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Many of us remember either having a measles infection or knew someone who did. It was not a pleasant experience. Measles is a highly infectious viral illness that causes a rash, fever, inflamed eyes and sore throat.

Also called rubeola, this illness kills. It is not a “mild” or “routine” childhood illness. There were 9 million reported cases last year with 128,000 deaths. This was a huge jump from 7.5 million cases and 60,700 deaths in 2020. Most are children who are unvaccinated.

Unfortunately, this disease may be heading for a resurgence, according to both the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). Both public health agencies called measles “an imminent threat in every region of the world” after noting that 40 million children missed their vaccine doses last year. This is a “record high” in missed vaccinations. The COVID lockdowns are the biggest contributing factor in the missed vaccinations but also weak surveillance during the pandemic, delayed response plans to the ongoing outbreaks in more than 20 countries, and misinformation have led to increased illness.

Measles symptoms typically appear 10 to 14 days after exposure. Mild to moderate fever, runny nose, cough, sore throat and conjunctivitis (inflamed eyes) are common and usually last about three days.

Then a rash appears as small red spots that cluster together; this starts on the face then progresses to the rest of the body, all the way to the feet. The fever can rise to as high as 105 degrees. The rash will usually fade after a week or 10 days. Most people will recover. But there can be acute complications that mostly affect children less than 5 years, adults over 20 years, pregnant women, and people with a compromised immune system. Complications include visual impairment, ear infections, diarrhea and pneumonia. One child out of every thousand will develop encephalitis (brain inflammation) that can cause seizures and lead to hearing loss or cognitive delay. Two children will die from respiratory or neurological complications.

The United States had declared measles eradicated after no cases were reported in 2000 but we still have an occasional outbreak. 2020 saw 13 cases, 2021 saw 49 cases and so far this year (as of Nov. 17) there have been 51 reported and documented cases. Right now, there is a very large outbreak ongoing in central Ohio. It began in June with the first recorded measles case in 20 years. As of Nov. 28, 32 children have confirmed illness. Thirty-one of those children are unvaccinated; the remaining child’s vaccination status is unknown. About 63% of those children are 1 to 2 years old, 19% are 3 to 5. Thirteen have been hospitalized.

At these ages, children are most vulnerable to complications that can occur. The Disneyland measles outbreak of 2014-2015 caused the greatest number of infections in 20 years. It spread to seven states in the United States, Mexico and Canada.

The first case was in an unvaccinated 11-year-old. The case count for 2015 was 1,274. The Brooklyn outbreak in 2018 saw 654 measles cases. About 73% of patients were not vaccinated. The report said 125 of these patients needed hospitalization and 65 reported complications, including pneumonia and encephalitis. The largest measles outbreak in Arizona since 2000 was in 2016. Thirty-two cases were diagnosed at an Eloy detention center, according to the Arizona Department of Health Services. This was the biggest outbreak in the United States that year.

Most of the people who get measles have not been vaccinated. Here in the United States, we have the MMR (measles, mumps, and rubella) usually given at age one with the booster at age 4. When unvaccinated people travel to areas where the disease may be more prevalent, they are more likely to get sick.

Several areas of Africa, Asia, the South Pacific and Europe harbor the measles virus. Once home, they spread it to others who also may not have been vaccinated. The anti-vaccination movement in this country is often based on misinformation and downright untrue information regarding vaccine safety. That MMR causes autism is a classic example of a fraudulent initial paper and subsequent repetition of a falsehood.

This movement has unfortunately grown and there are pockets of children at increased risk of serious illness. Kindergarteners in Marin County in California are twice as likely to be unvaccinated than other children that age. A record number of parents in California claimed “personal belief exemptions” from vaccines in 2014. That year the state recorded the most measles cases in 20 years and the highest rate of pertussis (whooping cough) in 68 years. Those statistics changed with the 2016 law mandating full immunization for all children entering public school. (Valid exemptions include some illnesses and true allergies.)

“Measles is one of the most contagious diseases on the face of the earth” said New York’s health commissioner, Dr. Oxiris Barbot, after the 2016 Brooklyn outbreak. “There may no longer be local transmission of measles in New York City, but the threat remains given other outbreaks in the U.S. and around the world. Our best defense against renewed transmission is having a well immunized city.”

Routine childhood vaccination rates are declining in some areas due to “vaccine hesitancy,” a fear that the vaccine will cause harm. Social media reinforces many false claims and contributes to the risks of resurgence of many infectious diseases. There are public health and economic consequences in unvaccinated communities. The Sept. 1, 2017, issue of JAMA Pediatrics (Journal of the American Medical Association) reported that a “5% decline in MMR coverage in the United states would result in a three-fold increase in measles cases for children ages 2 to 11 years nationally every year with an additional $2.1 million in public sector costs.”

We need to vaccinate our children and ourselves against preventable illness. When enough people are vaccinated, we create “herd immunity” to protect our most vulnerable neighbors who may not be vaccinated such as newborns and the immunocompromised. A 95% vaccination rate helps to create that community, or herd, immunity. We are currently at 90.6% in Arizona. Five cases have been documented in Arizona this year, and those patients were not vaccinated. Prevention is the key.

Mia Smitt is a longtime nurse practitioner. She writes a regular column for Tucson Local Media.

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