 CLEVELAND – According to the latest report from the U.S. Centers for Disease Control and Prevention (CDC), the number of reported measles cases in the U.S. has reached 555. The measles outbreak has now spread to 20 states. According to Camille Sabella, M.D., an infectious disease expert at Cleveland Clinic Children’s, measles can look at like a common cold at first, but the symptoms escalate quickly. “It usually starts out with some cold symptoms, some coughing; red eyes, and then they quickly develop a high fever of 104 or 105,” he said. “They will have a bright red rash, which usually starts on the face, and the head and the neck, and spreads down to the trunk and the extremities.” Dr. Sabella said the rash typically lasts for about four to five days, and the fever lasts for a few days. He said it’s possible for complications to develop from the measles and these can be severe. One of the main concerns is that a person can develop primary measles pneumonia, or a secondary bacterial pneumonia. Another troublesome complication that can result from measles is acute encephalitis. “The other main complication that we worry about is acute encephalitis, which is a swelling of the brain, which has a very significant mortality rate,” said Dr. Sabella. “And those that do survive, can certainly have some long-lasting neurodevelopment problems.” Dr. Sabella said because measles is such a contagious virus, if it gets introduced into a community where not everyone is vaccinated, it can spread very rapidly. Measles symptoms are severe in both children and adults, however, he said the complication rates are actually a little higher in adults. Dr. Sabella said because we’ve done such a good job vaccinating against measles, it’s easy for people to think that the danger doesn’t exist anymore, but this current outbreak shows how easy it is for this dangerous disease to spread. He said every healthy person age one and older should receive the MMR vaccine, which protects against measles, mumps and rubella.
How dangerous is measles? Chicken pox isn’t that serious and every kid gets that and it’s no big deal. Is measles basically the same? If that’s the case, why bother with the MMR vaccine? Or can measles kill you?
Measles can kill, but is rarely fatal. Measles of either type usually clears up on its own in seven to 10 days. Once a person has had a case of the measles, they are typically immune for life. Complications are rare but may be serious. This is the reason why health care professionals recommend vaccination. There are two types of measles, each caused by a different virus. Although both produce a rash and fever, they are different diseases. When most people use the term measles, they are referring to the first condition below.
Although red measles is often a mild disease, a few serious complications may occur. Red measles makes people more vulnerable to pneumonia and bacterial ear infections. Pneumonia as a complication of measles is especially serious in infants and is responsible for most deaths in this age group. Inflammation of the brain (encephalitis) occurs about once in every thousand cases of measles and is a serious complication that can be fatal. Red measles is particularly severe in people with weakened immune systems, including people who are malnourished or have HIV. The most feared complication of rubella is "congenital rubella," which occurs when an infected pregnant woman passes the virus to her unborn child. Among other problems and birth defects, affected infants may have cataracts, heart defects, hearing impairment, and learning disabilities. The risk of transmission is highest early in pregnancy. The virus may also cause miscarriage or stillbirth. There is no specific antiviral treatment or cure for measles. Children should stay at home and out of school until cleared to return by their health care professional. Health researchers have noticed that some children in underdeveloped countries or those throughout the globe who develop a severe case of measles have low vitamin A blood levels and seem to have a reduction of their symptoms if given vitamin A supplementation. But you likely won’t have to worry about any of these possible complications if you received the MMR vaccine, which is the safest and best way to prevent measles. Because of widespread vaccination of children, both kinds of measles occur much less often than in the past. However, recently there have been a number of well-publicized outbreaks in communities around the United States, including an active 2019 outbreak. In the United States in 2017, there were 118 rubeola cases in the United States, and the majority of those affected were unimmunized. Outbreaks in the U.S. continue, with up to 90% due to importation of measles from another country, including many European countries. Due to different vaccination policies than followed in the U.S., measles is still common in Europe, Asia, Africa, and the Pacific Island states. Examples of other outbreaks include a major outbreak in France in 2011 that involved more than 15,000 people. In 2014, there were 667 U.S. documented cases of rubeola. In 2015, a multi-state outbreak originated in a California amusement park, likely due to an international traveler. From Jan. 1, 2018, to July 14, 2018, rubeola reportedly infected 107 people from 21 states and the District of Columbia. For more information, read our full medical article on measles.
American Academy of Pediatrics. "Measles (Rubeola)." In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics, 2018: 537-550; 705-710. American Academy of Pediatrics. "Rubella." In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Itasca, IL: American Academy of Pediatrics, 2018: 705-710. United States. Centers for Disease Control and Prevention. "Measles -- United States, 2011." MMWR 61.15 Apr. 20, 2012: 253-257. Measles is a highly contagious, serious disease caused by a virus. Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year. Measles is caused by a virus in the paramyxovirus family and it is normally passed through direct contact and through the air. The virus infects the respiratory tract, then spreads throughout the body. Measles is a human disease and is not known to occur in animals. Accelerated immunization activities have had a major impact on reducing measles deaths. During 2000– 2018, measles vaccination prevented an estimated 23.2 million deaths. Global measles deaths have decreased by 73% from an estimated 536 000 in 2000* to 142 000 in 2018. Signs and symptomsThe first sign of measles is usually a high fever, which begins about 10 to 12 days after exposure to the virus, and lasts 4 to 7 days. A runny nose, a cough, red and watery eyes, and small white spots inside the cheeks can develop in the initial stage. After several days, a rash erupts, usually on the face and upper neck. Over about 3 days, the rash spreads, eventually reaching the hands and feet. The rash lasts for 5 to 6 days, and then fades. On average, the rash occurs 14 days after exposure to the virus (within a range of 7 to 18 days). Most measles-related deaths are caused by complications associated with the disease. Serious complications are more common in children under the age of 5, or adults over the age of 30. The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia. Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases. Who is at risk?Unvaccinated young children are at highest risk of measles and its complications, including death. Unvaccinated pregnant women are also at risk. Any non-immune person (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected. Measles is still common in many developing countries – particularly in parts of Africa and Asia. The overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures. Measles outbreaks can be particularly deadly in countries experiencing or recovering from a natural disaster or conflict. Damage to health infrastructure and health services interrupts routine immunization, and overcrowding in residential camps greatly increases the risk of infection. TransmissionMeasles is one of the world’s most contagious diseases. It is spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions. The virus remains active and contagious in the air or on infected surfaces for up to 2 hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts. Measles outbreaks can result in epidemics that cause many deaths, especially among young, malnourished children. In countries where measles has been largely eliminated, cases imported from other countries remain an important source of infection. TreatmentNo specific antiviral treatment exists for measles virus. Severe complications from measles can be reduced through supportive care that ensures good nutrition, adequate fluid intake and treatment of dehydration with WHO-recommended oral rehydration solution. This solution replaces fluids and other essential elements that are lost through diarrhoea or vomiting. Antibiotics should be prescribed to treat eye and ear infections, and pneumonia. All children diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart. This treatment restores low vitamin A levels during measles that occur even in well-nourished children and can help prevent eye damage and blindness. Vitamin A supplements have also been shown to reduce the number of measles deaths. PreventionRoutine measles vaccination for children, combined with mass immunization campaigns in countries with high case and death rates, are key public health strategies to reduce global measles deaths. The measles vaccine has been in use for nearly 60 years. It is safe, effective and inexpensive. It costs approximately one US dollar to immunize a child against measles. The measles vaccine is often incorporated with rubella and/or mumps vaccines. It is equally safe and effective in the single or combined form. Adding rubella to measles vaccine increases the cost only slightly, and allows for shared delivery and administration costs. In 2018, about 86% of the world's children received 1 dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000. Two doses of the vaccine are recommended to ensure immunity and prevent outbreaks, as about 15% of vaccinated children fail to develop immunity from the first dose. In 2018, 69% of children received the second dose of the measles vaccine. Of the estimated 19.2 million infants not vaccinated with at least one dose of measles vaccine through routine immunization in 2018, about 6.1 million were in 3 countries: India, Nigeria and Pakistan. WHO responseIn 2010, the World Health Assembly established 3 milestones towards the future eradication of measles to be achieved by 2015:
In 2012, the Health Assembly endorsed the Global Vaccine Action Plan, with the objective of eliminating measles in four WHO regions by 2015 and in five regions by 2020. By 2018, the global push to improve vaccine coverage resulted in a 73% reduction in deaths. During 2000– 2018, with support from the Measles & Rubella Initiative and Gavi, the Vaccine Alliance, measles vaccination prevented an estimated 23.2 million deaths; most of the deaths averted were in the African region and in countries supported by the Gavi Alliance. But without sustained attention, hard fought gains can easily be lost. Where children are unvaccinated, outbreaks occur. Because of low coverage nationally or in pockets, multiple regions were hit with large measles outbreaks in 2018, causing many deaths. Based on current trends of measles vaccination coverage and incidence, the WHO Strategic Advisory Group of Experts on Immunization (SAGE) concluded that measles elimination is greatly under threat, and the disease has resurged in a number of countries that had achieved, or were close to achieving, elimination. WHO continues to strengthen the global laboratory network to ensure timely diagnosis of measles and track international spread of the measles viruses to allow more coordinated country approach in targeting vaccination activities and reduce measles deaths from this vaccine-preventable disease. The Measles & Rubella InitiativeLaunched in 2001, the Measles & Rubella Initiative (M&R Initiative) is a global partnership led by the American Red Cross, United Nations Foundation, Centers for Disease Control and Prevention (CDC), UNICEF and WHO. The Initiative is committed to ensuring that no child dies from measles or is born with congenital rubella syndrome. The Initiative helps countries to plan, fund and measure efforts to stop measles and rubella for good. |
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