Target Health Blog

Measles

February 4, 2019

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30 January 2019: The current measles outbreak in Washington state has tallied the highest number of infections since 1996. The 37 cases there include 36 in Clark County, across the Columbia River from Portland, Oregon, and one case in King County, which includes Seattle; one case in Oregon is linked to the outbreak, Washington Secretary of Health. Two patients have been hospitalized. Hawaii also reported two cases of measles in travelers who were infected in Washington before their visit to the Big Island. In New York there have been 209 cases there since October, according to New York State Department of Health: 64 cases in Brooklyn and 145 cases in Orange and Rockland counties. Most of these cases are in people who were not vaccinated.

A strong positive celebration to the high worth of individuality, helped to settle the United States, and to build this country into a great nation. In doing so, we've reached the point where we sometimes forget, that an emphasis on individuality may have worked well at the beginning. Now, in the next stage, cooperation is the key word, without losing individuality. In healthcare, public health depends upon the importance of personal responsibility within a community.

16th-century Aztec drawing of someone with measles
Graphic credit: By Unknown - (2009) Viruses, Plagues, and History: Past, Present and Future, Oxford University Press, USA, p. 144 ISBN: 0-19-532731-4., Public Domain,
https://commons.wikimedia.org/w/index.php?curid=12255043

Measles affects about 20 million people a year, primarily in the developing areas of Africa and Asia. No other vaccine-preventable disease causes as many deaths. In 1980, 2.6 million people died of it, and in 1990, 545,000 died; by 2014, global vaccination programs had reduced the number of deaths from measles to 73,000. Rates of disease and deaths, however, increased in 2017 due to a decrease in immunization. The risk of death among those infected is about 0.2%, but may be up to 10% in people with malnutrition. Most of those who die from the infection are less than five years old. Measles is not believed to affect other animals.

The measles virus is one of the most infectious 1) ___ known to man. A person with measles can cough in a room, leave that room and hours later, if unvaccinated, others could catch the virus from the droplets in the air that the infected person left behind. No other virus can do that. For anyone born before 1960, there's a good chance they suffered through a 2) ___ infection. They may have lived to tell about it, but they probably had friends who didn't. In the US, before a vaccine was introduced in 1963, there were 4 million measles cases with 48,000 hospitalizations and 500 deaths in the US every year. Measles was also a leading killer of children globally.

The beauty of the vaccine is that people who get the proper doses will never get sick with measles, even if they're exposed. And by 2000, because of widespread 3) ___, the virus was declared eliminated in the US. Enough people were immunized that outbreaks were uncommon, and deaths from measles were scarcely heard of. Measles is a deadly infectious disease that typically strikes 4) ___. After an incubation period of 10 to 12 days, measles comes on as a fever, cough, stuffy nose, and bloodshot and watery eyes. Loss of appetite and malaise are common too. Several days after these initial symptoms, an uncomfortable spotty rash begins to spread all over the body, starting on the face and neck and moving downward. The rash usually lasts for three to five days and then fades away. In uncomplicated cases, people who get measles start to recover as soon as the 5) ___appears and feel back to normal in about two to three weeks. But up to 40% of patients have complications from the virus. These usually occur in the very young (children under 5), in adults over 20, and in anybody else who is undernourished or otherwise immunocompromised. Children under 5 have the highest probability of 6) ___. The most common complication from measles is pneumonia, which accounts for most measles-related deaths. Less frequently, measles can lead to blindness, croup, mouth ulcers, ear infections, or severe diarrhea. Some children develop encephalitis (swelling of the brain), which can lead to convulsions, loss of hearing, and mental retardation. Again, these complications mostly arise in people whose immune systems are already weakened because of their age, preexisting diseases, or malnutrition.

There's also been an uptick lately in the US, Canada, and across Europe primarily because too many people are skipping vaccines. In the first half of 2018, Europe recorded more than 41,000 cases, a record high in the post-vaccine era. In the US in 2018, there were 17 outbreaks totaling 349 cases. Now, there's an outbreak of measles in Washington state that has prompted the governor there to declare a public health 7) ___. As of last Friday, there were 41 cases in Washington's Clark County, which borders Portland, Oregon and health officials were investigating 15 more cases. Most all of the cases involved children between 1 and 10 years old who had not been vaccinated. There's also one adult case in King County, whose largest city is Seattle. And health officials think this outbreak is going to get a lot bigger, and fast. We are burdening the health system and a generation of doctors who have never seen measles, with a disease that could have absolutely been prevented through routine vaccination.

Estimates based on modern molecular biology place the emergence of measles as a human disease sometime after 500 CE (the former speculation that the Antonine Plague of 165-180 CE was caused by measles is now discounted). The first systematic description of measles, and its distinction from smallpox and chickenpox, is credited to the Persian physician Rhazes (860-932), who published The Book of Smallpox and Measles. Given what is now known about the evolution of measles, Rhazes' account is remarkably timely, as recent work that examined the mutation rate of the virus indicates the measles virus emerged from rinderpest (cattle plague) as a zoonotic disease between 1100 and 1200 CE, a period that may have been preceded by limited outbreaks involving a virus not yet fully acclimated to humans. This agrees with the observation that measles requires a susceptible population of >500,000 to sustain an epidemic, a situation that occurred in historic times following the growth of medieval European cities.

Measles is an endemic disease, meaning it has been continually present in a community, and many people develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating. In 1529, a measles outbreak in Cuba killed two-thirds of those natives who had previously survived smallpox. Two years later, measles was responsible for the deaths of half the population of Honduras, and it had ravaged Mexico, Central America, and the Inca civilization. Between roughly 1855 and 2005, measles has been estimated to have killed about 200 million people worldwide. Measles killed 20% of Hawaii's population in the 1850s. In 1875, measles killed over 40,000 Fijians, approximately one-third of the population. In the 19th century, the disease killed 50% of the Andamanese population. Seven to eight million children are thought to have died from measles each year before the vaccine was introduced.

In 1954, the virus causing the disease was isolated from a 13-year-old boy from the United States, David Edmonston, and adapted and propagated on chick embryo tissue culture. To date, 21 strains of the measles virus have been identified. While at Merck, Maurice Hilleman developed the first successful 8) ___. Licensed vaccines to prevent the disease became available in 1963. An improved measles vaccine became available in 1968. Measles as an endemic disease was eliminated from the United States in 2000, but continues to be reintroduced by international travelers. When used properly, measles vaccine is estimated to prevent 1 million deaths per year.

Measles is a highly contagious infectious disease caused by the measles 9) ___. Symptoms usually develop 10-12 days after exposure to an infected person and last 7-10 days. Initial symptoms typically include fever, often greater than 104 oF, cough, runny nose, and inflamed eyes. Small white spots known as Koplik's spots may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms. Common complications include diarrhea (in 8% of cases), middle ear infection (7%), and pneumonia (6%). Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Rubella, which is sometimes called German measles, and roseola are different diseases caused by unrelated viruses.

Measles is an airborne disease which spreads easily through the coughs and sneezes of infected people. It may also be spread through contact with saliva or nasal secretions. Nine out of ten people who are not immune and share living space with an infected person will be 10) ____.

People are infectious to others from four days before, to four days after the start of the rash. Most people do not get the disease more than once. Testing for the measles virus in suspected cases is important for public health. The measles vaccine is effective at preventing the disease, and is often delivered in combination with other vaccines. Vaccination resulted in a 75% decrease in deaths from measles between 2000 and 2013, with about 85% of children worldwide being currently vaccinated. Once a person has become infected, no specific treatment is available, but supportive care may improve outcomes. This may include oral rehydration solution (slightly sweet and salty fluids), healthy food, and medications to control the fever. Antibiotics may be used if a secondary bacterial infection such as bacterial pneumonia occurs.

ANSWERS: 1) diseases; 2) measles; 3) vaccination; 4) children; 5) rash; 6) death; 7) emergency; 8) vaccine; 9) virus; 10) infected

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