The United States has experienced a record number of measles cases this year — the highest number since 2000, the year that U.S. health officials declared that endemic measles had been eliminated from the country, according to new numbers released last week by the Centers for Disease Control and Prevention (CDC).
As of Oct. 31, there were 20 outbreaks and 603 individual cases of measles in 22 states, including Minnesota, which has had two reported cases so far this year.
To understand exactly how troubling those national numbers are, consider this: In 2011 — the year that, until now, had the most measles cases since 2000 — 222 people (including 21 Minnesotans) came down with the virus in the United States.
All outbreaks of measles since 2000 have occurred after people traveling to other countries became infected with the virus and then brought it back to the United States.
Measles is a highly contagious disease — one of the most contagious of those that can be prevented with a vaccine. The average person with measles would be able of infecting 12 to 18 other people if all of his or her contacts were unvaccinated or hadn’t developed immunity by already having had the disease, experts say.
Measles is also a serious disease, particularly in children under the age of 5 and in adults. Complications from the disease include diarrhea, dehydration, ear infections (which can result in permanent hearing loss), pneumonia, encephalitis, blindness and even death. In the United States, an estimated 0.1 to 0.3 percent of people who develop measles die from its complications. In the developing world, the death rate from the disease can be as high as 15 percent.
A single dose of the measles vaccine, if given before the second year of life, is 94 percent effective at preventing the disease. Two doses administered on or after a child’s first birthday and spaced at least a month apart protect almost everybody against measles for life.
Stalled progress
The CDC, in conjunction with the World Health Organization, also issued an international report last week that had mixed news about measles. Between 2000 and 2013, vaccination programs have led to a 72 percent decline in the global incidence rate for measles and a 75 percent drop in the disease’s death rate. During that 13-year period, an estimated 15.6 million measles-related deaths were prevented — a stunning accomplishment.
But that progress has stalled. The number of deaths from measles increased from an estimated 122,000 in 2012 to 145,700 in 2013, mostly as a result of outbreaks in China, Nigeria and the Democratic Republic of the Congo, according to the report.
Reduced global funding for vaccination programs is a major factor behind those rising numbers, the health officials stressed.
What happens overseas has a direct effect on measles outbreaks in the United States. For, as two health experts note in a commentary published Oct. 30 in the New England Journal of Medicine, the contraction of the disease by susceptible U.S. residents travelling overseas is one of the major reasons behind the rising number of cases that are occurring here.
The other reason: the increasing number of U.S. parents who refuse or delay having their children vaccinated.
“Despite the overwhelming evidence that vaccines — including the measles, mumps and rubella [MMR] vaccine — are safe, too many people still believe that greater risk is posed by vaccinating than by not vaccinating,” the commentary’s authors write.
Measles in Minnesota
To find out about current measles trends here in Minnesota, MinnPost sent some questions last Friday to Emily Banerjee, an epidemiologist with the Minnesota Department of Health (MDH). Her lightly edited responses are below.
MinnPost: Is the MDH alarmed by the reported national jump this year in measles cases?
Emily Banerjee: Minnesota is concerned. With the exception of 2011, in which Minnesota had a measles outbreak of 21 cases, we have had an average of about one case per year since 2000. When there are more and more cases in the United States, there is a higher chance that Minnesota will also have cases as a result of people spreading measles to others during domestic travel.
MP: How many documented cases have we had this year in Minnesota?
EB: We have had two reported cases of confirmed measles in 2014. Measles is not a disease that is endemic in Minnesota, meaning it is not currently spreading among the population. MDH investigates suspect rash illness cases, and laboratories and health-care providers are required by law to report suspect cases of measles immediately to MDH so that we can collect the proper lab specimens and take immediate public health action if it turns into a case.
MP: What do we know about these cases? Were they contracted while the children’s families were traveling overseas?
EB: The first case contracted measles while traveling overseas and then transmitted measles to the second case (an adult business traveler) in passing at a U.S. airport gate. Both cases were confirmed by laboratory testing and had illnesses that were clinically compatible with measles, including high fever and maculopapular rash.
MP: What role did lack of immunization play in these cases?
EB: The first case was an age-appropriately vaccinated child with one dose of MMR, and represents the 2-5 percent of individuals who do not respond to the first dose (primary vaccine failure, which is why a second dose of MMR is routinely recommended). The second case had unknown vaccination status and is part of a large group of Americans born between 1963 and 1978 who may have received a far less effective version of the MMR vaccine.
MP: What is the current rate of childhood-disease immunization in Minnesota? Is it up or down from previous years?
EB: More than 90 percent of Minnesota kindergarteners were vaccinated against diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, hepatitis B and chickenpox for the 2013-14 school year. MMR (measles, mumps and rubella) vaccination rates are steady from previous years — they have hovered at around 90 percent.
MP: How concerned are you and your colleagues about current trends in immunization?
EB: For the most part, we see level immunization rates, but, of course, we would like to see them inching upward. Most parents vaccinate their children. Parents who delay some vaccinations put their child at risk for serious diseases that can be prevented. Once those diseases are in your community, it may be too late for their child to get vaccinated. MDH does keep an eye out for areas where vaccine refusal is higher. This is done through the Annual Immunization School Report (AISR). Schools are a place where diseases can spread quickly among children who are unvaccinated.
MP: What should parents know about measles (and other childhood diseases) and immunizations for those diseases?
EB: Vaccination is one of the most amazing public health accomplishments that have happened in the past century. In years past, parents dreaded the diseases we no longer see. Measles is no exception. Measles is not a mild disease. Every day, somewhere in the world, 430 children die of measles. This is preventable. Two years ago, a young Minnesota boy almost died of pneumonia caused by measles. Parents have the power to prevent these diseases, including measles, from returning to our communities by making sure their child is vaccinated on time, every time.
You can read more about measles and its prevention on the CDC’s website.
Senior CDC scientist admits MMR data fraud w/whistleblower atty
Statement of William W. Thompson, Ph.D., Regarding the 2004 Article Examining the Possibility of a Relationship Between MMR Vaccine and Autism
“I regret that my coauthors and I omitted statistically significant information in our 2004 article published in the journal Pediatrics. The omitted data suggested that African American males who received the MMR vaccine before age 36 months were at increased risk for autism.”
http://www.morganverkamp.com/august-27-2014-press-release-statement-of-william-w-thompson-ph-d-regarding-the-2004-article-examining-the-possibility-of-a-relationship-between-mmr-vaccine-and-autism/
No evidence of fraud or wrongdoing
Dr. Thompson may have been bothered by his and his co-authors’ decision to omit what was clearly a spurious result, but scientists can disagree on which problematic sub-analyses to include in a paper – and that wasn’t fraud. There’s no evidence there ever was a real link between vaccines and autism, the paper was done according to scientific criteria, and there’s no evidence of wrongdoing.
Here is a detailed discussion of this “manufactroversy” and how misleading the anti vaccine claims are: http://www.harpocratesspeaks.com/2014/09/mmr-cdc-and-brian-hooker-media-guide.html
Nearly 2/3 of this year’s cases are from one Ohio outbreak
Basically it was a series of unlikely events.
A group of Amish missionaries flew to the Philippines. They were unaware that there were a large amount of cases of measles there this year and apparently were not advised to be vaccinated prior to departure. Upon returning, when they complained of illness, it was misdiagnosed as dengue fever – which is understandable, since very few physicians nowadays have experience with people who have measles. Then these men went back to their community, which has little or no vaccination, and the undiagnosed measles quickly spread. Once people understood it was measles, the community was receptive to being immunized.
Factor this fluke out and this year’s numbers, while higher than some years, is well within a normal range for a country of this size – a few hundred out of 320 million. No fatalities, either.
Thankfully Ms. Banerjee clarified how immunization rates are stable, so it’s not because of some big drop in people being immunized.
Unfortunate
It’s unfortunate that the choice of some not to be vaccinated – a choice based on misinformation – has lead to a spike in cases of this preventable, dangerous disease. Minnesota seems lucky so far – California has seen a rise in exemptions in recent years and has seen 61 cases so far this year.
Hopefully, people will realize the problem with refusing vaccination and we can stop this increase.
No correlation
“It’s unfortunate that the choice of some not to be vaccinated – a choice based on misinformation – has lead to a spike in cases of this preventable, dangerous disease.”
cf.
“Most of the 58 patients were either unvaccinated (25 [43%]) or had no vaccination documentation available (18 [31%]). Of the 25 patients who were known to be unvaccinated, 19 (76%) had philosophical objections to vaccination, three (12%) were too young (aged ≤12 months) for routine vaccination, and three (12%) were unvaccinated for unknown reasons.”
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a6.htm
So less than a majority of the California cases involved people known to be unvaccinated and 2/3 of cases were with people who do not fit the narrative of “unvaccinated based on misinformation”. And 2/3 is a conservative estimate, because we don’t know the precise nature of objection of those 16 individuals.
As for it being “dangerous”, it’s non-fatal in roughly 99.9% of cases and is among the least likely causes of death in the US. Pretty much anything that can kill a person is more likely to kill them than the measles in the US.
The rational explanation for this year’s numbers in California (and nationally) is travel to the Philippines. As stated above, 2/3 of the cases nationally came from one outbreak related to an Amish group that travelled to the Philippines. These are not people who watch TV and take vaccination advice from Jenny McCarthy.
The vast majority of importations of measles into California this year are also from the Philippines. California has roughly half the US Filipino population within its borders, so it’s almost certainly because a small number of people traveled there because of family ties and returned with the disease. As evidenced by the outbreak in the Philippines, it’s clear they aren’t as rigorous about vaccination as the US, which would explain why US Filipino immigrants may not know if they’re immunized or not. Again, these are not people who get their vaccination guidance from Jenny McCarthy.
Lastly, the non-vaccination rate for US children is below 1% and has been steady at that level long before Ms. McCarthy started sharing her views. There is no correlation between this year’s numbers and “the choice of some not to be vaccinated – a choice based on misinformation”.
It’s essential that people understand the public health benefits of vaccination, but let us convey that without resorting to narratives that have no scientific/statistical basis themselves. Let us also contextualize that we’re talking about 61 cases in California in a population of over 37 million — less than 1 in 600,000 people. It’s a statistically non-existent risk.