Disneyland Measles Outbreak: Should You Be Concerned?
Jan 22, 2015

Measles was declared eliminated from the U.S. in 2000, but every now and then we hear about an outbreak in this country. Typically it goes something like this:

An unvaccinated American travels to some place like Europe, Asia, the Pacific, or Africa where there are 20 million measles cases a year. They are exposed to the disease, arrive back in the states and begin exhibiting symptoms. Eventually they’re diagnosed with measles and public health officials work diligently to identify and isolate subsequent cases.  Within a few weeks the outbreak is contained and people go about their business like nothing ever happened.  

So why has there been such a fuss about the recent measles cases in Disneyland?

At first, news reports identified nine cases among visitors of the Southern California amusement park in December 2014. Eight  of the patients – ranging in age from 8 months to 21 years – had been vaccinated, and two were too young to have been vaccinated.

But then the outbreak appeared to be spreading to different states and lots of new cases. The latest report from the CA Department of Public Health confirms 59 cases of measles in CA since December 2014. Of the confirmed cases, 42 have been linked to an initial exposure in Disneyland and include five Disney employees.  Patients range in age from seven months to 70 years and the vaccination status is documented for 34 of the 59 cases. Of these 34, 28 were unvaccinated, one had received one dose and five had received two or more doses of MMR (measles, mumps, rubella) vaccine.  The CDC indicates that the measles cases we’ve seen so far in 2015 span six different states, largely due to the outbreak that originated at Disneyland.  As the outbreak spreads, we’re seeing evidence of secondary infections and secondary effects.  For instance, in an effort to contain the spread of measles in Orange County schools, public health officials are requiring some parents to keep their unvaccinated children home from school for 21 days after a fellow student was diagnosed with measles as part of the outbreak.

Now many people are wondering,”Is measles something I should be worried about?” 

Most vaccinated individuals aren’t very concerned.  After all, they were vaccinated against measles as children.  Doesn’t that make them immune to measles infection for the rest of their lives? Not exactly. 

And then there are those who have chosen not to get themselves or their children vaccinated.  They’re not all that concerned either.  After all, measles isn’t all that dangerous, right?  People don’t die from measles in this country, do they?  Besides, if they eat an organic diet and avoid toxins than their immune system should easily be able to fight off a measly measles infection. Right?

In order to determine whether we should be concerned, we need to starts with the facts. The truth is that measles presents a risk to everyone, even the vaccinated, and here’s why:

• Measles is highly contagious.  Even more contagious than Ebola.  It’s been said that you can catch measles just by being in a room where a person with measles has been up to 2 hours after that person is gone.  That translates into a huge number of people who were likely exposed in the many enclosed attractions at Disneyland.  Measles is so infectious that 90% of people who are not immune will contract the virus if exposed.  It is also contagious up to four days before the onset of the rash, which makes it likely that people will be out in public spreading the disease before they even realize they’re sick.

• Measles can be dangerous and is not treatable.  While it’s true that measles isn’t typically life-threatening, and that most people will eventually recover, there are cases that result in hospitalization, miscarriage, brain inflammation, secondary infection, pneumonia, deafness and yes, even death. Unfortunately, there is no way to treat measles, so the best doctors can do is treat the symptoms.  Even so, as many as one in three people will develop complications, one out of every 1,000 people will develop inflammation of the brain, and about one out of 1,000 will die.  According to Dr. Iannelli’s “Measles Myths“, there have been 11 deaths in the U.S. among about 3,000 cases since 1995.  So while it’s not likely a U.S. patient will die, it’s still a possibility.  That’s the thing about infectious diseases.  You just never know who it will strike, when it will strike, or how badly it will strike.

• Children are at the greatest risk.  The current recommendations are for children to get their first MMR vaccine between 12-15 months of age.  Since it’s unreasonable to expect parents to isolate their children at home until they’re vaccinated, children will remain vulnerable to preventable diseases circulating in our communities until they are fully immunized.  This is unfortunate due to the fact that young children, as well as  pregnant women, are at the greatest risk of complications from a measles infection.

• People who refuse vaccines tend to cluster together.  This makes for under-vaccinated communities where viruses like measles can thrive.  In the case of measles, community immunity is compromised when the number of immune individuals falls below 95 percent.  So, while Disneyland isn’t to blame for this measles outbreak, it’s location (in Southern California which historically suffers with low vaccination rates), visitor demographics (to include young children, and both out-of-state and international travelers) and timing of the outbreak (over the busy holiday season) has really set the stage for the perfect trifecta of infection.

• Measles vaccination is highly effective, but no vaccine is 100% effective.  Studies show that two doses of the MMR vaccine is more than 99% effective in preventing measles. Even a single dose may be up to 94% effective, which is good news for adults who were born before the second dose was recommended in 1989.  But again, no vaccine offers a 100% guarantee.  And even though measles vaccination appears to induce long-lasting immunity in most persons, with approximately 95% of vaccinated persons still immune 15 years after the second dose, there is still the possibility that immunity may wane sometime in adulthood.

Knowing the facts about measles raises valid concerns when we hear about outbreaks in the U.S.  If you want to ensure your taking the appropriate preventive measures, here are a few things to consider:

• Immunize your children according to the recommended schedule and don’t delay their MMR vaccine. 

• Know the vaccination status of friends, family members, caregivers and classmates.  If it is at all possible, limit your child’s exposure to unvaccinated individuals who are more likely to fall ill with an infectious diseases like measles, and increase the risk of disease to vaccinated individuals.

• If you’re traveling out of the country, or to an area with a known outbreak, discuss travel vaccines with your doctor or health clinic. Before any international travel infants 6 through 11 months of age can receive a precautionary MMR vaccine and children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days.  Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days.

• If you’re an adult who is uncertain about your vaccination status, consider getting an additional dose of MMR vaccine.  As an adult it’s possible that you’re immunity from a childhood vaccine may wane and you may have never received a second dose.  Talk to your doctor and ask if it would be advisable to get vaccinated, especially if you’re a parent, college student, caregiver, healthcare worker, international traveler or you live in an area with known outbreaks.

• If you’re an unvaccinated person, or the parent of an unvaccinated child, consider the fact that measles is preventable with a safe and highly effective vaccine.  Check out the personal stories of those who have suffered with measles and then consider that an unvaccinated person is 35 times more likely to contract measles than the person who is vaccinated.

The good news is we have a strong and responsive public health system that we need to continue to support.  

While it’s unfortunate that we’ve seen a record number of measles cases (644) in the U.S. in 2014 – the highest number of cases since measles was declared eliminated from the U.S. in 2000 – we still have a long way to go before we’re in the situation Europe has faced in recent years.  In 2010 measles outbreaks in Europe caused over 30,000 cases and 21 deaths. And in 2011, outbreaks resulted in over 30,000 cases, 7 deaths, 27 cases of measles encephalitis and 1,482 cases of pneumonia.

To continue to prevent widespread outbreaks, we must encourage widespread vaccination – not just across the nation, but in every community in the nation, and even across the world. 

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