Recent outbreaks of measles in the United States have raised serious concerns over the gaps in immunizations. The disease, which affects mostly children, has seen a resurgence in recent years with the highest number of cases reported in 2011 (233) and 2013 (189). These represent the largest outbreaks since 1996, when some 500 cases occurred. Measles had been all but eradicated by 2000 in the U.S., but the preventable disease still haunts us with the reminder that, in an open world of increasingly active travel, infectious disease has become a concern that needs to be addressed globally.
Measles, a highly infectious viral disease, spreads by droplet via the respiratory tract of infected persons. Initial symptoms appear from 10 to 12 days after exposure and include high fever, rhinitis, conjunctivitis, cough and white spots inside the mouth, which are transient but considered diagnostic if seen in time. After two or three days a rash appears on the face and upper neck before enveloping most of the body, often causing itching. Although the disease runs its course in two to three weeks, malnourished and immunocompromised children can fall prey to serious complications such as blindness, pneumonia, otitis media, and severe diarrhea.
Although vaccinations rates for measles in the U.S. exceeds the recommended 90 percent, the recent outbreaks may be attributed to national geographic gaps in immunization, affecting the vulnerable portion of the population. Within the U.S., where vaccines are widely available, experts single out those with objections to vaccines as the major impediment to herd immunity. U.S. citizens have a variety of reasons for declining vaccinations for themselves or their children. Some have religious objections. Others resent authority controlling their lives. Quite a few people, influenced by blogs and highly emotional websites, feel that vaccines may contain harmful additives or that the attenuated virus can hamper the full potential of the immune system. For example, in 1998 Andrew Wakefield, a former British surgeon and medical researcher, published an article blaming the MMR (measles, mumps, and rubella) vaccine for the rise in autism rates among children. The topic spread like wildfire over the internet, influencing parents’ perceptions about child immunizations.
So far, this year, at least 53 people in 10 states have been diagnosed with measles. The states include California, Oregon, Texas, New York, and Hawaii. Not far from the northwest U.S. border, the disease has been verified in at least 100 people living in the east Fraser Valley of British Columbia, the most recent exposure occurring at a school in Chilliwack, in a community with traditionally low rates of immunization. Victoria Lee, a spokesperson for the Fraser Valley Health Authority stated that overall immunization rates for the area fall between 60 and 70 percent but that, in some of the schools, the rate is as low as zero percent.
The U.S. receives scores of unvaccinated visitors from poor countries around the world, with little to no access to immunizations. These visits bring viruses that affect the vulnerable portion of the population. In 2013, over 99 percent of young children in the U.S. received measles vaccinations. Still, health authorities confirmed 159 cases of the infection. Almost all of these were attributed to these “imported” viruses, brought from overseas.
In summary, the U.S. has seen a recent rise in measles outbreaks, raising awareness over gaps in immunization. Encouraging parents to immunize their child may help to reduce the rate of infections.
By Robert Wisnewski