Here’s a certainty about measles. Anyone who receives the proper dose of measles vaccine will never get the infectious viral disease, even if exposed to it. Unfortunately, health officials announced the year’s fourth case of measles in Connecticut on Oct. 25.
Some baby boomers will recall the days before the vaccine was introduced in 1963, when there were 4 million cases, 48,000 hospitalizations and 500 deaths nationally every year. By 2000, though, measles essentially vanished from the United States, wiped out by immunization. But now it’s back, with outbreaks recently in California, Washington state, New York and New Jersey.
Even though the four cases in Connecticut are higher than last year’s total, the high rate of vaccination in the state could minimize the chances of a widespread outbreak.
“That remains to be seen,” says Dr. Jack Ross, chief of infectious disease at Hartford Hospital, “but the past suggests Connecticut will not see the scope of Washington or California, but be at risk for imported cases as in the past.”
Measles, a highly infectious disease with complications particularly dangerous for young children, is back at least in part because of lapses in vaccination fueled by mistrust and misinformation. In a recent week, the Centers for Disease Control and Prevention said 20 of 30 cases reported in Clark County, Wash., were people who had not been immunized. By the end of January, 47 cases had been reported in Clark County.
“Vaccination is key to public health,” says Dr. Ross, “relieving all of us of the tragedy and misery of vaccine-preventable diseases such as polio, smallpox, measles and meningitis. Ask anyone who has experienced shingles — they would gladly, in retrospect, take the shingles vaccines.”
The suspicion about the possible dangers of the measles vaccine is associated with an article in the journal Lancet in 1998 by British physician Andrew Wakefield that linked the vaccine to autism in children. Although the article was debunked — Wakefield was subsequently banned from practicing medicine — parents in several areas around the country, still clinging to the vaccine-autism myth, have not allowed their children to be vaccinated.
“Sadly,” says Dr. Ross, “the Lancet article has led to the current situation and the previous outbreak at Disney (2015) in California. The article has been totally refuted and retracted when shown to be fraudulent due to fabrication of the data by the author. Unfortunately, celebrities and parents looking for an explanation for their offspring’s condition have perpetuated the myth.”
Measles typically begins with a fever, cough, runny nose and red, watery eyes. It progresses, three to five days later, to a rash that begins at the hairline on the face and spreads to much of the body. Those most likely to get measles are children under 5 and adults over 20. Pneumonia is a common complication and the most likely to cause death. (Children under 5 have the highest chance of death attributed to measles.)
“Measles is spread by the airborne route and persists suspended in the room up to two hours after a person with measles departs,” says Dr. Ross. “It has an attack rate of 90 to 95 percent in those not immune to measles, especially the young. One case of measles can lead to 18 additional cases in non-immune contacts.”
The first reports of measles in the state this year has not resulted in widespread alarm because, for the 2017-18 school year, 98.2 percent of kindergartners and seventh-graders were vaccinated against measles, according to public health records. In Connecticut, students are allowed a religious or medical exemption. That accounts for the remaining 1.8 percent of the 83,508 students. The state also requires vaccination with two doses of MMR, unless exempted, to attend in-state schools and colleges.
In California, however, several counties reported vaccination rates lower than the required 90 percent for herd immunity that also protects people in the community who have not been vaccinated. Local officials say more parents in these areas are seeking medical exemptions from willing doctors.
“The use of medical exemptions is fashionable in some social circles among misinformed parents,” said Dr. Ross, “and usually are not based on valid reasons to exempt. The social psychology on the medical provider to please the parent, and give the exemption, is immense at times. These practices undermine the public health for all of us, and threaten the public health gains of the last 60 years.”
If you have questions or concerns about your health, talk to your doctor. If you’re in need of a doctor, please visit myhhcdocs.org.