The consequences of a completely preventable disease

When I was in medical school in the 1990s, my professor told the class that we wouldn’t need to worry about measles, because we would probably never see it.

Now, less than 30 years later, I have seen dozens of cases of measles over the last year.

As of last week, there were more than 2,800 confirmed cases of measles in the United States. Pennsylvania has become a particular hot spot for measles, with 393 cases so far this year, including two deaths. This is the most cases we have seen in the U.S. since 1991.

These numbers only reflect the number of people whose cases have been formally diagnosed and verified — not the likely hundreds and hundreds of others who did not seek medical attention for the illness.

Only 26 years ago, measles was declared eliminated from the U.S., meaning the absence of continuous spread of disease was greater than 12 months. We are very much in danger of losing that eliminated status this year.

Measles is the most contagious virus we know of. It is spread in the air by tiny respiratory droplets produced when an infected person breathes, coughs or sneezes. The droplets can stay in the air or on surfaces for more than two hours, even after the infected person has left the room.

Common symptoms from the measles include a high fever, cough, runny nose, red and watery eyes and the characteristic rash. Symptoms appear a week or two after exposure, on average. 

Fortunately, most patients recover from measles and do not require hospitalization, but younger children, pregnant women and the immunocompromised are at a higher risk. It is not a disease to take lightly because it can cause several complications that may require hospitalization. These include pneumonia, encephalitis, permanent brain damage and, in rare cases, even death. 

In fact, we have had children hospitalized at our children’s hospital this year from complications from the measles virus, with care ranging from supportive to intensive.

There is no antiviral treatment or cure for measles. Treatment focuses on relieving the symptoms with rest, fluids and fever-reducing medications. The best course of action is not to get measles in the first place — by getting the vaccine.

The MMR (measles, mumps and rubella) vaccine has provided excellent protection, with two doses of the vaccine providing 97% protection against measles. Those two vaccinations are typically administered when children are between 12 and 15 months old and again between 4 and 6 years old. 

It is extremely rare for vaccinated people to get the measles. About 3 out of 100 fully vaccinated people may contract measles if exposed to a prolonged outbreak. 

In the rare situation where a vaccinated person develops measles, the illness is usually less severe and less likely to result in serious complications. Vaccination not only protects the person receiving it, but because they are less likely to transmit measles, it also protects vulnerable members of our community. These include infants who are too young to be fully vaccinated and those with certain medical conditions that prevent them from being vaccinated. 

When at least 95% of the community is vaccinated, transmission of the virus is stopped and through so-called “herd immunity,” the unvaccinated people in our communities are also protected.  

Recent gaps in vaccination, though, have allowed measles to return. Data from the last few years shows vaccination rates have dropped 2% or 3% for kindergarten students across the state. Although it seems like a small dip, it allows the virus to reach unvaccinated communities and leads to outbreaks like we are seeing now. 

The cause for the dip in vaccinations could be due to misinformation about the safety of vaccinations, or maybe vaccine hesitancy stemming from the COVID-19 pandemic. 

Whatever the reason, I encourage patients and families to have conversations with their primary care providers and pediatricians when considering immunizations and vaccinations.

At Geisinger, we continue to follow the evidence that has showed the effectiveness of the immunization schedules for children by following the guidance and vaccine schedule provided by the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians.

We cannot afford to have our communities sickened by an illness that is completely preventable.