Measles Is Preventable. How Did the World End Up Back Here?
— Health professionals must encourage vaccination and fight misinformation
I remember being very sick when I had measles as a child. I was confined to a darkened room for more than a week, and there was concern that it would affect my vision. Decades later, I work with patients who have had encephalitis as a result of measles, and families who are left bereaved by the disease.
Because of the successopens in a new tab or window of the measles, mumps, and rubella (MMR) vaccine, most people have never seen a case of measles and think it is just a rash that clears up in a few days. But measles is not the innocuous childhood illness that the unfamiliar or vaccine deniers believe.
Measles is serious and deadly. Complications occur in up to 40% of patientsopens in a new tab or window, and may include blindness, hearing loss, pneumonia, seizures, and meningitis. The numbers are alarmingopens in a new tab or window: between one and three in 1,000 children with measles will develop encephalitis, 10%-to-15% of whom will die, and 25% of whom will have permanent neurological damage. For children under the age of 1, one in 5,500 will develop subacute sclerosing panencephalitisopens in a new tab or window, a rare and fatal degenerative neurological condition that can develop years after a measles infection.
Most vulnerable are babies, young children, pregnant women, and the immunocompromised. Measles is so contagious that just a single infected person can infect nine peopleopens in a new tab or window who are unvaccinated or never had the illness; by comparison, someone with COVID-19 may infect between one and threeopens in a new tab or window other unvaccinated people.
Measles kills. It is that simple.
The great irony is that measles has become a worldwide public health crisisopens in a new tab or window at a time when it is one of the most vaccine-preventable diseases in existence.
A Historic Look at Measles
Let's look back to a time before the vaccine existed.
Take the case of Barbara Leonhard, who contracted measles along with her siblings when she was 6 going on 7 years old. Her siblings recovered, but she developed encephalitis, was totally paralyzed, and spent 30 days hospitalized in a coma. She was lucky: doctors said she'd never walk again, but she learned how to walk. Though the disease left her with memory and learning issues, she excelled and became a sign language instructor at the University of Missouri, as well as a poet, author, and editor.
That was in 1958 -- 66 years ago -- when Leonhard became one of 763,094 peopleopens in a new tab or window in the U.S. to contract measles, the highest number of cases in a single year. In 1963, when the measles vaccine became available, her parents jumped at the chance to have their children vaccinated. Viewed as a miracle, the vaccine reduced measles cases by 95% over the next 5 years; by 2000, the disease was declared eliminated in the U.S.
Fast forward. Since October 2023, there have been 1,109 confirmed measles casesopens in a new tab or window in England. Meanwhile, in 2022-2023, MMR vaccinations for children under 2 had fallen to 89.2% (herd immunity requires 95% of the population be fully vaccinated). In the U.S., the CDC reports that MMR vaccination ratesopens in a new tab or window fell from 95% in 2019-2020 to 93.1% for the 2022-2023 school year; this two-point drop means 250,000 kindergartners are at higher risk for developing measles. Herd immunity is critically important because it allows us to accommodate people who can't be vaccinated for medical, personal, or religious reasons.
How Did We Get Here?
One of the primary contributors to the current anti-vaccine movement was the 1998 publication of a now-retracted paperopens in a new tab or window in The Lancet by disgraced former physician Andrew Wakefield, who inaccurately linked the MMR vaccine to autism.
In addition to misinformation about vaccine safety, the current crisis has been fueled by complacency, vaccination delays during the pandemic, lack of access to vaccines in some cases, international travel, mistrust in the government and the pharmaceutical industry, and the expansionopens in a new tab or window of medical and religious exemptions.
The biggest hurdle we face is convincing skeptics that most vaccines are safe. This is despite the fact that the science is clear: only one or two people in a million develop some kind of adverse eventopens in a new tab or window because of vaccination.
But sometimes parents who have lost children or whose children have life-changing disabilities may believe vaccination was the cause. I have seen and heard from these parents -- their loss and distress are palpable and heartbreaking. In addition to the patients and families affected by the complications of measles, these parents are victims of erroneous and misguided information.
The MMR vaccine prevents hundreds of thousands of deaths and disabilities, but the vaccine-hesitant voices are very loud. To combat them, healthcare and public health professionals can show patients data demonstrating that vaccines are safe and effective.
Efforts to Encourage Vaccination
In the U.K., the government is conducting a highly successful national catch-up campaignopens in a new tab or window to encourage parents to vaccinate children between 6 and 11 years old who missed their MMR vaccines. It is also targeting unvaccinated adolescents and adults. There are many forms of encephalitis that cannot be prevented, but there is no reason anyone should get encephalitis from measlesopens in a new tab or window.
There is still time for the U.S. to prevent the more extreme situation we are experiencing in Europe and around the world. Most measles cases in the U.S. appear to be the result of an infected person travelingopens in a new tab or window from a country where measles is endemic or where there is an outbreak. In fact, just this week, CDC published a Morbidity and Mortality Weekly Report article on 57 measles casesopens in a new tab or window tied to a migrant shelter in Chicago.
Healthcare professionals should speak to parents to make sure children are up to date on vaccinations. This is particularly important for families who plan to travel internationally, especially to areas where there are measles outbreaks.
I've heard some stories about physicians refusing to treat patients who are not vaccinated against MMR. While it can be difficult to maintain patience and compassion when faced with parental resistance, we must remember that many of these parents come from a legitimate place of fear for their child's health. Listening to and addressing their concerns may go a long way in convincing them that vaccines are safe.
It is heartbreaking to know that children are being needlessly affected by this terrible disease. We must make vaccinations more accessible and fight vaccine misinformation by overpowering it with the truth: that vaccines save millions of lives around the world each year.
Ava Easton, PhD,opens in a new tab or window is chief executive of the non-profit Encephalitis International. She is a researcher and global expert on encephalitis patient outcomes and quality of life, and the author of Life After Encephalitisopens in a new tab or window.
Disclosures:
Easton does not receive any personal grants or honoraria from corporate or pharmaceutical companies. Encephalitis International does receive grants, expenses, and honoraria from a range of corporate partners, including those in pharmaceutical and diagnostic technology.