Measles has made a resurgence in the U.S. after being declared eradicated in 2000, following development of a vaccine in 1963. Prior to the vaccine, 3-4 million people were infected in the U.S. each year, resulting in 48,000 hospitalizations, 400-500 deaths and approximately 1,000 who developed chronic disabilities.
Even with modern medical care, the disease can lead to serious complications, including blindness, pneumonia, otitis media and severe diarrhea. Despite the availability of a vaccine it remains a leading cause of death among young children worldwide, with deaths mainly attributable to the complications of the disease.
Measles is a highly contagious disease caused by an airborne virus that can remain infectious for up to two hours after an infected person leaves the room. More than 90 percent of susceptible people, usually unvaccinated, develop the disease after being exposed. There is no treatment except to make the patient as comfortable as possible by keeping them hydrated and trying to control the fever. Unvaccinated young children and pregnant women are at the highest risk for measles and its complications, including death.
According to the World Health Organization (WHO), measles is still common in a number of developing countries, especially parts of Asia and Africa. Of the over 20 million people infected with the disease each year, over 95 percent of the deaths occur in countries with weak health infrastructures and low per capita incomes. Outbreaks can be a particular problem in countries experiencing natural disasters or conflicts that damage the health infrastructure, affecting the availability of routine immunization. Since 2000, over 1 billion children in high-risk countries have been vaccinated through mass immunization campaigns. 145 million were immunized in 2012 alone, helping reduce worldwide measles deaths by 78 percent.
The Centers for Disease Control and Prevention (CDC) reports that only about only 55 people in the U.S. contracted measles in 2012. Vaccination, in use since 1963, is safe and inexpensive, costing only about $1 per dose, but despite its wide availability the disease has made a resurgence in 2014, with 554 cases reported already this year.
Most measles cases are associated with foreign travel, typically when unvaccinated Americans travel abroad and contract the disease, then bring it back into the U.S. Most cases this year have come from the Philippines, where there has been a large outbreak.
The first symptom of measles is typically a high fever, beginning 10 to 12 days after exposure, and lasting four to seven days. In the initial stage the infected person can develop a runny nose, watery and red eyes, cough and small white spots inside the cheeks. A rash breaks out after several days, usually on the upper neck and face and spreading to hands and feet.
A new Global Measles and Rubella Strategic Plan was launched by the Measles & Rubella Initiative in 2012 that includes global goals of reducing measles deaths worldwide by at least 95 percent in the period of 2010 to 2015, and achieving measles elimination in at least five WHO regions by the end of 2020. The strategy for accomplishing these goals is based on the core concepts of high vaccination coverage, effective disease monitoring, development of outbreak preparedness, communicating the need for and building public confidence in immunizations, and performing the research and development needed to improve diagnostic and vaccination tools.
Britain has also seen a resurgence of the disease since 1998 when a paper was published that suggested a link between autism and the measles-mumps-rubella (MMR) vaccine. The paper was later withdrawn and the author’s British medical license revoked, but the country’s vaccination levels have still not returned to pre-1998 levels. Measles cases in Britain have risen to over 10 times what was reported a decade ago.
Despite the inexpensive cost of the measles vaccine, immunization campaigns have suffered since 2008 due to funding cutbacks, contributing to the resurgence of the disease in the U.S. and other countries worldwide. MMR vaccination schedules include two doses, the first being given shortly after 12 months of age. A second dose is necessary as not everyone develops immunity from the first dose.
By Beth A. Balen
World Health Organization
Centers for Disease Control and Prevention (Frequently Asked Questions)
Centers for Disease Control and Prevention (Measles Cases)
Centers for Disease Control and Prevention (Measles Vaccination)
Immunization Action Coalition
New York Times