As Measles Cases Reach New High, Think of The Few at Risk

Measles cases in the United States have reached an annual high since it was first considered eliminated in 2000, according to the US Centers for Disease Control and Prevention (CDC). As of this week, the count is 704 across 22 states. Naturally, many patients are concerned about what this means for them, and physicians need to stick to the facts of the situation.

Fortunately, for the vast majority of Americans, the measles outbreak poses little risk. First—according to the CDC, about 91% of children since 1963 have been vaccinated against measles. The measles, mump and rubella (MMR) vaccine was introduced in 1970, and is 97% effective. For unknown reasons, about 3 of every 100 vaccinated patients can get measles, but the cases are attenuated, mild, and complications are uncommon.

And yes—in recent years, vaccination rates have declined slightly, particularly in isolated communities. The policies of parents refusing to vaccinate their children are based upon spread misinformation, outdated religious beliefs, and some excuse that it violates their children’s rights. Many patients believe that the MMR vaccine can cause autism. This is based upon the work of Dr. Andrew Wakefield, a British physician who published a pair of papers 21 years ago suggesting that MMR vaccine could cause autism.

Those papers were ultimately shown to be scientifically flawed ,and Dr. Wakefield was later accused of being paidd a large sum of money by attorneys involved with lawsuits against vaccine manufacturers. He eventually lost his license to practice, but his work still caused thousands of parents to stop vaccinating with MMR—leading to a huge epidemic of measles in the UK. No study to date has shown a relationship of MMR vaccination to autism.

For healthy children, a case of measles is unlikely to even be life-threatening. In the days prior to MMR vaccination, there were about 4 million cases annually—of which 400 people died, and 4000 people developed encephalitis. That translates into a death rate of 1 in 10,000. Not inconsequential, but not bad in terms of risk, considering the risk of dying as the result of a car or motorcycle crash is about 1 in 77.

The problem is mainly for people who have immune deficiencies, allergies to vaccines, or the very frail who are not vaccinated. But these are far more legitimate reasons for measles susceptibility than the current trend of patients believing they were once defending their individual rights by not vaccinating their children. Sure, there are many examples of the government imposing regulations to protect the public by limiting the “rights” of citizens. States have imposed laws mandating that motorcycle and bicycle riders wear helmets. Why? Because the accidents sustained by unprotected riders pose a public risk, and increase medical costs for their injuries. Legislators also made it illegal for drivers to operate their cars if they have been drinking alcohol. Are such dissenters being deprived of their rights? Maybe, but it's for the greater good.

It’s time to eliminate exemptions from vaccination. By refusing to vaccinate their children, parents not only put them at risk, but also those with immune compromise—a legitimate concern—at deadly risk.

To date, there are no recommendations for re-vaccination. If patients are unsure, they should be tested. The vaccine was introduced in 1963, but improved in 1970 to include mumps and rubella. After 1963, cases of measles fell from several million to several thousand annually.

Patients diagnosed with measles should be isolated and in direct contact with their physician. The odds such a patient will suffer any real problems are slim to none, unless they ate unfortunate enough to be immunocompromised. In that case, intense medical attention is necessary.

Yes, there are currently about 700 cases of measles in the US. But to date, less than that have even died among the 350 million-plus cases in US history. If that number terrifies you, fine—don’t drive, don’t travel, and stay at home.

But for those who haven’t vaccinated their children, it's time to think about the welfare of immunocompromised, frail, and the rare person without the same immunity as the rest of us. They are all at risk, so as long as vaccination exemptions persist.

Anyone interested in tracking new US measles cases can do so with the Contagion® Outbreak Monitor here.

Simon Murray, MD, is an internist based in Princeton, NJ. The piece reflects his views, not necessarily those of the publication.Healthcare professionals and researchers interested in responding to this piece or contributing to MD Magazine® can reach the editorial staff here.