The Critical Role of Vaccination in Preventing Measles Outbreaks
- drosbornelewis
- 3 days ago
- 7 min read
As measles cases surge in several parts of the world, public health experts are sounding the alarm: this entirely preventable disease is making a dangerous comeback. Once considered nearly eradicated in many regions, measles is now re-emerging, fueled by declining vaccination rates and widespread misinformation.
Understanding Measles
Measles is not just a childhood disease; it is a highly contagious viral infection that can result in serious health complications, such as pneumonia, encephalitis, and even death. Measles is caused by a virus that spreads through respiratory droplets when an infected person coughs, sneezes, talks, etc. This virus can remain active on surfaces for up to two hours, making it extremely contagious. Measles is contagious 4-5 days prior to symptoms developing as well as 4-5 days afterward, which means an infected person can spread measles without even knowing they have it. Measles typically infects 90% of the unvaccinated exposed to it.
Symptoms of measles include high fever (may spike higher than 104 degrees F), cough, runny nose, red and watery eyes, and rash. The rash doesn't develop until 3-5 days after symptoms start. The rash which is large flat spots and small raised brumps typically first appear on the face and behind the ears then progresses to include the chest and back then finally the arms and legs. Koplik spots (tiny white spots inside the mouth) can appear 2 to 3 days after symptoms begin. Complications of measles include hospitalization, pneumonia, hearing loss, brain swelling (encephalitis) and even death. Measles can also cause subacute sclerosing panencephalitis to develop 7-10 years after recovery from measles, especially in children who were younger than 2 years old when they had measles. Early symptoms of subacute sclerosing panencephalitis may include behavioral changes, forgetfulness, poor school performance, and myoclonic jerks. Later symptoms include seizures, blindness and coma.
Children under five years old, especially infants, are at the highest risk of complications including death. Pregnant women are also a very high risk. If a pregnant woman catches measles, then she herself is at high risk of dying, having her baby die or be born with birth defects. Immunocompromised individuals as well as the unvaccinated are also vulnerable to severe complications from measles.
The Vaccine: MMR
The Measles, Mumps, and Rubella (MMR) vaccine is the leading method for preventing measles as well as mumps and rubella. It is administered in two doses: the first dose is typically given between 12 to 15 months of age, and the second between 4 to 6 years old. These two doses provide about 97% protection against measles and one dose is about 93% effective.
This vaccination not only protects individuals but also contributes to herd immunity. Herd immunity occurs when a significant percentage of the population is immunized, making it harder for the virus to circulate and affecting even those who cannot be vaccinated. This includes the most vulnerable - children under the age of one years old. According to the World Health Organization and CDC, a community needs about 95% vaccine coverage to prevent outbreaks. When vaccination rates dip below this threshold—as has happened in several countries recently, including the United States —measles regains a foothold.
When the MMR vaccine first became available, there were slightly above 500,000 confirmed cases of measles in the US yearly. Among those cases, approximately 400-500 died; 48,000 were hospitalized, and 1,000 developed encephalitis. After the introduction of the vaccine, rates of measles dropped dramatically - between 1965 and 1968, the number of cases of measles dropped by more than 95%.
Importance of Vaccination
Vaccination should be seen as a shared responsibility. When a large portion of the community is vaccinated, the chances of outbreaks decrease significantly, protecting both individual and public health.
1. Protecting the Vulnerable
Certain individuals cannot receive vaccines for medical reasons, such as those with compromised immune systems or serious allergies. When the majority of the population is vaccinated, it acts as a barrier protecting these at-risk individuals from measles outbreaks.
2. Reducing Healthcare Costs
Preventing measles through vaccination has significant financial benefits. Treating an individual for measles can cost thousands of dollars, including hospitalization and medical care. For instance, the average hospital cost per child admitted due to measles is around $10,000-20,000+ for moderate to severe cases and $50,000+ if intensive care is needed. This does not include the costs of parents missing work, school shutdowns and the public health response necessary to curb an outbreak. A mild case of measles that doesn't require hospitalization cost can range from $200-$1000+. The total cost for the MMR vaccine series is at most around $200, but most patients are able to receive it for free with their insurance or through the Vaccine for Children Program.
3. Preventing Complications
Vaccination can drastically lower the chances of severe complications related to measles, such as pneumonia and encephalitis. According to the World Health Organization (WHO), around one in five unvaccinated individuals diagnosed with measles will need hospitalization due to complications. Vaccination can cut down on these risks, resulting in healthier communities.
Global Impacts
While measles was eliminated in many countries, recent statistics indicate a troubling comeback in cases, especially in regions with lower vaccination rates.
The WHO reported a staggering 556% rise in measles cases across Europe in 2019 compared to the previous year. This sharp increase highlights the urgent need for robust vaccination programs worldwide. Countries must collaborate to ensure that vaccines are available, particularly in underserved areas where vaccine misinformation is rampant.
Current Impact in the United States
This year there have already been over 1,000 cases of measles confirmed in the US. While the majority of the current cases are in Texas, there are outbreaks in Ohio, Indiana, Tennessee, Michigan, Pennsylvania, Montana, Kansas, Oklahoma, and New Mexico as well. Kentucky has had 1 confirmed case this year. 96% of these confirmed cases of measles are unvaccinated. 68% of the cases are 19 or younger. 30% of the cases are under 5 years old and 23% of these cases has had to be hospitalized. There have already been 3 deaths.
Addressing Vaccine Hesitancy
In 2000, measles was considered eradicated from the US, meaning that there were no measles spreading in the US and the only new cases were when measles was contracted abround and returned back to the US. However, since 2008, there has been a dangerous trend emerging. Cases of measles in the US have started to rise again. This is due mainly to the decline of vaccination against measles.
Vaccine hesitancy poses one of the biggest hurdles to achieving high vaccination rates. Misconceptions and misinformation can create doubt and fear among parents and communities.
One of the biggest misconceptions and misinformation about the MMR vaccine is that it causes autism. This is because in 1998, Andrew Wakefield published a research article stating that the MMR vaccine may predispose children to autism. However, this study was retracted due to mutliple issues. For instance, Wakefield's study only looked at 12 research subjects - a small observational study has to have at least 100-200+ subjects to be valid. These subjects were also specifically chosen instead of randomly selected. His results were based on antedoctal reports from parents, not actual scientific data. When he first planned his research study, he was actually looking at whether the MMR vaccine caused inflammatory bowel disease, but decided to suggest that the MMR vaccine caused intestinal inflammation, which could in turn lead to autism. However, the biggest problem with his research was that he failed to disclose that he was being paid by lawyers who were preparing a lawsuit against vaccine makers and that he conducted invasive procedures on children without proper ethical approval and consent.
Since Wakefield's study, there have been multiple large scale studies around the world completed that show no link between the MMR vaccine and autism. These studies include 1,000-10,000+ subjects per study with some of them involving over a million children.
Another source of misinformation is anti-vaccine groups that correlate the number of autism diagnoses with the number of vaccines given. For instance, the cases of autism diagnosed in children age 8 in 2000 was about 1 in every 150 children; whereas in 2022 that had rose to about 1 in every 31 children age 8. However, while autism was first described in the early 1900s it was not a widely known diagnosis until about the 1950s-60s. At this time, the medical thinking by psychologists for the cause of autism was cold, unaffectionate mothers. This was known as the "refrigerator mother" theory. It wasn't until the 1980s that autism was added to the DSM (Diagnostic and Statistical Manual of Mental Disorders) and a set criteria for diagnosis was agreed upon. Since then, the awareness of the autism diagnosis as an explanation for social communication deficits and restricted, repetitive behaviors or interests has expanded, and therefore is more commonly diagnosed. We also know that autism has a complex set of genetic and environmental causes.
It is during this timeframe of autism awareness and diagnosis that the MMR vaccine became readily available, so it is easy for someone to misuse the statistics of autism and MMR to try to correlate the two into a causal relationship. Another example of this is if you look at ice cream sales and drowning rates. Both ice cream sales and drowning rates increase during the summer, so someone could look at those statistics and determine that eating ice cream causes drowning. However, we know that ice cream doesn't cause drownings, but that these similarities in statistics is due actually to a cofounding factor - the weather/season/temperature. In other words, we know that during the summer it is warming which leads people to eat more ice cream and to swim more (which increases the possibly of drowning).
Complications from the MMR Vaccine
Serious side effects are extremely rare. Mild side effects like fever or a sore arm may occur, but these are temporary and far less serious than the diseases the vaccine prevents.
Final Thoughts
Facts about measles:
1 out of 5 people who get measles will be hospitalized
1 out of every 20 children with measles will get pneumonia, the most common cause of death from measles in young children.
1 out of every 1,000 people with measles will develop brain swelling, which may lead to seizures, brain damage, and death.
1 to 3 out of every 1,000 people with measles will die.
About 90% of the people exposed to measles that are not vaccinated will develop measles.
The MMR vaccine is safe and does not cause autism.
Children should get two doses of the vaccine with the first dose at 12-15 months and the second dose at 4-6 years old. Adults born after 1956 who haven't had measles or the vaccine should get at least one dose. If you are unsure, bloodwork can be done to show whether you have immunity or not. If traveling to an area where measles outbreaks are common, you made need to be vaccinated prior to traveling.
Vaccination serves as a critical tool in preventing measles outbreaks and ensuring public health.
By recognizing the importance of the MMR vaccine, we can effectively protect ourselves, our families, and our communities through herd immunity. As we confront challenges from misinformation and vaccine hesitancy, staying informed and advocating for vaccination is crucial.
So, in other words get your vaccine if you are unvaccinated and medically able to!
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