On the heels of the first death in an ongoing US-based measles outbreak, Paul Offit, MD, discusses how outbreaks are the first sign that childhood vaccination rates are starting to decline.
February 26: The Texas Department of State Health Services has reported the first death from measles in the ongoing outbreak in the South Plains and Panhandle regions of a school-aged child who was not vaccinated. The child was hospitalized in Lubbock the week prior and had tested positive for measles at that time.2
In the fall of 1990, the city of Philadelphia started seeing cases of measles. It eventually became an epicenter for a major measles outbreak that went well into 1991. It caused more than 1400 cases, with a majority in unvaccinated children, and led to 9 children dying.1 Paul Offit, MD, the director of the Vaccine Education Center and an attending physician in the Division of Infectious Diseases at Children's Hospital of Philadelphia (CHOP), treated several children involved in that outbreak.
“Both children's hospitals [in Philadelphia] were utterly overwhelmed with that virus. You had to make decisions about who would or wouldn't come into the hospital,” Offit told Contagion®.
Within that outbreak, 486 cases and 6 measles-associated deaths were reported to the Philadelphia Health Department from members of 2 fundamentalist church communities. The 2 communities promoted "a reliance on prayer, not medical care, to cure disease."1
Flash forward to today, and Texas is in the midst of a measles outbreak largely amongst the Mennonite community.2 On February 25, the Texas Department of State Health Services announced that there are now 124 cases that have been identified since late January. Eighteen of those patients have been hospitalized, and 5 of those cases are in vaccinated individuals. The rest are unvaccinated, or their vaccination status is unknown.3 Additionally, there are 9 cases in New Mexico.2
“[Measles] is not a disease you want to get. Every year, before there was a vaccine, about 50,000 children would be hospitalized and 500 would die."—Paul Offit, MD
“I do expect to see greater amounts of measles outbreaks in the coming year for this reason: the CDC recently reported that more parents are choosing nonmedical vaccine exemptions for their children than ever before," Offit said. "There are a number of jurisdictions where the number of children who are now at risk for measles has become so great that we have lost herd immunity. So, I think what you're seeing in West Texas right now that has spilled over into New Mexico is probably a sign of more to come.”
Offit points out that for the younger generation of clinicians, who have little to no experience in seeing and treating measles, there are some clinical care nuances and considerations when dealing with measles.
“Young doctors really haven't seen measles, and so they may not be so quick to diagnose it," he explained. "The other thing that I worry about is that they may be quick to bring children into the hospital who don't necessarily need to be hospitalized because you don't want the measles virus in your hospital,” Offit said. “It's very hard to contain measles. It has a contagious index—meaning how many people you infect during a typical day—that is 5 times greater than COVID... When you bring measles into the hospital, there are a lot of children who are immune-compromised and, therefore, may be at greater risk of measles.”
Offit does understand parents’ concerns around the number of childhood vaccines but cautions families about not getting these vital immunizations. “We ask a lot of parents in this country; we ask them to get vaccines against 14 different diseases in the first few years of life, which can mean as many as 25 shots during that time. It can mean as many as 5 shots at 1 time to prevent diseases that most people don't see, using biological fluids that most people don't understand. So, I think pushback on vaccines is understandable, but know this: the canary in the coal mine—whenever you start to see vaccine rates erode—is measles. It's always the first one to come back, because it's not only the most contagious vaccine-preventable disease; it is the most contagious infectious disease.”
He stresses that measles can make children very sick, causing a high fever, photophobia, and dehydration, and it can lead to more serious health issues, including pneumonia and a rare chronic measles disorder, subacute sclerosing panencephalitis (SSPE), a neurological disease that can be fatal.
“This is not a disease you want to get. Every year, before there was a vaccine, about 50,000 children would be hospitalized and 500 would die,” he said.
Measles is a highly contagious respiratory illness that can be life-threatening. During an outbreak, estimates suggest that 1 in 5 infected people will be hospitalized, and 1 in 20 will develop pneumonia. In rare cases, measles can lead to swelling of the brain and death, and can cause pregnancy complications.
Measles can be transmitted via direct contact with infectious droplets and/or by airborne spread via breaths, coughs, or sneezes. Those infected experience symptoms onset within 1-2 weeks post-exposure, with early symptoms including high fever, cough, runny nose, and red, watery eyes. A telltale rash will often break out with flat, red facial spots that spread down the neck and torso. The contagious period tends to be approximately 4 days prior to the rash and lasts until 4 days post-rash. Those who believe they have measles or may have been exposed should isolate themselves and call their health care provider before arriving to be tested, according to state and federal guidance.2
