In the 9th century, a Persian doctor for the first time published a written account of measles. Francis Home, a Scottish physician first reported that measles was caused by an infectious agent. In 1912 measles became a notifiable disease and about 6000 deaths per year was reported. Measles vaccine was licensed in 1963 and now is usually combined with mumps and rubella (MMR).
Symptoms of measles are fever, cough, runny nose and red watery eyes. Two to three days after symptoms begin tiny white spots may appear inside the mouth. Three to five days after symptoms begin, a rash breaks out.It usually begins as flat red spots that appear on the face and spread downward to the neck, trunk, arms, legs and feet. Usually fever subsides with the appearance of the rash. Unfortunately many of the newly trained physicians in USA have not seen a case of measles and hence might miss the diagnosis. Complications associated with measles include ear infection, pneumonia, diarrhea and postinfectious encephalitis. Measles run a more devastating course in children in developing countries. A natural infection usually gives a lifelong immunity.
Since the introduction of the vaccines, deaths from measles are down globally. In developing countries measles used to have a high mortality in children as the infection causes a decrease in immunity which in turn makes dormant infections like tuberculosis fulminant. Lots of these children become malnourished which also contributes to high mortality. The number of measles related deaths has decreased 79% from 586,000 at the beginning of the century to 114.900 in 2014.Measles cases worldwide increased by 79% in 2023. The rise of anti vaccination sentiments during the Covid-19 pandemic might be playing a role in this decline. CDC is focused on eliminating measles in every region of the world. The Democratic Republic of Congo, Ethiopia, Indonesia, Nigeria and Pakistan account for half of unvaccinated infants and 75% of measles deaths.
In 1974, measles was among the first disease targeted by the World Health Organization (WHO) when it established the Expanded Program on Immunization (EPI). WHO recommends vaccination starting at 9 months of age in endemic countries and at 1 year in non-endemic countries. A booster is given at 4 years of age. The goal to eliminate measles in American region by 1982 did not meet its goals and finally was eliminated in 2000.
A minor setback for the success of the measles vaccine occurred in 1998, when a fraudulent research paper was published asserting a link between MMR vaccine and autism without any scientific evidence. Because measles has such high infectivity rate, the threshold for protection is also very high, requiring at least 95% of immunity among population to prevent an epidemic.
Over 61 million doses of measles containing vaccine were postponed or missed from 2020 to 2022 due to Covid related delays. This increases the risks for out breaks around the globe including United States. Although measles was declared eliminated in the United States Right now measles outbreaks are occurring all around the world and it can enter through infected travelers. Although measles was eliminated in United States in 2000,almost 1300 cases of measles were reported in 31 States in 2019. As of March 14, 17 States including Pennsylvania, have reported a total of 58 cases this year- 54 of which were linked to international travel. Late last month there was a large out break in Florida. It can also be fatal. In 2021 an estimated 128,000 people most of whom are children, died from the disease. In 2014 there was a measles outbreak that began in Disneyland.
131 Californians were affected and there were 16 cases in 6 other states. Many people thought of measles as a disease of the past, and the Disney out break came as a surprise. Unfortunately there is still a large population who are anti vaxers and refuse vaccines. We will have to have legislative laws passed to make some of these vaccines mandatory for school, travel etc. A recent nationwide survey found that Southern California alone has 350 schools falling short of the desired threshold. Following Disneyland outbreak in California in 2015, the legislature passed a law to remove the “personal belief” exemptions. Vaccine exemptions laws vary widely across the U.S., with some states allowing only medical exemptions, some allowing religious exemptions, and others permitting philosophical exemptions too. All states except California, Mississippi and West Virginia gives religious exemptions. All states give medical exemptions. Currently there are only 14 states that allow people to refuse vaccine for personal or philosophical beliefs.
Moving forward we have to be very vigilant. Babies 6 months and above should be vaccinated for measles before their travel to an endemic part of the world. Clinicians should be very aware of measles and should always suspect measles when a child with fever and rash is seen. A nasal swab or urine can be tested with PCR to make the diagnosis. All suspected cases should be isolated since the disease is highly contagious. Diagnosed cases should be reported to to public health authorities. Unfortunately since it is a viral infection there is only conservative treatment. American Academy of Pediatrics recommends Vitamin A administration to all children with severe measles. Parents should be educated about an illness which is trivial but could also be fatal. It will be real global shame if a vaccine preventable illness like measles comes back takes innocent lives. The pitch should be Vaccination. Vaccination...Vaccination..
