How Measles Made a Comeback After Elimination in U.S.

(Bloomberg) -- Thanks to the introduction of a vaccine in 1963, measles was declared eliminated in the U.S. in 2000. Yet the number of cases of the highly contagious disease this year has surpassed 700, spread across 22 states and focused in New York. The outbreak has prompted authorities to quarantine university students, fine parents for not immunizing their children and bar unvaccinated minors from public places.

1. How did measles make a U.S. comeback?

Measles cases are increasing globally, resulting in 110,000 deaths in 2017, up from less than 90,000 a year earlier, according to the World Health Organization. Health authorities link the U.S. outbreaks to travelers who brought measles back from other countries, including Israel, Ukraine and the Philippines. This phenomenon has become more common as the number of Americans who are unvaccinated against childhood illnesses has increased because of persistent and incorrect beliefs that immunizations are more dangerous than beneficial. According to the Centers for Disease Control and Prevention, 82 people brought measles to the U.S. from abroad in 2018.

2. Who’s been most affected?

The largest outbreaks have been in New York state. In the Brooklyn and Queens sections of New York City and in Rockland County, north of the city, Orthodox Jewish communities have been hard hit. There’s no doctrinal reason for Orthodox Jews to resist vaccination. However, anti-vaccination groups have targeted these communities with direct-mail campaigns that overstate immunization risks. Residents of Brooklyn’s Williamsburg neighborhood received a mass mailing of “The Vaccine Safety Handbook,” a glossy 40-page booklet containing false claims that vaccines cause autism and contain cells from aborted human fetuses and “monkey, rat and pig DNA as well as cow-serum blood, all of which are forbidden for consumption according to kosher dietary law.”

3. How have authorities responded?

The New York City Health Department closed seven Jewish Orthodox schools in Williamsburg for failing to comply with state requirements that students be vaccinated against childhood diseases unless they have a medical or religious exemption. Five have reopened after proving they turned away unvaccinated students. In April, New York City Mayor Bill de Blasio declared a public health emergency. The city has issued summonses to dozens of residents who refuse to get themselves or their children vaccinated. Each summons carries a fine of up to $1,000 — or double that if the person does not appear in court. A group of parents has sued the city, claiming the order violates their free exercise of religion. A judge blocked an emergency declaration by Rockland County barring unvaccinated minors from public places but left intact an order prohibiting them from schools or day care facilities. In California, hundreds of people were quarantined at two Los Angeles-area universities.

4. Why such a big deal over a childhood disease?

Measles is an extremely contagious virus that can be deadly, particularly in babies and older people or those with suppressed immune systems, such as cancer patients receiving radiation or chemotherapy. It’s characterized by a rash of tiny red spots that start at the head and spread throughout the body. Symptoms include cough, runny rose, red eyes, diarrhea and ear infections. It can lead to pneumonia, brain damage and deafness. Measles during pregnancy can lead to miscarriage, early delivery and low birth weight.

5. How does one get measles?

You can catch it just by being in the same room where an infected person has breathed, coughed or sneezed within two hours. A person can spread the disease unknowingly before showing any signs or symptoms. According to the CDC, if you are exposed to measles and have not had the vaccine, you will almost certainly become infected.

6. Does measles vaccination cause autism?

No. Some parents might worry that the vaccine causes autism because signs of the developmental disorder typically appear around the same time that children are recommended to receive the first dose of measles vaccine, at roughly one year of age. But the idea that the vaccine is linked to autism is based on a 1998 study that turned out to be fraudulent. It was retracted and its author, Andrew Wakefield, was stripped of his U.K. medical license for “dishonest” and “irresponsible” work. Repeated studies have debunked any connection between autism and vaccines.

7. What are the vaccine’s actual risks?

The vaccine, which is combined with immunizations against mumps and rubella into a shot called the MMR, is extraordinarily safe. Side effects include a sore arm from the shot, fever, mild rash, and temporary joint pain and stiffness, mostly among teenage or adult women not already immune to rubella. The MMR vaccine has been linked with a very small risk (four cases in every 10,000) of seizures caused by a spike in temperature that have no long-term effects. Serious allergic reactions are extremely rare but have been experienced by patients allergic to the antibiotic neomycin. They should avoid the vaccine, according to the CDC.

8. What’s the treatment for measles?

An infected individual must allow the virus to run its course, relying on the body’s immune system for a cure. Acetaminophen may relieve fever and muscle aches. Rest will boost the immune system. Six to eight cups of water a day will help with hydration. A humidifier can ease a sore throat and cough. While unpleasant, it’s a condition that usually ends within seven to 10 days. After contracting measles, a person is almost always immune for life.

The Reference Shelf

• A QuickTake explainer on the vilification of vaccines.
• The measles pages of the World Health Organization and the U.S. Centers for Disease Control and Prevention.
• The New York City Department of Health’s webpage on the outbreak.

To contact the reporter on this story: Henry Goldman in New York at hgoldman@bloomberg.net

To contact the editors responsible for this story: Flynn McRoberts at fmcroberts1@bloomberg.net, Lisa Beyer, William Selway

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