Measles virus. Courtesy photo

BY RICHARD SKOLNIK
White Rock

The first vaccine against measles was approved for use in the US in 1963 and the US eliminated measles in 2000. Yet, last week there were 35 cases of measles spread among 15 American states and we will likely see more cases in the near future.

Although our risk of getting measles today in New Mexico is small, there are a number of reasons why measles should be of concern to all of us:

 Measles is among the most contagious diseases in the world. It is caused by a virus that is spread in the air and by contact with nasal and throat secretions from infected people. The virus can also remain in the air for two hours after an infected person leaves an area. Anyone can be infected but measles is mostly a “childhood disease.” Each person with measles would infect 12-18 people in a totally unvaccinated (susceptible) population. Once you get measles, you are permanently immune to it.

 The number of measles cases has been growing globally, spurred largely by the damage COVID did to routine vaccination programs. In 2022, there were 9 million cases of measles in the world, an 18% increase over the previous year. Measles in any country represents a measles threat to all other countries.

 Measles typically begins with high fever, cough, runny nose, and red watery eyes. Tiny white spots may appear inside the mouth two to three days after symptoms begin. Three to five days after the onset of symptoms, the infected person will get a rash that starts on the face and spreads to the rest of the body. The incubation period of measles averages about 14 days from exposure to the appearance of the symptomatic rash. The period of communicability extends for 4 days before the onset of rash until 4 days after that.

 Complications of measles are most common in the US among those under 5, over 20, pregnant women, and the immune-compromised. The most common complications of measles include ear infections and diarrhea. However, measles can also lead to severe complications, especially in the young, including hospitalization, pneumonia, and encephalitis, which can cause deafness and intellectual disability. Measles can also be especially dangerous to unvaccinated pregnant women and lead to premature birth and the birth of low-birthweight babies. In addition, it is estimated that measles caused about 136,000 deaths worldwide in 2022. Prior to the development of the measles vaccine, in fact, about 6 million Americans were infected with measles every year and 450 died of it annually.

 The vaccine is safe and effective. In fact, two doses of the (MMR) vaccine against measles are 96% effective against the virus. The notion that the vaccine is associated with autism has repeatedly been shown to be invalid. The 1998 article that first posited a link between the measles vaccine and autism was retracted by the publisher.

 Because measles is so infectious, 95% vaccine coverage is needed for herd immunity. Yet, several states in the US, and many counties within them, are substantially below herd immunity, such as Idaho, with only 82% of its children vaccinated against measles. Los Alamos has very high vaccine coverage rates for measles among our schoolchildren. In addition, self-reported data from schools shows that 94.9% of New Mexico’s kindergarten students and 97.4% of New Mexico’s 7th graders were vaccinated against measles in the 2022/2023 school year. Moreover, New Mexico has not had a measles case since 2019.

However, even within New Mexico, there is considerable variance by county in vaccination coverage. The rates of coverage against measles also declined from 2020 to 2022 both in New Mexico and the US and some states are proposing measures that will reduce vaccine coverage further.

Given the above, I encourage everyone to vaccinate your children on schedule, keep abreast of measles outbreaks so that you can avoid exposing those most at risk to the disease, and support efforts in the US and globally to strengthen vaccine coverage. It is important to remember that most of us have not seen anyone with measles or its complications precisely because we have a safe and effective measles vaccine that so many people have chosen to get to protect themselves, their families, and their community.

For more information on this important topic, you may wish to consult the materials on measles from which this piece is drawn from the World Health Organization, CDC, and the NM Department of Health.

Richard Skolnik is the former Director for Health, Nutrition, and Population for South Asia at the World Bank. He was a Lecturer in Global Health at The George Washington University and Yale, where he still holds an appointment, and the Executive Director of a Harvard AIDS treatment program for three countries in Africa. Richard is also the Instructor for the Yale/Coursera course Essentials of Global Health and the author of Global Health 101, Fourth Edition.