Tag: measles

Making America Measly Again

Believe it or not, measles didn’t get it’s name from the measles virus.

Charles Bruxton did his dissertation on measles in 1793.
Charles Bruxton did his dissertation on measles in 1793.

After all, the virus wasn’t discovered until 1954, by John Enders.

Making America Measly Again

So where did the name measles come from?

One idea is that it came from the Middle English word mesel, which means a leper. Another that it is from the Latin misellus, the diminutive form of miser – wretched.

“Measles is, he says, derived from the Dutch maseln (measles) ; the disease is also called in Holland mczsel-sucht, the measle-sickness; so translated by an old English writer. The literal sense is “small spots.” The original word occurs in the Middle High German mase,’ Old High German masa, a spot. Hirsch also states that the English word “measles” corresponds to the German Maal, and Masern, and the Sanscrit masurra, spots. Doubtless it is to this meaning of spots, hence spotty, that we owe the term “measly pork,” as applied to the meat of the pig when infested with scolices of tasnia.”

Sykes On the Origin and History of Some Disease Names

Most people think that the etymology of measles is Dutch.

It’s shouldn’t be a surprise that few of us know where the name comes from, as few folks have actually seen a kid with measles, even with the recent rise in measles cases.

“Typical case of measles – a couple days of high fever, with a sick (miserable) looking kid with running nose, bad cough, and red eyes. You can see Koplic’s spots if you know to look for them on the buccal mucosa (I describe them as grains of salts on red tablecloth). Fever gets higher and rash appears at peak of fever (day 3-4). The rash disappears with a brawny hyperpigmentation appearance. The child frequently gets diagnosed with an ear infection. If no complications (ear infection or pneumonia), recovery is quick once the fever resolves, but these kids look really sick, miserable, and sad during the acute phase. They have a measly look.”

Jeed Gan, MD

But I’m sure most of us can imagine that measly look…

A child with measles and four days of the classic measles rash.
A child with measles and four days of the classic measles rash. Photo by CDC/NIP/ Barbara Rice

What else can you imagine?

Roald Dahl's daughter died of measles in 1962, the year before the development of the first measles vaccine.
Roald Dahl‘s daughter died of measles in 1962, the year before the development of the first measles vaccine.

Can you imagine losing your child to a vaccine-preventable disease?

Measles deaths were once common in the United States. Let’s stop the outbreaks, as we have a safe vaccine, with few risks, and not bring measles deaths back as we get even more measles cases.

More on Making America Measly Again

Why Haven’t We Eradicated Measles Already?

The first measles vaccine was developed in 1963.

So why do we still have measles?

Shouldn’t measles be on the list with all of the other eradicated diseases, like smallpox and, well smallpox…

Why Haven’t We Eradicated Measles Already?

Eradicating a disease is not as simple as developing a vaccine.

If it were, a lot of diseases would have been eradicated already.

Hopefully, we will add more to the list of eradicated diseases, but there are some that will never be eradicated. Tetanus, for example, is ubiquitous in soil, so would be nearly impossible to eradicate. Other diseases, like rabies and yellow fever, would be hard to eradicate because they can infect animals or insects.

What about measles?

Anti-vaccine folks do not understand herd immunity.

While there was never a goal to eradicate measles by 1967, we have missed several deadlines to get measles under better control.

What was the first deadline?

“Recent successes in interrupting indigenous transmission of measles virus in the Americas and in the United Kingdom prompted the World Health Organization (WHO), Pan American Health Organization (PAHO), and CDC to convene a meeting in July, 1996 to consider the feasibility of global measles eradication.”

Measles Eradication: Recommendations from a Meeting Cosponsored by the World HealthOrganization, the Pan American Health Organization, and CDC

Folks started talking about measles eradication in 1996.

Before that though, there had been a goal to eliminate measles in the United States.

“An effort is underway to eliminate indigenous measles from the United States; a target date of October 1, 1982 has been set.”

Although we missed that initial target date, we weren’t too far off.

“In 1978, the US Public Health Service initiated a Measles Elimination Program with the goal of eliminating measles from the United States by 1982. The goals of this program included (1) maintenance of high levels of immunity,(2) careful surveillance of disease, and (3) aggressive control of outbreaks. Unfortunately, the program failed, predominantly because of the failure to implement the recommended vaccination strategy and because of vaccine failure. An increase in measles cases was sustained from 1983 through 1991 and was particularly dramatic from 1989 through 1991.”

Poland et al on Failure to Reach the Goal of Measles Elimination

There is also the fact that measles is just so dang contagious!

Improving vaccination rates and a two-dose MMR schedule helped decrease measles rates even further and finally eliminate the endemic spread of measles in the United States in 2000.

What were some other deadlines and goals?

  • In 1989, the World Health Assembly resolved to reduce measles morbidity and mortality by 90% and 95%, respectively, by 1995, compared with disease burden during the prevaccine era.
  • In 1990, the World Summit for Children adopted a goal of vaccinating 90% of children against measles by 2000.
  • Regional measles-elimination goals have been established in the American Region (AMR) by 2000, the European Region (EUR) by 2007, and the Eastern Mediterranean Region (EMR) by 2010.
  • A regional measles-elimination goals have been established in the Western Pacific (WPR) by 2012.
  • In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan with the objective to eliminate measles in four World Health Organization (WHO) regions by 2015 – the Region of the Americas, EUR, EMR, and WPR.
  • Countries in all six WHO regions have adopted goals for measles elimination by 2020.

Obviously, we haven’t hit all of the goals and deadlines on time.

What have we done?

We have tremendously reduced the number of children who get measles and who die with measles. For example, instead of meeting the 2010 goals of decreasing global measles mortality by 90% over 2000 levels, we have decreased it by 74%. The world has gone from an estimated 100 million cases and 5.8 million deaths in 1980 and an estimated 44 million cases and 1.1 million deaths in 1995 to “just” 7 million cases and 89,780 deaths in 2016.

There is still some work to be done though, especially with the uptick in cases and deaths in the last few years.

“Eradication of both measles and rubella is considered to be feasible, beneficial, and more cost-effective than high-level control.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review report: Background and summary

Work that we can still do if everyone makes the commitment to implement their elimination plans.

And folks vaccinate and protect their kids!

What’s the alternative?

To go back to when even more kids got sick and died with measles?

More on Eradicating Measles

Remembering When Everyone Had Measles

In the pre-vaccine era, everyone got measles.

What was that like?

Remembering When Everyone Had Measles

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.

Well, for one thing, before we had a measles vaccine, having measles was considered a rite of passage for kids, but only because they had no choice except to eventually get it!

And when measles came to town, as it inevitably did, most folks got it, leading to missing weeks of school, play, and work, etc.

But it wasn’t all fun and games.

At best, measles left you feeling miserable.

Tragically for some, they didn’t survive having measles.

“Before a vaccine became available in 1963, measles was a rite of passage among American children. A red rash would spread over their bodies. They would develop a high fever. Severe cases could cause blindness or brain damage, or even death.”

CDC says measles almost eliminated in U.S.

It should be clear that when measles was everywhere and everyone had measles, it could affect every aspect of your life.

Quarantines for measles were once very common, although everyone still ended up getting measles eventually.
Quarantines for measles were once very common, although everyone still ended up getting measles eventually.
In 1959, the Los Angeles Times reported that 80% of the kids in this school’s lower grades would be absent in an outbreak that had been ongoing since the previous month
Could you imagine your child’s college shutting down for two weeks because kids were getting sick? This was in 1956.
If measles was so mild, why were colleges shutting down for two weeks?
Quarantines were common to control outbreaks in 1949.
Too bad they didn’t have laptops in 1947, although even if they did, Will Jones would have been too sick to have worked from home when he had measles…
Remember the Lassie episode when Timmie had measles...
Remember the Lassie episode when Timmie had measles… When everyone got measles, measles was every were, even on TV.
Delaying a movie isn’t so bad…
But what about almost delaying a trip to the moon? Remember Apollo 13?
Measles deaths were common in 1952.

When everyone got measles, everyone had problems with measles.

We know what happens when immunization rates drop…

That’s why most of us are very glad to vaccinate and protect our kids. We don’t want them to get measles or any other vaccine-preventable diseases.

More on Remembering When Everyone Had Measles

Did Gregory Poland Really Say That MMR Vaccines Can’t Prevent Measles Outbreaks?

One of the pillars of the anti-vaccine movement is their belief that vaccines don’t even work.

They even think that they have graphs to prove it! They don’t…

Did Gregory Poland Really Say That MMR Vaccines Can’t Prevent Measles Outbreaks?

To help them try and argue their point, they also seem to like to cherry pick and misuse quotes from real experts.

Anti-vaccine propaganda from Lawrence Solomon.
Is that what Dr. Poland said?

In 2012, Gregory Poland, the Editor-in-Chief of the journal Vaccine, did publish the article, The Re-Emergence of Measles in Developed Countries: Time to Develop the Next-Generation Measles Vaccines?

No where in the article does he say that the measles vaccine can’t prevent measles outbreaks.

He is just saying that since the vaccine isn’t 100% effective and because measles is so contagious, that it can’t prevent all measles outbreaks.

“Thus, measles outbreaks also occur even among highly vaccinated populations because of primary and secondary vaccine failure, which results in gradually larger pools of susceptible persons and outbreaks once measles is introduced.”

Poland et al on The Re-Emergence of Measles in Developed Countries: Time to Develop the Next-Generation Measles Vaccines?

And we likely won’t be able to eradicate measles with our current measles vaccine, “even though measles can be controlled, and even eliminated in some regions for defined periods of time.”

“Thus, while an excellent vaccine, a dilemma remains.”

Poland et al on The Re-Emergence of Measles in Developed Countries: Time to Develop the Next-Generation Measles Vaccines?

The dilemma is that measles is still around and that people who are too young to be vaccinated, too young to be fully vaccinated, and those with immune system problems who can’t be vaccinated sometimes get measles, in addition to folks who are intentionally unvaccinated.

With a better vaccine, fewer people would get caught up in outbreaks that are typically triggered by folks who are intentionally unvaccinated.

Remember, most outbreaks are traced back to someone who is unvaccinated. This is the person Dr. Poland is describing when he says “once measles is introduced,” as the endemic spread of measles has been eliminated in the United States. All cases are reintroduced from outside the country, typically when someone who is intentionally not vaccinated travels overseas and then returns with measles while they are still contagious.

“But he also said that sometimes people who oppose the vaccines will pick out one sentence in the scientific study and extrapolate it to mean things that it does not mean… He said that measles is the most contagious disease that we know, and yet we found that fear and ignorance is more so.”

Senator Carla Nelson on The Anti-vaxxers Might Wish that What was Lost had not been Found

Unfortunately, a better measles vaccine still won’t protect us from anti-vaccine propaganda.

Vaccines are safe, with few risks, and necessary. Get vaccinated and stop the outbreaks. You don’t have to wait for a new measles vaccine…

More on Did Gregory Poland Say That MMR Vaccines Can’t Prevent Measles Outbreaks?

Did the Measles Vaccine Have Only a Meager Effect on Deaths?

Anti-vaccine folks seem to think that they found another big bombshell report!

As you will see, the “meager effect” of the measles vaccine prevented over 500 measles deaths in the United States each year!

They are talking about an article from 2001, The Role of Public Health Improvements in Health Advances: The 20th Century United States, by David Cutler, which found that “clean water was responsible for nearly half of the total mortality reduction in major cities, three-quarters of the infant mortality reduction, and nearly two-thirds of the child mortality reduction.”

The article even included mortality graphs for anti-vaccine folks to misuse!

Did the Measles Vaccine Have Only a Meager Effect on Deaths?

What are they missing?

“In the early 20th Century, mortality in the United States declined dramatically. Mortality rates fell by 40% from 1900 to 1940, an average decline of about 1% per year”

Cutler on The Role of Public Health Improvements in Health Advances: The 20th Century United States

Most of the decline the article talks about came at the beginning of the 20th Century, before these vaccines were developed.

What about the vaccines for whooping cough, diphtheria, and tetanus, which were developed in the earlier part of the 20th Century? They weren’t routinely used until much later. Remember, the individual diphtheria, tetanus, and pertussis vaccines didn’t even become combined into a single DTP vaccine until 1948.

Clean water and sanitation only had so much effect on mortality rates and much of it was in the early part of the 20th Century. Vaccines and other medical interventions took us the rest of the way!

But, all of these diseases that are now vaccine preventable were still very deadly in the 1940s and 1950s, even with clean water and sanitation.

Sure, mortality rates had declined already by this time, just like they had for most other things, but the effects of clean water eventually plateaued and a lot of people were still getting measles and a lot of people were still dying.

Why so many deaths in 1950 if they had been eliminated by clean water and sanitation?

At least they were until the measles vaccine was discovered and more and more people started getting vaccinated and protected.

You can even ask the author of the article in question…

“Dear Lord.  The fact that vaccines aren’t the only reason why mortality declines in no way means that vaccines are not an important reason why mortality declines.”

David M Cutler, Harvard College Professor, Otto Eckstein Professor of Applied Economics

The idea that the measles vaccine had only a relatively meager effect on deaths due to measles infections is silly. It’s also dangerous if you believe it and leave your kids unvaccinated and at risk to get measles, which is clearly a deadly disease.

More on Anti-Vaccine Mortality Graphs

Who Dies with Measles?

Measles is another of those diseases that some claim used to be mild and a rite of passage for kids.

That’s why there was an episode of the Brady Bunch about it, right?

An episode in which all of the kids got sick and they had to call two pediatricians to do house calls…

Who Dies with Measles?

While measles was a rite of passage for kids, it wasn’t the kind you looked forward to, because measles is rarely mild.

“Before a vaccine became available in 1963, measles was a rite of passage among American children. A red rash would spread over their bodies. They would develop a high fever. Severe cases could cause blindness or brain damage, or even death.”

CDC says measles almost eliminated in U.S.

Instead, most people develop 10 days of measles symptoms, including a high fever, cough, runny nose, watery eyes, and a rash. Photophobia, irritability, sore throat, headache, and abdominal pain are other symptoms that children with measles might have.

Many require hospitalization and some die.

But isn’t it just older people or those with immune system problems that die with measles?

“From 1964 through 1971, 16.7% of the death certificates reviewed noted some underlying pathologic condition.”

Roger Barkin, MD on Measles mortality. Analysis of the primary cause of death.

Nope.

It is most often children, typically young children, without any medical problems who die.

Before the routine use of vaccines, most measles deaths were young children without any medical problems.
Before the routine use of measles vaccines, most measles deaths were young children without any previous medical problems.

In the post-vaccination era, no one would be expected to die with measles, but those with immune system problems sometimes do, as most others are vaccinated and protected. As vaccinated rates drop though, even otherwise healthy children and adults can once again die of measles.

Remember the measles outbreaks at the end of the 1980s?

“Complications were reported in 672 (9.8%) cases, including otitis media in 318 (4.6%) cases, pneumonia in 178 (2.6%), diarrhea in 171 (2.5%), and encephalitis in five (0.1%). Nine hundred thirteen patients (13.3%) were hospitalized, and 10 measles-associated fatalities were reported (case-fatality rate: 1.5 deaths per 1000 reported cases). Eight of the deaths were reported in children less than 5 years of age, all of whom were unvaccinated. None had a reported underlying illness or immunodeficiency. Most deaths have been attributed to pneumonia.”

Measles — United States, First 26 Weeks, 1989

Probably not, but from 1989 to 1991 there were at least 123 measles deaths across the United States, even after measles had been declining for years with the introduction of the measles vaccine in the 1960s. Most of the deaths were otherwise healthy, without underlying medical problems.

They were unvaccinated and unprotected.

Because we don’t typically hear any details about measles deaths, including the almost 90,000 measles deaths that continue to occur around the world each year, most people likely assume that measles only kills in third world countries, where kids are already sick or malnourished. Of course, that wouldn’t explain how over one hundred people died with measles in Europe over the past few years…

Still think that measles isn’t deadly?

Tragically, there are plenty of stories (although most are never reported in the news and we don’t hear about them) and case reports that will prove you wrong:

  • Olivia Dahl died with measles when she was 7-years-old (1962)
  • an unvaccinated 3-year-old died in Maricopa County (1970)
  • a 13-year-old girl who had previously been vaccinated with one of the first inactivated measles vaccines which were found to be ineffective and were replaced with the newer live vaccines died in Michigan (1978)
  • a 9-month-old died in Chicago (1990)
  • an unvaccinated 13-year-old died in Kansas (1990)
  • Tammy Bowman, an 11-year-old unvaccinated girl died in Michigan (1990)
  • an unvaccinated 13-year-old became the first person in the UK to die with measles in 14 years (2006)
  • a 14-year-old died of Subacute Sclerosing Panencephalitis (SSPE), a late complication of a natural measles infection (2015)
  • an immunocompromised woman died after she was exposed in an outbreak in Clallam County, Washington (2015)
  • a 6-year-old boy with leukemia died in Italy caught measles from his intentionally unvaccinated sibling (2017)
  • an 11-month-old unvaccinated infant died in Greece (2017)
  • an intentionally unvaccinated 9-year-old girl with chromosomopathy, which is not a contraindication to getting vaccinated, died in Italy (2017)
  • a 10-month-old unvaccinated boy who likely caught measles when he had been hospitalized for an RSV infection, died in Italy (2018)
  • a 16-year-old who had received a heart transplant when she was 2-years-old died in France (2018)
  • an unvaccinated toddler in Jerusalem (2018)

Measles as a rite of passage?

“We baby boomers were apparently the last generation whose doctors, and therefore parents, accepted the measles as just one more annoying rite of passage of childhood that also happened to prime the immune system and provide lifelong immunity. Medical texts prior to the advent of the vaccine described measles as a benign, selflimiting (sic) childhood infectious disease that posed little risk to the average well-nourished child.”

Darrerl Crain, DC on The Great Measles Misunderstanding

While early pediatric textbooks did a great job describing the symptoms of measles, they also did a great job of documenting that measles was never a benign disease, something anti-vaccine folks still misunderstand because vaccines can do such a good job controlling the disease.

Even as overall mortality improved in the mid-20th Century, measles still wasn't a benign disease.
Even as overall mortality improved in the mid-20th Century, measles still wasn’t a benign disease.

Do benign, self-limiting childhood infections diseases kill hundreds of children every year?

This toddler died of measles in 1955.
This toddler died of measles in 1955.

Measles as a rite of passage is something we don’t want to have to go back to. It was a rite of passage that was endured because there was no other choice.

We have a choice now.

Don’t be misled into making the wrong one.

Don’t help anti-vaccine folks bring back measles and other vaccine-preventable diseases.

Vaccines are safe, effective and necessary.

“Today, vaccination is a cornerstone of pediatric preventive health care and a rite of passage for nearly all of the approximately 11,000 infants born daily in the United States.”

Cohn et al on Immunizations in the United States: A Rite of Passage

Getting vaccinated and protected is a rite of passage that you can look forward to, thanks to the many benefits of vaccines, not one that you should dread or avoid.

More on Measles Deaths

Myths About Warnings and Adverse Reactions in the MMR Package Inserts

Have you heard that the MMR package insert “contains 42 paragraphs of warning and adverse reactions?”

And some of those warnings include “seizures, encephalitis, pneumonia, deafness, death and MEASLES?”

Measles? From the measles vaccine?

Myths About Warnings and Adverse Reactions in the MMR Package Inserts

Is that really in the MMR package insert?

Package inserts aren't so scary once you learn what's really in them.
Package inserts aren’t so scary once you learn what’s really in them.

Let’s see, 42 paragraphs of warning and adverse reactions???

Nope.

Anti-vaccine propaganda is not informed consent.
Anti-vaccine propaganda is not informed consent.

The Warning Section, which lists all adverse reactions and safety hazards that may occur after getting a vaccine and what you should do if they occur, actually only contains five paragraphs!

There are 23 more paragraphs in the Adverse Reactions section, but as most folks understand, this section includes clinical trials experience, postmarketing experience, and voluntary reports, so it is not always possible to establish a causal relationship to vaccination for the adverse effects listed here.

What does the MMR package insert say about seizures, encephalitis, hearing loss, and death?

“Measles is also known as rubeola. It is a serious illness. Measles virus can be passed to others if you have it. Measles can give you a high fever, cough, and a rash. The illness can last for 1 to 2 weeks. In rare cases, it can also cause an infection of the brain. This could lead to seizures, hearing loss, mental retardation, and even death.

Mumps can also be passed to others. This virus can cause fever and headache. It also makes the glands under your jaw swell and be painful. The illness often lasts for several days. Sometimes, mumps can make the testicles swell and be painful. In some cases, it can cause meningitis, which is a mild swelling of the coverings of the brain and spinal cord.

Rubella is also known as German measles. It is often a mild illness. Rubella virus can cause a mild fever swollen glands in the neck, pain and swelling in the joints, and a rash that lasts for a short time. It can be very dangerous if a pregnant woman catches it. Women who catch German measles when they are pregnant can have babies who are stillborn. Also, the babies may be blind or deaf, or have heart disease or mental retardation.”

So the package insert is telling folks to get vaccinated and protected to avoid seizures, encephalitis, and death. Why don’t anti-vaccine folks ever mention that part of the package insert?

Don’t listen to anti-vaccine propaganda about vaccine package inserts.

Learn the risk of misinformed consent and following bad advice – leaving your kids unvaccinated and unprotected.

More on Myths About Warnings and Adverse Reactions in the MMR Package Inserts