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Vincent Iannelli, M.D.

Are Measles Outbreaks Getting Out of Control?

By March 7, 2014

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A measles alert posted on a home of a child with measles by the health department. - Photo by Buyenlarge/Getty ImagesMany people likely thought measles was getting into out of control territory when we continued to hit new records in the last few years, including:

  • 220 measles cases in 2011 - a 15 year record and the highest number of cases since 1996
  • 58 cases in the 2013 New York City measles outbreak - the largest outbreak since the endemic spread of measles was eliminated in the United States
  • local and state public health departments spending from $2.7 million to $5.3 million US dollars to contain just half of the measles outbreaks in 2011

Unfortunately, this year is looking to be even worse considering we have already seen about 4x the number of measles cases we had seen at this point in 2011. Earlier in the week, the CDC reported 54 cases of measles in the United States - more than was reported in all of 2007 (just 43 cases all year).

The number of measles cases is likely to jump significantly though, as the latest CDC report likely doesn't include the latest measles outbreaks:

  • a measles outbreak in New York City that is already affecting 7 adults and 9 children in northern Manhattan and the Bronx.
  • two more cases of measles in San Diego, California which are linked to an outbreak in February, when a person exposed others at two different Naval medical facilities after contracting measles in the Philippines. The new cases likely exposed hundreds of other people at four different sites around San Diego, including an urgent-care center.
  • a second case of measles in Macomb, Illinois.
  • two more cases of measles in Massachusetts, this time in Middlesex County.

Why the jump in cases? The CDC puts some of the blame on unvaccinated children and adults traveling to the Philippines, where a large outbreak recently killed 23 children, but it is important to keep in mind that there are outbreaks in many other countries too.

In addition to the Philippines, there are outbreaks of measles in the Netherlands, Turkey, Italy, Germany, the UK, Vietnam, Indonesia, and Japan, too. Although Europe reported a milder measles season last year, they still had over 10,000 cases, which were complicated by 8 cases of acute measles encephalitis and 3 deaths.

Measles is a vaccine-preventable disease though. We don't have to let it get out of control. We can stop the outbreaks before we start to see even more cases and start to see more complications of measles.

Get Educated. Get Vaccinated. Stop the Outbreaks.

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March 7, 2014 at 1:52 pm
(1) Vaccine Skeptic Society says:

Can you please provide a breakdown of the vaccination status of each of the measles cases?

March 7, 2014 at 3:02 pm
(2) Vincent Iannelli, MD says:

I have listed the vaccination status when it has been reported by the local or state health department in my list of measles outbreaks.

I can not recall a single instance when one of the cases was fully vaccinated this year.

A good example is the outbreak in Hawaii – an unvaccinated infant catches measles and then infects a toddler who was just late getting vaccinated.

In Europe, when they had more than 30,000 cases of measles in 2011, and 8 deaths, 27 cases of measles encephalitis, and 1,482 cases of pneumonia, most cases were in unvaccinated (82%) or incompletely vaccinated (13%) people.

The MMR vaccine is 99% effective at providing immunity to measles after two doses. Of course, you have to be old enough to have gotten both doses to be protected (12 months = 1st dose, 4years = 2nd dose) and can’t have anything wrong with your immune system (chemotherapy or other immune system problem), or you could be at risk during these outbreaks, even if you do vaccinate your kids.

March 7, 2014 at 4:23 pm
(3) Harriet h says:

VSS you are asking the wrong question. It will not give you any useful information. The correct question is how many vaccinated people exposed and what fraction of those became ill and how many unvaccinated exposed and what fraction of those became ill. From past experience only 1-2% of fully vaccinated people become I’ll with measles after exposure while over 90% of unvaccinated will become sick with measles after exposure. Furthermore in vaccinated people measles is usually much milder than in the unvaccinated.

March 7, 2014 at 7:25 pm
(4) Vaccine Skeptic Society says:

You need to define ‘fully vaccinated’. For example, in the Bronx outbreak that is currently going on, 3 of the measles cases were vaccinated and were between the ages of 13 – 15 months. These babies would be fully vaccinated for their age as the second dose isn’t required until 4-6 years old.

The breakdown of the current Bronx/Manhattan outbreak is as follows (unfortunately the vaccine status of the adults is not given):

“Four of the affected children were too young to have been vaccinated; three who had been vaccinated were 13 to 15 months old and two others had not been vaccinated by parental choice, the Health Department said. The affected adults range in age from 22 to 63 years.”

March 7, 2014 at 11:03 pm
(5) Vincent Iannelli, MD says:

“You need to define ‘fully vaccinated’. For example, in the Bronx outbreak that is currently going on, 3 of the measles cases were vaccinated and were between the ages of 13 – 15 months. These babies would be fully vaccinated for their age as the second dose isn’t required until 4-6 years old.”

Your own answer made it clear why it really isn’t necessary to further define fully vaccinated.

Three of the measles cases are presumably in toddlers who got one dose of MMR and who “would be fully vaccinated for their age.”

You had to add “for their age” to clarify that they weren’t really fully vaccinated, which would have meant that they had already received two doses of the MMR vaccine.

In addition to the two children whose parents chose not to get vaccinated, it is the kids (4 in this outbreak) who are too young to be vaccinated, and too young to be fully vaccinated (3 in this outbreak) who get caught up in these outbreaks and bust the anti-vax myth that their unvaccinated kids don’t pose a risk to the rest of us.

March 8, 2014 at 12:05 am
(6) harriet h says:

Again VSS why the fixation on vaccination status. It is not going to provide any useful information it is a red herring. Vaccinated people vastly outnumber the unvaccinated. I don’t know what the overall vaccination rate is in NYC but let’s assume 90%. The effectiveness of MMR after 1 dose is 95% and 98% after 2 doses. To make the math simpler let’s go with 90% effective. Assume 1000 people exposed, 900 vaccinated of which 90 would be vulnerable to measles. 100 unvaccinated and all would be vulnerable to disease. If we assume 90% of vulnerable people exposed to measles become ill then 81 vaccinated people would become sick and 90 unvaccinated. So less than 10% of vaccinated people exposed became ill but 90% of the unvaccinated became ill. There are similar numbers of ill people regardless of vaccine status but the 2 groups have polar opposite risks of becoming ill. Furthermore breakthrough measles in vaccinated groups is usually quite mild whereas the unvaccinated have all the risks of measles including permanent harms like breathing problems from lung damage, deafness, brain damage and death.

March 15, 2014 at 12:13 am
(7) IB says:

Thank you Harriet! The failure to understand base rates is consistently the largest reasoning flaw with the anti-vaccination crowd. Your example put it perfectly.

March 28, 2014 at 6:04 am
(8) Jeff Pique says:

Vaccine Skeptic Society.. who are you and why are you a one person non profit that is not listed in the directory of non profits?? what is your name and qualifications?? why do you have a website that has a secret registration as to be anonymous??

March 28, 2014 at 10:08 am
(9) Vincent Iannelli, MD says:

<a href=”http://pediatrics.about.com/bio/Vincent-Iannelli-M-D-8777.htm”>Vincent Iannelli, M.D.</a>

Jeff, you don’t sound like a skeptic so much as some one searching for conspiracy theories…

I have an LLC for another personal pediatrics/parenting website (keepkidshealthy.com) that I recently took down because I didn’t have time to work on it and for my other writings. I’m not a non-profit. I may have anonymously registered some domains, but they are not related to pediatrics or vaccines and were never even developed.

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