Target Health Blog

Measles

April 21, 2019

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Quiz
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This illustration provides a 3D graphical representation of a spherical-shaped, measles virus particle that is studded with glycoprotein tubercles. Those tubercular studs colorized maroon, are known as H-proteins (hemagglutinin), and those colorized gray are referred to as F-proteins (fusion). The F-protein is responsible for fusion of virus and host cell membranes, viral penetration, and hemolysis, and the H-protein is responsible for binding of virus to cells. Both types of proteinaceous studs are embedded in the envelope's lipid bilayer.
Graphic credit: CDC.gov; This image is in the public domain and thus free of any copyright restrictions. As a matter of courtesy, we request that the content provider be credited and notified in any public or private usage of this image (CDC/ Allison M. Maiuri, MPH, CHES, Illustrator: Alissa Eckert)

The vaccine-autism myth is one chilling example of fraudulent science. February 28, 2018 marks the 20th anniversary of an infamous article published in the prestigious medical journal, The Lancet, in which Andrew Wakefield, a former British doctor, falsely linked the MMR (measles, mumps and rubella) vaccine to autism. The paper eventually was retracted by the co-authors and the journal. Wakefield was de-licensed by medical authorities for his deceit and “callous disregard“ for children in his care. It took nearly two decades for the UK immunization rates to recover. By the end, UK families had experienced more than 12,000 cases of measles, hundreds of hospitalizations - many with serious complications - and at least three deaths.

Measles vaccine is a treatment that prevents measles. Nearly all of those who do not develop immunity after a single dose develop it after a second 1) ___. When rates of vaccination within a population are greater than 92%, outbreaks of measles, typically no longer occur. However, they may occur again if rates of vaccination decrease. The vaccine's effectiveness lasts many years. It is unclear if it becomes less effective over time. The vaccine may also protect against measles if given within a couple of days after exposure to 2) ___. The vaccine is generally safe, even for those with HIV infections. Side effects are usually mild and short lived. These may include pain at the site of 3) ___ or mild fever. Anaphylaxis has been documented in about 3.5-10 cases per million doses. Rates of Guillain-Barre syndrome, autism and inflammatory bowel disease do not appear to be increased by measles vaccination. Research shows that this vaccine and others, do not cause autism.

The vaccine is available both by itself and in combinations such as the MMR vaccine (a combination with the rubella vaccine and mumps vaccine) or the MMRV 4) ___ (a combination of MMR with the chickenpox vaccine). The measles vaccine is equally effective for preventing measles in all formulations, but side effects vary depending on the combination. The WHO or 5) ___ ___ ___ recommends measles vaccine be given at nine months of age in areas of the world where the disease is common, or at twelve months where the disease is not common. Measles vaccine is based on a live but weakened strain of measles. It comes as a dried powder which is mixed with a specific liquid before being injected, either just under the skin or into a muscle. Verification that the vaccine was effective can be determined by blood tests.

About 85% of children globally have received this vaccine as of 2013. In 2015, at least 160 countries provided two doses in their routine immunization. It was first introduced in 1963. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a 6) ___ system. The wholesale cost in the developing world is about 0.70 USD per dose as of 2014. As outbreaks easily occur in under-vaccination populations, the disease is seen as a test of sufficient vaccination within a population.

Measles cases 1944-1964 follow a highly variable epidemic pattern, with 150,000-850,000 cases per year. A sharp decline followed introduction of the vaccine in 1963, with fewer than 25,000 cases reported in 1968. Outbreaks around 1971 and 1977 gave 75,000 and 57,000 cases, respectively. Cases were stable at a few thousand per year until an outbreak of 28,000 in 1990. Cases declined from a few hundred per year in the early 1990s to a few dozen in the 2000s. Before the widespread use of the vaccine, measles was so common that infection was considered “as inevitable as death and 7) ___.“ In the United States, reported cases of measles fell from hundreds of thousands to tens of thousands per year following introduction of the vaccine in 1963. Increasing uptake of the vaccine following outbreaks in 1971 and 1977 brought this down to thousands of cases per year in the 1980s. An outbreak of almost 30,000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule. No more than 220 cases were reported in any year from 1997 to 2013, and the disease was believed no longer endemic in the United States. In 2014, 667 cases were reported.

The benefit of measles vaccination in preventing illness, disability, and death have been well documented. Within the first 20 years of being licensed in the U.S., measles vaccination prevented an estimated 52 million cases of the disease, 17,400 cases of mental retardation, and 5,200 deaths. During 1999-2004, a strategy led by the World Health Organization and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles 8) ___ worldwide. The vaccine for measles has led to the near-complete elimination of the disease in the United States and other developed countries. While the vaccine is made with a live virus which can cause side effects, these are far fewer and less serious than the sickness and death caused by measles itself, side effects ranging from rashes to, rarely, convulsions, occur in a small percentage of recipients.

Measles is common worldwide. Although it was declared eliminated from the U.S. in 2000, high rates of vaccination and excellent communication with those who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles in the U.S. Of the 66 cases of measles reported in the U.S. in 2005, slightly over half were attributable to one unvaccinated individual who acquired measles during a visit to Eastern Europe. This individual returned to a community with many unvaccinated children. The resulting outbreak infected 34 people, mostly children and virtually all unvaccinated; 9% were hospitalized, and the cost of containing the outbreak was estimated at $167,685. A major epidemic was averted due to high rates of vaccination in the surrounding communities. The vaccine has non-specific effects such as preventing respiratory infections, that may be greater than those of measles prevention alone. These benefits are greater when the vaccine is given before one year of age. A high titre vaccine resulted in worse outcomes in girls and thus is no longer recommended by the World Health Organization.

The World Health Organization recommends two doses of vaccine for all children. In countries with high risk of disease the first dose should be given around nine months of age. Otherwise it can be given at twelve months of age. The second dose should be given at least one month after the first dose. This is often done at age 15 to 18 months. After one dose at the age of nine months 85% are immune, while a dose at twelve months results in 95% immunity. In the US, the CDC recommends that children aged 6 to 12 months traveling outside the United States receive their first dose of MMR vaccine. Otherwise the first dose is typically given between 12-18 months. A second dose is given by 7 years (on or before last day of year 6) or by kindergarten entry. In the UK, the NHS recommendation is for a first dose at around 13 months of age and the second at 3 years and 4 months old. In Canada, Health Canada recommends that children travelling outside North America should receive an MMR vaccine if they are aged 6 to 12 months. However, after the child is 12 months old they should receive 2 additional doses to ensure long-lasting protection.  Adverse effects associated with the MMR vaccine include fever, rash, injection site pain and, in rare cases, red or purple discolorations on the skin known as thrombocytopenic purpura, or seizures related to fever (febrile seizure).

In 2019, the dozens of new infections take the count to 465 confirmed cases this year, the second-greatest number of reported cases in a year since 2000, when measles was declared 9) ___ in the United States.

At the current rate, the country would surpass by midyear the number of measles cases in 2014, when an outbreak in Ohio drove the total to 667 reported cases, the high mark for this century. An untrue scare, that the MMR vaccine was the cause of autism, began in Great Britain when published research made the claim. Later there was a retraction by the Lancet. However, much damage was done, gullible people believed the false claims, spreading rumors around the globe. Naturally, parents were concerned about their children becoming autistic and eschewed the MMR vaccine and others. This has led to a greater outbreak of measles, especially in New York and New Jersey.Much more education is needed to set the story straight. Numerous studies have found no relationship between MMR vaccine and 10) ___.

ANSWERS: 1) dose; 2) measles; 3) injection; 4) vaccine; 5) World Health Organization; 6) health; 7) taxes; 8) deaths; 9 eliminated; 10) autism

New York Times April 2019 article re: measles

Click to read about the Lancet retraction and more

Time Magazine: The vaccine scare

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