One day the world could be measles-free. The 15 children that die every hour from measles infections could be saved. The 20–30% of infected people who require hospitalization could be spared the expense and experience. The threat of the rare, neurologically debilitating, and fatal disease (SSPE) that can develop decades after infection could be eliminated. How? Through life-saving immunizations.
I’ve decided to focus this blog on one vaccine—the measles (MMR, MMRV)1 vaccine. Why just one vaccine as opposed to all vaccines in general? The main reason is that this one holds the real promise of one day becoming unnecessary.
Like smallpox, which was eradicated from the human population and the world in the 1970s (except for a few high-containment facilities), measles virus naturally infects only people. This means measles can’t hide out in nature only to reemerge. Only people infect people with measles. If we remove measles from the human population the same way we eradicated smallpox, through worldwide vaccination campaigns and cooperation of people who understand the severity of the disease, measles will be gone forever. And measles vaccinations will no longer be needed.
Eradication Goals Averted
Until recently, humanity had been on target for global eradication of measles and a world where measles vaccines would no longer be necessary. The Americas and much of Western Europe had already achieved protective levels of immunization, preventing the natural spread of measles. But then the unfounded fears of anti-vaxxers, sparked by a single falsified study, crept in and spread through social media’s misinformation milieu. Ironically, we now face many more years (or decades) of ongoing immunizations due to anti-vaxxer actions.
In most developed countries measles infections happen at very low rates and are usually caused by importation. In most cases, someone susceptible to measles travels abroad to areas where measles infections still occur within the general (unvaccinated) population, importing the disease on their return.
Some people say things like, “So what! Measles isn’t that serious of a disease.”2 But that’s just false. Worldwide, measles still kills about 15 people (mostly children) every hour. Measles infections result in hospitalization 20–30% of the time and are often associated with pneumonia and other respiratory complications. Many parents might think the odds against infection are in their favor if an unvaccinated child encounters someone with measles. Unfortunately, that’s also false.
Measles is one of the most infectious viruses known to humankind. Most other viruses don’t even come close. Measles is much more infectious than influenza or ebola viruses. The infectivity rate for measles is greater than 90%. That’s crazy infectious! Measles is spread through aerosolized droplets and enters the body through inhalation of air during respiration. On average, in an unvaccinated population, one infected person will infect 12–18 others.
Although the majority of infected individuals will recover and experience near life-long immunity to reinfection with no serious complications, the news surrounding natural measles infections still isn’t all that good.
Measles by the Numbers3
- Measles virus is 3–10 times more infectious than influenza and 4–12 times more infectious than ebola viruses.
- One measles-infected person will spread the virus to almost all unvaccinated (and some partially immunized) individuals they encounter. Measles is infectious even before symptoms (and rash) appear, which is typically 12–14 days after infection.
- Measles infection will produce serious symptoms/diseases for approximately 8% of infected individuals, including pneumonia (1 in 20), encephalitis, ear infection/hearing loss (1 in 10), mental impairment, seizures, and death.
- Approximately 25% of infections will require hospitalization, usually due to respiratory and/or neurological complications.
- Nearly 1 to 3 of every 1,000 children who become infected with measles will die.
- Individuals recovering from natural measles infection are more susceptible to other bacterial and viral infections for many years due to a loss of immune cell function following measles infection.
- People who experience “routine” measles infections are vulnerable to a rare but neurologically devastating complication (SSPE) for decades—with some cases appearing up to 35 years after infection. This neurological disorder can lie dormant for years and, upon appearing, is 100% fatal. There is no cure. For babies who get measles before being vaccinated, the rate of SSPE is 1 in 609.
- Many people cannot be safely vaccinated because of underlying conditions. Thus, vaccination rates of 95% in the general population are needed to protect these vulnerable individuals from infection in outbreak situations.
Side effects after vaccination indicate that the immune system is responding to the vaccine. But let’s take a moment to consider risks associated with mild and adverse reactions to the MMR vaccine and similar live-attenuated measles vaccines.4
- Soreness (pain), redness, or rash can develop where the shot is given following immunization.
- Joint stiffness, fever, or swelling of the glands in the cheeks or neck sometimes occur.
- More serious reactions happen rarely, including pneumonia, seizures (1 in 3,000–4,000 children), or temporary low platelet count which can cause unusual bleeding or bruising (1 in 40,000 children), swelling of the brain and/or spinal cord covering (a single occurrence in an immunocompromised child). Severe allergic reactions rarely occur but may also be life-threatening.
- Live-attenuated vaccines may cause life-threatening infections in people with serious immune system problems. These people should not get MMR/MMRV vaccines.
- Although rare, the MMRV vaccine is associated with increased risk of seizure compared to the MMR vaccine when given as the first immunization in the two-dose series.
Truth over Fear
My emphasis is not to show that these numbers are low (or high) depending upon your perspective. The point is that these numbers could one day, in our lifetimes, be ZERO. Zero people infected and zero people needing measles vaccination. We have the very real opportunity to wipe measles out of existence, forever.
We had basically done this in the Americas and in Western Europe. But then, some people started believing inaccurate news about vaccinations and the MMR vaccine in particular. They didn’t just believe it, they started passing along fraudulent information. Thus, other people who no longer saw the effects of measles disease began to fear the very thing that was wiping measles off the face of the earth. They were deceived. And now they’re endangering themselves and others by spreading misinformation.
There were over 82,500 measles cases in Europe in 2018, more than three times as many as in 2017 and 15 times as many as in 2016. In 2016 and 2017 there were 49 deaths from measles in Europe, and 2018 saw another 72 deaths. Some countries have reported that over 60% of measles cases have required hospitalization. There have been particularly serious outbreaks in Serbia, Ukraine, Georgia, Greece, Romania, Italy, and France, with over 40% of cases in Europe occurring in adults over the age of 20.5
The current 2019 measles outbreak in the US involves 1,250 reported cases, 119 hospitalizations, and 61 individuals who have experienced severe complications including pneumonia and encephalitis. (Data through October 3, 2019) These are the highest numbers of measles cases in the US since 1998—prior to initiation of the WHO global immunization and eradication efforts.
With social media now prevalent, anecdotes often rule over reason. Personal stories are powerful. Yet stories about the dangers of measles vaccination are reminiscent of those that once sent supposed witches to their deaths. They are stories borne out of fear, personal experience, and a desire to place blame. Yet, unlike the days of hunting down witches, we now live in an age of accumulated scientific knowledge. And the science is irrefutable that measles vaccines save lives.
Bearers of Hope and Good News
Vaccinations have side effects. The vast majority are inconsequential. It is almost certain that the extremely rare, severely adverse side effects that follow vaccination with a weakened measles virus occur in individuals who would have fared (far) worse had they encountered the highly infectious, more virulent measles virus in an unvaccinated community.
I encourage you, if you haven’t already done so, to read my other blogs about vaccine safety. There I discuss how taking an informed stance on vaccination that reflects Christ’s call to consider others as more important than oneself can open ongoing, meaningful conversations with astute, compassionate, civic-minded, and scientifically informed nonbelievers. When we act out of fear, or knowingly and intentionally spread misinformation because of fear or distrust, we create significant obstacles to the gospel. However, when we act with compassion to protect the most vulnerable, we show the world a hope and a love that invites explanation and opens doors for the gospel.
- One of the very best reviews I have read on measles is a 2016 article by Austrian researchers entitled “Eradication of Measles: Remaining Challenges.” I recommend it to all who would like more information. The Washington Post has a series of videos featuring Anna Rothschild that cover the history and reality of measles and measles vaccines. I encourage you to watch these. I also invite your comments on my Facebook page.
- “Measles Outbreaks Put U.S. at Risk of Losing Prized ‘Elimination’ Status“
- “Measles Outbreak Questions and Answers: Everything You Want to Know“
- Measles and Rubella Initiative
- Global Measles and Rubella Strategic Plan: 2012-2020
- MMR/MMRII (and MMRV) vaccines are the current vaccines for measles, mumps, rubella, (and varicella, i.e., chicken pox) viruses. Mumps, rubella, and chicken pox, like measles, are highly contagious childhood diseases that can be easily prevented by immunization. Rubella, like measles, is associated with very significant disease including extreme risks of congenital rubella syndrome (CRS) to children in utero. Prior to vaccination, 12.5 million infectious cases occurred in the US in 1964–65 with ~20,000 birth defects recorded, including blindness, deafness, heart defects, mental retardation, and spontaneous abortions at an ~85% incidence rate for 1st trimester pregnancies. The Centers for Disease Control and Prevention recommends children get two doses of the MMR (measles, mumps and rubella) vaccine, starting with the first dose at 12 to 15 months of age and the second dose at 4 to 6 years of age. People born between 1957 and 1989 generally only had one MMR dose. One dose is about 93 percent effective at preventing measles, but anyone in that age group can (and should) still get a second dose. Two doses are about 97 percent effective. Even if you had two doses (or can’t remember), it’s OK to get a third dose. Lena H. Sun, “How Does Measles Spread? Do I Need Another MMR Vaccine Shot? How Dangerous Is Measles? FAQ on the Outbreaks,” The Washington Post, April 11, 2019.
- Lena H. Sun and Amy Brittain, “Meet the New York Couple Donating Millions to the Anti-vax Movement,” The Washington Post, June 19, 2019.
- Heidemarie Holzmann et al., “Eradication of Measles: Remaining Challenges,” Medical Microbiology and Immunology 205, no. 3 (March 2, 2016): 201–08, doi:10.1007/s00430-016-0451-4; “Are Vaccines Safe? The Vaccines Project, Episode 3,” Vaccine Knowledge Project, “Measles,” Oxford Vaccine Group, University of Oxford, last updated June 25, 2019; Centers for Disease Control and Prevention, “Complications of Measles,” last reviewed June 13, 2019; Kristen Wendorf et al., “Subacute Sclerosing Panencephalitis: the Devastating Measles Complication Is More Common Than We Think,” ID Week: Advancing Science, Improving Care, Oral Abstract Session: “Vaccines, Vaccine Preventable Disease, and Their Impact,” October 28, 2016.
- Centers for Disease Control Vaccine Information Sheets for MMR and MMRV (August 15, 2019); and “Are Vaccines Safe?
- Vaccine Knowledge Project, “Measles.“