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In 2000, the United States achieved elimination of endemic measles (no reported cases in legal U.S. residents). This was accomplished by very high coverage of measles vaccinations, robust surveillance, coordination of rigorous outbreak (defined as six or more reported cases) responses, and increased measles control in other countries. Controlling the disease in other countries was coordinated by the World Health Organization. The accomplishment of elimination in the U.S. is unfortunately being unraveled by groups of people who are refusing vaccinating themselves and their children for various reasons. In 2010, there were 63 reported cases, in 2014—667, and so far this year, 314.

Measles is a highly contagious viral disease. Ninety percent of unprotected (unvaccinated) individuals exposed to it will be infected. Its symptoms include fever (as high as 104), rhinitis (runny nose), cough, red eyes, sore throat, and a red rash. The rash, however, does not appear until several days after symptoms begin. An infected person can be contagious four days before the rash appears and four days after it appears. It is spread by coughing and sneezing. While measles may cause serious issues like meningitis, one of the biggest dangers of the disease is that it suppresses the immune system for as long as two to three years after the initial infection. This increases the likelihood of the person contracting opportunistic infections like ear infections, diarrhea, and pneumonias. Opportunistic infections are those that occur because the person has a suppressed immune system, much like a person on chemotherapy would have. Measles infects vital white blood cells that are responsible for cellular immunity. These cells create immunoglobulins and antibodies that attack viruses and bacteria that invade the body. In short, measles causes immunologic amnesia.

So far, in 2019, outbreaks were reported in Rockland county, NYC, Washington, Texas, Illinois, and California. These outbreaks were due to unvaccinated infected travelers returning from Israel and Ukraine, where there are large outbreaks. While measles was eliminated in the U.S., or so we thought, it is still common in Europe, Asia, the Pacific, and Africa. Responding to outbreaks is a costly undertaking, costing as much as $142,000 for a single case. In 2011, the estimated total cost of measles outbreaks in the U.S. was $2.7 to 5.3 million. These costs include post-exposure prophylaxis (post-exposure vaccination and immunoglobulin injections), laboratory testing, healthcare professional compensation and overtime, public outreach regarding risk and prevention, and establishing quarantine of exposed susceptible individuals. As an aside, that reminds me of a Honeymooners episode where Ralph is quarantined because of possible measles exposure. Ralph says to Norton, “Don’t touch me, I’m measled!” When outbreaks do occur, resources and personnel must be diverted from other programs and functions, potentially disrupting existing healthcare systems.

In the measles post-elimination era, vaccine hesitancy and refusal have created a threat to the health of the general public. Those who foolishly or selfishly refuse vaccination for themselves and/or their children are placing others in danger, not to mention themselves and their children. The CDC and many states are considering changing the rules to eliminate the ability to refuse vaccination as the health of the public is in peril.

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