On a crisp sunny day in July of 2007, I arrived to work at a small community clinic on the outskirts of Lusaka, Zambia. Instead of the usual handful of patients waiting to be seen, I found hundreds of women and children lined up outside. It was the first day of a week-long national measles campaign, where families were encouraged to bring their children to the nearest clinic for a free measles vaccine. As the day wore on, the line grew longer, snaking back and forth to fit everyone in the dusty clinic courtyard. Some mothers reported starting their trek at dawn, waiting in line for hours for their children to get a single shot with the hope of making it back home before dusk. Often the breadwinners, these women gave up an all-important day at the market for their children to get the measles vaccine. Why?
Measles, I was told by the clinic nurses, had been one of the top five causes of childhood illness and death in recent years. Due to the lack of consistent primary care, the vaccine was given out every couple of years in nationwide campaigns. A measles vaccination campaign back in 2003 had dramatically reduced the number of cases and childhood deaths but the numbers had come up again. It was time for another campaign. Like other clinics across the nation, our small clinic continued to see hundreds of women and children line up for the vaccine every day. By the end of the week, more than 2 million Zambian children across the country had received the measles vaccine. Zambian mothers were clearly taking measles seriously and making it a priority to have their children vaccinated. This made me wonder: should we be taking measles more seriously back home?
So what’s the history of measles in the U.S.?
Prior to the introduction of the vaccine in 1963, measles was a common disease in the U.S. Although most recovered, there were about 48,000 hospitalizations, 4,000 cases of encephalitis (inflammation of the brain) and 400 deaths every year in the U.S. from measles. In the year 2000, measles was considered eliminated from the U.S. However, we continue to have outbreaks most frequently attributed to unvaccinated Americans traveling abroad and bringing measles back to under-vaccinated communities in this country. Last year the U.S. experienced 644 cases of measles, the largest number in decades, and 2015 is on track to break that record. This means we need to be vigilant and continue to protect our children from this disease.
But is measles really that serious?
Yes, it can be. About one in twenty people with measles will develop pneumonia and one in one thousand will develop encephalitis, both of which can be very serious. The popular children’s author Roald Dahl wrote a heartbreaking account of the death of his daughter Olivia from measles encephalitis. You can read it here. It’s a sad reminder that this disease can be deadly.
Don’t we have better treatment for measles now?
No. There are no anti-viral medicines to treat measles. We can support patients with fluids and medicines to treat fever. We can treat secondary bacterial infections due to measles with antibiotics and we can provide breathing support for those with serious pneumonia. But we have no therapies to prevent the virus from doing damage once a patient is infected. The best treatment is prevention.
Is the vaccine safe?
Yes, the measles vaccine is safe. The most common side effects are soreness at the injection site, fever and mild rash. About one in three thousand children will have an isolated seizure related to the fever but it does not lead to permanent problems. Serious allergic reaction occurs in fewer than one in one million cases. Some people have heard rumors the vaccine causes autism. It doesn’t. Many scientific studies have come to the same conclusion: there is no link between the measles vaccine (or any other vaccine) and autism. The autism advocacy group Autism Speaks urges that all children be fully vaccinated.
How effective is the vaccine?
The measles vaccine is extremely effective. Remember: measles is one of the most contagious diseases in history. A non-immune individual has a 90 percent chance of becoming infected with the virus if they come in contact with infectious droplets in the air or on surfaces, even up to two hours after the infected person leaves the room. No vaccine is 100 percent protective but the measles vaccine is one of the most effective vaccines we have. One shot provides immunity in 94 percent of children and the second shot raises that number to greater than 97 percent. That means that those who are fully vaccinated have about a 2 percent chance of getting measles if exposed to an infected person whereas those who are not vaccinated have a 90 percent chance of becoming infected. Vaccination matters not just for protecting your own child but for protecting the entire community from an outbreak. Check out this simulation to see how measles spreads in populations of varying vaccination rates. And remember that there will always be a small portion of the population that cannot be vaccinated due to age or medical condition (such as leukemia) so it is important that all children who are able to get vaccinated do so in order to protect those who cannot.
Can measles be eradicated from the planet?
Yes. Because humans are the only reservoir for measles and because we have a very effective vaccine, it is possible to have worldwide eradication of measles. Imagine that. But we can only achieve this if we have high rates of vaccination. In 2013, the virus killed 145,000 people worldwide. This is a vast improvement from the 2.6 million measles deaths that occurred yearly prior to the widespread use of the vaccine in 1980. The World Health Organization estimates that 15.6 million lives have been saved since 2000 because of the measles vaccine. It’s an amazing feat that we’ve accomplished through vaccination but we can do better.
No child should become ill or die from an infection that’s preventable with vaccination. Not in the U.S., not in Zambia, and not anywhere. Make sure you, your friends and your family are vaccinated against measles. If you want to do more to help globally, consider donating to the Measles Initiative to help fund measles campaigns in places like Zambia where children are not lucky enough to have easy access to the vaccine their parents are so desperate for them to receive.
Rebecca Bell, MD, MPH, is a pediatric critical care physician at The University of Vermont Children’s Hospital.