Measles, the eight-day kind, was once a rite childhood of passage in Montana. Most of us of a certain age remember having it — looking in the mirror to see an alien covered with red spots, feeling wretched with fever, wishing it would be over, yearning to get back to normal life. The measles virus remains in the air for as long as two hours after an infected person leaves a room – so at least 90% of kids contracted measles before a vaccine was available. Most everyone lived through it. So why the big concern about a recent increase in cases in the United States — more than 1,000 thus far in 2019?
Measles is the most infectious virus we know of — roughly nine times more transmissible than the Ebola virus. Before measles vaccination was available in the 1960s, several hundred children died every year from complications, usually from pneumonia or encephalitis. Even today, measles can be deadly for anyone who is immuno-suppressed, as from chronic illness, malnutrition, or HIV infection.
Small babies are particularly susceptible before their immunizations are complete. And here’s the problem: When children are not immunized, either because their parents have limited access to health care or worry about side effects, the risk is not only to the child’s health but potentially that of countless others. Groups of children at the movies, in church, in classrooms or daycare – all are potential hotbeds of transmission.
I saw firsthand the tragedy that measles can bring when I spent a year in rural Nepal in the late 1970s on a health project. It was just a few years before measles immunization was available for countries like Nepal that lacked good refrigeration systems. One morning I walked through a village with a local health worker to see a young child with measles who had symptoms of pneumonia. As we drew near the house, I began to hear eerie howling sounds echo down the trail toward us, growing louder as we approached.
The health worker shook his head in despair, knowing only too well that we were hearing the distinctive wail made by Nepali women when someone had died. More than just a death, this case was the death of a child who might have been saved with a few doses of penicillin, but his supplies of antibiotics had run out weeks before.
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That day was not the only time I saw the dangers of a measles outbreak. More than once I found that as many as a third of the youngest children in a small village had been wiped out by a measles epidemic. And even today, over 100,000 mostly unimmunized children still die from measles every year around the globe.
There is another potentially bigger measles-type problem called rubella (also known as German or three-day measles). Protection from rubella is part of the combination vaccine given along with measles and mumps (the MMR). The danger of rubella is that if an unimmunized woman contracts rubella early in pregnancy, she has a 90 percent chance of passing the virus on to her fetus, and the results are devastating. A whole range of fetal problems can result, including miscarriage, stillbirth, or infants with serious malformations such as deafness and congenital heart disease, known as congenital rubella syndrome. Most women of childbearing age today were immunized against rubella as children. But do we want a cohort of girls growing up without that protection against this tragic risk? Is this step backward what we want for the coming generation?
When I hear about parents who won’t have their kids vaccinated because of worry about side effects, I sympathize with their fears. We all want our children to be safe, and the list of recommended immunizations for youngsters seems to be growing every year. But the many studies that have investigated possible links between vaccines and a range of problems such as autism have all come to the clear conclusion that they are safe. There simply is no known biological reason to reject vaccination, yet there is cause to celebrate the end of the dozens of diseases that they can prevent.
Let’s not wait until the first American child dies from complications of measles, or an infant is born with rubella deformities. These are tragedies we never need to see again.