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.
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.
So far this year, there are reports of :
the death of a 10-month-old unvaccinated child in Bulgaria (among just 61 cases)
the death of a 17-year-old girl who was not vaccinated in Portugal (among just 23 cases)
the death of a vaccinated man who was being treated for leukemia in Switzerland (among just 52 cases)
Unfortunately, measles cases continue to rise in most of these countries and many others…
Are you planning a trip to Europe any time soon? How about Indonesia or Australia, 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.
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
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.
While a trip abroad can be a great experience for kids, whether you are just site seeing or you are visiting family, don’t forget to take some simple precautions so that your family comes back safe and healthy.
Get a Vaccine Checkup Before You Travel
It is important to remember that just because your kids are up-to-date on their routine childhood immunizations, that doesn’t mean that they are ready to travel out of the country.
It might surprise some folks to know that there are many vaccines that kids in the United States don’t routinely get, like vaccines that protect against cholera, yellow fever, typhoid, and Japanese encephalitis, etc. These are considered to be travel vaccines and may be recommended or required depending on where you are going.
How do you know which vaccines your kids need?
The CDC Traveler’s Health website is the best place to figure it out. With a list of 245 destinations, in addition to offering advice on how to avoid vaccine-preventable diseases, you get recommendations on avoiding others too, like Zika and malaria.
Don’t wait until the last minute before checking on these vaccine recommendations though. These are not vaccines that most pediatricians have in their office, so call or visit your pediatrician a few months in advance to plan out how you will get them. As a last resort, if your pediatrician can’t order them, can’t help you get them from an area pharmacy, and they aren’t available at your local health department, you might look to see if there is a “travel clinic” nearby.
Don’t Forget the Early MMR Recommendations
It’s also important to remember to make sure your child’s routine vaccines are up-to-date too. Confusing things a little, that can mean getting their MMR vaccines early.
Many parents, and some pediatricians, often forget that before traveling out of the United States:
Infants 6 months through 11 months of age should receive one dose of MMR vaccine. While this early dose should provide protection while traveling, it doesn’t provide full protection, doesn’t count as the 12 to 15 month routine dose, and will need to be repeated.
Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days. So even if your child is less than 4-years, he or she needs two doses of MMR before traveling out of the country. This second early dose won’t have to be repeated when they do turn 4.
Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days. While some adults are considered fully vaccinated with one dose of MMR, that isn’t true if they are traveling out of the country. Travelers need two doses!
Continuing outbreaks of measles linked to unvaccinated and partially vaccinated travelers highlight the need to spread the word about these recommendations.
Traveling is fun. Be sure to bring back some great memories and a few souvenirs. Don’t bring home measles or other diseases that you can then spread to others in your community or on the plane ride home.
In the early 1960s, the American Character Doll Company produced a series of Whimsie dolls, including:
Annie the Astronut
Fanny the Flapper
Hilda the Hillbilly
Lena the Cleaner (baseball)
Samson the Strongman
Simon the Degree
Wheeler the Dealer (casino dealer)
Zero the Hero
Hardly politically correct for our times, the stereotyped dolls do provide a look at the history of their time.
One other doll, Hedda Get Bedda, is especially helpful in that sense.
Made in 1961, this Whimsie doll could change her face, letting you know how she was feeling when you turned the knob on her head. She could go from having a sleeping face, to a sick face (perhaps having chicken pox or measles), to a happy face (once you made her better).
Does the fact that she also came with a hospital bed mean anything?
Just like some anti-vaccine folks like to think that the simple fact that they made a doll that had measles or chicken pox could possibly mean that they looked at them as mild diseases, you could just as easily say that including the hospital bed means ‘they’ understand they were life-threatening diseases that could put land you in the hospital.
We are talking about the pre-vaccine era after all, and in 1961, and when the Hedda Get Bedda doll came out, there were about 503,282 cases of measles in the United States and 432 measles deaths.
Like the Brady Bunch measles episode, the Hedda Get Bedda doll is sometimes used to push the myth that vaccine-preventable diseases aren’t that serious, helping folks justify their decisions to intentionally skip or delay vaccines and leaving their kids unprotected.
“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”
Walter Orenstein, MD
For example, if you believed that measles, chicken pox, or Hib were mild diseases, then you might feel better about not getting your child the MMR, chicken pox, or Hib vaccines.
Sure, many people get measles and do get better without any complications. On their way to getting better though, even they have high, hard to control fever for 5 to 7 days, with coughing and extreme irritability.
But while most get better, we shouldn’t forget that some people don’t survive measles without complications. Natural immunity sometimes comes with a price, from vision problems and permanent hearing loss to brain damage.
And tragically, some people don’t get to survive measles.
Breaking News – We already have reports of measles cases in at least 67 people from 11 states (California, Colorado, Florida, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah, and Washington) in 2017, including an ongoing outbreak in Minnesota that is now up to 32 cases. Also many reports of measles outbreaks in Europe. (see below)
We have come a long way since the development of the first measles vaccines in the early 1960s…
Pre-Vaccine Era Measles Outbreaks
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
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, 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
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 goes on already, with other measles cases in 2017 including:
at least 67 cases (as of late April)
cases in 11 states, including California, Colorado, Florida, Michigan, Minnesota, Nebraska, New Jersey, New York, 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 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.
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.
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.
the latest cases – three more cases in Minnesota, as the outbreak spreads to the third county – Ramsey County.
How many cases will we end up with this year? It is certainly getting off to a quick start, which could mean a big year for measles, although it is certainly hard to predict what will happen.
2016 Measles Outbreaks
Starting slow, 2016 ended as a fairly average year for measles:
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
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.
International Measles Outbreaks
The endemic spread of measles was stopped or eliminated in 2000. Since then, most of the measles outbreaks in the United States begin when someone travels out of the country, gets sick, and exposes others. Or less commonly, when an international traveler brings measles into the country.
That makes it easy to understand that large outbreaks of measles in other parts of the world could increase the risk that we have more outbreaks here. And that’s what happened in 2014 when there was an epidemic of measles in the Philippines and we ended up with the most cases since 1994, many linked to travel to and from the Philippines.
This year, the world is seeing large outbreaks of measles in:
European Union – Austria (71 cases), Belgium (266 cases), Bulgaria (61 cases, including one death – a 10-month old unvaccinated child), Denmark, France (134 cases, including 2 cases of encephalitis), Germany (410 cases), Hungary (41 cases), Iceland (2 cases. 10-month-old unvaccinated twin siblings), Italy (1,603 cases), Portugal (21 cases, including one death), Spain (35 cases), and Sweden (15 cases). The largest outbreak is in Romania, where there have been 4,793 cases and 21 deaths in the past 13 months.
Switzerland – the Swiss Sentinel Surveillance Network already reports 52 measles cases in 2017, compared to 36 in 2015 and 71 in 2016. Many of the cases are in young adults, aged 20-24 years. There has been one death, a vaccinated man being treated for leukemia.
Australia – 34 cases so far in 2017
Canada – over 30 cases including an outbreak in Nova Scotia (15 cases)
Japan – 139 cases so far in 2017 (they had 5 in April 2016…)
Guinea – a measles epidemic has been declared in the country, with at least 1,527 cases and 2 deaths this year
Indonesia – island of Bali
Republican of South Sudan
These outbreaks are a great reminder to review the special vaccine travel requirements, including that adults who “plan to travel internationally should receive 2 doses of MMR at least 28 days apart,” that infants traveling abroad can get their first dose of MMR as early as age 6 to 11 months, with a repeat dose at age 12 months, and that “children aged who are greater than or equal to 12 months need 2 doses of MMR vaccine before traveling overseas,” even if they aren’t four to six years old yet.