Measles Kills 400 People a Day—But Costs Less Than a Buck to Avoid

Almost all of the most recent U.S. cases were acquired while traveling abroad—or in unvaccinated people.

Typical measles symptoms include an uncomfortable rash, high fever, runny nose, and watery eyes. But up to 30 percent of cases develop into pneumonia, ear and eye infections, and diarrhea —and even worse, including hearing loss, brain damage, and even death. There is no specific treatment or cure for measles. (Scott Camazine/CDC)

The Disease Daily is a publication from HealthMap at Boston Children's Hospital.

There’s a dangerous virus spreading through Europe, Africa, and North America. This virus can lead to serious complications such as permanent hearing loss, brain damage, and even death. Would you be surprised to learn this threatening disease is measles?

Measles is not a thing of the past, nor is it a disease limited to developing countries. Today measles is one of the leading causes of death of children worldwide, despite the availability of a cheap, effective vaccine. Just in 2013, measles has already claimed the lives of over 100 children in Pakistan, nearly 20 children in Nigeria, and sickened more than 2,000 children in China. In 2012, the United Kingdom reported the highest number of new cases in 18 years. The U.S. reported a whopping 222 measles cases in 2011, up from an average of 60 cases. 

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Typical measles symptoms include an uncomfortable rash, high fever, runny nose, and watery eyes. However, up to 30 percent of cases develop complications—including pneumonia, ear and eye infections, and diarrhea. In severe cases, permanent hearing loss, encephalitis (irritation and swelling of the brain), brain damage, and even death may occur. There is no specific antiviral treatment or cure for measles; good nutrition and hydration are the best therapies.

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The World Health Organization (WHO) reported 158,000 measles deaths in 2011. That’s 430 deaths every day. A shocking statistic, considering it costs less than $1 to immunize a child for measles.

The measles virus is exceptionally contagious; contaminated droplets, spread via coughing and sneezing, remain alive and infectious outside the body for up to two hours. Estimates say that 90 percent of non-immune people exposed to the virus will contract the disease. If immunized, this figure drops to 5 percent.

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Measles was eliminated from the United States in 2000 due to widespread immunization with the MMR (measles, mumps, rubella) vaccine. “Elimination” means that the virus no longer spreads within the country year-round. But travelers can easily bring measles into countries from which it has been eliminated. Just this month, a man was diagnosed in Toronto, Canada, with measles after a vacation in Mexico. In 2008, measles was declared endemic again in the United Kingdom because of poor vaccine coverage. In 2011, the European Center for Disease Control (ECDC) reported more than 30,000 measles cases, many linked to other outbreaks across the globe. That same year, the United States was battling the largest measles epidemic since 1996. Almost all of the 222 reported measles cases in the United States were acquired from travel abroad and in unvaccinated individuals.

The best prevention against this dangerous and potentially deadly disease is vaccination. Contrary to vaccine naysayers' beliefs, the MMR vaccine is both safe and effective. Scientific evidence has shown no causal link between the MMR vaccine and the onset of developmental disorders such as autism.

Receiving an MMR vaccine not only protects you; it protects vulnerable populations who can’t get a vaccine, like your neighbor undergoing cancer treatment or your cousin’s newborn. By being vaccinated, you offer protection through the phenomenon of what’s called “herd immunity.” That means that when a sufficient proportion of a population is immune to an infectious disease (either by contracting and recovering from the disease or by receiving a vaccine), the spread of that disease becomes more unlikely. Even those who are not vaccinated are offered some protection because the disease has little opportunity to spread within the population.

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Maybe you’re thinking, why should I get vaccinated? As long as other people get their shots, I don’t have to get one. Stop right there, freeloader! Remember that part about how a “sufficient proportion of the population” must be immune? Turns out that  proportion is directly related to how infectious the disease is. Simply put, the more infectious a disease is, the more people need to be vaccinated to achieve herd immunity.

To calculate this proportion, public health professionals turn to a number known as reproductive number, or R0. This number measures the average number of cases likely to arise from a single case; in other words, the other people you will infect once you’re sick.  The inverse of R0 is roughly equal to the proportion of a population that must be immune to control the spread of the disease. For example, say an imaginary disease has an R0 of two, which means that every person who becomes sick will infect two other people. The inverse of two is one-half, so around 50 percent of the population must be immune to control the spread of this disease.

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The R0 of measles is estimated to be between 12 and 18. So between 90 and 95 percent of the population must be immune to keep measles in check. Now, consider the fact that certain people cannot safely receive the vaccine (for example, MMR vaccine is not recommended for those with compromised immune systems, specific allergies, or cancer). They are effectively removed from our vaccine coverage numbers. We’re left with the fact that basically everyone who can get vaccinated should receive the MMR vaccine. According to the WHO and UNICEF, the United States has reported measles vaccination coverage over the past 10 years between 84 and 93 percent. It is critical to keep this number high. If you’ve never been vaccinated against measles (or had the measles), you can find a vaccine provider in your area using the HealthMap Vaccine Finder.

Have you been vaccinated against measles or had the virus? If you chose not to be vaccinated or not vaccinate your children, why not?

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--By Jane Huston and Katharina Schwan

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