Measles resurgence in the United States

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Young boy with measles in 1968 Boy with measles.jpg
Young boy with measles in 1968

Measles was declared eliminated from the United States in 2000 by the World Health Organization due to the success of vaccination efforts. [1] However, it continues to be reintroduced by international travelers, [1] and in recent years, anti-vaccination sentiment has allowed for the reemergence of measles outbreaks. [2] [3]

Contents

In 2018, 371 cases of measles were confirmed in the United States. From January to August 2019, 1215 cases across 30 states had been confirmed as measles by the Centers for Disease Control and Prevention (CDC). [4] This is the largest number of cases in one calendar year since the disease was declared eliminated. [5] In 2019, a state of emergency was declared in New York City [6] and Washington [7] in response to the extremely contagious disease. There is concern that the World Health Organization (WHO) may rescind the U.S.'s measles elimination status. [8]

The vast majority of people infected had not received vaccination and were living in close-knit communities where the immunization rate is lower than average. [9] The director of the National Institutes of Health wrote in 2016 that parents refusing to vaccinate their children were leading to outbreaks of preventable diseases, including measles. [10] The World Health Organization also reported that the rise in measles is a direct result of anti-vaccination movements. [11] The recommended measles vaccination protocol is to receive two doses, at least one month apart. One dose of the vaccination is 93 percent effective at preventing measles, while two doses is 97 percent effective. [12]

Measles is one of the most contagious of infectious diseases. [13] If not immunized, a person exposed to someone with measles has a 95% chance of becoming infected. During the early stage of an outbreak in an unvaccinated population, each infected person spreads the disease to an average of 12 to 18 other people. [14]

History

Measles cases in the US from 1938 to 2019 Measles US 1938-2019.png
Measles cases in the US from 1938 to 2019

Before the vaccine was available in the United States, the Centers for Disease Control and Prevention (CDC) estimated that about three to four million were infected each year, of which approx. 500,000 were reported, with 400 to 500 people dying and 48,000 being hospitalized as a result. [1] [15] The last major outbreak was before the disease was eliminated, and occurred from 1989 to 1991. During this outbreak, 123 people died, the majority of whom were preschool children. [16]

In the United States on average, two or three out of every 1000 children infected will die, and one will develop complications that often result in permanent brain damage. [13]

The 2019 outbreak prompted President Donald Trump to shift away from his previous goal of spacing out vaccinations, and to insist that parents must vaccinate their children, stating "They have to get the shots. The vaccinations are so important". [17] The Trump Administration also took a forceful position of requiring vaccination, with Trump's Surgeon General Jerome Adams calling for limitations on exemptions to vaccination. [18]

Local outbreaks

Centers for Disease Control and Prevention (CDC) reported measles cases in the United States by year, as of February 20, 2022 [4] [19]

There was one outbreak in 2015, involving 147 cases linked to exposure at Disneyland in California; one outbreak in 2017, among a largely unvaccinated Somali community in Minnesota; and 17 reported outbreaks in 2018. [20] In 2019, cases were reported in 23 states, and the total number of reported cases (764) reached the highest number in 25 years by April. [4] [21] More than 500 of these cases were people who were not vaccinated against measles, and another 125 had an unknown vaccination status. The bulk of those infected were from the Orthodox Jewish communities in and around New York City. [22]

Washington and Oregon

The areas surrounding Vancouver, Washington, namely in Clark County, experienced an outbreak of measles in late 2018 and early 2019. The area was referred to as an "anti-vaccination hotspot" and the vaccination rate was 78%, which is too low for herd immunity. [23] Oregon had reported that four residents have contracted measles due to the outbreak in neighboring Clark County. [24]

As of April 2019, 74 confirmed cases of measles had been reported to the health department. [25] More than half of those who fell ill were under the age of 10, and 70 of them had not been vaccinated or had unknown vaccination status. [26] The remaining three people had received one dose of the measles vaccine. [12]

In response to the outbreak, Representative Paul Harris proposed a measure that would remove the ability for parents to refuse any of the required childhood vaccines for philosophical reasons, otherwise keeping medical and religious exemptions. The bill was later amended to limit exemptions for the measles, mumps, rubella vaccine (MMR) vaccine. [7] Children would not be allowed to attend public or private schools or day-care without evidence of vaccination or approved exemption documents. The bill was passed in April 2019. [27]

New York

New York experienced outbreaks in New York City and Rockland County in 2018 and 2019.[ citation needed ]

Between October 2018 and April 2019, 423 confirmed cases of measles were reported in New York City. [28] The areas of Williamsburg and Borough Park, two Brooklyn neighborhoods with a high concentration of Orthodox Jews, have been most heavily affected. In response to the outbreak, Mayor Bill de Blasio declared a state of emergency and ordered mandatory vaccinations in the neighborhoods corresponding to the zip codes 11205, 11206, 11211, and 11249. It required that everyone living or working in the neighborhood who is more than six months old receive a vaccination or be subject to a $1,000 fine. Prior to the order, the health commissioner had required schools and day care centers in the area deny service to unvaccinated students to prevent the disease from spreading. [6] In April, city officials ordered the closure of a preschool that refused to cooperate with requests for vaccination information. [29] [30]

From October to April, 153 cases of measles were confirmed in Rockland County, New York. Despite 17,000 doses of the MMR vaccination being given, the vaccination rate of children in the area was 72.9 percent as of April. [31]

In December 2018, public health officials in Rockland County banned unvaccinated students from attending school. Parents of 42 students at Green Meadow Waldorf School, a private school, sued the Rockland County health department, but a judge denied the request to overturn the order. [32] According to the health department, Green Meadow Waldorf School had a 56% vaccination rate. [32]

In March 2019, a flight attendant flew from NYC to Tel Aviv, Israel. Passengers on the flight were informed several days later that the woman had developed measles encephalitis and is in the Intensive Care Unit (ICU) on a ventilator. The Israeli Ministry of Health reported that the woman may have been exposed in New York or in Israel. [33]

In April 2019, a state of emergency was declared in Rockland County, and unvaccinated children were barred from public places for 30 days. Parents of unvaccinated children that did not abide by this condition faced up to six months in jail or a $500 fine. [34] [31] A judge later lifted this ban, saying that the outbreak did not qualify for an emergency order. [35] That month, New York began considering legislation to join the seven states and Washington DC that allow children 14 years and older to seek vaccination without parental consent. [36]

In June 2019, New York State enacted a law repealing religious and philosophical exemptions for vaccination. [37] The association of the outbreak with the Jewish community led to a rise in instances of antisemitism being expressed in New York. [38]

Michigan

A man from Israel traveled into New York, where he spent a few weeks before making his way to Michigan in March 2019, while unknowingly infected with measles. Health officials reported that he spread the virus to 38 people there. [33] Because he was fundraising for Orthodox Jewish charities, he visited several synagogues each day while there. The man, who was not a US citizen, told health officials through a translator that he believed that he was immune to measles because he had it as a child. [39]

People do not acquire measles again after infection, so doctors believe he was either lying about prior infection, or perhaps due to being a citizen of Europe, had rubella (German Measles) which is a different virus, that shares symptoms with measles.[ citation needed ]

New Jersey

The CDC declared an outbreak in New Jersey in late 2018. 30 of the 33 confirmed cases were in Ocean County. It was determined that measles was contracted by a person who traveled to Israel and spread the virus upon returning to New Jersey. [40]

California

The CDC tracks the rate of vaccination at kindergartens. While statewide, California has a 97 percent vaccination rate for kindergarteners, some schools, particularly in the Bay Area, have vaccination rates below 50%. In 2018, the Santa Cruz Waldorf School in Santa Cruz had a vaccination rate of 33 percent. [41] In 2014, Berkeley Rose School, a Waldorf school in Alameda County, had a vaccination rate of 13 percent. In 2016, California eliminated "philosophical objections" as a reason for parents to refuse to vaccinate their children. Following this, the vaccination rate at Berkeley Rose increased to 57 percent. [42]

During the Disneyland measles outbreak, in 2015, a person infected with measles exposed others while visiting Disneyland. This led to the infection of 131 California residents, as well as people in six other states, Canada, and Mexico. [43] Following this outbreak, California changed its vaccination laws to only allow vaccination exemptions for those with medical conditions. [22]

From January to April 2019, 21 cases of measles were reported in California. [43] The CDC published in the Morbidity and Mortality Weekly Report a summary of one outbreak caused by an unvaccinated teenager traveling to England. [44]

During the 2019 resurgence that April, two California universities, Cal State Los Angeles and University of California, Los Angeles, had to quarantine over 300 students and faculty to prevent the spread of measles after persons now known to have measles used public buildings. [45]

American Samoa

On December 8, 2019, American Samoa declared an outbreak of measles, after nine positive cases, four of which are suspected of being locally transmitted. [46]

Florida

A measles outbreak in Florida began in February 2024 at Manatee Bay Elementary School in Broward County. [47] [48] The State Surgeon General of Florida, Joseph Ladapo, addressed a letter to parents amid the outbreak, acknowledging the "normal" recommendation that unvaccinated children stay home, but stating his department was "deferring to parents or guardians to make decisions about school attendance." [49] [50] Ladapo's advice contradicts CDC guidance, which suggests that anyone not previously infected with measles or immunized against the disease observe a 21-day quarantine. [51] On 8 March, the Broward public school district declared the outbreak had ended on 7 March. [52]

Katelyn Jetelina and Kristen Panthagani, writing for Scientific American , referred to Ladapo's advice that children without immunization to measles could continue attending school after exposure as "unprecedented and dangerous". [53] Leana Wen, in a column published by the Washington Post , characterized Ladapo's decision as "outrageous" due to the danger posed by measles. [54]

Chicago

On 8 March 2024, the Chicago Department of Public Health declared it had detected two measles cases. [55] The two measles cases were Chicago's first since 2019. [55] The cases were detected in a migrant shelter in the Pilsen neighborhood at 2241 S. Halsted Street. [55]

More cases at the shelter were reported the week of 10 March. [56] [57] On 12 March, a Centers for Disease Control team arrived in Chicago to assist with the outbreak. [58] On 13 March, the Chicago Department of Public Health announced that all residents of the shelter able to receive a vaccine had received one. [59] On 14 March, two cases were reported in Chicago Public Schools, Cooper Dual Language Academy and Armour Elementary, bringing the total cases in the city to 10. [60] On 15 March, Chicago announced it would require migrants at city shelters receive the MMR vaccine. [61]

As of 15 March, there were 12 cases of measles in the city. [62]

Combating methods

With the 2019 outbreak, the CDC stated that it may use its ability to put people on a "Do Not Board" list [63] for air travel should people known to be carrying measles continue to fly. This list was established in 2007, to combat tuberculosis, but was used to restrict travel of two people during the 2014 measles outbreak. The CDC has, in the past, told some individuals that they believe might have been infected with measles to not use air travel, with those patients voluntarily agreeing to alter travel plans. The CDC states that normally it would be extremely rare to catch measles from an infected passenger due to the overall high rate of vaccinated passengers on average, but the recent anti-vaccination trends threatens to disrupt that model. [64]

Social media platforms have made their own efforts to prevent the dissemination of false anti-vaccination claims. As of September 2018, Pinterest had banned users from searching for content about vaccines. [65] In January 2019, Facebook announced that it will be banning posts promoting anti-vaccination propaganda, and the website will no longer be suggesting anti-vaccination pages or groups for users to join. [66] In February 2019, YouTube stated that any user or channel endorsing anti-vaccination content will be demonetized entirely, and not receive any funding for advertisements played before videos. [67]

A number of U.S. states tightened vaccine exemptions in the wake of the outbreak, including New York, [37] Washington, [7] [27] and Maine. [68] Vaccination opponents forced a referendum on the issue in Maine, but the new restrictions prevailed with over 70% of voters supporting them. [68]

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<span class="mw-page-title-main">Vaccination</span> Administration of a vaccine to protect against disease

Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy. According to the World Health Organization, vaccination prevents 3.5–5 million deaths per year.

<span class="mw-page-title-main">Measles</span> Viral disease affecting humans

Measles is a highly contagious, vaccine-preventable infectious disease caused by measles virus. 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 40 °C (104 °F), 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, middle ear infection (7%), and pneumonia (6%). These occur in part due to measles-induced immunosuppression. Less commonly seizures, blindness, or inflammation of the brain may occur. Other names include morbilli, rubeola, red measles, and English measles. Both rubella, also known as German measles, and roseola are different diseases caused by unrelated viruses.

<span class="mw-page-title-main">MMR vaccine</span> Any of several combined vaccines against measles, mumps, and rubella

The MMR vaccine is a vaccine against measles, mumps, and rubella, abbreviated as MMR. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended for those who do not have evidence of immunity, those with well-controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.

<span class="mw-page-title-main">Vaccine hesitancy</span> Reluctance or refusal to be vaccinated or have ones children vaccinated

Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. The scientific consensus that vaccines are generally safe and effective is overwhelming. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. Therefore, the World Health Organization characterizes vaccine hesitancy as one of the top ten global health threats.

Vaccination and religion have interrelations of varying kinds. No major religion prohibits vaccinations, and some consider it an obligation because of the potential to save lives. However, some people cite religious adherence as a basis for opting to forego vaccinating themselves or their children. Many such objections are pretextual: in Australia, anti-vaccinationists founded the Church of Conscious Living, a "fake church", leading to religious exemptions being removed in that country, and one US pastor was reported to offer vaccine exemptions in exchange for online membership of his church.

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A breakthrough infection is a case of illness in which a vaccinated individual becomes infected with the illness, because the vaccine has failed to provide complete immunity against the pathogen. Breakthrough infections have been identified in individuals immunized against a variety of diseases including mumps, varicella (Chickenpox), influenza, and COVID-19. The characteristics of the breakthrough infection are dependent on the virus itself. Often, infection of the vaccinated individual results in milder symptoms and shorter duration than if the infection were contracted naturally.

A vaccination policy is a health policy adopted in order to prevent the spread of infectious disease. These policies are generally put into place by State or local governments, but may also be set by private facilities, such as workplaces or schools. Many policies have been developed and implemented since vaccines were first made widely available.

<span class="mw-page-title-main">Health in the United States</span> Overall health of the population of the United States

Health may refer to "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.", according to the World Health Organization (WHO). 78.7 was the average life expectancy for individuals at birth in 2017. The highest cause of death for United States citizens is heart disease. Sexually transmitted infections impact the health of approximately 19 million yearly. The two most commonly reported infections include chlamydia and gonorrhea. The United States is currently challenged by the COVID-19 pandemic, and is 19th in the world in COVID-19 vaccination rates. All 50 states in the U.S. require immunizations for children in order to enroll in public school, but various exemptions are available by state. Immunizations are often compulsory for military enlistment in the United States.

<span class="mw-page-title-main">Measles vaccine</span> Vaccine used to prevent measles

Measles vaccine protects against becoming infected with measles. Nearly all of those who do not develop immunity after a single dose develop it after a second dose. When the rate of vaccination within a population is greater than 92%, outbreaks of measles typically no longer occur; however, they may occur again if the rate of vaccination decreases. 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 measles.

Robert William Sears, known as Dr. Bob, is an American pediatrician from Capistrano Beach, California, noted for his unorthodox and dangerous views on childhood vaccination. While Sears acknowledges the efficacy of vaccines—for instance, he supports the claim that Chicken pox, measles, whooping cough, polio, diphtheria have all disappeared because of vaccines—he has proposed alternative vaccination schedules that depart from accepted medical recommendations. His proposals have enjoyed celebrity endorsement but are not supported by medical evidence and have contributed to dangerous under-vaccination in the national child population. While he denies being anti-vaccine, Sears has been described by many as anti-vaccine and as a vaccine delayer.

<span class="mw-page-title-main">Epidemiology of measles</span>

Measles is extremely contagious, but surviving the infection results in lifelong immunity, so its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities which generate insufficient new hosts the disease will die out. This concept was first recognized by Bartlett in 1957, who referred to the minimum number supporting measles as the critical community size (CCS). Analysis of outbreaks in island communities suggested that the CCS for measles is c. 250,000. Due to the development of vaccination against measles, the world has seen a 99% decrease in measles related cases compared cases before the vaccine was developed.

<i>Melanies Marvelous Measles</i> Anti-vaccine book with dangerous message that contracting the measles is beneficial

Melanie's Marvelous Measles is a self-published children's book written by Australian author and anti-vaccine activist Stephanie Messenger. Through its story, the book claims, contrary to scientific data, that contracting measles is beneficial to health, and that vaccines are ineffective.

In early months of 2019, a measles outbreak occurred in the Portland metropolitan area, including the Clark County, Washington suburbs, in the United States. At the time, the outbreak was the largest outbreak in more than two decades; outbreaks in 2019 in areas including Brooklyn and Rockland County, New York have since seen far greater numbers of cases.

The 2019 measles outbreaks refer to a substantial global increase in the number of measles cases reported, relative to 2018. As of April 2019, the number of measles cases reported worldwide represented a 300% increase from the number of cases seen in the previous year, constituting over 110,000 measles cases reported in the first three months of 2019. In the first half of 2019, the World Health Organization received reports of 364,808 measles cases from 182 countries, up 182% from the same time period of 2018 when 129,239 confirmed cases were reported by 181 countries.

The 2019 New York City measles outbreak was a substantial increase in the number of measles cases reported in the state of New York, primarily in New York City and neighboring Rockland County, New York in 2019, relative to the previous year.

<span class="mw-page-title-main">Vaccination policy of the United States</span> Overview of the vaccination policy in the United States of America

Vaccination policy of the United States is the subset of U.S. federal health policy that deals with immunization against infectious disease. It is decided at various levels of the government, including the individual states. This policy has been developed over the approximately two centuries since the invention of vaccination with the purpose of eradicating disease from the U.S. population, or creating a herd immunity. Policies intended to encourage vaccination impact numerous areas of law, including regulation of vaccine safety, funding of vaccination programs, vaccine mandates, adverse event reporting requirements, and compensation for injuries asserted to be associated with vaccination.

<span class="mw-page-title-main">2019 Samoa measles outbreak</span> Measles epidemic in Samoa in late 2019

The 2019 Samoa measles outbreak began in September 2019. As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874. Over three per cent of the population were infected. The cause of the outbreak was attributed to decreased vaccination rates, from 74% in 2017 to 31–34% in 2018, even though nearby islands had rates near 99%.

<span class="mw-page-title-main">Joseph Ladapo</span> American physician

Joseph Abiodun Ladapo is the surgeon general of Florida since 2021. He has attracted attention for promoting vaccine hesitancy and opposing various measures to control COVID-19.

<span class="mw-page-title-main">Disneyland measles outbreak</span> Event at Disneyland Resort, California

The Disneyland measles outbreak began at the Disneyland Resort, California, in December 2014, and spread to seven states in the United States, Mexico, and Canada, before it was declared over in mid-April 2015.

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  58. ↑ Christensen, Jen (March 12, 2024). "CDC team arrives in Chicago to help officials with response to measles outbreak linked to migrant shelter". CNN. Retrieved March 14, 2024.
  59. ↑ Christensen, Jen; Musa, Amanda (March 13, 2024). "All eligible people at Chicago migrant shelter have been vaccinated for measles in 'unprecedented operation'". CNN. Retrieved March 14, 2024.
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