Measles update, 2024. Where? How bad? Why it matters and why kids really need vaccinations.
Your major questions answered. (I can't believe we have to do this.)
In 2000, measles was declared eliminated from the United States. That didn’t last long. The anti-vax movement undermined science well enough to allow measles to make a comeback. So, while we hate to see it, we need to talk about measles…
Please read this, and share it with anyone who you think needs to see it.
Where is measles so far in the US?
As of February 22nd, 15 states have reported measles cases to the CDC. (Measles cases must be reported to the CDC, so these numbers are probably decent.) The states with reported measles case so far are: Arizona, California, Florida, Georgia, Indiana, Louisiana, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania, Virginia, and Washington.
How does this year stack up?
So far, in the US, the number of confirmed cases (35) does not exceed what we’ve seen in recent years, though this outbreak may be early.
But the context this year is different for two reasons. First, the number of cases worldwide is far higher than usual. Second, the Florida Surgeon General has made headlines for its pathetically milquetoast messaging on pediatric measles vaccination. That messaging could spill over to vaccine hesitancy in other places.
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Of note, you can see that 2019 had an unusually high number of cases. While we can’t know with certainty, we can guess why 2020 was a lot better; measles outbreaks often occur in late winter and early spring. So, it’s possible that the early Covid-19 “stay at home” period in 2020 stamped measles out (in addition to flattening the Covid curve). And in the fall of 2020, many schools were still teaching remotely—so measles had less of an opportunity to spread.
What are typical measles symptoms?
Per the CDC (I have not ever seen a case, thank goodness), measles symptoms include fever, cough, runny nose, and redness of the eyes (conjunctivitis). White lesions in the mouth sometimes appear a few days into the illness. The infamous measles rash is marked by tiny red bumps that you can feel with your fingers. The rash can come with very high fevers (104°F).
How bad is measles?
The CDC’s website is quite clear on the risk that measles poses. So, I am reproducing key information verbatim here:
Hospitalization. About 1 in 5 unvaccinated people in the U.S. who get measles is hospitalized.
Pneumonia. As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.
Encephalitis. About 1 child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability.
Death. Nearly 1 to 3 of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.
Complications during pregnancy. Measles may cause pregnant women who have not had the MMR vaccine to give birth prematurely, or have a low-birth-weight baby.
A very scary (though rare) complication called “Subacute sclerosing panencephalitis” can occur. (Never seen it. Don’t want to.)
Common complications include ear infections and diarrhea.
Who is at risk?
Again, the CDC’s website is good on this. Here is what the CDC says:
Children younger than 5 years of age.
Adults older than 20 years of age.
Pregnant women.
People with compromised immune systems, such as from leukemia or HIV infection.
How does measles cause “immune amnesia”?
Measles is an unusually bad virus (especially for kids, pregnant women, immunocompromised people, and older folks) for a few reasons. First, it can be deadly, or, more commonly, cause the awful problems listed above. Second, unlike most viruses, measles actually wipes out our immune system’s memory of other pathogens, due to the types of cells it infects. In impressive work by my friend Dr. Michael Mina and his former colleagues here at Brigham and Women’s Hospital/Harvard Medical School, it was shown that measles can effectively cancel 11%-73% of antibodies to other infections that the body already has. That effect can last years. So, measles vaccination not only protects against measles, but maintains the protection the body has built to other invaders.
Vaccines work. Vaccines are the answer. Vaccines, folks!
The worst outbreak of the century occurred in 2019. Most of the cases occurred in unvaccinated children. But if you want an amazing look at how effective vaccines have been in the real world, check out this animation by Dr. Kristen Panthagani (an Inside Medicine contributor, and author of a great blog called You Can Know Things). The power of vaccines is hard to deny:
Is the measles vaccine safe? (Yes.)
The measles vaccine has a long record of being safe and effective. Plus, the vaccine is exceedingly safer than unmitigated measles itself. The usual side effects are fever (usually a week after injection) and, rarely, febrile seizures (1 in 3,000 kids; these events are self-limited and almost never a genuine threat). Again, the virus does all that and more.
Can you catch measles if vaccinated?
Yes, though protection against severe disease is excellent, and lasts decades.
An American achievement.
We should celebrate when people in our country do good work. In the 1960s, scientists here in Boston developed the measles vaccine. That work has saved lives and misery (to say nothing of all the sick days prevented). When our leaders undermine vaccines, they are not only harming children and others at risk, but they are weakening the legacy of some of the truly great things that have been achieved here in the US. We should be leading the fight against viruses like measles, not aiding and abetting them!
Questions? Ideas? Please add them to the Comments section!
And thanks again to Dr. Kristen Panthagani for the data viz.
Back in 2015 I went back to grad school, and this being Massachusetts they required a measles titer and not just documentation of vaccination. Lo and behold, my childhood measles vaccine was no longer providing protection, and I had to get a new pair of MMR shots. (Yes, I'm in _that_ age group.)
So one thing I'd add to your discussion above is that people shouldn't assume that just because we were inoculated against measles decades ago, we're still covered.
"We should be leading the fight against viruses like measles, not aiding and abetting them!" - Amen. -- Just because it awakened a long-dormant memory: Like many my age, I had measles at about age 5. It was memorable, because it coincided with the first real snowstorm in Houston in many years, and I couldn't go out to play in it, so my father built me a snowman that I could watch from the window. The snowman disappeared before I recovered. -- Seriously, though: we need to consider how we have gotten to the point where doctors are ignoring or denying solid medical evidence in favor of advancing political agendas. (Of course, the AMA was long the primary opponent of changes to make health care more widely available, or even universal - but perhaps that doesn't count as 'medical' ...). But I digress: "Vaccines work. Vaccines are the answer. Vaccines, folks!"