Learning from the past

Douglas Fownes, MD
Douglas Fownes

They say it’s difficult to understand something unless you have lived through it. For many people today, the measles epidemic in the 1950s was resolved before many were even born. So it’s hard to know the impact this infection had on our country.

Here’s just a little of that history. In 1912, measles became a nationally notifiable disease in the United States, requiring U.S. health care providers and laboratories to report all diagnosed cases. In the first decade of reporting, an average of 6,000 measles-related deaths were reported each year.

In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated three to four million people in the United States were infected each year. Also each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles.

In 1978, the Centers for Disease Control and Prevention (CDC) set a goal to eliminate measles from the United States by 1982. Although this goal was not met, widespread use of measles vaccine drastically reduced the disease rates. By 1981, the number of reported measles cases was 80 percent less compared with the previous year. However, a 1989 measles outbreak among vaccinated school-aged children prompted the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) to recommend a second dose of MMR vaccine for all children. Following widespread implementation of this recommendation and improvements in first-dose MMR vaccine coverage, reported measles cases declined even more.

Measles was declared eliminated (absence of continuous disease transmission for greater than 12 months) from the United States in 2000. This was thanks to a highly-effective vaccination program in the United States, as well as better measles control.

However, as more parents are choosing not to vaccinate their children, the country is now facing a resurgence of measles as evidenced in news reports citing individual cases of measles in 11 states.

Measles is a highly-contagious respiratory infection. It is caused by a virus. It usually spreads when a person comes in contact with droplets from coughs or sneezes of someone with the virus. The symptoms of measles happen about eight to 12 days after coming in contact with a person with the virus.

Some people think of measles as just a little rash and fever that clears up in a few days, but measles can cause serious health complications, especially in children younger than five years of age. There is no way to tell in advance the severity of the symptoms your child will experience.

Measles spreads through the air when an infected person coughs or sneezes. It is so contagious that if one person has it, nine out of 10 people around him or her will also become infected if they are not protected. Your child can get measles just by being in a room where a person with measles has been, even up to two hours after that person has left. An infected person can spread measles to others even before knowing he/she has the disease - from four days before developing the measles rash through four days afterward.

The best protection against measles is measles-mumps-rubella (MMR) vaccine. MMR vaccine provides long-lasting protection against all strains of measles. A child needs two doses of MMR vaccine for best protection.

These outbreaks are a clear sign of the fraying of “herd immunity,” the overall protection found when a large majority of a population has become immune to a disease. However, “herd” immuninity is no longer effective since the critical percentage of immunized children has dropped to an all-time low.

The important message for parents to leave with is don’t delay, don’t wait until measles comes to Wisconsin. We know parents have questions, and the best steps that parents can take are to talk directly with their child’s primary care provider. This helps to avoid any misinformation that may be out there, and helps us hopefully avoid repeating history.

Douglas Fownes, MD, Family Medicine

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