Tag: measles deaths

When Was the Last Measles Death in the United States?

How many measles deaths have there been in the United States in the past ten years? Dr. Bob Sears frequently says that there have been none. It is easy to see that Dr. Bob is wrong, not even counting the latest death in 2015.

Measles Deaths in the United States

Measles deaths are thought to occur in about 1 in every 500 to 1,000 reported cases. This is not just in developing countries or in people with chronic medical conditions.

Consider that in an outbreak in the United States from 1989 to 1991, amid 55,622 cases, there were 123 deaths.

More recently, measles cases and measles deaths in the United States include:

2000 – 86 cases – 1 measles death (infant) – endemic spread of measles eliminated in U.S.
2001 – 116 cases – 1 measles death
2002 – 44 cases
2003 – 55 cases – 1 measles death (1 year old)
2004 – 37 cases – record low number of measles cases
2005 – 66 cases – 1 measles death (1 year old)
2006 – 55 cases
2007 – 43 cases
2008 – 140 cases
2009 – 71 cases – 2 measles deaths
2010 – 63 cases – 2 measles deaths
2011 – 220 cases
2012 – 55 cases – 2 measles deaths
2013 – 187 cases (large outbreak in New York City – 58 cases)
2014 – 667 cases (the worst year for measles since 1994, including the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio)
2015 – 188 cases – got off to a strong start with a big outbreak in California – 1 measles death
2016 – 86 cases
2017 – 118 cases

So that’s 11 measles deaths since 2000 and at least 8 measles deaths since 2005.

Why do people say that there have been no measles deaths in the United States in the past 10 years? Whether they are misinformed or intentionally trying to misinform people, they are wrong.

The Last Verifiable Measles Death in the United States

The CDC is actually contributing a bit to the confusion over measles deaths, in that when asked, they have said that “the last verifiable death in the United States from acute measles infection occurred in 2003 when there were 2 reported deaths.”

They explain the discrepancy between that statement and other CDC reports, like the recently published “Summary of Notifiable Diseases — United States, 2012,” which clearly documents measles deaths in 2005, 2009, and 2010, by saying that those reports are based on “statistical information about deaths in the United States.”

But that statistical information comes from death certificates that are sent in from all over the United States to the National Vital Statistics System. The system isn’t like VAERS, where just anyone can send in a report. You don’t necessarily have to be a doctor to sign and file a death certificate though either, which is why the CDC is probably hung up on saying that the last verifiable measles deaths were in 2003.

To be more precise when talking about measles deaths in the United States, since it doesn’t seem like the CDC has verified each and every measles death after 2003, it is likely best to say that death certificates have been filed in 2005, 2009 (2), 2010 (2), and 2012 (2) that listed measles as a cause of death code.

Of course, that still means that there have been measles deaths in the United States since 2003.

SSPE – More Measles Deaths

Lately, in addition to deaths from acute measles infections, there have been even more deaths from subacute sclerosing panencephalitis (SSPE).

About 6 to 8 years after having measles, children with SSPE develop progressive neurological symptoms, including memory loss, behavior changes, uncontrollable movements, and even seizures. As symptoms progress, they may become blind, develop stiff muscles, become unable to walk, and eventually deteriorate to a persistent vegetative state.

Children with SSPE usually die within 1 to 3 years of first developing symptoms, including in the United States:

2000 – 5 SSPE deaths
2001 – 2 SSPE deaths
2002 – 5 SSPE deaths
2003 – 0
2004 – 1 SSPE death
2005 – 2 SSPE deaths
2006 – 3 SSPE deaths
2007 – 3 SSPE deaths
2008 – 3 SSPE deaths
2009 – 2 SSPE deaths
2010 – 0
2011 – 4 SSPE deaths
2012 – 1 SSPE death
2013 – 1 SSPE death
2014 – 0
2015 – 0
2016 – 0
2017 – 0

That’s 32 SSPE deaths since 2000 and at least 19 SSPE deaths since 2005. Why so many? Many of them can likely be attributed to the large number of cases associated with measles outbreaks from 1989 to 1991.

Fortunately, as the number of measles cases has been dropping in the post-vaccine era, so have the number of SSPE deaths.

The National Registry for SSPE, reported that there were at least 453 cases between 1960 and 1976. There were 225 deaths from SSPE between 1979 and 1998. The registry wasn’t established until 1969 though, and it is now becoming clear that the risk of developing SSPE is much higher than once thought.

A recent study of measles in Germany has found that the risk of developing SSPE is about 1 in 1,700 to 1 in 3,300 cases of measles.

Other Myths About Measles Deaths

One of the classic measles myths we hear is that measles was disappearing even before the measles vaccine was developed. It is true that measles deaths had been dropping since the turn of the century.

The measles death rate (deaths per 100,000 people) in the United States was:

1900 – 13.3 (about 7000 deaths)
1910 – 12.4
1920 – 8.8
1930 – 3.2
1935 – 3.1
1940 – 0.5
1945 – 0.2
1950 – 0.3 (468 deaths)
1955 – 0.2 (345 deaths)
1960 – 0.2 (380 deaths)
1963 – first measles vaccine licensed
1965 – 0.1 (276 deaths)
1970 – 0.0 (89 deaths)
1975 – 0.0 (20 deaths)
1980 – 0.0 (11 deaths)
1985 – 0.0 (4 deaths)

That’s not surprising though. The general death rate had dropped from 17.8 in 1900 to 7.6 in 1960. For infants under age 12 months, the death rate dropped from 162.4 in 1933 to 27 in 1960.

This simply reflects that vaccines were not the only medical technology that helped to save lives in the 20th century and not that measles was already disappearing. Penicillin, insulin, vitamin D, blood typing (allows transfusions of blood that has been typed and cross-matched), dialysis machines, and mechanical ventilators were all discovered in the early 1900s.

anti-vax-measles-graph — Despite how anti-vaccine charts try and mislead you, measles was still very deadly when the first measles vaccines were introduced.

If you notice though, the death rate for measles got stuck after the 1940s at about 0.2 to 0.3, even as modern medicine continued to advance. That’s about 300 to 500 measles deaths each year in the United States. This was after World War II and through the 1950s and early 1960s, hardly a time of poor hygiene or poor nutrition or when Americans were without access to medical care.

It took about 20 years for those deaths to start dropping again, and it took the coming of the measles vaccine to do it.

So if we stop vaccinating, we won’t get to 7,000 measles deaths a year again in the United States. Modern medicine has improved a great deal since 1900. We would eventually get to about 320 to 960 measles deaths a year though (using our current population of 320 million people and a measles death rate between 0.1 and 0.3).

Other Facts About Measles Deaths

People still die of measles.

What else do you need to know about measles deaths?

SSPE is caused by wild type measles. Vaccine strain measles has never been found in the brain tissue of anyone who has ever died of SSPE.
Although SSPE was first described by Dr. James R. Dawson, JR as a new type of epidemic encephalitis in 1933 (Dawson’s disease), that it is a late complication of a natural measles infection wasn’t discovered until much later.
People have recently died of measles in other industrial countries too. Basically anywhere there have been measles outbreaks, there have been measles deaths, including Canada, Japan, Germany, the Netherlands, the UK, and France, etc.
Worldwide, about 400 people die each and every day from measles.

The latest measles deaths we have been hearing about?

Dozens of infants, children, and adults, almost all unvaccinated have died in large outbreaks since the beginning of 2016 in Europe.

What To Know about Measles Deaths

Measles is still deadly, even in this era of modern medicine, sanitation and good nutrition.

Why Do We Only Fear Vaccine Preventable Diseases?

How many diseases can be prevented with vaccines?

Would you believe that there are about 29 vaccine-preventable diseases, from adenovirus and anthrax to typhoid fever and yellow fever?

That’s a lot more than the 16 that kids today routinely get vaccinated against…

Diseases That Are Not Vaccine Preventable

Whether you think about 16 or 29 vaccine-preventable diseases, they are a drop in the pocket when you think about all of the diseases that can’t be prevented with a vaccine.

Just consider all of the viruses and bacteria that can get you sick during cold and flu season:

group A Streptococci – strep throat and scarlet fever
Human metapneumovirus (HMPV) – bronchiolitis, colds, and viral pneumonia
Human parainfluenza viruses (HPIVs) – bronchiolitis, bronchitis, colds, croup, or viral pneumonia
norovirus – diarrhea and vomiting
respiratory adenovirus – bronchitis, colds, croup, viral pneumonia, pink eye, and diarrhea
Respiratory syncytial virus (RSV) – wheezing and bronchiolitis in younger children, but colds in older kids and adults
rhinovirus – the classic common cold
rotavirus – diarrhea and vomiting, was much more common in the pre-vaccine era
seasonal coronavirus – colds, bronchitis, and viral pneumonia
Streptococcus pneumoniae – ear infections, meningitis, sinus infections, and pneumonia

In addition to the flu, only rotavirus and Streptococcus pneumoniae (pneumococcal vaccines) are vaccine preventable.

And there are still thousands of other diseases that aren’t vaccine preventable, including African trypanosomiasis, Chagas disease, Chikungunya, Cytomegalovirus (CMV), Dengue fever, Ebola, Herpes Zoster, HIV, Hookworm disease, Leishmaniasis, Malaria, Schistosomiasis, and Zika, some of the most deadly diseases around.

Why Do We Only Fear Vaccine-Preventable Diseases?

So is it true that we only fear vaccine-preventable diseases and that’s why folks get vaccinated?

“Why aren’t you walking around concerned about leprosy every day? Why aren’t you concerned about someone from another country bringing leprosy into Australia or the US and somehow exposing all of our most vulnerable to this illness? I’ll tell you why. Because there’s no vaccine for leprosy. You are afraid of what we vaccinate for because these illnesses are hyped up all of the time. It’s propaganda. You are told what to fear, so they can then sell you an alleged solution.
The only diseases we fear are the ones that a vaccine has been developed and marketed for. We never feared measles and mumps in the early 20th century… Because its what the media tells us to do.”

Learn the Risk – Why aren’t we afraid of all diseases?

Did you know that there actually is a vaccine for leprosy? Don’t expect it to be added to our immunization schedule any time soon or to increase your fears about leprosy, as leprosy is not highly contagious and it can be cured.

Forget about leprosy though… If folks didn’t fear measles and mumps in the early 20th century, before we had vaccines to control these diseases, then why did epidemics so often lead to newspaper headlines, quarantines, and school closings?

Quarantines were routine in the pre-vaccine era.

And if we only fear diseases that a vaccine has been developed and marketed for, then why are so many parents afraid of RSV and herpes?

How many new parents won’t even let family members kiss their newborns because they are worried about herpes, even if they don’t have a cold sore? How many parents get panicked if they hear RSV, which can cause severe disease in high risk babies, but typically only causes cold symptoms in most others.

Anyway, fear doesn’t drive most of us to vaccinate and protect our kids. We just understand that vaccines are safe and necessary and that getting vaccinated is a smart decision.

It is the diseases that aren’t vaccine preventable that might scare us a little bit…

What to Know About Fearing Vaccine-Preventable Diseases

Anti-vaccine folks push propaganda to make parents afraid of vaccines and to scare them away from vaccinating and protecting their kids. The idea that we are only afraid of vaccine preventable diseases is a good example.

A History of Measles Outbreaks in United States

We have come a long way since the development of the first measles vaccines in the early 1960s…

Pre-Vaccine Era Measles Outbreaks

Unvaccinated children exposed to measles are quarantined for at least 21 days.

In the pre-vaccine era, measles was a very common childhood disease.

As it is now, it was also a deadly disease.

In the 1950s, there were 5,487,332 cases (just under 550,000 a year) and 4,950 deaths (about 500 each year).

In 1962, there were 469,924 cases of measles in the United States and 432 deaths.

Post-Vaccine Era Measles Outbreaks

The first measles vaccines were licensed between 1963 and 1965, but it was the first national measles eradication campaign in 1966 that got people vaccinated and measles rates down.

In 1970, there were only 47,351 cases and 89 deaths.

Rates continued to drop until the large outbreaks between 1989 to 1991, when there were 55,622 cases and 123 deaths. The addition of a measles booster shot got measles outbreaks under control again. By 2000, when measles was declared eliminated in the United States, there were just 86 cases and one death.

Post-Elimination Era Measles Outbreaks

Measles cases usually begin increasing in April and May. How many cases will we see this year?

Declaring measles eliminated in the United States didn’t mean that we didn’t have any more measles, after all, it hasn’t been eradicated yet. It just that we are no longer seeing the endemic spread of measles. Since 2000, all of the latest measles outbreaks have been imported from outside the country, or at least they are started by cases that are imported.

We have seen more than a few records in the post-elimination era, including:

the year with the historic low number of measles cases – 37 cases in 2004
the year with the largest number of cases since 1994 – 667 cases in 2014
the largest single outbreak since the endemic spread of measles was eliminated – 377 cases in Ohio in 2014

In 2015, we got a reminder of how deadly measles can be. Although there have been other measles deaths and SSPE deaths in the past ten years, unlike the 2015 death, they are usually buried in CDC reports and aren’t published in the newspaper.

2017 Measles Outbreaks

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died. Photo by Jim Goodson, M.P.H.

The first new case of 2017 was an unvaccinated adult in San Luis Obispo County, California who was exposed to international travelers over the holidays. The person exposed others to measles at the Twin Cities Community Hospital emergency department in Templeton while contagious in early January.

The second case of 2017 was related to an LA county outbreak that started at the end of 2016 – a resident of Ventura County.

And it went on, with other measles cases in 2017 including:

at least 122 cases
cases in 16 states, including California, Florida, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Utah, and Washington
an infant in San Luis Obispo County that was too young to be vaccinated and who had contact with an unvaccinated adult with measles
one new case in the Los Angeles County outbreak, which is now up to 20 confirmed measles cases (including 18 in LA County), all unvaccinated
four new cases in Ventura County, California that are linked to another Ventura County measles case and the LA County outbreak, which is now up to 24 cases
a case in Jersey City, New Jersey following international travel who exposed people at multiple places, including a hospital, pharmacy, mall, and on a commuter train
an infant in Suffolk County, New York who had been overseas
an unvaccinated 7-month-old baby from Passaic County, New Jersey who had been traveling out of the country and may have exposed others at area hospitals (a good reminder that infants who are at least 6 months old should get an MMR vaccine before leaving the country)
two cases in Salt Lake County, Utah – which began in a resident who had “received all appropriate vaccinations” and developed measles after traveling outside the US and then spread to another person “who had contact with the first case.” According to the SLCoHD, “One of the two individuals with measles had received one MMR vaccine.”
two cases in King County, Washington – a man and his 6-month-old infant, both unvaccinated, developed measles after traveling to Asia, and exposed many others around Seattle, including at a Whole Foods, a sandwich shop, their apartment building, and two Amazon buildings.
a confirmed case in Omaha, Nebraska, who exposed people on a Delta flight and multiple places in Douglas and Sarpy counties, including the Bergan Mercy Hospital Emergency Room.
a young child in Macomb Count, Michigan who required hospitalized and has been linked to international travel
a suspected case at William Allen White Elementary School in Lyon County, Kansas which has led to the quarantine of unvaccinated students for 3 weeks
an unvaccinated student at Laguna Beach High in Orange County, California, which led to the quarantine of at least 6 unvaccinated students
a staff member at Discovery Academy of Lake Alfred in Florida
an unconfirmed case in an infant who attended the College of Staten Island Children’s Center in New York
two children in Minnesota without a known source of infection
another child in Minnesota – among the three Somali Minnesotans in this outbreak are two children who are just two years old – all of the cases were unvaccinated and two required hospitalization, although the common source is still not known. Vaccine hesitancy has been a problem among the Somali Minnesotans because of Wakefield‘s MMR study.
five more unvaccinated children in Minnesota, as the outbreak grows to 8.
a confirmed case in North Platte, Nebraska who may have exposed others at a middle school, church youth group, the Great Plains Health Emergency Room, a medical office, and a lab.
a resident of Livingston County, Michigan who exposed others at area restaurants and St. Joseph Mercy Brighton Hospital after getting measles on a plane ride with an unvaccinated child
another case in Minnesota, bringing the outbreak count to 9 unvaccinated children.
three more cases in Minnesota, bringing this outbreak case count to 12, with at least 200 people in quarantine.
four possible cases in Nebraska
eight more cases in Minnesota, bringing this outbreak case count to 20 young children under age 5 years, and now including an infant under age 12 months.
four more cases in Minnesota, bringing this outbreak case count to 24 young children under age 5 years and surpassing the size of the 2011 measles outbreak in the Somali community in the same area, which was also mostly among intentionally unvaccinated children.
five more cases in Minnesota, including the first outside of Hennepin County – spreading to nearby Stearns County, bringing this outbreak case count to 29 young children under age 5 years, with only one that was vaccinated.
three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
more measles (2 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and now Le Sueur County), where the ongoing outbreak is up to 66 cases, almost all unvaccinated children and where there has been a call to accelerate the two dose MMR schedule for kids over age 12 months.
a teen visiting the United States from India who developed measles and exposed others at a hotel and a hospital in Bergen County, New Jersey and in upstate New York.
a child in Maryland who was admitted to Children’s National Medical Center in Washington, D.C.
more measles (3 new cases) in Minnesota (Hennepin County, Ramsey County, Crow Wing County, and Le Sueur County), where the ongoing outbreak that has been confirmed to be from the wild type B3 strain is up to 68 cases, almost all unvaccinated children.
a case in Pennsylvania who exposed others at a visitor center
someone who visited the MIT Museum in Cambridge, Massachusetts.
two new cases in Minnesota, ending speculation that the outbreak, now up to 70 cases, was over…
one new case in Minnesota, raising the number of cases in this ongoing outbreak to 78 cases.
a healthcare worker in New York who is employed by Hudson Headwaters Health Network and also works at a Warren County medical practice.
someone in Franklin County, Maine (their first case in Maine in 20 years!) who traveled out of the country and caught measles, returning home and possibly exposing others at a movie theater, restaurant, farmers market, and hospital.
A case in Butler County, Kansas. Many remember that one of the largest outbreaks of 2014 was in Kansas.
an unvaccinated man who lives in Hennepin County, raising the number of cases in this ongoing outbreak (an outbreak that has already cost over $500,000 to contain and which many hoped would soon be over) that started in March to at least 79 cases. With the new case, the clock starts ticking again and Minnesota will have to wait to see if new cases appear over the next 3 weeks.
passengers from 13 states on an American Airlines flight from New York to Chicago were exposed to a person with measles in early July, including a 12-week-old infant who required preventative treatment with immune globulin (IG), as she was too young to be vaccinated.
a fully vaccinated resident of Onondaga County, New York who was exposed on a domestic flight, only developed mild symptoms, but did expose others.
someone who exposed others at the Penn State University Hetzel Union Building Bookstore and other places in State College, Pennsylvania.
a second case in the Wichita, Kansas area, this time in Sedgwick County, with exposures at a church, dental office, elementary school, and multiple stores over at least 3 days.
a possible case in Sedgwick County, Kansas, a child too young to be vaccinated who may have been exposed at a church. Three other exposed infants who were too young to be vaccinated and who were considered at risk to get measles in this outbreak received immunoglobulin treatment.
a traveler who spent time in Hampton Beach in New Hampshire, exposing others.
a 46-year-old male in Ohio that got the disease while traveling internationally.

2017 would have been a mild year for measles, except for the really big outbreak in Minnesota… 79 people got measles, 71 were unvaccinated, more than 500 people were quarantines, and the outbreak cost over $1.3 million to contain.

2016 Measles Outbreaks

Starting slow, 2016 ended as a fairly average year for measles:

83 cases
cases in 17 states, including Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, Tennessee, Texas, and Utah
a large outbreak in Arizona, 23 cases, linked to a private detention center
a large outbreak in Shelby County, Tennessee, at least seven cases, including six unvaccinated and one partially vaccinated child
an ongoing measles outbreak in Los Angeles County and Santa Barbara County that has been linked to the Los Angeles Orthodox Jewish community
a case in Colorado in which an unvaccinated adult traveled internationally and ended up exposing many people “from Dec. 21 to 29, 2016, who was at a wide variety of locations in the Denver-Boulder area,” including an Urgent Care center and the Parker Adventist Hospital Emergency Department

As in other years, many of these outbreaks involved unvaccinated children and adults. One case involved a child at the Yuba River Charter School in California, a Waldorf School with very high rates of unvaccinated children.

2015 Measles Outbreaks

With a large outbreak in California, 2015 got off to a very strong start.

Most concerning, more and more, cases don’t seem to have an source that is easy to find, which could mean that the endemic spread of measles has returned in the United States. So instead of having to travel out of the country or be exposed to someone who got measles with a link to international travel, you could get measles just by going to a ball game, a movie theater, or to Disneyland. That makes it more important than ever to learn how to avoid measles.

Among the 189 measles cases and outbreaks in 2015 were:

113 cases that were associated with a multi-state outbreak that was linked to Disneyland in California. Before it was declared over on April 17, a few unvaccinated travelers also help spread measles from this outbreak to large outbreak in Quebec, Canada. All in all, the outbreak was linked to at least 113 cases in California and an additional 169 cases in Arizona (5), Nebraska (1), Utah (3), Colorado (1), Washington (2), Oregon (1), Mexico (1), and Canada (155).
13 cases, including an adult worker and 12 infants too young to be vaccinated at the KinderCare Learning Center in Illinois.
At least 13 cases, all intentionally unvaccinated, in a South Dakota outbreak that started with an unvaccinated adult traveling to India.
Five cases in Clallam County, Washington, including four who were not vaccinated, which cost at least $36,000 to contain and led to the death of an immunosuppressed woman.

In addition to these large outbreaks, 2015 also saw a number of quarantines for unvaccinated students, closing of daycare centers, and a recommendation from a California Department of Health state epidemiologist that people who are not vaccinated against measles “avoid visiting Disney” and “crowded places with a high concentration of international travelers, such as airports.”

Other measles cases in 2015 include:

A student at UC Berkeley who may have exposed others to measles on a public bus.
A confirmed case in Fairbanks, Alaska – their first case in 15 years, who flew in from Seattle (and is probably the King County case discussed below) and may have exposed others at an area Walmart, Home Depot, Walgreens, several supermarkets, the airport, and hospital, etc.
A confirmed case in King County, Washington, who may have exposed others in Seattle, including at an area McDonalds, the Baroness Hotel, a drug store, and the Sea-Tac Airport.
A confirmed case in Branson, Missouri, a traveler from Asia, who was contagious when visiting the ER, three local businesses, and perhaps his flight to town.
A confirmed case in the Washington D.C. area.
Another case of measles in Spokane County, Washington – an unvaccinated person that was exposed to the other case in the area.
An unvaccinated student from Europe in Boston, Massachusetts who also traveled to Maine and New Hampshire.
Another unvaccinated child in St. Lucie County, Florida – bringing the total to five cases in central Florida in what so far looks like two separate outbreaks.
Another case in Indian River County, Florida – an unvaccinated child.
An unvaccinated adult in Spokane, Washington – the first case in the area since 1994.
Two unvaccinated adults in Indian River County, Florida, one of whom contracted measles while traveling out of the country.
An unvaccinated 6-year-old in St. Lucie County, Florida who attended Fairlawn Elementary School in Fort Pierce – leading to five unvaccinated students being kept out of school until early May.
The first case in Oklahoma since 1997, a case in Stillwater.
A case in Florida, a traveler who was contagious while attending a conference at the Gaylord Palms Resort and Convention Center and also in Maimi-Dade, Orange, and Sarasota counties.
A new case in Illinois, the 15th – and so far not linked to the other two outbreaks in the state.
A student at Princeton University in New Jersey.
Another case of measles in the Washington D.C. area, a case without a known source.
A case in a student at Elgin Community College in Kane County, Illinois.
A hospitalized infant in Atlanta, Georgia.
An unvaccinated 1 year old in Jersey City, New Jersey.
A traveler in King County, Washington that may have exposed others in Seattle. The unvaccinated visitor is from Brazil, where there was a large outbreak of measles last year (almost 400 cases).
At least one more case in Clark County, Nevada and four more possible cases in Southern and Northern Nevada, which led to the quarantine of at least 11 students at the Spanish Springs Elementary School.
A case in Franklin County, Pennsylvania.
Four cases of measles in travelers, including two international travelers, who visited Florida.
A case in Washington D.C.
A student at Bard College in Dutchess County, New York, who exposed many people while traveling on an Amtrak train to Penn Station in New York City.
An unvaccinated woman in New Castle County, Delaware who had recently traveled out of the country.
A case on the University of Minnesota Twin Cities campus in a student that had recently returned from out of the country. Although others were exposed, it is considered to be a “highly immunized” population, so hopefully the outbreak won’t spread.
Two more cases in Arizona that are tied to the Disneyland outbreak, including a woman in Phoenix who may have exposed others up to 195 children at the Phoenix Children’s East Valley Center, including a 3-year-old getting chemotherapy for leukemia.
An adult in Cook County, Illinois which in not linked to Disneyland.
A student at Valley High School in Las Vegas which led to the quarantine of 36 unvaccinated students until early February.
Four cases among an unvaccinated family in Kearny, Arizona that is directly linked to the Disneyland outbreak.
A child in Sioux Falls, South Dakota that is unrelated to 13 recent cases in the area and which has no link to travel out of the area.
A new case in Oakland County, Michigan that is likely linked to the Disneyland measles outbreak, meaning that the outbreak has now spread to include 7 states and 2 countries.
A case in Maricopa County, Arizona has been linked to the Disneyland outbreak.
A person in Nebraska who could have exposed others in Omaha and Blair, including at the Omaha Children’s Museum.
A case in Lane County, Oregon that has been linked to the Disneyland measles outbreak.
A resident of Tarrant County in North Texas who developed measles after a trip to India.
Another unvaccinated person in Utah with links to the Disneyland outbreak has tested positive for measles, bringing the total in that state to 3 cases.

In addition to the 36 measles cases that have been associated with the Disneyland outbreak, California already has 5 additional measles cases this year with no link to Disney, including cases in Alameda, Orange, and Ventura Counties.

For More Information On Measles Outbreaks:

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Measles Returns to California

Breaking News – There are now six cases of measles in the San Francisco Bay Area, all unvaccinated, in an ongoing outbreak that has also spread to Nevada.

There are now six cases of measles in the San Francisco Bay Area as the outbreak grows.

Is anyone surprised that a student in California has measles?

Actually, a lot of folks are probably surprised. After all, didn’t lawmakers in California recently pass a law that mandated everyone in school get vaccinated?

Well yeah, but SB277 didn’t apply to all students. Only new students and those transitioning to a new grade span (for example, moving from K-6th to 7th grade) have to meet the new minimum immunization requirements. That means it will take more than a few years until all of the kids already in school whose parents have skipped or delayed any vaccines have gotten caught up or have graduated.

And that means we will still see some of these outbreaks of vaccine preventable diseases.

There is also a little issue with medical exemptions somehow rising being abused after the personal belief exemption was eliminated in the state…

Measles Outbreaks in California

When you think of measles and California, most people probably think of the 2015 Disneyland outbreak, which was linked to:

134 cases in California, including at least 50 cases without a known source
13 cases in Arizona, Nebraska, Utah, Colorado, Washington, and Oregon
1 case in Mexico
159 cases in Canada

The Disneyland outbreak included a lot of intentionally unvaccinated kids and kept unvaccinated kids from school, closed daycare centers, and led to hospitalizations of more than a few people.

“The ongoing measles outbreak linked to the Disneyland Resort in Anaheim, California, shines a glaring spotlight on our nation’s growing antivaccination movement and the prevalence of vaccination-hesitant parents.”

Majumder et al. on Substandard Vaccination Compliance and the 2015 Measles Outbreak

Schools in California were closed for at least two weeks in 1917 because of measles epidemics.

The Disneyland outbreak wasn’t the first big measles outbreak in California in recent years though.

No, I’m not talking about the really big outbreaks from the pre-vaccine era. Or even the outbreaks in the late 1980s, just before we started giving an MMR booster. Believe it or not, 75 people died between 1988 and 1990 with measles – just in California.

More recently, there was the 2008 outbreak in San Diego that was triggered by an unvaccinated 7-year-old boy who had traveled to Switzerland with his family.

He returned with measles and got at least 10 other unvaccinated children sick, including four infants who were too young to be vaccinated and were unknowingly exposed at their pediatrician’s office.

“Almost 100 children (including babies who were too young for the MMR vaccine) were quarantined or hospitalized after they were exposed at the pediatrician’s office, Whole Foods or day care. In all, 11 children caught the measles. As it turns out, the boy who spread measles is a patient of Dr. Bob Sears…”

OC’s Dr. Bob Sears discusses measles outbreak on NPR

One of those infants was hospitalized when his fever spiked to 106 degrees and he wouldn’t eat or drink.

“We spent 3 days in the hospital fearing we might lose our baby boy. He couldn’t drink or eat, so he was on an IV, and for a while he seemed to be wasting away. When he began to be able to drink again we got to take him home. But the doctors told us to expect the disease to continue to run its course, including high fever—which did spike as high as 106 degrees. We spent a week waking at all hours to stay on schedule with fever reducing medications and soothing him with damp wash cloths. Also, as instructed, we watched closely for signs of lethargy or non-responsiveness. If we’d seen that, we’d have gone back to the hospital immediately.”

Megan Campbell on 106 Degrees: A True Story

Measles cases also began rising in 2011, as unvaccinated travelers brought measles back from trips to Europe, Asia, and Africa, where there were large outbreaks. There were 31 measles cases in California in 2011.

While 31 cases might not seem like much, consider that between 2001 through 2006, there were just 66 cases in California, with only 4 cases in 2005!

Will we ever get to a year with just 4 cases in California again?

It didn’t happen in 2017.

Last year started with a big outbreak in Los Angeles County that grew to include at least 24 cases and a few surrounding counties. There was also a case involving an unvaccinated student at Laguna Beach High in Orange County which led to the quarantine of at least 6 unvaccinated students.

The Latest California Measles Outbreak

What kind of a measles year will we see in 2018 in California?

There is just one case, so far.

Well, it was just one case. There are six cases now… Seven if you count the linked case in Nevada.

Did you eat lunch at the Westgate Center food court on Friday, March 2?

It started when an unvaccinated student returned from a trip to Europe and developed measles, exposing others between February 28 through March 2 in Santa Clara County at a school in Campbell and at the Westgate Center food court in San Jose.

With an average incubation period of 10 to 12 days, that means exposed people might begin to show symptoms by March 14. Keep in mind that the incubation period can be as long as 21 days though, so be on the watch for measles symptoms until at least March 23 if you could have been exposed.

Since we don’t know when the new cases began to show symptoms, it is hard to know how much longer we can expect to see new cases. Hopefully these folks were already in quarantine and didn’t expose anyone else.

Would you recognize measles?

It is important to understand that the first symptoms of measles don’t include a rash. Instead, you get a high fever, runny nose, cough, and pink eye. The measles rash comes a few days later, as the high fever continues.

It is also important to understand the the MMR vaccine is safe and works very well to prevent measles.

This exposure is a great reminder that vaccines are necessary and that you shouldn’t wait for your kids to get exposed to get them caught up and vaccinated and protected.

What to Know About Measles Outbreaks in California

A recent outbreak of measles in California, this time in Santa Clara County, is a good reminder that the MMR vaccine is necessary to keep your kids protected.

More on Measles Outbreaks in California

Updated April 7, 2018

Recommendations for Reporting on Measles Outbreaks

Unfortunately, we hear news reports about measles outbreaks a lot more than we should.

We don’t get much information in many of those news reports though…

Anatomy of a Measles Outbreak Report

The big reason we don’t get a lot of information in those news reports is that many of them are simply repeating health department press releases.

A news release from the Texas Department of State Health Services.

Those press releases often leave a lot of important information out though.

Although that information might not be available yet, if you are a journalist covering a measles outbreak, instead of simply repeating the health department news release, you might call the local or state health department and ask a few questions:

Where did the person get measles? Most cases these days are imported – an unvaccinated person travels out of the country and returns home with measles, starting an outbreak. If they didn’t recently travel out of the country, then there’s a problem – where did they get measles? Unless there is already an ongoing outbreak in the area, then that means someone else in the area has measles that we don’t know about.
Where did the person go while they were still contagious and might have exposed others?
Hold old are they and were they vaccinated?

Do we have a right to this information? While the Health Insurance Portability and Accountability Act (HIPAA) protects a person’s medical information, those rules don’t necessarily always apply in an emergency or outbreak situation. Plus, you are still getting de-identified information.

“Health care providers may share patient information with anyone as necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.”

HHS on HIPAA Privacy in Emergency Situations

How is knowing someone’s vaccination status going to be helpful? Unvaccinated folks tend to cluster together, so knowing the person is unvaccinated, especially an unvaccinated child, might indicate that many more people have been exposed. But then, most measles outbreaks are started by someone who is unvaccinated…

Important Points for Covering Measles Outbreaks

In addition of covering the basics about the person with measles, there are other important points to cover, especially that measles is a vaccine-preventable disease!

Two doses of the MMR vaccine offers great protection against measles, and is especially important if you are unvaccinated and are going to travel out of the country. Even infants as young as six months old should get an MMR before international travel.

While most people hopefully know all that, they may not know:

the vaccination rates in your area schools
the non-medical vaccine exemption rates in your area schools
the number of measles cases in your area and in your state over the past few years
that measles is very costly to contain
that the incubation period for measles is 10 to 21 days after you were exposed, so it can take that long before you show symptoms
that they should warn their doctor or hospital before getting evaluated so that they can make sure you don’t expose other people, as measles is very, very contagious
that the quarantine period for unvaccinated people who have been exposed to someone with measles is typically up to 21 days after their last possible contact
that a dose of MMR within three days of exposure can help prevent your child from getting measles if they aren’t already fully vaccinated

Vaccine preventable diseases are just a plane ride away.

You should also consider interviewing and quoting a local pediatrician and reinforcing the facts that vaccines work and they are safe.

And obviously, as we see with these outbreaks, vaccines are necessary.

You should avoid also false balance in your reporting.

You should fully cover each outbreak in your area, as they help remind people to get vaccinated and protected.

What to Know About Reporting on Measles Outbreaks

Journalists can help reduce the size of measles outbreaks with good reporting that vaccines work and that they are safe and necessary and by reminding folks to get vaccinated and protected.

Measles Propaganda from The Physicians for Informed Consent

Most people understand that measles can be deadly.

“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.”

WHO Measles Fact Sheet

In the United States alone, in the pre-vaccine era, “an average of 549,000 measles cases and 495 measles deaths were reported annually.”

That roughly translates into about one death for every 1,000 cases, or a case-fatality rate of about 0.1%.

That’s in line with the typical case-fatality rate of measles of 0.1 to 0.2%.

Just How Deadly Is Measles?

Not surprisingly, many others have reported a similar case-fatality rate for measles.

Not everyone though.

The ironically named Physicians for Informed Consent suggests that it should be much, much lower.

Why?

Because of a 1989 report that said that “Before measles vaccine was available, more than 400,000 measles cases were reported each year in the United States. However, since virtually all children acquired measles, the true number of cases probably exceeded 4 million per year (i.e., the entire birth cohort).”

Their idea is that if there were more cases (i.e., the entire birth cohort), then even if almost 500 people died each year, the extra cases would make the death rate lower.

There are a lot of problems with that reasoning though…

For one thing, 500 people dying each year of a now vaccine-preventable disease is a lot of people, no matter how you to frame it!

I fixed this graph from The Physicians for Informed Consent to more accurately represent measles mortality data in the pre-vaccine era.

And the traditional stat about the measles fatality rate clearly mentions that this is about reported cases.

You can’t change the number of measles cases to a theoretical number, the entire birth cohort, and keep the number of deaths based on the number of reported cases, and think that you are still talking about the same thing. What if deaths from measles were under-reported too?

“Death from measles was reported in approximately 0.2% of the cases in the United States from 1985 through 1992.”

CDC Pink Book

And there are plenty of more recent statistics, when far fewer people were getting measles, that show a similar case fatality rate.

What Is the Measles Fatality Rate?

How else do we know that The Physicians for Informed Consent is misinforming people?

“…any parent who has seen his small child suffer even for a few days with persistent fever of 105 F, with hacking cough and delirium, wants to see this prevented…”

Alexander D Langmuir, MD on the Medical Importance of Measles

Their measles ‘information’ sheet, made by folks who have likely never treated a child with measles, say that “most measles cases are benign.”

That’s a bit different than Dr. Langmuir’s 1962 account of how the typical child suffered with measles and why he welcomed the new measles vaccine.

“Nevertheless, a resurgence of measles occurred during 1989–1991, again demonstrating the serious medical burden of the disease. More than 55,000 cases, 123 deaths, and 11,000 hospitalizations were reported”

Orenstein et al on Measles Elimination in the United States

What was the case fatality rate during the measles outbreaks in the late 1980s?

It was a little over 0.2%. Did we again under-count cases or was the case-fatality rate so high because most of the cases were in younger, preschool age children?

Anyway, whether the case fatality rate is 1 in 1,000 or 1 in 10,000 (the UK lists their measles case fatality rate at 1 in 5,000), it doesn’t mean that someone will die when you hit case number 1,000, 5,000, or 10,000. It could be the 1st case in an outbreak or the 15,000th.

Measles can be deadly. That’s why most of us choose to have our kids vaccinated and protected.

Do you know how many people had measles in the 2013 outbreak in Brooklyn when a pregnant woman developed measles and had a miscarriage? The outbreak that was started by an unvaccinated teenager included a total of 58 cases.

How about the 2015 outbreak in Clallam County, Washington in which an immunocompromised woman died of pneumonia due to measles? There were only five other cases, almost all unvaccinated.

And in many European countries last year, many of the deaths are in countries with few cases. When the 17-year-old unvaccinated girl in Portugal died, there were just 31 cases. In Switzerland, a vaccinated man with leukemia died in an outbreak with just 69 cases. There were only 163 cases when an unvaccinated 10-month-old died in Bulgaria. And there were fewer than 1,000 cases in Germany when a partially vaccinated mother of three children died.

More Myths About Measles

The Physicians for Informed Consent pushes a lot of other myths and misinformation about measles:

about using vitamin A to treat measles – where this works, in developing countries, untreated measles has a case fatality ratio of 5 to 40% because of malnutrition! It isn’t usually thought to be very helpful in an industrial country without malnutrition. And no, simply having a picky eater or one who eats a lot of junk food doesn’t mean that he will be helped by vitamin A if he gets measles
about using immunoglobulin to treat measles – the MMR vaccine and immune globulin can be used for post-exposure prophylaxis, but it is not a treatment once you have measles!
they misuse VAERS data to try and say the MMR vaccine is more dangerous than getting measles

Not surprisingly, the information that The Physicians for Informed Consent provides rarely matches that of the references they cite.

The Physicians for Informed Consent even talks about benefits of getting measles, but somehow leaves out any talk about the risk of getting SSPE after a natural measles infection.

What else do they leave out? The idea that people who survive a measles infection can have some immunosuppression for up to two to three years! This measles-induced immune damage puts them at risk of dying from other diseases and helps explain why kids who are vaccinated against measles are also less likely to die from other childhood infections.

They even published a press release claiming that they “recently reported in “The BMJ” that every year about 5,700 U.S. children suffer seizures from the measles, mumps and rubella (MMR) vaccine.”

Their report? It was a “letter to the editor” that anyone can submit online…

Get educated so that you aren’t fooled by this kind of propaganda and anti-vaccine talking-points.

What to Know About Measles Propaganda from The Physicians for Informed Consent

The Physicians for Informed Consent push propaganda to make you think that vaccine-preventable diseases, like measles, aren’t that bad and that vaccines are really, really dangerous.

More on Measles Propaganda from The Physicians for Informed Consent

Physicians for Informed Consent – another radical anti-vaccine group
Will 2017 be the antivaccine year?
WHO – Measles Fact Sheet
CDC – Measles (Pink Book)
CDC – Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP)
CDC – Manual for the Surveillance of Vaccine-Preventable Diseases
Study – Measles elimination in the United States
Editorial – Medical importance of measles
CDC – Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013
Study – Measles mortality. Analysis of the primary cause of death.
Study – Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality.
Study – Measles mortality reduction contributes substantially to reduction of all cause mortality among children less than five years of age, 1990-2008.
Study – Vitamin A for measles in children
Immune Globulin for Measles Postexposure Prophylaxis

What Ronald Reagan Can Teach Us About Vaccine Policy

Many U.S. Presidents, even George Washington, worked to get people vaccinated and protected. Well, Washington got them variolated and protected against smallpox, but that still counts.

As can be expected, some Presidents did a better job than others.

“Government’s first duty is to protect the people, not run their lives.”

Ronald Reagan

Do you have to run someone’s life to prevent outbreaks and help make sure folks get protected against vaccine-preventable disease?

Ronald Reagan’s Vaccine Policy

A lot happened in regards to vaccines when Reagan was President. After all, he was the President who signed the National Childhood Vaccine Injury Act (NCVIA) of 1986, which created VAERS and the NVICP!

What else happened?

“…the Reagan Administration starved the Federal program for childhood immunization…”

The Shame of Measles

That’s right, Federal support for vaccine programs reached a low point during Reagan’s years in office, as rates of children living in poverty and without health insurance also increased.

That’s not a good mix!

“During the Reagan years, the price of vaccine went up and Federal funding for childhood immunization went down.”

The Measles Menace

Not only did the price of vaccines go up, but new vaccines were added to the immunization schedule in the mid-1980s.

So even if Federal funding for vaccines had stayed the same, it would essentially have been a big cut!

“Measles is a wholly preventable disease, and it was almost eradicated from the country in 1983, when only 1,497 cases were reported. But by 1990, after Federal budget cuts and the end of the Government’s monitoring of immunization programs, more than 30,000 cases of measles and more than 60 deaths were reported.”

Panel Ties Measles Epidemic to Breakdown in Health System

All of this followed President Jimmy Carter’s National Childhood Immunization Initiative in 1977, which reached its goal of immunizing over 90% of children!

Not surprisingly, this followed a growth in federal grants from $5 million to $35 million towards state immunization budgets. Yes, it costs money to get kids vaccinated and protected. But don’t forget that it costs even more money to control outbreaks once they start.

“Immunization policy during the Carter Administration demonstrated that when both an administration and key congressional actors viewed immunization as a priority and made sufficient funds available to support the public health delivery system and its infrastructure, coverage levels would continue to rise and disease levels continue to decline.”

Johnson et al on Federal immunization policy and funding: A history of responding to crises

Unfortunately, the coverage levels and growth during the Carter administration weren’t sustained for very long after Reagan took office in 1981.

As can be expected, neither were declines in rates of measles.

Instead, we eventually saw big outbreaks of measles across the United States. From 1989 to 1991, at least 123 people died among 55,000 cases, with another 11,000 hospitalized.

“The measles outbreak of 1989–1991 exposed many incorrect assumptions behind the belief that low levels of coverage were sufficient to control the transmission of infectious disease. The changing demographics of society, the mixing of young children in day care settings, new patterns of health care delivery, high rates of uninsured children, and the shrinking size and morale of health departments all fostered circumstances in which disease transmission occurred within major metropolitan areas even though disease reports were low, and state health officials believed statewide immunization coverage was at acceptable levels.”

Calling the Shots: Immunization Finance Policies and Practices

How did it get fixed?

President George HW Bush announced his own immunization action plan to raise vaccinated rates, and we once again put more Federal money into our immunization programs.

The result?

Immunization rates went up and the outbreaks stopped.

The President and the Children

Outbreaks that didn’t have to happen.

A 1987 op-ed in the New York Times warned about was coming and how to prevent it…

“Each dollar spent to immunize young children saves $10 in later medical costs. Yet in 1985, one of four children between ages 1 and 4 was not immunized for rubella, mumps, polio or measles and 13 percent lacked immunization for diphtheria, tetanus and pertussis. Congress would increase funding by about $20 million, enough to immunize 600,000 more youngsters.”

The Reagan administration didn’t listen.

The Children's Defense Budget analysis details how Reagan proposed cutting $2 to $3 million a year from the immunization program beginning with his 1982 budget. — The Children’s Defense Fund budget analysis details how Reagan proposed cutting $2 to $3 million a year from the immunization program beginning with his 1982 budget.

Are we headed for something similar in the years ahead?

Consider that:

the Children’s Health Insurance Program (CHIP) expired on September 30 and it has yet to be reauthorized
the short-term CHIP “fix” took $750 million cut from the Prevention and Public Health Fund, which provides 40% of the total funding for the CDC’s immunization program
the Section 317 Immunization Program was already slated for a big drop in President Trump’s FY 2018 Budget

So we may have fewer kids with insurance and less money for immunization programs.

When did we last see that scenario?

Take Action and remind Congress and our President of the “critical role” they play in protecting our children and that they should #PutKidsFirst.

“As Members of Congress, we have a critical role to play in supporting the availability and use of vaccines to protect Americans from deadly disease.”

Sens. Lamar Alexander et al Dear Colleague Letter

“Supporting the availability and use of vaccines” does not mean decreasing funding for vaccine programs!

And protecting “Americans from deadly disease” certainly does not mean having fewer people covered on insurance plans.

What to Know About Ronald Reagan’s Vaccine Policy

Ronald Reagan essentially starved the Federal program for childhood immunization, which led to lower vaccine rates and deadly outbreaks of measles. Let’s not allow history to repeat itself.

VAXOPEDIA