June 20, 2019
Hello,
The Centers for Disease Control and Prevention (CDC) reported that with 1,044 cases in 28 states, 2019 has been the worst year for measles in the United States in the last 25 years. This is a dramatic uptick from 2018, when there were 372 reported cases of measles in the United States. Worldwide, the World Health Organization (WHO) reported a 300% increase in the number of measles cases in 2019 compared with the first 3 months of 2018. This is the highest number of cases since measles was “eliminated” from the United States in 2000.
Measles, one of the most contagious diseases, is a respiratory infection caused by a virus that can remain in the air for up to two hours after an infected person leaves an area. Measles is so contagious that up to 90 percent of people who are not immune and who come into close contact with a single infected person – even if they only walk through the same area – may become infected. The dangers of measles are real and include extreme dehydration, ear infections, pneumonia, encephalitis, blindness, and even death. Children and adults with weakened or impaired immune systems caused by diseases, age, or medications, are at higher risk for severe complications from measles, including pneumonia.
Vaccines are safe, prevent a host of infectious diseases, including measles. Vaccines are among the greatest medical advances of the last century. The WHO estimates that worldwide vaccines prevent an estimated 2-3 million deaths per year. The CDC estimates that over the past 25 years, vaccines prevented about 936,000 deaths and 419 million illnesses in the United States alone.
The Advisory Commission on Immunization Practices (ACIP) recommends two doses of the MMR vaccine for children – the first at 12-15 months old and the second dose at 4-6 years of age – and CDC estimates that these two doses should provide 97 percent protection from disease. Persons vaccinated between 1963 and 1989 would likely have received only one dose of vaccine; many who were vaccinated in the early years received a vaccine based on an inactivated version of the virus. For travelers to outbreak areas abroad, the CDC recommends adults consider another dose of MMR unless they have proof of receiving two doses, have a blood test showing immunity, or were born before 1957 – as older persons would likely have been exposed directly to the virus in an outbreak. It is important to be re-immunized, if needed. Recent news reports underscore the risks with outbreaks on U.S. college campuses and on a cruise ship, with quarantine due to measles. Special guidelines are in place for children traveling internationally.
The current U.S. measles epidemic is a palpable example that despite advances in child health, vaccine science, health information, and public health strategies, vaccine-preventable diseases continue to pose a serious threat. The WHO notes that vaccine hesitancy – the reluctance or refusal to vaccinate despite medical recommendation and availability of vaccines – threatens to reverse progress made in reducing vaccine-preventable diseases worldwide and lists vaccine hesitancy as a top 10 global health threat for 2019.
Texas allows exemption from childhood vaccination for medical and nonmedical reasons. The number of exemptions in Texas has jumped since 2003 – when the state started allowing nonmedical exemptions – with more than 76,000 vaccine exemption affidavit requests on record in 2018. Herd immunity (protection of an entire population) occurs when a sufficient number of people are vaccinated against a particular infection – estimated to be 95 percent of the population. Failure to vaccinate makes our population vulnerable to infectious diseases and puts everyone at risk. There is little movement politically to eliminate vaccine exemptions.
The return of measles with widespread activity throughout the United States – including Harris County – is no long a theoretical concern … it’s our reality. As health care providers, we should all become familiar with vaccination recommendations, clinical presentation, and post-exposure management. This is also a time for all of us to review our own immunization or disease history – and catch up on immunization, if needed.
For the latest information, see the CDC’s digital toolkit for providers. UTHealth has a measles FAQ posted on the intranet.
As students, trainees, health care providers, researchers, and health care advocates, it is important to help our community stay informed about health issues, including understanding the individual and public health value of immunizations.
Warm regards,
Barbara
P.S. This month we celebrate LGBT Pride Month to commemorate the Stonewall riots, which occurred at the end of June 1969 and to recognize the impact of the LGBT community on our city and beyond.
The UTHealth community is invited to join the 2019 Pride Houston parade in downtown Houston at 8 p.m. this Saturday, as well as other events earlier in the day.
|