There’s one fact that makes the measles virus really scary: it’s one of the most infectious diseases known to man. A person with measles can cough in a room, leave, and — if you were unvaccinated — hours later, you could catch the virus from the droplets in the air that they left behind. No other virus can do that.
If your parents were born before 1960, there’s a good chance they suffered through a measles infection. They may have lived to tell about it, but they probably had friends who didn’t. In the US, before a vaccine was introduced in 1963, there were four million measles cases with 48,000 hospitalizations and 500 deaths every year. By 2000, because of the vaccine, the virus was declared eliminated here: enough people were immunized that outbreaks were uncommon, and deaths from measles were scarcely heard of.
measles
(The New England Journal of Medicine)
But measles appears to be making a comeback, which leads us to the second fact that most disturbs public-health officials: it’s an entirely preventable illness. Most everybody who gets the proper doses of the vaccine will never get sick with measles, even if they're exposed.
Despite this, there are still intense pockets of transmission around the world, especially in low-income areas but also in places like the US and Canada. In America, we're in the middle of what appears to be a pretty big measles outbreak, with nearly 80 people getting the infection because of an exposure at Disneyland in California. We’re burdening the health system — and a generation of doctors who have never seen measles — with a disease that could have been prevented. Here are nine questions you were too afraid to ask about this deadly virus:
1) Why are we talking about measles again?
disney
Disney, Anaheim, California. (David McNew/Getty)
There’s a big outbreak right now that started in December at the happiest place on Earth — Disneyland theme park in Orange County, California — and has since spread to six other states and Mexico.
Though "patient zero" — the first case — hasn't yet been identified, the California department of health found that 48 of the confirmed cases could be traced back to an initial exposure at the Disney park, and these people have now spread the virus to others.
In total, 78 people in 11 California counties, and Utah, Arizona, Nebraska, Washington, Oregon, Colorado, and Mexico have been infected. About a quarter of them have been hospitalized. So far, none have died.
2) Why did the Disney outbreak spread so quickly?
Health officials believe that the fact that "patient zero" was surrounded by people who weren't vaccinated helped the virus spread around California and beyond. More than 80 percent of those who get measles in this outbreak were not vaccinated against the disease, including six infants who were too young to get their shots (since the measles vaccine is not licensed for use on children younger than 12 months).
3) What does measles feel like and is it deadly?
Measles is a deadly, infectious disease that typically strikes children. After an incubation period of ten to 12 days, measles comes on as a fever, cough, stuffy nose, and bloodshot and watery eyes. Loss of appetite and malaise are common, too. Several days after these initial symptoms, an uncomfortable spotty, rash begins to spread all over the body, starting on the face and neck, and moving downward. The rash usually lasts for three to five days and then fades away.
In uncomplicated cases, people who get measles start to recover as soon as the rash appears and feel back to normal in about two to three weeks.
But up to 40 percent of patients have complications from the virus. These usually occur in the very young (children under five), in adults over 20, and in anybody else who is undernourished or otherwise immunocompromised. Children under five have the highest probability of death.
"one or two in 1,000 children with measles will die"
The most common complication from the measles is pneumonia, which accounts for most measles-related deaths. Less frequently, measles can lead to blindness, croup, mouth ulcers, ear infections, or severe diarrhea. Some children develop encephalitis (swelling of the brain), which can lead to convulsions, loss of hearing, and mental retardation. Again, these complications mostly arise in people whose immune systems are already weakened because of their age, preexisting diseases or malnutrition.
According to the US Centers for Disease Control and Prevention (CDC), the horrible mathematics of measles looks like this: one out of every 20 children with measles gets pneumonia; one in 1,000 will develop encephalitis (swelling of the brain); one or two in 1,000 children will die.
4) What does a measles rash look like?
measles
Measles infection. (Konmesa/shutterstock)
5) How do you prevent measles?
With a vaccine. Measles is prevented through the combination MMR (measles, mumps, and rubella) shot. The CDC recommends that children get two doses:
The first dose, at 12 through 15 months of age.
The second dose, at 4 through 6 years of age.
Immunity from the vaccine lasts for decades, but you should ask your health provider about booster shots if you’re an adult.
The vaccine is known to be extremely safe and very effective: it contains a live but weakened version of the virus, and it causes your immune system to produce antibodies against the virus. Should you be exposed to actual measles, those antibodies will then fire up to protect against the disease.
Again, side effects are rare and mostly very mild. According to the CDC, for example, fevers after the MMR vaccine occur in one out of six people, and mild rashes, in one in 20. More severe problems are virtually non-existent: serious allergic reactions happen in less than one in a million cases. Deafness, seizures, and permanent brain damage are "so rare that it is hard to tell whether they are caused by the vaccine." So the benefits of the vaccine — the protection of children and the communities they live in — vastly outweigh the harms.
6) How easy is it to get measles?
If you’re not vaccinated, it’s extremely easy to get measles. In an unimmunized population, one person with measles can infect 12 to 18 others. That's way higher than other scary viruses like Ebola, HIV or Sars. (With Ebola, one case usually leads to two others. With HIV and Sars, one case leads to another four.)
"Measles can live on surfaces for up to two hours "Measles is an airborne virus, transmitted by respiratory droplets from the nose, mouth, or throat of an infected person. So usually through coughing or sneezing. Small particle aerosols from someone with measles can stay suspended in air for long periods of time after they’ve left a room, and the virus can live on surfaces for up to two hours.
What worries health officials is that the measles virus can spread in a person four days before the onset of the telltale rash. So people with the virus start being contagious before they’d ever know they had measles. (They stop being contagious about four days after the rash appears.)
In exceptionally rare cases, even if you are vaccinated, you can still get measles. In a small percentage (less than five percent) of vaccinated people, their immune systems just don't kick in even with the shots. Researchers aren't sure why.
Getting only one dose of the vaccine instead of the recommended two also seems to increase people's chances of getting measles if they're ever exposed. There's also some question about whether the timing of the first dose of the MMR vaccine can increase the likelihood of vaccine failure — an issue that is believed to have exacerbated a recent measles outbreak in Quebec, Canada.
In the recent California outbreak, because of some combination of the above, five people who had been vaccinated still contracted measles.
7) Is there a treatment for measles?
There is no treatment for measles. Doctors can help patients avoid the more severe complications (blindness, pneumonia) by making sure patients have good nutrition and enough fluids.
For eye and ear infections that can arise, doctors can prescribe antibiotics. And because measles depletes its victims' vitamin A levels, doctors usually give patients two doses of vitamin A supplements.
8) How often do parents refuse to vaccinate their children?
Overall, MMR vaccine refusal is not that common in the US. Across the country, 92 percent of young children got the MMR vaccine, according to the CDC's latest data in 2013. That's nearly enough for what's known as "herd immunity": in order for any vaccine to be effective, you need to have a certain percentage of people in a population immunized. This means diseases can't spread through populations very easily, and it protects even those who aren't vaccinated. With the MMR vaccine, 95 percent of people need to get the shot.
California is just about average: 91 percent of children got the MMR vaccine, according to the CDC's 2013 survey.
As for parents who refuse to vaccinate their kids, the exemption rate in California schools — according to state data last year — was 0.29 percent for medical reasons and 2.95 for personal belief reasons. In recent years, the number of kids who are getting all their required immunizations at school dropped by three percent, from about 92 percent in 2009/2010 to 89 percent last year.
vaccines
Percentage of California child care enrollees getting all their required immunizations by facility type. (California Dept. of Health)
The CDC found that this amounted to an exemption rate of 3.3. percent in California. This is lower than Oregon's high of 7.1 percent, but it's higher than the median state exemption rate of 1.8 percent.)
Still, these overall figures hide clusters of vaccine refusal across states, including ground zero of the Disney outbreak. The New York Times reported that there are pockets of California with extremely high exemption rates, including parts of Los Angeles and Orange County where the rates exceed 10 percent.
This data visualization from the website Silk shows elementary schools in California with some of the highest vaccine exemption percentages, including one where nearly half (43 percent) of children didn't get their required vaccines:
(Data from californiakindegartenvaccinations.silk.co)
Getting an exemption from the vaccine is easier in some states than others. An analysis in Mother Jones found that of the 20 states that allowed "personal-belief" exemptions for children, less than a third made it difficult to allow parents to opt-out, and nine states made it pretty easy by requiring parents to only sign a form. Meanwhile, 48 states allow people to refuse vaccines on religious grounds, and every state allows for medical exemptions (ie, an allergic reactions).
Now, not all of these vaccine refusals have to do with denialism and the anti-vaccine movement. Sometimes, as we've seen, religion is a factor. Sometimes, busy parents just don't have time to bring their kids to necessary doctors' appointments. What's clear, according to Mother Jones, is that in places where getting a non-medical exemption is easier, fewer kids get their required shots.
measles exemptions
Vaccine exemptions in the US by state. (Mother Jones)
9) Will we ever eradicate measles?
The measles virus could theoretically be wiped off the face of the planet, never to infect another human again. That’s because it fits the profile of diseases that can be eradicated: people, and not animals, are the only carriers of the virus (so eradication wouldn't require killing off an entire animal species), we have an effective vaccine, and we have readily available and accurate diagnostic tests to identify the disease.
Globally, there’s some good news on this front: in 2013, about 84 percent of the world's children received one dose of measles vaccine by their first birthday, which is an increase from 73 percent in 2000, according to the World Health Organization.
But this isn’t enough for total eradication. While most (about 95 percent) of today’s outbreaks occur in developing countries, particularly in Africa and Asia, as we’ve seen in the Disney case, measles can take off anywhere as long as there are enough people who did not get the vaccine.
In the US, the disease seems to be making a comeback. Last year, the New England Journal of Medicine reported that there were more measles in 2014 than during any year in the past two decades. In addition to vaccine refusal, there is another key reason measles is spreading in the US: because the disease hasn't been eliminated everywhere, travelers are bringing measles to the US with them.
In an examination of 2014 measles outbreaks, the CDC reported, "Of the 288 cases, 280 (97 percent) were associated with importations from at least 18 countries." Many of these travelers were coming back from the Philippines, which has been dealing with a massive outbreak since fall 2013.
Of the cases examined in 2014, 195 involved US residents who were unvaccinated. Eighty-five percent of these people had refused vaccination because of religious or personal beliefs. Again, these travelers would not be getting sick and infected others if they were vaccinated.
So Disneyland is the perfect incubator for a measles outbreak, with its mixture of international travelers and very young unimmunized children, in a state where vaccine refusal is not all that uncommon. It's also a potential harbinger of more to come.
Card 1 of 18 Launch cards
What is a vaccine?
Vaccines are drugs that bolster the body's immunity to particular diseases. They work by imitating — but not causing — an illness in a way that forces the body to develop a supply of defensive cells. These cells can then recognize and fight off a future infection, should it occur.
Vaccines have eliminated some of the most dangerous, fatal diseases in human history. The World Health Organization in 1979 declared smallpox globally eradicated, and the Centers for Disease Control and Prevention (CDC) that same year proclaimed polio eradicated in the United States. Other vaccines have managed to push various diseases to the brink of extinction, including tetanus and whooping cough.
The scientific community widely supports vaccines, seeing them as one of the most crucial medical breakthroughs of the past few centuries. At the same time, some groups generally oppose vaccination — both now and historically. Most recently, some vaccine opponents argued that vaccines may cause autism, although the link is not supported by current scientific research.
Source:vox
There’s one fact that makes the measles virus really scary: it’s one of the most infectious diseases known to man. A person with measles can cough in a room, leave, and — if you were unvaccinated — hours later, you could catch the virus from the droplets in the air that they left behind. No other virus can do that.
If your parents were born before 1960, there’s a good chance they suffered through a measles infection. They may have lived to tell about it, but they probably had friends who didn’t. In the US, before a vaccine was introduced in 1963, there were four million measles cases with 48,000 hospitalizations and 500 deaths every year. By 2000, because of the vaccine, the virus was declared eliminated here: enough people were immunized that outbreaks were uncommon, and deaths from measles were scarcely heard of.
measles
(The New England Journal of Medicine)
But measles appears to be making a comeback, which leads us to the second fact that most disturbs public-health officials: it’s an entirely preventable illness. Most everybody who gets the proper doses of the vaccine will never get sick with measles, even if they're exposed.
Despite this, there are still intense pockets of transmission around the world, especially in low-income areas but also in places like the US and Canada. In America, we're in the middle of what appears to be a pretty big measles outbreak, with nearly 80 people getting the infection because of an exposure at Disneyland in California. We’re burdening the health system — and a generation of doctors who have never seen measles — with a disease that could have been prevented. Here are nine questions you were too afraid to ask about this deadly virus:
1) Why are we talking about measles again?
disney
Disney, Anaheim, California. (David McNew/Getty)
There’s a big outbreak right now that started in December at the happiest place on Earth — Disneyland theme park in Orange County, California — and has since spread to six other states and Mexico.
Though "patient zero" — the first case — hasn't yet been identified, the California department of health found that 48 of the confirmed cases could be traced back to an initial exposure at the Disney park, and these people have now spread the virus to others.
In total, 78 people in 11 California counties, and Utah, Arizona, Nebraska, Washington, Oregon, Colorado, and Mexico have been infected. About a quarter of them have been hospitalized. So far, none have died.
2) Why did the Disney outbreak spread so quickly?
Health officials believe that the fact that "patient zero" was surrounded by people who weren't vaccinated helped the virus spread around California and beyond. More than 80 percent of those who get measles in this outbreak were not vaccinated against the disease, including six infants who were too young to get their shots (since the measles vaccine is not licensed for use on children younger than 12 months).
3) What does measles feel like and is it deadly?
Measles is a deadly, infectious disease that typically strikes children. After an incubation period of ten to 12 days, measles comes on as a fever, cough, stuffy nose, and bloodshot and watery eyes. Loss of appetite and malaise are common, too. Several days after these initial symptoms, an uncomfortable spotty, rash begins to spread all over the body, starting on the face and neck, and moving downward. The rash usually lasts for three to five days and then fades away.
In uncomplicated cases, people who get measles start to recover as soon as the rash appears and feel back to normal in about two to three weeks.
But up to 40 percent of patients have complications from the virus. These usually occur in the very young (children under five), in adults over 20, and in anybody else who is undernourished or otherwise immunocompromised. Children under five have the highest probability of death.
"one or two in 1,000 children with measles will die"
The most common complication from the measles is pneumonia, which accounts for most measles-related deaths. Less frequently, measles can lead to blindness, croup, mouth ulcers, ear infections, or severe diarrhea. Some children develop encephalitis (swelling of the brain), which can lead to convulsions, loss of hearing, and mental retardation. Again, these complications mostly arise in people whose immune systems are already weakened because of their age, preexisting diseases or malnutrition.
According to the US Centers for Disease Control and Prevention (CDC), the horrible mathematics of measles looks like this: one out of every 20 children with measles gets pneumonia; one in 1,000 will develop encephalitis (swelling of the brain); one or two in 1,000 children will die.
4) What does a measles rash look like?
measles
Measles infection. (Konmesa/shutterstock)
5) How do you prevent measles?
With a vaccine. Measles is prevented through the combination MMR (measles, mumps, and rubella) shot. The CDC recommends that children get two doses:
The first dose, at 12 through 15 months of age.
The second dose, at 4 through 6 years of age.
Immunity from the vaccine lasts for decades, but you should ask your health provider about booster shots if you’re an adult.
The vaccine is known to be extremely safe and very effective: it contains a live but weakened version of the virus, and it causes your immune system to produce antibodies against the virus. Should you be exposed to actual measles, those antibodies will then fire up to protect against the disease.
Again, side effects are rare and mostly very mild. According to the CDC, for example, fevers after the MMR vaccine occur in one out of six people, and mild rashes, in one in 20. More severe problems are virtually non-existent: serious allergic reactions happen in less than one in a million cases. Deafness, seizures, and permanent brain damage are "so rare that it is hard to tell whether they are caused by the vaccine." So the benefits of the vaccine — the protection of children and the communities they live in — vastly outweigh the harms.
6) How easy is it to get measles?
If you’re not vaccinated, it’s extremely easy to get measles. In an unimmunized population, one person with measles can infect 12 to 18 others. That's way higher than other scary viruses like Ebola, HIV or Sars. (With Ebola, one case usually leads to two others. With HIV and Sars, one case leads to another four.)
"Measles can live on surfaces for up to two hours "Measles is an airborne virus, transmitted by respiratory droplets from the nose, mouth, or throat of an infected person. So usually through coughing or sneezing. Small particle aerosols from someone with measles can stay suspended in air for long periods of time after they’ve left a room, and the virus can live on surfaces for up to two hours.
What worries health officials is that the measles virus can spread in a person four days before the onset of the telltale rash. So people with the virus start being contagious before they’d ever know they had measles. (They stop being contagious about four days after the rash appears.)
In exceptionally rare cases, even if you are vaccinated, you can still get measles. In a small percentage (less than five percent) of vaccinated people, their immune systems just don't kick in even with the shots. Researchers aren't sure why.
Getting only one dose of the vaccine instead of the recommended two also seems to increase people's chances of getting measles if they're ever exposed. There's also some question about whether the timing of the first dose of the MMR vaccine can increase the likelihood of vaccine failure — an issue that is believed to have exacerbated a recent measles outbreak in Quebec, Canada.
In the recent California outbreak, because of some combination of the above, five people who had been vaccinated still contracted measles.
7) Is there a treatment for measles?
There is no treatment for measles. Doctors can help patients avoid the more severe complications (blindness, pneumonia) by making sure patients have good nutrition and enough fluids.
For eye and ear infections that can arise, doctors can prescribe antibiotics. And because measles depletes its victims' vitamin A levels, doctors usually give patients two doses of vitamin A supplements.
8) How often do parents refuse to vaccinate their children?
Overall, MMR vaccine refusal is not that common in the US. Across the country, 92 percent of young children got the MMR vaccine, according to the CDC's latest data in 2013. That's nearly enough for what's known as "herd immunity": in order for any vaccine to be effective, you need to have a certain percentage of people in a population immunized. This means diseases can't spread through populations very easily, and it protects even those who aren't vaccinated. With the MMR vaccine, 95 percent of people need to get the shot.
California is just about average: 91 percent of children got the MMR vaccine, according to the CDC's 2013 survey.
As for parents who refuse to vaccinate their kids, the exemption rate in California schools — according to state data last year — was 0.29 percent for medical reasons and 2.95 for personal belief reasons. In recent years, the number of kids who are getting all their required immunizations at school dropped by three percent, from about 92 percent in 2009/2010 to 89 percent last year.
vaccines
Percentage of California child care enrollees getting all their required immunizations by facility type. (California Dept. of Health)
The CDC found that this amounted to an exemption rate of 3.3. percent in California. This is lower than Oregon's high of 7.1 percent, but it's higher than the median state exemption rate of 1.8 percent.)
Still, these overall figures hide clusters of vaccine refusal across states, including ground zero of the Disney outbreak. The New York Times reported that there are pockets of California with extremely high exemption rates, including parts of Los Angeles and Orange County where the rates exceed 10 percent.
This data visualization from the website Silk shows elementary schools in California with some of the highest vaccine exemption percentages, including one where nearly half (43 percent) of children didn't get their required vaccines:
(Data from californiakindegartenvaccinations.silk.co)
Getting an exemption from the vaccine is easier in some states than others. An analysis in Mother Jones found that of the 20 states that allowed "personal-belief" exemptions for children, less than a third made it difficult to allow parents to opt-out, and nine states made it pretty easy by requiring parents to only sign a form. Meanwhile, 48 states allow people to refuse vaccines on religious grounds, and every state allows for medical exemptions (ie, an allergic reactions).
Now, not all of these vaccine refusals have to do with denialism and the anti-vaccine movement. Sometimes, as we've seen, religion is a factor. Sometimes, busy parents just don't have time to bring their kids to necessary doctors' appointments. What's clear, according to Mother Jones, is that in places where getting a non-medical exemption is easier, fewer kids get their required shots.
measles exemptions
Vaccine exemptions in the US by state. (Mother Jones)
9) Will we ever eradicate measles?
The measles virus could theoretically be wiped off the face of the planet, never to infect another human again. That’s because it fits the profile of diseases that can be eradicated: people, and not animals, are the only carriers of the virus (so eradication wouldn't require killing off an entire animal species), we have an effective vaccine, and we have readily available and accurate diagnostic tests to identify the disease.
Globally, there’s some good news on this front: in 2013, about 84 percent of the world's children received one dose of measles vaccine by their first birthday, which is an increase from 73 percent in 2000, according to the World Health Organization.
But this isn’t enough for total eradication. While most (about 95 percent) of today’s outbreaks occur in developing countries, particularly in Africa and Asia, as we’ve seen in the Disney case, measles can take off anywhere as long as there are enough people who did not get the vaccine.
In the US, the disease seems to be making a comeback. Last year, the New England Journal of Medicine reported that there were more measles in 2014 than during any year in the past two decades. In addition to vaccine refusal, there is another key reason measles is spreading in the US: because the disease hasn't been eliminated everywhere, travelers are bringing measles to the US with them.
In an examination of 2014 measles outbreaks, the CDC reported, "Of the 288 cases, 280 (97 percent) were associated with importations from at least 18 countries." Many of these travelers were coming back from the Philippines, which has been dealing with a massive outbreak since fall 2013.
Of the cases examined in 2014, 195 involved US residents who were unvaccinated. Eighty-five percent of these people had refused vaccination because of religious or personal beliefs. Again, these travelers would not be getting sick and infected others if they were vaccinated.
So Disneyland is the perfect incubator for a measles outbreak, with its mixture of international travelers and very young unimmunized children, in a state where vaccine refusal is not all that uncommon. It's also a potential harbinger of more to come.
Card 1 of 18 Launch cards
What is a vaccine?
Vaccines are drugs that bolster the body's immunity to particular diseases. They work by imitating — but not causing — an illness in a way that forces the body to develop a supply of defensive cells. These cells can then recognize and fight off a future infection, should it occur.
Vaccines have eliminated some of the most dangerous, fatal diseases in human history. The World Health Organization in 1979 declared smallpox globally eradicated, and the Centers for Disease Control and Prevention (CDC) that same year proclaimed polio eradicated in the United States. Other vaccines have managed to push various diseases to the brink of extinction, including tetanus and whooping cough.
The scientific community widely supports vaccines, seeing them as one of the most crucial medical breakthroughs of the past few centuries. At the same time, some groups generally oppose vaccination — both now and historically. Most recently, some vaccine opponents argued that vaccines may cause autism, although the link is not supported by current scientific research.
Source:vox
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