What's So Bad About Measles?

Measles is back

Measles. Getty

Measles is real. 

Around the world, about 20 million are infected each year; 146,000 are thought to die. In the US, the first 5 weeks or so of 2015 saw 121 people from 17 states infected. Most cases were connected to exposures from visiting Disneyland. Infections also occur with travelers returning from the Philippines and Europe, especially Germany. Outbreaks are also reported in Africa.

Most people born before 1957 lived through measles.

Almost all were infected. Those who are alive today lived. Those who died are not around. Measles can kill. Before the vaccine was licensed in the US in 1963, about 549,000 people had measles in the US each year; about 495 died annually from measles.

Measles is very infectious

Measles is one of the most infectious diseases we know. It is airborne. It can spread through the air from someone who has the virus but doesn't know. Measles begins to spread from person to person before there is a rash, before someone knows they have measles. It spreads unseen, unknowingly. 

Each infectious person infects approximately 15 others, if no one is vaccinated. Greenland learned this the hard way. Greenland was once measles free. In 1951, measles arrived. Only 5 people in a population of 4262 were not infected. That is, to say, in a non-vaccinated population, measles quickly spreads to 99.9% of the population.


Measles can be bad in healthy people

The disease itself, though most survive without further repercussions, is a risk. Healthy children may need to be hospitalized. Many develop pneumonia (about 1 in 20). Others - about 1 in every 1000 - develop encephalitis - inflammation of their brains in reaction to the virus.

Some have ear infections (about 1 in 10). A smaller number will permanently lose some or all of their hearing. Encephalitis from measles can lead to brain damage that cannot be reversed. It's part of the terrible lottery of measles. Others will die from measles - about 1 or 2 in every 1000 children are expected to die from the breathing (pneumonia) or brain (encephalitis, neurologic effects) that can come with measles.  

Others develop a disorder called SSPE (Subacute sclerosing pan encephalitis). It is a disease that can affect anyone who has had measles. It develops 6 to 10 years after a measles infection, especially if the infection occurred in a young child (under 2). SSPE causes a slow deterioration in intellect (memory loss) and behavior (irritability), causing seizures as well. It can progress to a comatose or vegetative state. Most die within 1 to 3 years of diagnosis. SSPE has become quite rare since vaccination began, declining by 90% in vaccinated countries, to just 10 cases a year in the US.

There is concern that the disease will become more prevalent as measles becomes more prevalent.

Doctors today in many countries like the US do not have much experience with measles. The disease was actually declared eliminated from the US in 2000. Many doctors in countries like the US have never seen measles, so it will be more difficult for hospitals to care for a disease which many do not have experience with.

The disease is worse in those under 5 and adults over 20

Many who need the vaccine the most cannot be vaccinated

There are very few people who cannot be vaccinated against measles for medical reasons. Unfortunately, those who cannot be vaccinated (or who do not respond to the vaccine) are those who most need its protection. Those who would get the sickest from measles can't always be effectively vaccinated. Those with AIDS (CD4 <200 or symptoms) are not recommended to receive the vaccine, which is a live, attenuated virus. Those who have leukemia or other severe immune system problems also do not have the immune system to respond to the vaccine. These are people who also often spend more time in hospital and clinic settings, potentially exposing them to others who are ill, maybe with measles, in waiting rooms.

​Women should also be vaccinated for measles before becoming pregnant. Women should not be vaccinated while pregnant. They should preferably be vaccinated at least one month, or 4 weeks, prior to vaccination - though hopefully much earlier than that. Measles can be particularly dangerous to a fetus if a woman contracts measles during pregnancy.

Infants can become very sick from measles. The vaccine won't work in small babies. Their immune systems haven't matured enough to create the needed protective immunologic response to the vaccine. The vaccine is first recommended from 12 to 15 months and then a second dose from 4 to 6 years in children in the US. If an infant is going to travel abroad, it is recommended that an infant has one MMR vaccine shot between the ages of 6 and 11 months.

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