When sound public health practices wane, dangerous diseases like measles make a comeback
In this guest editorial, Bernhard L. “Bud” Wiedermann, MD, MA, a pediatric infectious disease physician at Children’s National Medical Center in Washington, D.C., and a professor of pediatrics at The George Washington University School of Medicine and Health Sciences, discusses the dangers associated with the resurgence of vaccine-preventable diseases. He explains why immunization is so critically important, especially amid a “perfect storm” caused by complacency, anti-vaccine sentiment, increasing international travel and a highly contagious virus like measles.
Turn back the clock to 1961 and picture yourself as a pajama-clad 8-year-old boy, flush with a slight fever and a mild rash, surrounded by jabbering, giggling teenage girls rubbing cheeks with you and clamoring to drink your Dr. Pepper. That boy was me. I was the star at a German measles “party” thrown for my sister and her friends, and I was mortified.
I had German measles, or rubella. As vaccine-preventable diseases go, rubella is a relatively mild infection for many people. However, if a woman contracts rubella during pregnancy, it can result in very severe complications in the developing fetus, including hearing loss, blindness, intellectual disability, heart defects and stillbirth. A vaccine first became available in the United States in 1963. Before that, desperate parents took desperate measures to try to prevent future grandchildren from suffering harm from rubella.
Now, flip the clock forward to 2019. We are faced with a resurgence of measles — a much more serious vaccine-preventable disease than rubella — due to a perfect storm of sorts. Increased international travel combined with complacency about these infections and outright vaccine refusal, plus a particularly contagious virus, has resulted in an uptick in measles cases around the globe, including numbers in the U.S. this year that the CDC says are the second highest since endemic measles transmission was declared eliminated in the country in 2000.
Measles is an illness usually characterized by high fever accompanied by cough, runny nose and red eyes in its early stages, followed by the appearance of a striking rash starting at the head and progressing downward. It is spread by coughing and sneezing, and the virus can linger in the air for up to 2 hours after an infected individual has left a room. Unvaccinated people do not need to have direct contact with a measles case to become infected. It is so highly contagious that nine of 10 unvaccinated people who come in close contact with a person with measles become infected.
Although most infected individuals feel miserable but will recover without serious long-lasting damage, measles can be fatal. In resource-poor settings, the mortality rate approaches 30%. Even in industrialized countries like the U.S., an estimated one to three infected individuals per 1,000 will perish despite the best health care. What’s more, serious complications like pneumonia occur in one in 20 infected individuals, and encephalitis develops in one in 1,000 cases. Children aged younger than 5 years, pregnant women, and individuals with poorly functioning immune systems are at higher risk for complications and death from measles.
The measles vaccine is one of the safest and most effective vaccines we have available. A single dose, usually given to children aged 12 to 15 months of age, protects at least 93% of recipients; a second dose at age 4 to 6 years increases the protection to at least 97%. Still, with such a contagious virus, it takes only a handful of exposures to trigger an outbreak. From Jan. 1 to April 11, 555 cases of measles have been confirmed in 20 states, and that number certainly will grow unless overall vaccination levels in the general population rise quickly.
Another serious problem with measles is that some individuals, by virtue of having certain health conditions, cannot receive measles vaccine because of concerns about their unique risks for side effects. These folks have illnesses that are associated with weakened immune systems, including individuals receiving immune-suppressing drugs for transplanted organs, inflammatory diseases or cancer therapy; malnutrition; and poorly controlled HIV infection. An estimated 95% of a population needs to be immune to prevent an outbreak in a community — the threshold for herd immunity. Sadly, vaccination levels have fallen below this mark in many U.S. jurisdictions. Without improved vaccination rates, it is a matter of when, not if, these communities will experience a measles outbreak.
I have survived the mortification of being the object of teenagers’ attention during my rubella “party.” Such embarrassment fades after 5 decades. But imagine my shock when I learned in 2019 that people still choose to have their children attend “chickenpox parties” rather than have them receive the safe, effective and easily available varicella vaccine. Complications from natural infection — whether from measles, varicella or any of the other vaccine-preventable diseases — is much higher and more serious than the rare complications from any of the vaccines. Parents, just like their children’s physicians, ultimately want to see children protected from harm, including from preventable infectious diseases. Gatherings intended to deliberately expose children to these diseases should remain relegated to history.
CDC. Measles cases in 2019. https://www.cdc.gov/measles/cases-outbreaks.html. Accessed April 12, 2019.
CDC. Measles (rubeola). https://www.cdc.gov/measles/index.html. Accessed April 12, 2019.
CDC. Measles (rubeola). Transmission. https://www.cdc.gov/measles/about/transmission.html. Accessed April 12, 2019.
History of vaccines. https://www.historyofvaccines.org/content/herd-immunity-0. Accessed April 12, 2019.
Disclosure: Wiedermann reports no relevant financial disclosures.