By Dr. Grace Chen O'Neil, Tripler Army Medical Center Emergency DepartmentApril 9, 2019
HONOLULU (April 9, 2019) - Before mass vaccination, in the decade before the live measles vaccine in 1963, nearly 500 deaths were reported in the U.S. due to measles every year. Measles is still widespread in other countries, but it was essentially eliminated from the U.S. in 2000 due to the country's successful vaccination program. However, it has resurfaced since then.
Starting in 2008, the U.S. experienced several large outbreaks. In 2014, a large outbreak was reported among unvaccinated Amish communities in Ohio. In 2015, there was a multi-state outbreak linked to resorts in California. In 2017, there was an outbreak in a Minnesota community with poor vaccination coverage.
The outbreak in 2018 in the New York City and New Jersey areas were primarily among unvaccinated Orthodox Jewish communities associated with travelers that brought measles back from Israel.
Currently, there is a measles outbreak in the Pacific Northwest, primarily in unvaccinated children. It began in January of this year in southern Washington State and now has risen to about 80 cases in Washington and Oregon.
Measles is common in Asia, the Pacific, Africa, and in some European countries. International travelers with measles bring the disease into the U.S., and it can spread to unvaccinated people.
Measles lives in the mucus of an infected person. The virus can live for two hours in the air where an infected person coughs or sneezes. Other people can become infected when they breathe the contaminated air or touch the contaminated surface and then touch their own eyes, nose, or mouth. Infected people can spread measles from four days before, to four days after the rash appears.
The symptoms of measles appear in about seven to fourteen days after the person is infected. Symptoms include a high fever, cough, and runny nose, and red, watery eyes. Tiny white spots may also appear on the inside of the mouth called "koplik spots." In three to five days after symptom onset, the measles rash begins as flat red spots on the face at the hairline and spreads downward. Small raised bumps can also appear on top of the flat red spots. The spots may become confluent as they spread.
The most common complications of measles are middle ear infections, pneumonia, diarrhea, and bronchitis. Measles can also cause more severe illnesses. Some people will die from breathing and neurological complications of measles. One in one thousand people will get encephalitis, which is inflammation of the brain, potentially causing permanent brain damage. Subacute sclerosing panencephalitis can occur as well. This is a disease of chronic progressive brain inflammation that occurs seven to ten days after measles. There is no cure, and it is usually fatal.
People at the highest risk for severe illness include children less than five years old, adults more than 20 years old, pregnant women, and people who have a compromised immune system.
Fortunately, there is a vaccine to prevent measles, the Measles Mumps Rubella (MMR) vaccine. This vaccine is 93 percent effective against measles. The first dose is usually given at 12 months to 15 months of age. The second dose of MMR is given at four to six years old or at least 28 days after the first dose. One dose of the MMR vaccine is 93 percent effective, and two doses are 97 percent effective against measles.
The Centers for Disease Control and Prevention (CDC) advises those who have not had an MMR vaccination at post-high school educational institutions have two doses of the MMR vaccine, and all other adults without immunity get at least one dose of the MMR vaccine.
Also, those traveling to other countries six months or older should be protected with at least one dose of the vaccine. Children 12 months or older should have two doses of the MMR vaccine.
To learn more about measles or the MMR vaccine, to include recommendations from the CDC, visit https://www.cdc.gov/. For questions, contact the 24/7 Defense Health Agency (DHA) Immunization Clinical Support Center at 1-877-GET-VACC, 1-877-438-8222.