Measles Outbreaks Continue

CDC Not Overly Concerned

As one physician has characterized it, measles is an “exquisitely contagious” disease. Recent and persistent outbreaks in the United States would support that sentiment. Although eradicated from this country nearly 20 years ago, measles is making a bit of a comeback in the U.S. As of Feb. 7, the Centers for Disease Control and Prevention (CDC) had confirmed 101 individual cases of the disease across 10 states. This number represents an increase over the record number of 82 imported cases tabulated in 2018 but pales in comparison to the 372 overall cases reported last year and the 667 documented cases that occurred in 2014, the most of any year over the last decade, according to CDC surveillance. In the state of Washington, where at least 58 people had been diagnosed as of Feb. 13 (see sidebar), Dr. Alan Melnick, MD, MPH, director of the Clark County health department, eloquently described the disease’s ability to spread in an interview with CNN. CDC officials have advised, however, that the situation is not likely to become endemic, or permanent, in the U.S. because vaccination rates for the country are generally high and the recent trend reflects that the outbreaks stem from people who have brought measles into the country after traveling.

According to a report by the Journal News of Rockland/Westchester in New York, another of the 11 states to have reported cases in 2019, Dr. Tom Clark, MD, MPH, deputy director of the CDC’s division of viral diseases, claims that all incidences in 2019 have been associated with travel and that there is no reason to believe that a new high will be seen in the overall number of cases as the year progresses. Additionally, repeated introductions by multiple individuals who happen to live in certain geographic regions have contributed to the persistent outbreaks of late, particularly in New York, Clark told the Journal News. It is true that certain communities are said to be under-vaccinating as compared to the country as a whole, which will contribute to outbreaks, which seems to be a cause of concern among the public.

A disease caused by a virus that presents as a fever before developing into a cough, runt nose, red eyes, and telltale red-spotted rash, can be especially dangerous to young children. Spread through the air when an infected person coughs or sneezes, the condition can lead to pneumonia, encephalitis, and death and is considered by the CDC to be so contagious that “if one person has it, 90% of the people around him or her will also become infected if they are not protected.” According to the World Health Organization (WHO), complications associated with measles can be avoided if patients receive good nutrition, sufficient fluids (including replacement of fluids lost due to dehydration, diarrhea, and vomiting), and antibiotics. Supplements of vitamin A for immune system support have also been shown to reduce deaths by 50%, according to the WHO. In 2017, measles infections were responsible for 110,000 deaths, the most recent statistical year, according to WHO numbers. Most of those who died were children under the age of 5 years. The challenge with protecting the youngest of children is that they cannot receive the first dose of the vaccine until between 12 and 15 months of age. A second shot is then administered between the ages of 4 and 6 years. Further complicating matters is that some adults in various countries fear that the vaccine can be harmful to children and potentially be linked to autism development. Officials from the CDC and the WHO have gone on record refuting any such claims, and the WHO has issued a warning about a “backsliding” occurring related to the efforts to eliminate the disease, at least in part due to such vaccine concerns and a subsequent reluctance by some parents to vaccinate their children.

The anti-vaccination narrative has become alarming and impactful enough to cause Facebook officials to take action against posts deemed to be anti-vaccination in nature by reducing or removing content deemed to be inappropriate, according to a recent report by USA Today. In Clark County, a largely unvaccinated population has contributed to the state of emergency (see sidebar) has led to one of the country’s lowest vaccination rates among school-age children, according to the CNN report. In 2018, the U.S. saw 17 outbreaks arise and in New York and New Jersey a contingent of unvaccinated people in Orthodox Jewish communities was notably diagnosed and associated with travelers who brought measles back from Israel, where a large outbreak is still occurring, according to the CDC. In the U.S., other states that make up the 10 aforementioned that are experiencing outbreaks include California, Colorado, Connecticut, Georgia, Illinois, New Jersey, Oregon, and Texas. As of ADVANCE’s deadline, reports were beginning to surface of a case involving a young child in Kentucky who had been diagnosed but had not yet been accounted for on the CDC’s online listing of outbreaks. We will continue to monitor the developments.