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Measles is back. Could it be here to stay?

January 29, 2015

    Sam Bernstein, The Daily Briefing

    In 2000, health officials declared that measles was eliminated from the United States.

    This meant that CDC no longer considered the disease native to the United States thanks to a highly effective vaccination program that brought the number of U.S. cases down from 3 to 4 million per year in the 1960s to the low hundreds in the 2000s.

    Now, 15 years later, public health officials are warning that pockets of unvaccinated Americans may be contributing to the resurgence of the disease and it could reclaim its place as a communicable disease native to North America.

    According to data from the CDC, the ongoing measles outbreak in California—which likely started at a Disney theme park—has sickened at least 87 people in seven states and Mexico. At least a quarter of the 73 patients in California have been hospitalized.

    What to know about measles

    Measles is described as the world's most contagious disease, with nearly every unvaccinated person who comes into direct contact with an infected person becoming ill. The most common symptoms are fever, rash, and cough. However, some cases can develop pneumonia, hepatitis, and brain swelling.

    How measles spreads through U.S. communities

    Greg Poland, professor of medicine and infectious diseases at the Mayo Clinic, doesn't mince words about the dangers of Measles. "Children die as a result of this disease," he says, noting that in the early 1990s measles was fatal in approximately three in 1,000 children.

    What is behind the comeback?

    Although it is too early to know whether the California outbreak will surpass other large outbreaks in recent years, public health officials say that measles seems to be making a comeback.

    Although the vaccination rate for measles remains high overall, pockets of unvaccinated people have formed that make some communities vulnerable. A Kaiser Permanente study released this month found that at least five communities in Northern California had low rates of vaccination. Vallejo, a city near San Francisco, had a vaccination rate of approximately 75%. (For context: Medical experts say that between 92% and 95% of children should receive two doses of the measles, mumps, and rubella (MMR) vaccine to maintain herd immunity against measles.)

    In wealthy L.A. schools, up to 70% of parents exempt kids from vaccines

    In 2014, CDC reported a sharp spike in measles cases, with 644 cases across 23 outbreaks.

    "In some sense the success of our immunization program is its own enemy," says Walter Orenstein, associate director of the Emory Vaccine Center at Emory University. He argues people have become complacent because they haven't seen the disease in decades.

    Fighting back

    Orenstein says his "biggest fear is we will re-establish transmission and have many more cases." Currently, he is heading the National Vaccine Advisory Committee to devise strategies for increasing vaccine acceptance. Tracy Lieu, who worked on the Kaiser study, agreed that more outreach to communities with low vaccination rates is needed. "We need to figure out how to better meet parents' needs," she says.

    Clinicians may also need a refresher, experts warn. In terms of training, "It's not something you spend a great deal of time on at all, for obvious reasons," says William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. "If you haven't seen it before, it can be puzzling."

    James Cherry, a UCLA research professor, says measles is especially easy to miss because it presents in the same way as other common illnesses in its early stages. But several days after the initial symptoms, doctors can look for so-called Koplik spots inside the cheek, and then later a telltale rash.

    Unfortunately, some think the best preparation is experience. Paul Offit, a physician and advocate for immunization, says, "You can read about it, but there's nothing like seeing it."

    The takeaway: Doctors should be on the lookout for possible cases of measles, which may be resurging because of pockets of unvaccinated people that appear to have corroded herd immunity in some communities.

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