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Measles report: Why we still need vaccines

A child with rash of measles.
CDC/Barbara Rice
A child with the measles rash.

On Wednesday, the Minnesota Department of Health reported that a 10-month-old child in Hennepin County had been diagnosed with measles. Yes, the measles.

According to the Health Department, the child was first evaluated in an emergency room on July 29, presumably with the typical symptoms that develop a week after exposure to the measles virus: fever, bad cough, runny nose, red eyes. The classic measles rash begins at the hairline two to three days later and is densest around the shoulders.

The child was seen again on Aug. 2 and Aug. 3, each time in a different clinic. One can see the pattern: The child wasn't getting any better, and the parents were searching for answers.

If you thought that measles had been eradicated, you might be shocked to know that there are still 20 million cases worldwide each year. Thankfully, very few of those occur here in the United States. "The CDC [Centers for Disease Control] came out in 2000 and said that measles has been eliminated from the United States," explained Dr. Ruth Lynfield, state epidemiologist for the state Health Department, "because the 30 to 120 cases per year that we're seeing [here in the U.S.] were directly linked to imported cases; in other words, people who had traveled or had been exposed to someone who had traveled."

Gone but not forgotten
Only eight cases of measles have been reported in Minnesota since 2000, and over that same time frame, the average number of annual cases nationally has been 62. But recently there has been an uptick in the number of cases here in the U.S., with 64 being reported from January through April of this year. None of those was in the Land of the Loon, but four were reported in Wisconsin. The majority of infections occurred in New York City, Arizona and California, and half involved children age 4 or younger.

Not surprisingly the majority of these cases could be linked to exposure to people who had traveled overseas to disease- and poverty-ridden countries like, you guessed it — Switzerland, Israel, Belgium and Italy. These four countries accounted for all but one of the 10 people who imported the virus, the other being from India. That's right: Modern countries like Israel and Switzerland have been experiencing measles outbreaks (1,000 and 2,250 cases respectively), and it's because vaccination rates have fallen to the point that what we call "herd immunity" is waning. That is, a significant unvaccinated population provides enough tinder so that a spark from a country in which measles is endemic is enough to start a fire. The vaccination rate for measles in Switzerland is 78 percent, well below the 95 percent coverage we have here in Minnesota.

Like the 10-month-old sickened in Hennepin County, almost all of the national cases involved patients who were either unvaccinated or weren't sure they had been vaccinated.

Why not get vaccinated?

To some, it has to do with what they find more threatening: the vaccine or the disease itself. A physician I was talking to recently recalled summers in the time of polio, when parents were shipping kids out of town, and the pools and lakes were empty of swimmers. The threat of paralysis — or worse — was palpable and imminent, and the vaccine was a godsend: Parents didn't spend a lot of time worrying about possible side effects.

As Dr. Lynfield put it, "The current generation of parents of young children don't have the same visceral respect for infectious diseases as prior generations."

What next?
Measles is highly contagious. For the state Health Department, the questions are who gave the 10-month-old the measles, and who did the baby expose to it?

The infected infant has not traveled out of the U.S., so it's highly likely that the source case is a traveler. Beyond that, health officials have no early leads.

Health officials in Hennepin County are working with infection control workers in each of the three facilities to go back through records and decide what other patients may have been exposed. The exposure window of concern is from the time the child arrived in the waiting room, until several hours after the child left the facility. Those exposed who are either not immunized or at higher risk of infection (those with weakened immune systems, or pregnant for example) will receive either a vaccine booster, or an infusion of antibodies against the measles virus.

Small risk of a serious illness
"The main message from my standpoint is that measles is a bad disease, and it is even a bad disease in the developed world," Lynfield said, pointing out that 22 percent of the U.S. cases reported earlier this year ended up in the hospital, and that even with good medical care, the death rate is estimated at about one in 1,000. "There's also an incidence of encephalitis [direct brain infection] of one in a thousand, and people can be left with very significant, severe sequelae (other conditions)," Lynfield warned.

This is no pandemic. It's hoped the infected Hennepin County infant will recover and the number of cases will be quite limited. But it's a good reminder of why we take our kids in to get vaccinated. It isn't just for a sucker and a cartoon sticker, though that's the explanation we give our kids.

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Comments (9)

I think people who don't vaccinate their children are selfish (which I understand is not the case with this child, who was to young to get the vaccine.) While they are saying they are weighing the disease against the possible problems (unproven) with the vaccine, they forget what happens to all the people they spread the diseas on to.

When an unvaccinated person gets an infection disease, they need to consider not only how their health was impacted, but also how the health of every other person they gave it to was impacted, and the people they gave it to, and the people they gave it to. Is it really worth the small umproven risk of the vaccine to possibly spread a dangerous and possibly deadly disease on?

I wonder where the 10 month old got infected. A mystery traveler? Someone with a mild case of measles that didn't go to the Dr & get diagnosed? Or a recently vaccinated child/adult. The MMR shot uses live virus that can shed the virus for a few weeks after the shot. Also are there more admits to the hospital for measles just so the infectious person is contained. Maybe the pt is a bit "dehydrated" so the docs admit them, tuck them in an isolated room & keep them out of general population for a few days. Helps keep the outbreak low.

"Like the 10-month-old sickened in Hennepin County, almost all of the national cases involved patients who were either unvaccinated or weren't sure they had been vaccinated."

That quote illustrates how ridiculous this article is. It's filled with scare-mongering about an incredibly rare disease. You attempt to blame the 10 month old and his/her parents, while neglecting to point out that kids should not receive the measles vaccine until after they reach 12 months of age. In other words this kid was too young for the vaccine.

Vaccinations are important, but not if your kid is too young to fight the live virus strains in the vaccine.

For Lisa Schwartz - I am not aware of any instances of attenuated measles virus having been transmitted between people, and the Vaccine Information Statement doesn't say anything about that being a risk. The virus in the vaccine is weakened so that it replicates only a few times. Please give a reference for your claim so that others may evaluate it.

For Reggie McGurt: I don't think that Dr. Bowron was trying to say the 10-month-old should have been vaccinated, but rather that people who are unvaccinated for any reason (including young age or contraindications) are at particular risk in a measles outbreak.

It also sounds as though you may have a mistaken impression about the strength of the attenuated measles virus in the MMR vaccine. Here is a very nice new site offering information on the vaccine-preventable diseases of childhood and common misconceptions about vaccines:

http://www.vaccinateyourbaby.org

Thank you, Lisa Randall, for coming to my defense. I agree with your thoughts, and indeed, it would have helped to clarify that the 10-month-old was too young to be vaccinated (the first MMR shot comes at 12-15 months of age).

The purpose of this post was to remind readers that the measles has been forgotten, not eradicated; that this serious and potentially lethal infection remains quite common worldwide, including in developed countries where immunization levels have fallen.

The subject of vaccinations has become somewhat contentious. Clearly vaccinations have their own risks, and although those risks are relatively fixed, they loom larger when the threat (the incidence) of the disease of interest is on the wane (typically because of vaccination programs). It's a Catch-22 that the more successful a vaccine is, the less it appears that we need it.

According to the CDC article that I linked in the post, before the measles vaccine came out in 1963, 3-4 million Americans contracted the disease annually; 1,000 were permanently disabled from encephalitis, and 400-500 hundred died. Those numbers logarithmically exceed the established risks for immunization. According to the National Vaccine Injury Compensation Program, since 1988, 795 complaints have been issued against the measles vaccine (MMR), including 52 deaths. 327 of those cases were dismissed, and 279 were compensated.

http://www.hrsa.gov/vaccinecompensation/statistics_report.htm

I admit, I find the whole issue of vaccination quite confusing. I'm 50 years old and when I was a child, were only vaccinated for small pox and polio. The rest were considered "childhood diseases" and we were just expected to get vaccinated through getting the diseases. As a child, I had red measles, german measles, mumps, chicken pox, and scarlet fever. While I was sick as a child, I wasn't unusual -- virtually all of my friends had their turn as well. Today, I'm healthier than ever, and rarely get sick. I credit it to my strong immune system developed in childhood.

I say that vaccinations are confusing for several reasons reasons: 1.) I do think it's great that kids won't get sick like I did, however, 2.) my mother-in-law nearly died from guillian barre syndrom (a paralyzing disease) after receiving a required vaccination so she could go to India) and 3.) as I understand, recent studies have suggested a link between vaccinations and autism.

Confusing... definitely confusing.

Hi Debbie,

None of the people who died of the infections you survived are around to say that they actually were pretty bad.

Rubella ("German measles") does not generally cause severe illness in a child but, if caught by a pregnant woman, can easily cause miscarriage/stillbirth, mental retardation, severe heart defects, blindness, deafness, or other malformations and disabilities in the fetus.

An average of over 500,000 cases of of measles ("red measles") occurred annually in the five years before its vaccine became available. The experience of having measles and its true seriousness are described here: http://www.ajc.com/opinion/content/opinion/stories/2008/10/09/kielyed_10...

Per the CDC's Pink Book, "[m]umps was...one of the most common causes of aseptic meningitis and sensorineural deafness in childhood. During World War I, only influenza and gonorrhea were more common causes of hospitalization among soldiers." Other complications include orchitis and spontaneous abortion.

Chicken pox may have been a trivial disease to you, but try telling that to the parents of the 100 or so U.S. children who died from it (or its complications) every year before there was a vaccine.

Scarlet fever is not a vaccine-preventable disease. It is due to group A strep infection.

Guillain-Barre syndrome is poorly understood. In a few instances, vaccines have appeared to be associated with it (such as the 1976 influenza vaccine), but the nature of the true association, if any, is unclear. For more information, see this article: http://www.factsandcomparisons.com/assets/hospitalpharm/IMM1.pdf

Finally, no credible studies have linked vaccines with autism. This is a persistent urban legend that has discouraged many parents from protecting their children through immunization. In fact, many large studies undertaken to address the pervasiveness of this belief have made extremely clear that there is no connection.

That sick boy's skin shows what many "autistic" kids look like internally.

Biopsies show vaccine-strain measles in lesions lining the gastrointestinal tract -- in the small intestine, even in the esophagus.

You can read about MMR injury and similar vaccine injuries in the Vaccine Adverse Events Reporting System, in reports to the National Vaccine Injury Compensation Program, and expert testimony to the Federal Omnibus Autism Proceedings.

The CDC does not offer any medical treatment or assistance to children injured by vaccines. Families are left to fend for themselves with antivirals, nutritional supplements, steroids etc. The American Academy of Pediatrics is happiest when quoting falsified statistics instead of actually looking at these sick and hurting children.

No other consumer product manufacturer in this country could get away with such negligence. And at the very least, such poor postmarketing surveillance.

The hardest part of the vaccine injury epidemic is getting medical professionals to realize that their good intentions are harming a significantly large subset of our population. What happened to "primum non nocere"?

It's a misconception that autistic children have measles virus in their intestines. The study that popularized this idea was shown to have based its conclusions on lab error. One of the world's leading authorities on polymerase chain reaction analysis summarized the results of an investigation into the laboratory techniques that produced the erroneous results:

"This exhaustive analysis of the experimental RT-qPCR data generated by the Unigenetics laboratory demonstrates persistent and widespread contamination with F-gene DNA. As a result there is no credible evidence for the presence of either MV [measles virus] genomic RNA or mRNA in the GI tracts of any patient investigated by this laboratory. Consequently, this finding excludes any link between MV and, by extension, the MMR vaccine and autism."

(Bustin SA, European Pharmaceutical Review, 2008, issue 1)

Also, an attempt to replicate the results of the original study came to this conclusion:

"This study provides strong evidence against association of autism with persistent MV RNA in the GI tract or MMR exposure."

(Hornig M et al., PLoS One, Sept. 4, 2008)

While, as Nancy notes above, many have claimed that MMR vaccines caused their children to become autistic, this has never been substantiated; in fact, the lack of connection between MMR vaccine and autism has been repeatedly demonstrated through large epidemiologic studies.