Measles is one of the most contagious diseases ever studied – in fact, as many as nine out of every ten unvaccinated people who are exposed to the measles virus will contract it. Although the CDC officially declared the disease “eliminated” in 2000 due to record low numbers and thorough vaccination, the number of cases rose sharply recently. Given the current outbreak in Washington, should we be concerned that measles is back?
What Is Measles?
Measles is a virus that causes an infection of the respiratory system. After an incubation period of around twelve days, primary respiratory symptoms, including a cough and runny nose, begin first.
Usually, respiratory symptoms are accompanied by a fever and red-rimmed eyes. Often, these symptoms persevere for a few days before others set in.
The telltale symptom of measles is the reddish-brown rash that appears three to five days after initial symptoms begin. This rash begins at the top of the forehead, and then spreads down the face, neck, and torso. Before long, the patient’s arms, legs, and feet are affected, and fever can spike as high as 104 degrees.
A good percentage of measles patients do not suffer complications and return to normal within a few weeks. However, as many as 40% of measles cases experience complications.
Many of these patients are immunocompromised, but some are completely healthy. Of these, most are under the age of five, or above the age of 20. Complications include:
The most severe complications of measles are pneumonia and encephalitis, or swelling of the brain. Experienced by one in twenty and one in one thousand children, respectively, these complications cause death in two of every one thousand children.
Is Measles Contagious?
Measles is passed through contact with bodily fluids.
Most commonly, people inhale virus-containing droplets of saliva or mucus that have been sprayed into the air when an infected person sneezes or coughs.
Unfortunately, the virus is contagious as many as four days before symptoms appear, and as many as four days after the rash appears, although the highest risk of spreading measles occurs when the patient has a cough.
If a person with measles coughs in a room and leaves, the tiny aerosol droplets of saliva that remain in the air can infect another person hours later.
This fact alone is proof that measles is significantly different from other viruses, and speaks to the high numbers of measles cases before vaccination protocols were in existence. In fact, before the vaccine’s development in 1963, an average of 4 million measles cases were reported every year, resulting in an average of 500 deaths, yearly.
Wasn’t Measles Eliminated?
After the development of the measles vaccine, enough people were immunized that the CDC declared the virus eliminated in 2000.
While small pockets of the disease persisted in lesser-developed countries, vaccination kept cases of measles extremely low in the United States. Despite a spike in 2014, measles has remained low ever since.
However, 2018 saw 17 different outbreaks of measles, comprised of 372 unique cases.
Currently, there is an ongoing measles outbreak in Washington state. What’s behind the rise in cases? What can be done about it?
Is The Measles Spike Related To Vaccine Rates?
In the current Washington state measles outbreak, as in the New York outbreak that spanned the end of 2018 and the beginning of 2019, the majority of the cases occurred in children between one and ten who had not received vaccinations.
Initially, a carrier – or patient zero – picks up the virus while overseas, many times, in countries that still experience measles at a high rate. Then, the virus passes to other unvaccinated individuals.
In both the New York and Washington outbreaks, measles spread first among members of a small, insulated community that tends to opt out of vaccination. In the New York case, Orthodox Jewish communities were affected; in Washington, Slavic immigrants that do not believe in vaccination propagated the disease.
In highly insulated communities that do not vaccinate, the disease spreads quickly, and then moves on to the outside community at neighborhood schools, stores, and other facilities.
Is The Vaccine Safe?
Since avoidance of the measles vaccine seems to be a primary factor in the recent outbreaks, many people are wondering if the vaccine itself is safe. After all, why are so many avoiding vaccines?
Severely immunocompromised individuals aside, many people avoid vaccines due to misinformation about their side effects.
However, side effects are extremely mild – usually, just a fever or slight rash – and very rare, affecting only one in every six recipients of the vaccine.
More severe side effects, such as seizure, deafness, and brain damage, cannot be officially linked to the vaccine.
Why Do People Opt Out?
Since people opting out of vaccines are disproportionately affected by measles and continue to spread the disease beyond the initial patient, it is useful to discuss vaccine exemptions.
Some individuals – such as babies and the immunocompromised – cannot receive immunizations due to health concerns. Others choose to opt their children out of vaccine protocols for religious or ethical reasons.
Most states have legislation to ensure parents vaccinate their children. However, nearly all of those states allow religious exemptions, and 17 states allow moral exemptions for parents who otherwise oppose vaccination. Both of the recent outbreaks occurred in states that allowed moral exemptions at the time of the breakout.
Is Measles Back?
According to the CDC, measles has not become endemic yet. In other words, these measles outbreaks have not yet begun to maintain a constant presence in any part of the country. However, if populations continue to refuse vaccines, and if enough adults fail to realize that they may not have received all the necessary vaccines, the disease could once again become endemic.
If your child is not immunocompromised, it is important to ensure he or she receives the proper doses of measles vaccinations. If you are an adult who is unsure whether you have effective immunity, consult your vaccination records or ask a medical professional to review them.
Ensuring all members of the population receive the measles immunization is the only way to completely eradicate the disease and wipe it off the face of the planet. Since that means eliminating the disease from every country in the world, all countries must join in this fight.
Chief Operating Officer, The Compounding Pharmacy of America
Matthew Poteet, Pharm.D. graduated with Honors from Lee University with a Bachelors of Science in Biological Science. After his undergraduate training, he completed the Doctor of Pharmacy program at Mercer University Southern School of Pharmacy, graduating in 2004. Dr. Poteet has spent much of his pharmacy career on staff at two of the most prestigious academic teaching hospitals in the Southeast; Emory University in Atlanta and Vanderbilt University Medical Center in Nashville. At these institutions he received extensive experience and training in sterile products compounding.
He returned home to East Tennessee in 2010, where he has held the position of Pharmacy Director at two sterile products pharmacies in Knoxville. Matthew lives in Knoxville with his wife, Chris. Dr. Poteet is Tennessee’s first Board Certified Anti-Aging Pharmacist by the American Academy of Anti-Aging Medicine.