The Past and Present State of Measles


Odds are you have seen or read about the current outbreaks of Measles in different parts of the country right now (mainly in the Pacific Northwest). You have probably also seen the great social media debates on whether to vaccinate or not - please vaccinate. The following is a bit of research on the topic for everyone about the past and present state of the Measles Virus and the MMR/MMRV (Measles Mumps Rubella/Varicella) vaccine, as well as the outlook of Measles eradication.

The Past and Present State of Measles

Measles is known to be one of the most highly contagious diseases amongst humans. Measles is also easily preventable with vaccinations. The first Measles vaccination came out in 1963 when there were approximately 30 million cases a year, with 2 million of those cases resulting in death globally per year (WH, 2017). During these periods of massive global outbreaks, 95% of those who had acquired Measles were under the age of 15 (WHO, 2017). The World Health Organization states that in the years 2000-2015 the global rate of cases of Measles declined by 75%, and the global death rate had decreased to 134,200. The World Health Organization further discusses the 3 milestones that the MMR/MMRV vaccination has met:

1. More than 90% of patients at 1 year of age being vaccinated

2. The global rate of Measles mortality decreased by 95% from the rate in 2000,

3. The global rate of measles incidences being less than 5 per million people in 2015.

All simply because of the MMR/MMRV vaccine!

As of February 15th, 2019, there are 101 cases of measles, and five current outbreaks in the United States (CDC, 2019). According to the Center for Disease Control (CDC):

Cases of measles in the United States

2017 - 120 cases

2016 - 86 cases

2018 - 372 cases

We have been on a rather rapid increase in the number of people who have acquired measles, as well as an increasing number of people who choose not to vaccinate. While there are few reasons, medically or religiously, that people choose not to vaccinate, they rely on the rest of the country to be vaccinated to keep the number of cases and risk of acquiring diseases like Measles at bay. Therefore, if the amount of people who get vaccinated with MMR/MMRV increases, the cases of the disease will decrease.

Measles Presentation

Measles can be transmitted person to person via airborne droplets and direct contact with infected oral secretions. The clinical presentation includes fevers, rashes, and ‘bluish white Koplik's spots’ found in oral mucosa (WHO, 2017). The incubation period for persons infected with Measles is on average 10-14 days, with a full range of 7-23 days (WHO, 2017). There is approximately a 30% complication rate with Measles that can lead to croup, diarrhea, pneumonia, and middle ear infections, and if complications are severe enough, there is also the possibility of death from the virus. Complications are usually seen in younger patients.

The current treatment for Measles is supportive care for symptoms, as well as vaccinating within 72 hours of exposure to limit or decrease the severity of symptoms. The primary way of reducing the risk of acquiring Measles is by increasing the overall population immunity through routine vaccination.

Immunity

The most effective way of creating immunity for Measles is vaccination. The MMR/MMRV vaccine is a live attenuated version of the virus, given via IM injection, that causes a cellular and humoral immune response (IgM and IgA), the same way that the body would respond to acquiring the wild type measles virus. When acquired, the Wild Type Measles Virus causes an increased mortality in children who are infected and significant immunosuppression. Catching the Wild Type Virus does not sufficiently protect anyone against acquiring it in the future if they come in contact again.

Naturally-acquired immunity in infants only lasts 6-9 months postpartum and is from maternal anti-measles IgG antibodies, from both vaccine-induced immunity and wild type induced immunity. This brief period of Naturally-acquired immunity in newborns is why it is recommended to vaccinate around one year.

Misconceptions and Risks

The risks in receiving the MMR/MMRV vaccine are rare, but still can happen. These risks are an allergic reaction, or anaphylaxis, which occurs in 3.5-10 cases per million who receive the vaccine. Reactions are usually linked to unknown allergies to neomycin or gelatin. There is also a 2% risk of fever and transient rash following vaccination (WHO, 2017). Other than known allergies to Neomycin and gelatin, the only other contraindication to the MMR/MMRV is in persons with severe immunosuppression.

The MMR/MMRV vaccines are NOT linked to increased risk of Guillain Barre Syndrome. The MMR/MMRV vaccines are also NOT linked autism, or inflammatory bowel disease - there is substantial evidence to disprove this social media induced myth.

-Courtney Graham A.A.S, NRP, FP-C

References

Measles Vaccines: WHO position paper - April 2017. (2017). [ebook] World Health Organization, pp.205-228. Available at: https://apps.who.int/iris/bitstream/handle/10665/255149/WER9217.pdf?sequence=1 [Accessed 10 Feb. 2019].

Cdc.gov. (2019). Measles | Cases and Outbreaks | CDC. [online] Available at: https://www.cdc.gov/measles/cases-outbreaks.html [Accessed 15 Feb. 2019].

https://www.cdc.gov/vaccinesafety/concerns/autism.html