Measles, Vaccination and The Recent Global Surge

Measles, scientifically known as Rubeola, A viral infection that for a long time was kept under control, has resurfaced globally in the past few years and has caused significant public health challenges. In this article, first we will discuss what exactly measles is, then we will discuss measles vaccination, and at the end we will explain why measles has made its way back to headlines after all.

What is measles?

Measles is a highly contagious, potentially fatal disease caused by a virus named “Measles Virus.”. Because of the light weight and small size of the Measles virus, it is considered an “airborne” contagious disease, meaning that after a cough or sneeze of a contaminated person, the Measles virus can easily float in the air, making the disease very contagious. It may also spread through direct contact with the mouth and nasal secretions.

Symptoms of measles usually appear around 10 to 14 days after exposure to the virus. Signs and symptoms of measles may include:

• Fever that starts mild at first but rises after a few days
• Coughs that are usually dry
• Runny Nose and Sneezing
• Sore throat
• Red and inflamed eyes, swollen eyelids (Conjunctivitis)
• Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek are also called Koplik's spots. These spots appear in 50–70% of infected people and are pathognomonic to measles, meaning they are specific to measles and no other disease can cause them.
• A reddish-brown skin rash that usually emerges 2-3 days after non-specific symptoms, starting from the head. Spots and bumps in tight clusters give the skin a splotchy red appearance. Over the next few days, the rash spreads down the arms, chest, and back, then over the thighs, lower legs, and feet. At the same time, the fever rises sharply, often as high as 40 to 41 °C.
• Sleepiness, generalized body aches, and photophobia (a feeling of discomfort in a luminous environment) may also be present.

The measles rash usually lasts about seven days. They gradually fade, starting with the head and neck. As other symptoms of the illness go away, the cough and darkening or peeling of the skin where the rash was may last for about 10 days.

However, fully recovering after 2–3 weeks is not always the case. In some cases, especially in the at-risk population (children under 5 years, adults over 20 years, pregnant women, and other immunocompromised individuals), measles may lead to severe complications.

The complications of measles include:

• Middle Ear Infection (Otitis Media): Approximately 1 in 10 children with measles develops ear infections. These infections can lead to hearing loss or permanent deafness.
• Diarrhea: Diarrhea occurs in less than 1 in 10 people with measles.
• Pneumonia: is the most common cause of death from measles in young children.
• Encephalitis: a brain infection that causes swelling and can result in convulsions, deafness, or intellectual disability.

An infected person can spread the virus for about eight to ten days. Starting four days before the appearance of rash and ending when the rash has been present for a couple of days.

Measles vaccine and immunity against measles

Before the advent of vaccination, measles had long been endemic around the world – and it remained a worldwide epidemic disease. Measles was first described by a Persian physician named Zakariyya-e-Razi. During the 16^th century, measles became more widespread due to global exploration. In 1757, a Scottish physician named Francis Home identified measles as a pathogen. He demonstrated that it was caused by an infectious agent, leading to a better understanding of the disease. In the following centuries, there were major measles outbreaks, causing high casualties in isolated communities that had no prior exposure (The Faroe Islands (1846), Hawai’i (1848), Fiji (1875), and Rotuma (1911)). Before the invention of vaccine in 1954 and the widespread administration of the vaccine in the 60s, measles affected approximately 30 million people and caused 2 million deaths each year. Despite challenges at first, the measles vaccination has been very successful worldwide. Those who took the shots had an 85–100% chance of total immunity against measles (85-95% for a single dose and almost 100% after a second dose), and those who didn’t take the shots or, for some reason, didn’t get immunized with vaccination benefited from herd immunity. Herd immunity is a phenomenon that occurs when a sufficient proportion of a population is immune to a contagious disease, reducing its spread and protecting those who are not immune.

 It its estimated that between 2000 and 2020, measles vaccination prevented 31.7 million deaths worldwide. The measles vaccine stands as a remarkable achievement in public health.

The measles vaccine is available in two forms:

• Measles-Mumps-Rubella (MMR) Vaccine: Combines protection against measles, mumps, and rubella.
• Measles-Mumps-Rubella-Varicella (MMRV) Vaccine: Includes varicella (chickenpox) protection as well.

The measles vaccine gets administered twice, once at 12–15 months of age and once usually around or after 18 months (in some countries between 4-6 years of age), but not later than the start of school age. After the second dose, efficacy approaches 100%.

All adults who were born in or after 1970 should also be immunized (if not dined priorly) with the vaccine.

The recent surge in measles and what you should do as a parent

Despite the availability of safe and effective vaccine, measles has made a disconcerting comeback in recent years, posing a threat to public health. Canada reported a 23% rise in the number of cases in 2021 compared to 2020. In the first two months of 2022, reported worldwide measles cases increased by a staggering 79% compared to the same period in the previous year. By the end of 2022, deaths related to measles had increased by 43% globally. Reasons that caused the resurgence of measles include:

• Vaccine hesitancy: with the widespread use of social media, in the past few years, misinformation and distrust surrounding vaccines have spread, which has led to suboptimal vaccination rates.
• An increase in travel and globalization introduced the virus to new populations.
• Erosion of herd immunity: When vaccination rates drop, herd immunity weakens. Clusters of unvaccinated individuals create big communities that are vulnerable to the disease. In the United States, at least 8,500 schools have a vaccination rate of under 95% that is required for herd immunity and are at risk of measles outbreaks.
• The impact of COVID-19: 40 million children worldwide missed a measles vaccine dose in the year leading up to November 2022. In the United States alone, over 61 million doses of the MMR vaccine (which contains the measles vaccine) were delayed or missed entirely from 2020 to 2022 due to COVID-19.

As a parent or guardian, make sure you and your family have gotten two doses of measles containing vaccines (MMR or MMRV). All adults born in or after 1970 should take two doses of the vaccine. Taking the vaccine not only immunizes you and your loved ones, but also helps those who cannot take the vaccine by herd immunity. Combat vaccine hesitancy by providing accurate information. Talk to other parents about the importance of vaccination and advocate for vaccination policies in schools and communities. Keep track of measles outbreaks in your area. Follow guidance from local health authorities. If you suspect exposure, seek medical advice promptly, and finally, do not travel overseas if you are not immunized against measles.

Stay safe.

Authored By:
Dr. Alireza Sarmadi
Family Physician

References:

https://www.mayoclinic.org/diseases-conditions/measles/symptoms-causes/syc-20374857

https://www.webmd.com/children/news/20240130/measles-warning-signs-growing

https://www.who.int/news/item/16-11-2023-global-measles-threat-continues-to-grow-as-another-year-passes-with-millions-of-children-unvaccinated

https://www.unicef.org/stories/measles-cases-spiking-globally

https://www.cdc.gov/media/releases/2022/p1123-measles-threat.html

https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-12-measles-vaccine.html

https://immunizebc.ca/vaccines/measles-mumps-rubella-mmr

https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-measles-vaccination

https://en.wikipedia.org/wiki/Measles#:~:text=The%20classic%20symptoms%20include%20a,C%20(104%20%C2%B0F).

Pictures (from Wikipedia):

Figure 1 Koplik's spots in the mouth of a child with measles, appearing as "grains of salt on a reddish background.

Figure 2 A child with measles in the 4th day of rashes