Tag: Vaccine Preventable Diseases

Do You Know What Vaccine-Preventable Diseases Look Like?

Odds are that you have never seen anyone with smallpox, but what about measles or mumps?

No?

Have you ever even seen someone with chicken pox?

Photos of Vaccine-Preventable Disease

Maybe if more folks knew what typical vaccine-preventable diseases looked like, then they wouldn’t be so quick to think about skipping or delaying their kids vaccines.

And they certainly wouldn’t think that these are mild diseases that they wanted their kids to get, thinking natural immunity would be better than the immunity that they could more easily and safely get from a vaccine.

Severe dehydration in a child with a rotavirus infection.
Severe dehydration in a child with a rotavirus infection.

Kids with diphtheria develop a bull neck and a thick pseudomembrane that covers their throat.
Kids with diphtheria develop a bull neck and a thick pseudomembrane that covers their throat. Photo by the Japanese Society of Tropical Medicine

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

Newborns and infants have the highest rates of death from pertussis.
Newborns and infants have the highest rates of death from pertussis or whooping cough.

An infant with measles during the 2014 outbreaks in the Philippines.
An infant with measles during the 2014 outbreaks in the Philippines. Photo by Jim Goodson, M.P.H.

Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.
Mumps causes kids to have fever, puffy cheeks, and a painful, swollen jaw.

A baby with a congenital cataract and blueberry muffin rash - classic signs of congenital rubella syndrome.
A baby with a congenital cataract and blueberry muffin rash – classic signs of congenital rubella syndrome. (CC BY-NC-SA)

In addition to respiratory problems (think iron lungs), polio causes muscle atrophy.
In addition to respiratory problems (think iron lungs), polio causes muscle atrophy. (CC BY-NC 4.0)

This 2016 hepatitis A outbreak linked to frozen strawberries led to 143 cases and 56 hospitalizations.
This 2016 hepatitis A outbreak linked to frozen strawberries led to 143 cases and 56 hospitalizations.

Chronic hepatitis B is a silent killer.
Chronic hepatitis B is a silent killer.

A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis.
A papilloma caused by HPV on the vocal cords of a child with recurrent respiratory papillomatosis. (CC BY 4.0)

Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcemia.
Even if they survive, kids can lose fingers, toes, or even arms and legs to meningococcal disease.

In addition to pneumonia and meningitis, the Hib bacteria can cause epiglottitis, making it very difficult to breath.
In addition to pneumonia and meningitis, the Hib bacteria can cause epiglottitis, making it very difficult to breath. Seen here are the ‘thumb sign’ on X-ray and the cherry red epiglottis.

Before wide use of the Hib and Prevnar vaccines, infants with fever would routinely get spinal taps and you would hope for clear fluid (cloudy fluid could be a sign of a bacterial infection).
Before wide use of the pneumococcal vaccines, infants with fever would routinely a get spinal tap to make sure that they didn’t have bacterial meningitis.

If a mother get chicken pox late in her pregnancy, her baby will be exposed before he is born and will develop chicken pox, often severe, in his first week of life.
If a mother get chicken pox late in her pregnancy, then her baby will be exposed before he is born and will develop chicken pox, often severe, in his first week of life. (CC by 3.0)

Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant.
Although rare, even infants can develop shingles, most commonly if their mothers had a chicken pox infection while pregnant. (CC by 3.0)

Never touch a bat that you find on the ground during the day, as it might have rabies.
Animals acting strangely may have rabies. Photo by Radu Privantu (CC BY 2.0)

As in most years, flu deaths in children mostly occurred in kids who weren't vaccinated.
As in most years, flu deaths in children mostly occurred in kids who weren’t vaccinated.

Two kids with smallpox - one vaccinated and one unvaccinated. Can you guess which is which?
Two kids with smallpox – one vaccinated and one unvaccinated. Can you guess which is which?

Surprisingly, treatments haven't changed much since this photo was taken of a patient with yellow fever in 1898.
Surprisingly, treatments haven’t changed much since this photo was taken of a patient with yellow fever in 1898.

Mary Mallon (Typhoid Mary) was quarantined because she continued to work as a cook, spreading Salmonella typhi bacteria to other people.
Mary Mallon (Typhoid Mary) was quarantined because she continued to work as a cook, spreading Salmonella Typhi bacteria to other people.

Japanese encephalitis is spread by mosquito bites.
Japanese encephalitis is spread by mosquito bites.

I know what some of you are thinking. And no, just because these vaccine-preventable diseases aren’t as common as they used to be doesn’t mean that any of these vaccines aren’t necessary.

Why not?

We don’t see them as much as we did in the pre-vaccine era simply because these vaccines work!

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

We all know what happens if we stop vaccinating.

And it is not just that we get a few updated photos of kids with measles, mumps, diphtheria, and other vaccine-preventable diseases…

More on Photos of Vaccine-Preventable Diseases

 

Why Do We Only Worry About Measles?

Anti-vaccine folks often claim that health officials only worry about measles and measles outbreaks.

They can’t understand why anyone gets concerned by a few measles cases here and there, not understanding that a lot of work goes into containing measles outbreaks and making sure that they don’t grow beyond a few cases.

And health officials don’t just worry about measles. They work to control outbreaks of mumps, pertussis, hepatitis A, and all other diseases too.

Why We Worry About Measles Outbreaks

We do get concerned about measles outbreaks though.

“Whenever measles strikes, it’s more than just an outbreak of a single disease, or an indication that children aren’t receiving their measles shots; it’s also a warning that immunization coverage in general, for all vaccine-preventable diseases, is lower than it should be.

To put it another way: When rates of routine vaccination—children receiving all their shots on schedule, as a preventive measure rather than a reaction to an outbreak—start to fall, the first sign is usually a measles outbreak.”

Seth Berkley on Measles Outbreaks Are a Sign of Bigger Problems

The measles vaccine is among the most effective vaccines we have, so if we are seeing outbreaks, even though measles is very contagious, it means there is a problem.

“A focus on measles surveillance can help detect populations unreached by immunization systems and, by extension, program weaknesses. Measles serves as the ‘canary in the coal mine’ for detecting problems with immunization programs, a characteristic whose importance has recently been highlighted in the context of global health security.”

Orenstein et al on Measles and Rubella Global Strategic Plan 2012–2020 midterm review

In the late 1980s, when we had large outbreaks between 1989 to 1991, with 55,622 cases and 123 deaths, it meant that we weren’t vaccinating enough kids because Federal support for vaccine programs had dropped.

As much as anti-vaccine folks like to try and minimize how serious measles can be, it is easy to see that measles is indeed a serious, life-threatening disease. We had good nutrition, proper sanitation, and modern health care in 1990, and still, a lot of people died with measles. Rates of subacute sclerosing panencephalitis (SSPE), a late complication of measles, went up too, in the years after these outbreaks.

“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

Those outbreaks were fixed, as we improved access to help kids get vaccinated and protected. Unfortunately, the issue with outbreaks today isn’t about access to vaccines, at least not in the developed world. It is about parents intentionally skipping or delaying vaccines.

How do you fix that?

Hopefully with education.

Why You Should Worry About Measles Outbreaks

Did you know that after the measles outbreaks of 1989, we also saw outbreaks of rubella and congenital rubella syndrome?

  • 396 cases of rubella, 4 deaths, and 2 cases of congenital rubella syndrome in 1989
  • 1,125 cases of rubella, 8 deaths, and 32 cases of congenital rubella syndrome in 1990
  • 1,401 cases of rubella, 1 death, and 34 cases of congenital rubella syndrome in 1991

Did you know that because they have overall lower vaccination rates, measles outbreaks in Europe grow far larger, into the tens of thousands of cases, with dozens of deaths?

“We must not tolerate a world in which a child dies from a disease that can be easily prevented with a low-cost vaccine.”

Dr Tedros, WHO Director-General on World Immunization Week 2018

We worry about measles outbreaks, because we don’t want to go back to anti-vaccine folks push us back to pre-vaccine era levels of disease and deaths.

We know what happens when vaccine levels drop too low.

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 NY Times article reports.

We know that vaccines are safe and necessary.

You should know that anti-vaccine propaganda that scares parents away from vaccinating and protecting their kids is rooted in myths and misinformation. They often get away with it because most parents today ahve never seen how devastating measles and other diseases can really be, so they believe stories about the Brady Bunch, instead of the advice of real experts.

You hopefully understand that’s a mistake.

More on Worrying About Measles Outbreaks

How Many People Die from Vaccine Preventable Diseases These Days?

People don’t often die from vaccine-preventable diseases these days.

At least not in industrial countries.

Deaths from Vaccine-Preventable Diseases Today

Well, they aren’t supposed to.

Dr. Bob Sears actually reassured parents that measles wasn't deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe - another well-nourished population with lower vaccination rates than the U.S.
Dr. Bob Sears actually reassured parents that measles wasn’t deadly in developed countries, neglecting to mention the dozens of people who have died in outbreaks in Europe – another well-nourished population with lower vaccination rates than the U.S.

Tragically, we are seeing more and more deaths from vaccine-preventable diseases every day in countries that once had these diseases under good control:

  • over 100 measles deaths across Europe and a measles death in the United States a few years ago
  • diphtheria deaths in Australia, Belgium, South Africa, and Venezuela
  • life-threatening tetanus cases in Australia, Canada, New Zealand, and Ukraine
  • a rabies death in the United States in a child who’s parents skipped the post-exposure rabies vaccine
  • pertussis deaths in the United States
  • influenza – a record number of deaths in the United States, with most kids unvaccinated
  • rotavirus – yes, unvaccinated kids still die of rotavirus in the United States in the 21st Century! In a recent outbreak in California, in which a child died, almost all of the kids were unvaccinated.

And not surprisingly, these deaths are almost always in unvaccinated children.

Deaths from Vaccine-Preventable Diseases in the Pre-Vaccine Era

While tragic, we are still fortunate that these deaths are no where close to the levels we once saw before we had vaccines to protect our kids.

In the pre-vaccine era, we used to see:

  • up to 15,000 deaths and 200,000 diphtheria cases each year until the 1940s
  • an average of 175,000 cases of pertussis each year in the early 1940s, with about 1,118 deaths from pertussis in 1950 and 467 deaths from pertussis in 1955
  • up to 20,000 cases of paralytic polio each year until the early 1950s
  • an average of about 186,000 cases of mumps each year before 1967, with an average of 40 deaths a year
  • up to 500 deaths and 500,000 measles cases each year until the early 1960s
  • a rubella epidemic in 1964-65 that caused 12.5 million rubella virus infections and “resulted in 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with congenital rubella syndrome”
  • up to 20,000 cases of invasive H. influenzae (Hib) disease each year, with more than half of them having meningitis, and about 300 to 600 deaths, mostly children under age 2 years. In 1980, 45 children died with epiglottitis and there were an additional 222 deaths from Hib meningitis.
  • up to 11,000 hospitalizations and 100 chicken pox deaths each year until 1995
  • up to 17,000 cases of invasive pneumococcal disease in children younger than 5 years each year (before 2000), including 13,000 cases of bacteremia (blood infection) and 700 cases of pneumococcal meningitis, with 200 deaths.
  • just over 400,000 visits to the doctor and up to 272,000 visits to the emergency room, 70,000 hospitalizations and 20 to 60 deaths each year in children under age 5 years because of rotavirus infections until 2006

But that deaths from vaccine-preventable diseases aren’t common is hardly a reason to skip or delay your child’s vaccines, as some might suggest. It is just testament to the fact that vaccines work.

That these deaths from vaccine-preventable diseases quickly rise as rates of vaccinations drop is a tragic reminder that vaccines are necessary.

As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks.
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

And what makes it even more tragic is that this was all predicted and could have been prevented if folks didn’t listen to anti-vaccine propaganda that scares them away from vaccinating and protecting their kids.

Worldwide Deaths from Vaccine-Preventable Diseases

Of course, talk of deaths from vaccine-preventable diseases shouldn’t stop with the developed or industrial world.

Even as a lot of progress is being made, as more and more people get vaccinated, worldwide, there were:

  • about 89,780 measles deaths, mostly young children
  • about 215,000 deaths from rotavirus infections
  • at least 1 million deaths from hepatitis B
  • almost 200,000 deaths from Hib
  • over 4,200 deaths from chicken pox
  • about 50,000 deaths from meningococcal infections
  • about 160,000 deaths from pertussis
  • about 826,000 deaths from pneumococcal infections
  • almost 60,000 deaths from rabies
  • just over 70,000 deaths from tetanus
  • about 222,000 deaths from typhoid
  • between 30,000 to 60,000 deaths from yellow fever

As you can see, most of these diseases are still big killers around the world.

“You hear about people who don’t like to vaccinate their kids in the Western world, which I suppose is a personal choice, but when you’re out there, the result of your children not being vaccinated is that they’ll likely die, or be horribly maimed. So yes, I saw a real desire to have their children protected, and also a real understanding of it – I didn’t seem to come across anybody who went ‘What is it?’ Or ‘What does it do?’ They all seemed to know about it.”

Ewan McGregor on Cold Chain Mission

In most of these countries, the problem is access to vaccines though, not parents refusing to get their kids vaccinated.

What to Know About Deaths from Vaccine Preventable Diseases

Unvaccinated kids are still dying from vaccine-preventable diseases.

More on Deaths from Vaccine Preventable Diseases

Dear Anti-Vaxxers,

As someone who has always understood that vaccines are safe and necessary, who vaccinates his children, I’m asking you to hear me out.

Dear anti-vaxxers. Vaccinate your kids.

I don’t think that you are either stupid, uneducated, crazy, or that questioning vaccine safety is always associated with  believing in conspiracy theories.

I understand and appreciate that you do care about your children, that you care about their health, and that you want what’s best for your family.

I actually do get that. I really do.

But I know that while you believe that you have done years of research and investigation to help you decide that the potential benefits of vaccines don’t outweigh their risks, going out of your way to find information to support your decision and ignoring all of the rest that says you are wrong, isn’t really doing research.

Whether you have never set foot on a college campus, you have a PhD in immunology, or you are a toxicologist, I know that you are still vulnerable to the same cognitive biases, heuristics, and logical fallacies as everyone else, and those can keep you from coming to a truly informed decision.

And I know that you are mostly motivated by fear, anger, and mistaken ideas of vaccine injury, vaccine induced disease, and unexplained illness and sudden deaths.

We all care about our children and families. The difference between us is that you still believe that there are two sides to the vaccination debate.

There isn’t.

Vaccines are safe, necessary, and they work well to protect our kids from life-threatening vaccine-preventable diseases.

No, vaccines are not 100% safe and they don’t work 100% of the time, but neither are they responsible for all of the things you see in vaccine scare stories or all of the so-called vaccine induced diseases we hear about.

“What if doctors never actually learn about vaccines, their ingredients, or adverse events, in medical school? What if the medical textbooks are written with an enormous amount of funding from the pharmaceutical industry? What if the CDC owns patents on vaccines? What if the pharmaceutical industry is corrupt and funds studies which conveniently stop monitoring test subjects before adverse effects begin to manifest? What if vaccines contain toxic substances at levels which can cause chronic illness when children are repeatedly injected with them? What if we are trading temporary illness for the development of autoimmune and neurological disease later in life? What if the threat and danger of these “preventable” diseases has been inflated to push more vaccines? What if these vaccines are not even truly effective as we have been led to believe and we will always need more booster shots to try to make up for that fact? What if there is evidence for all of the above, you just haven’t seen it yet?”

Ashley Everly Cates

Listen.

If you don’t want to vaccinate your kids, then don’t.

But don’t be influenced by folks who say they have done their research and don’t believe in conspiracy theories, but use a book by Neil Z Miller as a reference and push every major anti-vaccine conspiracy theory.

And don’t expect that your vaccine choice will be consequence free, including that your child will be at increased risk to get a vaccine-preventable disease, you will be putting others at risk to get a vaccine-preventable disease if your intentionally unvaccinated child gets sick, and you may be kept out of daycare or school if you live in a state that doesn’t allow non-medical exemptions.

I hope that you will keep an open mind and genuinely take time to look into this for yourself, beyond the myths and claims of anti-vaccine heroes who ignore or are unaware of the massive amount of evidence that contradict their claims.

Please take caution and know that I don’t do this to be popular. I don’t do this to make friends, get likes on my Facebook page, or sell vitamins and supplements in an online store.

Truly. The only reason I speak out is to protect my children and your children from unnecessary harm.

After all, is it really so hard to believe that the great majority of pediatricians, infectious disease specialists, immunologists, toxicologists, and public health experts in the world and throughout history are right about vaccines?

More for Anti-Vaxxers

Are More People Dying of Viral Hepatitis?

We have two vaccines to protect folks against viral hepatitis.

The first, against hepatitis B, was developed in 1981, but was replaced by an improved vaccine in 1989. It wasn’t added to the immunization schedule until 1991 though. Next came the hepatitis A vaccine in 1996.

Are More People Dying of Viral Hepatitis?

Although we don’t often think of them that way, these types of hepatitis can cause life threatening infections. Hepatitis B can even cause cancer!

Are deaths from hepatitis really skyrocketing?
Are deaths from hepatitis really skyrocketing?

So why would more people be dying of hepatitis A and B after we developed vaccines to help prevent them, a new idea being pushed by anti-vaccine folks?

They aren’t.

For example, there were 31,582 cases of hepatitis A and 142 deaths in 1995, just before the vaccine was approved. In 2016, there were just over 2,000 cases and 70 deaths.

What about hepatitis B?

The record high for yearly new cases was in 1985. In 2016, we are near record lows, with 3,218 new cases and 1,698 deaths.

Why are people still dying of hepatitis B?

Because even though far fewer people are getting new infections, there are still an estimated 850,000 to 2.2 million adults in the United States who already have chronic hepatitis B infections.

“…rates of acute Hepatitis B in the United States have declined by approximately 82% since 1991.”

Hepatitis B FAQs for the Public

So how can they say that hepatitis deaths are skyrocketing?

It’s easy. It is classic anti-vaccine propaganda. To fool folks, they talk about “all strains” of hepatitis and not just vaccine-preventable types.

Remember, there are multiple types of hepatitis, including A, B, C, D, and E. These are all caused by different viruses, even though they all cause hepatitis.

And since 2006, the incidence of hepatitis C has been climbing sharply. Tragically, so have the number of deaths. In 2016, there were 18,153 deaths from hepatitis C, which is not yet vaccine-preventable.

Hepatitis deaths are increasing.

All strains? Nope. Just the non-vaccine preventable strains. Deaths from hepatitis A and hepatitis B have greatly decreased since the pre-vaccine era.

All ages? Nope. Children have been protected from rising hepatitis deaths, as they are not typically at high risk for hepatitis C, which is causing the surge in deaths, and they should be vaccinated and protected against hepatitis A and hepatitis B.

What to Know About Viral Hepatitis Deaths

Viral hepatitis deaths are increasing, but only for non-vaccine preventable strains.

More on Viral Hepatitis Deaths

 

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.
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.

More on Fearing Vaccine Preventable Diseases

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.
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?
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.
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.

 

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