Tag: measles outbreaks

The Myth That Measles Isn’t Deadly

Have you ever heard that measles isn’t deadly?

Sure, there are the folks who think that all vaccine preventable diseases are so mild that they wouldn’t kill you unless you lived in a Third World country.

The Myth That Measles Isn’t Deadly

But there are also folks, usually the same folks, who think that the measles virus doesn’t actually kill you – it is instead the complications that are deadly.

For most people, that’s a distinction without a difference.

“The acute pathological effects of measles include the destruction of respiratory epithelium and depression of cellular immunity. These effects interact to transiently increase measles-infected hosts’ susceptibility to respiratory bacterial strains to which they are not immune.”

Measles epidemics of variable lethality in the early 20th century.

After all, if you have measles and die, you probably don’t care if you died because of:

  • viral pneumonia
  • a secondary bacterial pneumonia
  • acute respiratory distress syndrome (ARDS)
  • acute measles encephalitis (swelling of the brain)
  • Subacute sclerosing panencephalitis (SSPE) – a late complication of natural measles infections

In the pre-vaccine era, before the early 1960s, about 400 to 500 people would die each year from measles and these complications.

So much for the myth that measles isn’t deadly.

But didn’t they all have underlying medical problems – another measles myth?

No they didn’t. One study of measles deaths in the 1960s found that only about 17% of the people who died with measles as the cause of death had an underlying disease.

And we now know that having a natural measles infection lowers your immunity and puts you at risk of dying from something else, even after you have recovered from your measles infection. That’s why mortality rates go down so much more than expected after measles vaccine programs are introduced in an area.

Measles Is Still Not Marvelous

Although the first measles vaccine was licensed in 1963, an improved version wasn't available until 1968.
Although the first measles vaccine was licensed in 1963, an improved version wasn’t available until 1968.

While it is true that people rarely die of measles in the United States and other developed countries anymore, that’s just because most people are vaccinated and really big outbreaks aren’t that common, especially since the endemic spread of measles was eliminated in 2000.

You don’t have to go back to the pre-vaccine era to remember how measles kills though.

Measles is still deadly, even in this era of modern medicine, good nutrition, and clean water. Not that people in the United States didn’t eat well and have access to indoor plumbing in the 1950s, but medical care has improved.

People can still die when they get measles though.

Consider that at least 123 people died in the United States during the large measles epidemics from 1989 to 1991. Another 11,000 were hospitalized, among only about 55,000 cases.

During even more recent outbreaks of measles:

  • a pregnant woman with measles was hospitalized and had a miscarriage (2013 measles outbreak in Brooklyn)
  • an immunocompromised woman died of pneumonia due to measles (2015 measles outbreak in Clallam County, Washington)

There have been other measles deaths and complications of these preventable infections.

Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.
Ending with 667 cases, 2014 became the worst year for measles in the United States since 1994.

Although before the Clallam County death, the CDC would say that “the last verifiable death in the United States from acute measles infection occurred in 2003 when there were 2 reported deaths,” death certificates had been filed in 2005, 2009 (2), 2010 (2), and 2012 (2) which listed measles as a cause of death code. These measles deaths are listed in the CDC “Summary of Notifiable Diseases — United States, 2012,” and in the CDC Wonder Compressed Mortality Files Underlying Cause-of-Death database.

Again, that there aren’t more simply reflects that most people are vaccinated.

But when we start seeing more and more cases of measles, more and more people will start to die. Just look at the outbreaks in Europe right now…

We also shouldn’t forget that worldwide, even after a 79% drop in measles deaths just since 2000, there were still 134,200 measles deaths in 2015, about 367 deaths a day.

What To Know About The Myth That Measles Isn’t Deadly

Not only are measles infections deadly, usually from pneumonia and encephalitis, but a natural measles infection can also cause years of immunosuppression, increasing your risk of death from other diseases too.

More About The Myth That Measles Isn’t Deadly

When Measles Epidemics Would Close Schools

Remember when measles epidemics and outbreaks used to close down entire schools and school districts?

No, I don’t either, but of course, like many of us, I’ve been fortunate enough to have grown up in the post-vaccine era for measles and many other vaccine-preventable diseases.

When Measles Epidemics Would Close Schools

Schools in California were closed for at least two weeks in 1917 because of measles epidemics.
Schools in California were closed for at least two weeks because of measles epidemics. Red Bluff Daily News, April 14, 1917

On April 16, 1917, as measles epidemics swept the United States, grammar schools in Red Bluff, California would shut down for at least two weeks.

Why?

Officials found that it was “impossible to cope with measles under present conditions” and they hoped this would help end the epidemic.

The city board of health also urged parents to “use every effort to stamp out the spread of the disease by keeping children at home, by having no child attend picture shows or even Sunday schools.”

This was hardly an isolated event though. School officials in Los Molinos and Redding, California had closed their high school and all grammar schools in late March for two weeks in the hopes “that the disease will wiped out in that time.”

Why the big push to end the outbreaks?

As experts warned that measles dangers were “too generally disregarded” by some, they also knew that “over 11,000 American children died of measles in 1910” and that “this did not include a large number who died of broncho-pneumonia.”

Tragically, there were many deaths in the 1917 measles epidemic too.

In nearby Chico, California, a mother and her 8-year-old died on the same day, while seven other family members were seriously ill and it was stated that “little hope is held for their recovery.”

Schools in Red Bluff didn’t open again until May 7, when finally the “epidemic of measles seems to have lessened its grip.”

Measles Were Never Marvelous

Some folks like to use the fact that there was a Brady Bunch episode about measles to make it seem like it was a mild disease.

If that’s true, then why do old newspaper clippings describe the “scourge of measles” and repeatedly warn how deadly it can be?

“Measles is often fatal to children under five years of age and on this account, special protection should be given to very young children. It is a mistake to expose a child to the disease so that he may “get ’em and have ’em over with.” The after results may effect the health of the individual all through his life.”

Red Bluff Daily News, Epidemic Measles Is Sweeping Over State California

Why were schools closed for three weeks?

Why did so many people die?

While some folks will blame it on a lack of modern medical care, poor nutrition, or poor sanitation back in the early 20th Century, you don’t have to go back that far to find reports of a lot of people dying of measles in the United States.

Even as improved nutrition, sanitation, and health care made many things less deadly, in the pre-vaccine era, in the late-1950s, there were about 450 measles deaths each year in the United States.

A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.
A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.

And at a time of modern nutrition, sanitation, and health care, at least 123 people died in the United States during the large measles epidemic from 1989 to 1991. Another 11,000 were hospitalized, among only about 55,000 cases.

“Two major causes of this epidemic were vaccine failure among a small percentage of school-aged children who had received 1 dose of measles vaccine and low measles vaccine coverage among preschool-aged children”

Dr. Walter Orenstein on the 1989-91 Measles Epidemics

Instead of “mild,” during the 1989-91 epidemics, you were more likely to hear terms like measles “emergency alert,” “Real Crisis Situation,” and “serious problem.”

Measles Still Keeps Kids From School

Fortunately, measles doesn’t close schools anymore. But not because measles has become more mild or easier to treat, after all, there is still no treatment for measles, but rather because most folks are vaccinated.

It can still lead to quarantines for those who aren’t vaccinated though. It is one of the ways that health officials work to control outbreaks.

During the Disneyland measles outbreak in California in 2015, a day care center in Santa Monica was closed (and 30 babies were put in home quarantine) and kids were kept from school at:

  • Amelia Earhart Middle School in Riverside – at least 6 unvaccinated students were kept from school after another student contracted measles
  • Palm Desert High School – 66 students were excluded from school because they are not fully vaccinated against measles
  • Huntington Beach High School – at least 24 unvaccinated students were excluded from school

But you don’t even have to go back that far to find these types of quarantines. In March, an unvaccinated student with measles led to the quarantine and exclusion of 7 other unvaccinated students from Laguna Beach High School in Orange County, California.

But a three week ‘vacation’ is hardly the worse thing that can happen when a measles outbreak comes to town. Measles is still deadly, even today.

Get educated and get vaccinated.

What To Know About When Measles Epidemics Would Close Schools

While you likely don’t remember when large epidemics of measles would close schools, it’s a reminder that measles wasn’t thought of as the mild disease that some claim it was.

More Information About History of Measles Epidemics

New Vaccine Laws and Mandates

Every good vaccine bill doesn't make it into law.
NY passed a law in 2015 that  eliminated religious exemptions to getting vaccines.

California passed a new vaccine law, SB 277, in 2015.

Most states, including California, already had vaccine mandates though. The difference now is that in California, you need a medical exception to attend school if your kids aren’t vaccinated.

With the passage of SB 277, California joined Mississippi and West Virginia as the only states that do not allow either religious or personal belief vaccine exemptions.

They still aren’t forcing anyone to get vaccinated though.

“The term mandate is somewhat misleading, because there are exceptions — always on medical grounds, frequently on religious grounds, and sometimes on philosophical grounds. Moreover, the thrust of mandates is not to forcibly require vaccination but to predicate eligibility for a service or benefit on adherence to the recommended immunization schedule of vaccination. ”

Y. Tony Yang on Linking Immunization Status and Eligibility for Welfare and Benefits Payments

And in some countries that already have mandates, they aren’t even doing a very good job of making sure that kids even get vaccinated. Many people will be surprised to learn that 14 European countries already mandate one or more vaccines, typically DTP, polio, and MMR.

What’s New in Vaccine Laws

Internationally, the idea of vaccine mandates is a big issue as we continue to see outbreaks of measles in Europe and other areas of the world.

“Parents who vaccinate their children should have confidence that they can take their children to child care without the fear that their children will be at risk of contracting a serious or potentially life-threatening illness because of the conscientious objections of others. ”

Australian Prime Minister Tony Abbott on “No Jab No Pay”

Unlike the Disneyland outbreak in California, the outbreaks in Europe are on a much bigger scale.

And with more cases we see what everyone fears – more deaths.

That’s why we are finally seeing new vaccine laws, including some that mandate vaccines in some other countries, including:

  • Australia – the Australian government began a “No Jab No Pay” plan in 2016 that removed the conscientious objector exemption on children’s vaccination for access to taxpayer funded Child Care Benefits, the Child Care Rebate and the Family Tax Benefit Part A end of year supplement.
  • Germany – a new law, if approved (it has already passed the Bundestag or national parliament), will require parents to have a medical consultation before deciding to delay or skip vaccines or they can be fined up to $2,800. Even with the law, in Germany, “vaccinations remain voluntary. But some politicians have suggested that mandatory vaccination is on the way if concerted efforts to encourage vaccinations don’t work.”
  • Italy – the Italian Parliament recently approved the Decree-Law Containing Urgent Measures on the Compulsory Vaccination of Children, which makes vaccinations against 12 diseases mandatory for children as a condition of school registration, for both private and public schools.
  • France – is working to expand their list of mandated vaccines to now include protection against 11 diseases instead of just three (diphtheria, tetanus, and polio). All of these vaccines were previously recommended to attend school, but were only voluntary.

Again, none of these laws mean that anyone is being forced to vaccinate their kids.

Even in the case of vaccine mandates, they are simply requirements to attend daycare or school.

We are also seeing some new vaccine laws in the United States, including changes for the start of the 2017-2018 school year:

  • Indiana – pharmacists can give more vaccines, any vaccine that the CDC recommends, either with a prescription or by protocol for kids over are at least 11 years old and adults
  • Iowa – now requires a meningococcal vaccine for students entering 7th (one dose) and 12th (one or two doses) grades
  • Nevada – now requires a meningococcal vaccine for students entering 7th grade (one dose) and college (a dose after age 16 years)
  • Pennsylvania – unvaccinated students now only have a 5 day grace period at the start of the school year to get vaccinated (it used to be 8 months) before getting expelled from school.

It’s easy to navigate the new laws.

Get educated and get your kids vaccinated. Vaccines are safe, vaccines work, and vaccines are necessary.

What To Know About Vaccine Mandate Laws

Vaccine mandate laws are expanding as we are seeing more outbreaks of vaccine preventable diseases.

More Information on Vaccine Mandate Laws:

Measles Vaccines vs Measles Strains

Most people understand that for every virus or bacteria, their can be multiple strains of the same organism that cause disease.

For example, there is flu A and B, swine flu, bird flu, and even dog flu.

In the case of flu, those different strains are a problem, because having immunity to one, doesn’t mean that you will have immunity to others. In fact, usually you won’t, whether it is natural immunity from a previous infection or immunity from a vaccine.

Pains with Strains

Do we have the same issues with other diseases?

We certainly have situations in which vaccines don’t cover all disease strains, including:

  • Gardasil – now covers nine strains of HPV that cause 90% of cervical cancers
  • Hib – only covers Haemophilus influenzae type b, which causes invasive disease, like meningitis, pneumonia, and sepsis, but not other Haemophilus influenzae strains that can cause ear infections
  • Polio – originally protected against three serotypes of polio, but monovalent (one strain) and bivalent (two strains) oral poliovirus vaccines have also been available to respond to outbreaks and bOPV is the one used for routine immunization, except in industrialized, polio-free countries that use the IPV shot
  • Prevnar – now covers 13 strains of Streptococcus pneumonia
  • Rotavirus – protects against severe disease caused by rotavirus strains that aren’t even in the vaccine

Fortunately, even when a vaccine doesn’t cover all strains, it does cover those that most commonly cause disease.

Measles Genotypes

Knowing the genotype of a measles strain can help you understand where measles outbreaks are coming from.
Knowing the genotype of a measles strain can help you understand where measles outbreaks are coming from.

What about measles?

There are at least 24 different genotypes of measles that come from 8 different clades (A-H), with even more wild type virus strains (based on those genotype).

These genotypes include A (all vaccine strains are genotype A), B2, B3, C1, C2, D2, D3, D4, D5, D6, D7, D8, D9, D10, D11, G2, G3, H1, and H2.

In general, genotypes are restricted to a specific part of the world, such as:

  • African Region – B2, B3
  • Eastern Mediterranean Region – B3, D4, D8
  • European Region – D4, D5, D6
  • Southeast Asian Region – D4, D5, D8, D9, G2, G3, H1
  • Western Pacific Region – D5, D9, G3, H1

In countries that have eliminated measles, like the United States, the genotypes that are found will depend on from where the measles strain was imported.

Additionally, five genotypes, B1, D1, E, F, and G1 are now inactive.

Measles Strains

Specific strains of measles viruses include the vaccine strains (Edmonston, Moraten, Zagreb, Schwarz, AIK‐C, CAM, Leningrad-16, and Shanghai-191, etc.) plus wild strains, like:

  • MVi/NewYork.USA/94 – a wild strain of B3 genotype
  • Johannesburg.SOA/88/1 – a wild strain of D2 genotype
  • Manchester.UNK/30.94  – a wild strain of D8 genotype
  • Hunan.CHN/93/7 – a wild strain of H1 genotype

Why so many vaccine strains?

It may come as a surprise to some people, but the whole world doesn’t use the same vaccines. For example, unlike the United States, Japan has used measles vaccines derived from AIK‐C, CAM, and Schwarz strains of the measles virus.

And just how many wild strains of measles are there? It’s hard to know, but consider that a study of 526 suspected measles cases from 15 outbreaks over 3 years in one state of India found at least 38 different strains.

Myths About Measles Strains

Do the measles vaccines cover all of the measles strains that cause outbreaks around the world?

Yes they do, despite the myths you may hear about mutated measles strains.

This came up a lot during the Disneyland measles outbreak, when folks first tried to place blame on a vaccine strain and then on the fact that the outbreak strain didn’t match the vaccine strain.

“…California patients were genotyped; all were measles genotype B3, which has caused a large outbreak recently in the Philippines…”

CDC Measles Outbreak — California, Dec 2014–Feb 2015

And it is coming again in the latest measles outbreak in Minnesota. Could that outbreak be caused by a vaccine strain? Anything is possible, but it’s not. A communication’s director for the Minnesota Department of Health has confirmed that “that the virus strain making people sick in this outbreak is the B3 wild-type virus.”

Of course, none of these outbreaks are started by a vaccine strain of measles shed from someone who was recently vaccinated. It also had nothing to do with the fact that the strains didn’t match – after all we aren’t talking about the flu.

These outbreaks are imported from other countries by folks who typically aren’t vaccinated or are incompletely vaccinated and mostly spread among other people who are unvaccinated.

So what’s the most important thing to understand when considering all of these vaccine strains and wild strains of measles? It is that “there is only 1 serotype for measles, and serum samples from vaccinees neutralize viruses from a wide range of genotypes…”

In other words, the measles vaccine works against all strains of measles in all genotypes of measles. That makes sense too, because the measles virus, unlike influenza, is monotypic.

There is only one main type of measles virus, despite the many small changes in the virus that can help us identify different strains and genotypes. And these changes don’t affect how antibodies protect us against the measles virus.

What To Know About Measles Strains

The best way to get protected against all measles strains is to get vaccinated with two doses of the MMR vaccine.

More About Measles Strains

Updated May 23, 2017

Measles Deaths in the 21st Century

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

Measles is a big killer.

According to the WHO, “In 2015, there were 134,200 measles deaths globally – about 367 deaths every day or 15 deaths every hour.”

But it wasn’t that long ago, in 1980, that measles was causing at least 2.6 million deaths a year. And just 17 years ago, in 2000, measles caused about 777,000 deaths worldwide.

Measles Deaths in the 21st Century

While some experts doubt if we will ever truly eradicate measles, like we have done for smallpox, a lot of progress is being made on reducing measles outbreaks and deaths thanks to routine and supplemental immunizations.

Tragically, measles still kills.

“For every 1,000 children who get measles, one or two will die from it.”

CDC – Complications of Measles

And it is not just in developing countries that don’t have access to vaccines or adequate levels of vitamin A or modern healthcare. It should also be obvious, when you look at the cases below, that you don’t have to wait for there to be a 1,000 people in an outbreak for there to be a death. It could be the first person in the outbreak or you might see 3 or deaths between cases 3,000 to 4,000.

During the 2010 and 2011 outbreaks in Europe, after all, with about 30,000 cases of measles each year, there were at least 28 deaths.

There are now 36 deaths in this year's measles outbreaks in Europe.
There are now 37 deaths in this year’s measles outbreaks in Europe.

So far, just this year, according to the ECDC, there are reports of:

  • the death of a 10-month-old unvaccinated child in Bulgaria (among just 163 cases)
  • the death of a 37-year-old partially vaccinated women (the mother of 3 kids) in Essen, Germany (among about 797 cases)
  • the death of a 17-year-old girl who was not vaccinated in Portugal (among just 31 cases)
  • 31 deaths in Romania, almost all unvaccinated children (among 7,491 cases since January 2016)
  • the death of a vaccinated man who was being treated for leukemia in Switzerland (among just 69 cases)
  • three deaths in Italy (among 3,672 cases), including a 6-year-old boy with leukemia who reportedly caught measles from an unvaccinated sibling.

Unfortunately, measles cases continue to rise in most of these countries and many others…

The latest death – a man in Dolj county, Romania, raising the number of measles deaths to 32 in that country.

Outside of the EU, cases of measles and deaths include:

  • 20,898 cases in the DR Congo with at least 241 deaths
  • 2,246 cases in Ethiopia
  • 1,891 cases in South Sudan with at least 16 deaths
  • 1,527 cases in Guinea with at least 2 deaths
  • 10 deaths of children in Bangladesh
  • 40 deaths of infants in Indonesia
  • 13,484 cases in Nigeria with at least 77 deaths

Are you planning a trip to Europe any time soon? How about Indonesia or DR Congo, for which the CDC has also issued travel health notices? Even if you aren’t, as these outbreaks rise, it increases the chances that another traveler will bring measles home and expose someone in your community, starting an outbreak.

And while we deal with folks who simply don’t want to vaccinate and protect their kids, no one should lose sight of the fact that “In 2015, there were 134,200 measles deaths globally – about 367 deaths every day or 15 deaths every hour.”

What To Know About Measles Deaths

Kids are still dying of measles and the big take away should be that it doesn’t take thousands of cases for there to be a death and it can happen to a healthy child in a developed country with modern healthcare.

Get Educated. Get Vaccinated. Stop the Outbreaks

More Information About Measles Deaths

Updated July 24, 2017

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About Those Measles Outbreaks in China

The MMR vaccine is one of the most effective vaccines ever made. Two doses are at least 99% effective at preventing measles infections. Even one dose is about 95% effective against measles.

We have measles outbreaks in the United States not because the MMR vaccine is not effective, but rather because there are still so many unvaccinated people around. Often, these unvaccinated people travel out of the country, get sick with measles, and start the outbreaks.

About Those Measles Outbreaks in China

A study in PLOS did not find massive outbreaks of measles in China despite high vaccination rates.
A study in PLOS did not find massive outbreaks of measles in China despite high vaccination rates.

But if the MMR vaccine is so effective, then why, as many anti-vaccine folks claim, is China having measles outbreaks when 99% are vaccinated?

The simple answer is that this claim is false – China is not having these big measles outbreaks among highly vaccinated people.

The source of the claim is from a real article in PLoS One, “Difficulties in Eliminating Measles and Controlling Rubella and Mumps: A Cross-Sectional Study of a First Measles and Rubella Vaccination and a Second Measles, Mumps, and Rubella Vaccination,” which found that in 2011, in Zhejiang province, there were:

  • 9 patients with measles, including 3 infants who were too young to be vaccinated and 6 young adults who were unsure if they had ever been vaccinated
  • 1122 patients with mumps
  • 186 patients with rubella

So no big measles outbreaks, but why the large number of cases of mumps and rubella?

History of Measles Vaccination in China

It becomes easy to understand when you look at their immunization schedule.

In the United States, the first live measles vaccine was introduced in 1963, the MMR was introduced in 1971, and a booster dose of MMR was added to the childhood immunization schedule in 1990. That helped to stop the endemic spread of measles in 2000 and rubella in 2004.

In contrast, the measles vaccine timeline has moved much slower in China:

  • a measles vaccine was introduced in 1966
  • continued use of a one-dose, single-antigen measles vaccine through the 1970s and mid-1980s
  • the addition of a single-antigen measles vaccine booster dose in 1985 to children who were 7-years-old
  • in 2007, the switch to a measles-rubella vaccine for 8 months old, with a MMR booster at 18-24 months
  • the addition of a measles-rubella vaccine booster for secondary school students in 2008
  • a campaign to get children between the ages of 8 months and 4 years vaccinated with a measles-mumps vaccine in 2010

So many of the children and young adults who had mumps and rubella would not have had a chance to get a mumps or rubella vaccine. They were too old when they started giving those vaccines and there was no catch-up for older children and adults.

The study authors conclude that a timely two-dose MMR vaccination schedule is recommended, with the first dose at 8 months and the second dose at 18–24 months. An MR vaccination speed-up campaign may be necessary for elder adolescents and young adults, particularly young females.

What To Know About Those Measles Outbreaks in China

Even considering the varied vaccine schedule, the study also clearly states that even for the measles vaccine, there is less than 95% coverage in almost all age groups and that measles cases are at an historic low.

It should be clear that anti-vaccine websites are putting out false information when they say that China is having measles outbreaks when 99% of the population is vaccinated.

More About Those Measles Outbreaks in China