades ago. Globally, there has been a 300 percent increase in 2019 (112,163 cases) compared to 2018 (28,124 cases) in 170 countries.

When was measles first discovered?

            Zakariya Razi, a Persian physician-philosopher was the one who described measles in the 9th century. In 1954 researchers Dr. Thomas C. Peebles and Dr. John F. Enders isolated the virus during the outbreak among Massachusetts students, which subsequently enabled the development of the measles vaccine in 1963. Past data show that “in 1920, the United States had 469,924 recorded cases of measles and 7,575 deaths associated with measles. From 1958 to 1962, the U.S. averaged 503,282 cases and 432 death associated with measles each year. 

What is the clinical picture of measles?

                The highly contagious airborne virus, morbillivirus, causes measles, which easily spreads by droplet infection thru sneezing, coughing, and contact with oro-nasal secretions. The patient comes in with very high fever, runny nose, cough, watery eyes, malaise, which develop between 7-21 days after exposure. Two to 3 days later, Koplik spots are seen in the mouth. A few days after the first sign shows up, the skin rash spreads to the face and throughout the entire body. Ninety percent of those exposed to it, even momentarily, could get infected unless previously vaccinated.

How long does the virus survive?

                The virus remains alive and contagious in the air and on surfaces for 2 hours, and in an examining room, it could still cause infection 2 hours after an infected patient has left the room. The patient is contagious 4 days before and 4 days after rash appears, so it is possible to get mealses from an infected person even before he/she develops the typical symptoms or rash. The transmission does not need close contact to happen.

How serious is measles?

            Measles carries severe potential complications like pneumonia, encephalitis (brains welling), and death. Children under five, adults older than 20, very old seniors, and those with compromised immune system, are more prone to develop complications. One of my professors in Pediatrics, only in his 50s, died in the USA from complications of measles. The CDC reports that “one in 1,000 to 2,000 patients with measles will have swelling of the brain (encephalitis) and approximately 6 percent of all measles cases will get pneumonia.”

What was the impact of MMR?

Between 2000 to 2016, there was an 84 percent reduction in deaths from measles: 20.4 million deaths have been prevented. Thanks to the measles vaccine. According to CDC “in the decade prior to the introduction of the MMR (measles-mumps-rubella) combination vaccine in the United States, it’s estimated that more than three million people were infected with the measles each year. Since MMR reached widespread use, measles cases in the country have been reduced by more than 99%.” Still, around 400 people die of measles each single day around the world today. As of March 14, 2019, 315 patients died out of 21,396 measles cases in the Philippines.

Why the resurgence?

Measles was declared eliminated in the United States in 2000. But today’s ease of travel makes it easy for the measles virus to spread around the globe.  According to the CDC, “about 50% of imported measles cases in the United States are in U.S. residents coming back from other countries.” More than 30 million children in the USA are not vaccinated, some because of parental refusal (fear of autism as a complication, which is baseless), others for lack of access, etc. In the USA, 91.1 percent of children have received MMR vaccine. This is a major part of the problem globally, including for the Philippines, where only about 3.9 million children (out of more than 30 million) have been vaccinated.

Why are some parents suing?                                    

Five anti-vaccine parents filed a suit against New York for its mandatory vaccination ordinance, which a Brooklyn Judge recently dismissed to protect the general public. Washington State a week ago passed a bill that removes the personal belief exemption from MMR vaccinations. These misguided parents are partly responsible for the resurgence of measles. Those parents against Gardasil (the 98-percent effective anti-cervical cancer vaccine), who unwittingly put young girls at risk for this dreaded cancer. A grave mistake. Rejection might be justified ONLY WHEN the illness was not contagious and would not harm others.

When was the vaccine introduced?

The measles vaccine was developed in 1963. In 1967, vaccines were available for mumps, and in 1969, for rubella (German measles). The 3 were then combined in 1971, popularly known today as MMR vaccine. The first national measles campaign of 1966 brought down the incidence of measles. Four years later, the rate came down to 47,351 cases and 89 deaths, a fraction of previous statistics before the vaccine was introduced. The worst in recent memory is in 2014, where there were 667 cases of measles in the USA.

How effective is the vaccine?

The MMR vaccine is 99 percent effective in preventing measles, mumps, and rubella. Unfortunately, as I have said earlier, there are many who refuse to avail of the protection vaccines could provide. The CDC recommends that all children get two doses of MMR vaccine….the first dose at 12 to 15 months and the second dose at 4 to 6 years. The CDC urges adults … to get vaccinated.” When vaccination rate is high, fewer unvaccinated individuals could also be exposed, therefore, less infection rate, the phenomenon called herd immunity. Vaccinations save not only the immunized person but also the unvaccinated ones. Measles vaccine protects for at least 20 years and life-long immunity for about 96 percent of people.

What is SSPE?

Those who develop chronic progressive brain inflammation called Subacute Sclerosing Pan-Encephalitis (SSPE) as a complication of measles could have the following, even 6 to 8 years after the infection: behavioral changes, uncontrollable movements, memory loss, blindness, inability to walk, seizures, coma, leading to a persistent vegetative state.

Measles is a most contagious disease, a potential killer. It is nothing to sneeze about.  The vaccine is 99 percent effective, safe, and a life-saver. The choice is a no-brainer.

Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: philipSchua.com and FUN8888.com   Email: [email protected]