Measles in Ohio and What Parents Need to Know

A recent case of Measles in Ohio has brought this dangerous disease back to the forefront of our attention. In 2000, the CDC declared Measles “eliminated” from the United States. While the disease was not eradicated worldwide, the high compliance rate notionally with the MMR vaccine had provided a protective shield to our country’s population.

Measles is caused by the Rubeola virus and was first described by a Scottish physician in 1757. In 1912, the US began to mandate reporting of Measles cases, and in the first decade of recording, an average of 6,000 Measles-related deaths per year were documented. In the 1950s, nearly all children became infected with Measles by the time they entered high school. Up to four million Measles infections per year, across all ages, were reported. Of those, about 500 cases were fatal, nearly 50,000 required the support of an acute hospital setting, and 1,000 deteriorated into encephalitis (swelling of the brain). Development of a Measles vaccine began in 1954 with a disease outbreak in Boston, and by 1963 the US began distributing the first Measles vaccine. This was replaced with 1968 with the vaccine we still use today, wherein Measles immunity is combined with that of Mumps and Rubella (hence, MMR).

This graph published by the CDC demonstrates the sharp decline in Measles cases following the introduction of the vaccine. In 1989, a rising case load prompted the decision to make the Measles vaccine a two-shot series to boost immunity. In 1998, Andrew Wakefield published an article falsely blaming the MMR vaccine for the development of Autism. This bogus claim sowed distrust between parents of young children and their health care practitioners, and the overall rates of vaccination dropped. Because it endangered a generation of children and propagated misleading medical information, this article was later retracted and its author’s medical license was revoked, due to the damage his misinformation had caused.

When vaccination rates dropped as a result of these false claims, we saw an increase in cases again. Measles symptoms include rash, high fever, nasal congestion, cough, appetite loss, and red watery eyes. The timeline of this infection is often predictable, starting with 5-6 days of rash that proceeds from the hairline down the body. Secondary symptoms of Measles include diarrhea and ear infections. Complications from a Measles infection are not uncommon and can be severe. For instance, one in 20 cases will result in pneumonia, the most common cause of death from Measles in young children. One in 1,000 cases will progress to encephalitis, which can lead to seizures and lasting deafness and intellectual deficits. Rarely, if Measles was contracted in a patient under 2 years of age, a delayed consequence called Subacute Sclerosing Panencephalitis (SSPE) can develop up to a decade later, and manifests as a progressive degenerative neurologic disease that results in death. Complications from Measles infections are more common in children under 5 years of age, adults over 20 years of age, pregnant women, and those with compromised immune systems.

Measles is an extremely contagious germ. It is spread through respiratory droplets (coughing, sneezing, talking), and the virus can live in the air for up to two hours. Patients with Measles can be contagious up to four days prior to the development of rash (the first symptom), so they may not realize yet that they are ill. Measles is so transmissible that anyone exposed to an infected individual has a 90% chance of contracting Measles.

These statistics change with vaccination. The MMR vaccine is powerfully protective. Statistics demonstrate the two-shot series is 97% effective in preventing a serious Measles infection. Experts recommend getting both doses prior to Kindergarten, but the vaccine is often dosed at 12 and 18 months of age, to effectively protect this young, vulnerable population.

Herd immunity explains the concept of a critical majority of people getting vaccinated to protect those who cannot, or whose immune systems will not respond. Because Measles is wildly contagious, the threshold for protective herd immunity for this germ is 95%. That means 95% of the population needs to be vaccinated against Measles in order to afford a defense to those without the benefit of immunization. This includes children under 12 months of age, for whom this vaccine cannot yet be administered and for whom the risks of serious consequences of a Measles infection are frightening. The underlying messaging has to be: If you can get vaccinated with MMR, you must– for your own safety and that of your community.

Measles infections are on the rise world-wide. The COVID pandemic should stand as a humble reminder of how connected the world is when it comes to contagious viruses. Ohio reported zero Measles cases from 2019 to 2021, but an outbreak in 2022 brought 90 cases to our state. In 2022, Ohio’s compliance rate with Measles vaccination was 88%. That’s good, but not good enough to protect the most susceptible and defenseless in our herd. And with globally rising infection rates, it’s only a matter of time before Measles finds its way back to Ohio. It’s vitally important to immunize every child against Measles, a hugely contagious but preventable contributor to serious lower respiratory disease and permanent neurologic damage and death in children.

From UH Pediatrician and PSI Medical Expert – Dr. Carly Wilbur.

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