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Measles were eliminated in the U.S. 19 years ago. So why is it suddenly raising such a fuss

DULUTH, Minn. - Today’s story will begin with a quiz.

Which of the following contagious diseases is most readily spread?

Ebola

  • Influenza

  • Measles

    If your answer was c. Measles, you can go to the head of infectious diseases class.

    “It’s very easily spread,” said Dr. Rajesh Prabhu, an infectious disease specialist for Essentia Health in Duluth. “It’s more so than Ebola, more so than flu.

    “It could stay in the air at least two hours or so. So someone (who is infected) could be walking through a space, and you go in to enter that same space and potentially catch measles.”

    Measles is virtually unique among contagious diseases, said Dr. Harmony Tyner, an infectious disease specialist at St. Luke’s in Duluth, in that it’s truly airborne.

    We might think of influenza as airborne, but it’s actually spread via tiny droplets. The measles virus hangs out in the air we breathe, waiting for a hapless victim upon which to pounce.

    Scary. But the question might arise: Why is a newspaper in more or less the heartland of the United States devoting space to measles? Isn’t it true that the Pan American Health Organization declared in 2000 that measles had been eliminated in the U.S.?

    Yes, it is. And for a disease that once was a rite of childhood, affecting between 3 million and 4 million people per year in the U.S., the numbers today are infinitesimal by comparison.

    But, alarmingly, they are on the rise. The U.S. Centers for Disease Control and Prevention reported 764 measles cases in the U.S. so far this year, as of May 3.

    That’s almost twice the number of cases as in all of 2018. It’s more cases than in any entire year since 1994, according to the CDC. Twenty-two states reported at least one case of the measles so far this year. As of last week, nine outbreaks (three or more cases) were underway, including hundreds of cases within the Orthodox Jewish community in New York City that were attributed to travelers to Israel bringing back the virus.

    Developments in and near the U.S. seemed to come almost daily last week:

    • Hundreds of people were confined to a cruise ship off the Caribbean Island of St. Lucia after a case of measles was confirmed on board, the Washington Post reported.

    • Health officials in Orange County, Calif., warned moviegoers that they might have been exposed to measles while attending a showing of the movie “Avengers: Endgame” at a theater in the city of Fullerton, according to The Hill.

    • Merck & Co., which makes the measles vaccine, announced it had increased production to meet an uptick in demand in the U.S., the New York Times reported.

    Measles by inforumdocs on Scribd

    ‘Sustained transmission’

    As of last week, no measles cases had been reported in Minnesota this year, said Ellen Hill, Minnesota Department of Health epidemiologist for the seven northeastern counties.

    But at least one case is reported in the state most years, Hill said.

    And sometimes more. “A couple of years ago, there was a little outbreak among the Somali community in the Twin Cities,” she said.

    That outbreak totaled 75 cases, according to the CDC.

    In the “measles-eliminated” era, the virus has come into the U.S. via people who have picked it up in other countries, Tyner said.

    But now “sustained transmission” is occurring, she said.

    “People are giving it to each other,” Tyner said. “It’s not just cases being brought in from other countries.”

    Why is this happening? Both Tyner and Prabhu pointed to lower vaccination rates. And although Prabhu said there can be a variety of reasons parents don’t get their children immunized, in many instances it’s because the parents are making an active choice against it.

    Much of the opposition to the MMR — Mumps, Measles, Rubella — vaccine appears to stem from a 1998 paper published in the British medical journal The Lancet suggesting a link between the MMR vaccine and autism. The Lancet retracted the paper in 2010, and the autism-MMR link “has been debunked by multiple studies,” Prabhu said.

    Most recently, a Danish study of more than 650,000 children born in Denmark from 1999 through 2010 “strongly supports that MMR vaccination does not increase the risk for autism,” the authors reported in the Annals of Internal Medicine last month.

    Oh, Marcia

    But a vigorous anti-vaccination movement holds to the concerns, and its advocates also argue that measles isn’t all that serious anyway. Part of the evidence: a 1969 episode of the “Brady Bunch” sitcom, in which all six of the Brady kids come down with measles and have a swell time. “If you have to get sick, you sure can’t beat the measles,” eldest daughter Marcia says cheerfully.

    The actress who played Marcia Brady responded angrily last week to the use of her character in anti-vaccination memes. Maureen McCormick, 62 — Wait. Marcia Brady is 62? — said the measles she experienced in real life was no light-hearted matter, and she made sure her own daughter was vaccinated for the disease.

    Measles is characterized by a high fever along with a rash that usually starts on the face or neck and spreads downward, Tyner said.

    Most cases are mild, she said, but serious complications can occur, and even death. She cited a particular example: Author Roald Dahl’s daughter Olivia caught measles in 1962, at age 7. The child seemed to be recovering, but when Dahl tried to show her how to fashion play animals out of pipe-cleaners, she suddenly became sleepy and was unable to make her fingers do what she wanted them to do.

    “In an hour, she was unconscious,” Dahl wrote 24 years later. “In 12 hours she was dead. The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.”

    Although most people will recover from measles without long-lasting effects, Tyner noted that there’s no treatment for the disease. “It’s not like we have medicine,” she said. “(You) isolate them and you support them and hope they get better.”

    A patient with measles in the hospital would be placed in a specially-adapted room that would trap the air inside, Tyner said.

    The vaccine, on the other hand, is extremely effective, Prabhu and Tyner said — 93% coverage from one dose and 97% coverage if the recommended second dose is added. That means there’s a slight chance you could have both doses and still get the measles, Tyner said. But the infection probably would be less severe.

    ‘Herd immunity’

    Both specialists said a return to the days of widespread measles outbreaks is unlikely. That’s because the vast majority of us have been immunized — a little more than 94% in Minnesota and just under 90% in Wisconsin, according to 2017 numbers from the CDC.

    But most of the U.S. falls a little short of what’s known as “herd immunity” — defined as a point at which so much of the population is vaccinated that it’s difficult or impossible for the virus to spread. The measles vaccination rate has to be at least 95% to achieve herd immunity, according to the World Health Organization’s European division. In the U.S., rates range from less than 86% in Missouri to more than 98% in Massachusetts.

    Measles outbreaks in the U.S. tend to occur in pockets of the population with lower immunization rates, according to the CDC.

    Tyner would like to see everyone who doesn’t have a medical barrier immunized, she said, but the issue is so emotionally charged that she doesn’t try to debate the doubters. She focuses more on an older segment of the population who would like to be fully covered but may not be.

    The current recommendation is that a child receives the first dose of MMR between 12 and 15 months old and the second dose somewhere between 4 and 6 years old.

    But from 1963 to 1989, only one dose was recommended, Tyner said. That means people who remember watching the “Brady Bunch” when it was new might not be covered as fully as they should be.

    If that’s you and you don’t know if you’ve had that second dose, there are steps you can take, Tyner said. First, you can check your childhood immunization records. If those records aren’t available, there’s a blood test that will show if you have antibodies against the measles. Or you could simply get a second MMR dose. That probably will be less expensive than the blood test, Tyner said, and even if it’s actually your third dose, “it won’t hurt you to get another dose.”

    With all the renewed concern about measles, it’s still an uncommon virus in the U.S. Tyner, 38, said she has never seen a case of the disease.

    So far.

    “My sense is that I’ll see a case of measles in my practice,” Tyner said.