Home > In the News, Outbreaks of Preventable Diseases, Preventable Diseases > Why Should Vaccinated Individuals Worry About Measles Outbreaks?

Why Should Vaccinated Individuals Worry About Measles Outbreaks?

The United States is well on our way to a record year for measles cases.  So far in 2017, we’re on track to see more cases this year than last year.

In the state of Minnesota alone, where a Somali-American community was encouraged to refuse MMR vaccine during visits from Andrew Wakefield and other vaccine critics, a drop in vaccination rates has resulted in a dangerous measles outbreak.  So far, the Minnesota Department of Health has identified 66 total cases spread among four counties, with many cases involving the hospitalization of children.

SOTI-MeaslesCasesIG As the number of measles cases in MN is expected to climb, health departments across the U.S. are beginning to identify other measles cases as well.

For instance, the Maryland Department of Health is investigating a potential outbreak after a patients was admitted to Children’s National Medical Center in the District.  The patient had previously sought medical treatment at Prince George’s Hospital Center in MD, exposing countless people in that area as well.  Meanwhile, a teenaged tourist staying in a NJ hotel contracted measles, and now the New Jersey State Health Department fear other people may have been exposed before the patient was treated at The Valley Hospital in Ridgewood, NJ.

With measles cases emerging across the U.S., and large-scale outbreaks of measles being reported by the World Health Organization in places like Romania and Italy, it’s important to ask if measles outbreaks should be a concern to those who are vaccinated.  

Aren’t vaccinated individuals protected during outbreaks?  And if so, why should we care if others remain unvaccinated?

When it comes to infectious diseases like measles, one person’s decision not to vaccinate can negatively impact the health of others.  There are plenty of unvaccinated individuals who rely on protection from the vaccinated, to include children under one year of age who are too young to be vaccinated for measles, individuals who have medical reasons that restrict them from being vaccinated, or people with compromised immune systems.  These individuals are all at great risk of contracting measles and suffering serious complications and the only protection they have comes from those who are vaccinated.

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In fact, in order to keep measles from spreading, about 92-95% of the population needs to be immune to the disease.  Unfortunately, in the case of measles, even small pockets of un-immunized individuals can threaten the herd immunity threshold.  This is exactly why we are seeing an outbreak in Minnesota.

What’s the big deal?  Is measles even that dangerous?

Measles is not just an unpleasant illness, but it Measles112315.pngcan also be quite dangerous. As many as one in four people who contract measles will be hospitalized, and one out of every 1,000 will develop encephalitis, a dangerous swelling of the brain that can leave a child deaf or intellectually disabled.  Even when children have access to advanced medical care, for every 1,000 children who get measles, one or two will die.

What are the chances of getting infected?

Measles is so contagious that if one person has it, 90% of people who come in contact with that person who are not already immune will also become infected.  Once an infected person sneezes or coughs, the virus that resides in the mucus of the nose and throat is forced into the air, spreading the disease to others and landing on surfaces that can remain contagious for hours.  One can even contract measles from being in the same place that an infected person once was, yet never encounter them face to face.  And since a person is contagious several days before the rash appears, individuals are often spreading the illness long before they realize they’re infected.

Is the measles vaccine effective?

Fortunately, the MMR vaccine (which protects against measles, mumps and rubella) has been proven to be both safe and effective.  The Center for Disease Control and Prevention recommends that children get two doses of MMR vaccine; the first dose at 12-15 months of age, and a second dose at 4-6 years of age.  With two doses of MMR vaccine, studies estimate the vaccine is about 97% effective at preventing measles.

Vaccination in the U.S. has led to an amazing 99% reduction in measles cases compared to the pre-vaccine era.  In the years prior to 1963, when our nation began a widespread measles vaccination program, it’s estimated that about 3 to 4 million people got measles each year, resulting in about 400 to 500 deaths, 48,000 hospitalizations and 1,000 cases of  encephalitis.

If children are vulnerable until they’re vaccinated, why do we wait until their first birthday to begin measles vaccination?

During measles outbreaks, parents of children who are too young to be vaccinated are often conflicted on how best to protect their children.  The MMR vaccine is not recommended until 12 months of age, but there are times when a doctor may recommend that the vaccine be administered early (as explained in the post “Giving MMR Vaccine Early to Protect Children Against Measles“).

However, this a less than ideal solution.  When a child is in the womb, they receive some passive protection from measles from their mother.  While these protective antibodies help protect them before they’re vaccinated, they begin losing this protection over time.  If a child is vaccinated while they still have these protective antibodies, it can interfere with the vaccine virus and reduce the efficacy of the vaccine.  While studies show that most children will no longer have any passive antibodies by 12 months of age, the timing can differ slightly from child to child.  This explains why some children can contract measles before they are vaccinated.  It also explains why a child who is vaccinated under 12 months of age (due to outbreaks or travel), should receive another dose of MMR vaccine at the recommended age to ensure the best protection available.

Why do some vaccinated individuals get measles?  Doesn’t that prove that the vaccine is not effective?

When an outbreak hits, large numbers of people are exposed to measles, so there are typically a few cases that occur among the vaccinated.  When you consider that many more vaccinated people get exposed but very, very few fall ill, you can contrast that data with the small percentage of unvaccinated individuals who are exposed and the overwhelming majority of unvaccinated individuals who fall ill.  So, while two doses of measles vaccine can be 97% effective, that leaves approximately 3% of vaccinated individuals who may remain vulnerable to infection.  It does not render the vaccine uneffective, but does point out the limiations of all vaccines (since no vaccine is 100% effective) and the importance of herd immunity.

Under-vaccinated individuals are also more apt to fall ill.  This accounts for individuals who may have only received one dose of vaccine versus the two doses that are recommended.  Since a second dose wasn’t recommended until the early 1990’s, there are some adults who may have only had one MMR vaccine and never realized they should get another.

Why should I be concerned about these most recent outbreaks?

Even though the risk of disease may be low for a fully vaccinated child or adult, the risk still exists because we can’t predict which individuals did not fully respond to the vaccine.  Additionally, we must acknowledge the risk that exists among people who can’t be immunized or who are not yet fully immunized.  These people rely on the protection they receive from the larger immunized community.

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Containing outbreaks of infectious disease is not only time-consuming, it’s also costly.  In Minnesota, while public health officials have already spent close to a million dollars to track down recent measles cases and contain the outbreak occuring there, we expect the costs to soar even higher.  At a time when our country is bracing for large cuts in public health funding, our best defense is a strong offense, and that can be achieved through prevention and immunization.

Please make sure that you and your family members have received two doses of MMR vaccine.  We must all do our part to put a stop to measles.  

To learn more about the recent measles outbreaks from the medical experts on the front lines of the Minnesota outbreak, listen to a recording of a recent conference call that was held with concerned parents here.  This recording is only available for a limited time, so check it out today.

  1. May 22, 2017 at 7:13 pm

    Thank you for this clear, thorough explanation of this.

    Like

  2. Alan Butterworth
    May 27, 2017 at 6:04 pm

    What an absolute load of rubbish this article contains. It mentions herd immunity….herd immunity is a term that is used to describe the natural immunity gained from contact with a natural live occurring disease, not one gained from vaccinations. The only way to prevent measles from taking hold in a population is to supply clean air, clean water and clean food. If measles is the killer you report, why has mankind survived? The ridiculous notion that everyone should be vaccinated to protect those that can’t receive vaccination is again too stupid for words. It presupposes that you’ll be safer from catching the disease if you’re vaccinated and also discounts any risk to the receiver from the vaccination. These risks are purposely played down and downright ignored by unscrupulous medical personnel but if you want to find out about the risks, either read the vaccine inserts provided by the manufacturer or instead look up all the cases that have received massive payouts from the Vaccine Injuries Compensation Fund and then decide which is a greater risk to you and your children’s health? A vaccine that is injected straight into your bloodstream, by-passing all your body’s natural defences and which the manufacturers already admit causes serious harm like brain-damage, autism and a host of other life-changing conditions, or measles which when monitored carefully can be nothing more than a few days annoyance and a life-time of immunity.
    If you look up the history of natural herd-immunity to measles, it will be apparent that the number of cases of the disease was falling year on year as the overall health and diet of the nation increased and nothing whatsoever to do with immunisation. I fear that this though is too simple and logical for most people to comprehend.
    Check out the rates of disease in the Amish community who refuse vaccines. Funnily enough, they have no incidences of autism either? Could the two be linked?

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  3. May 27, 2017 at 6:18 pm

    I’m afraid you’re wrong. Herd immunity applies just as much to vaccines. Herd immunity means enough people are immune that a germ can’t get hold. Doesn’t matter if they’re immune because they got sick and some survived, or because they vaccinated and didn’t get sick.

    Here are some helpful sources to explain why this is incorrect:

    List of studies showing herd immunity from vaccines works: https://www.facebook.com/notes/chillin-out-vaxin-relaxin-all-cool/published-studies-demonstrating-the-effect-of-herd-immunity/644388308958430

    Discussion of herd immunity: http://media.chop.edu/data/files/pdfs/news-views-herd-immunity-nov2014.pdf

    And the Amish do vaccinate – and have their share of problems, most genetic,.

    One of their communities that had low rates had a large outbreak of measles in 2014. After that that community too caught up on vaccines.

    Like

  4. Lawrence
    May 28, 2017 at 9:53 am

    I guess it shouldn’t surprise me anymore that we see someone repeating the same tired old lies and misrepresentations of the anti-vax movement.

    1) Vaccines are not “injected directly into the bloodstream.” They are either injected into the muscle, oral or nasal vaccines.

    2) Vaccine “inserts” are legal documents, not medical ones. And the manufacturers are required to list any adverse event reported during clinical trials – and adverse events are not side effects. For instance, several vaccines list “broken bones” as an adverse event, even though they are obviously unrelated to the vaccine.

    3) The only diseases which saw a drop in incidence because of “clean water or better hygiene” were water-borne diseases like Cholera. Airborne diseases, like measles, mumps and even smallpox, were unaffected by improvements in sanitation.

    And yes, we’ve looked at the records & incidence rates for these diseases did not drop until the advent of mass vaccination. Just a simple look at a disease like HiB, for which a vaccine wasn’t developed until the 1980s, incidence rates were steady, year over year, until the late 1980s, when incidence rates dropped precipitously.

    So, tell us what “miracle of sanitation” occurred in the late 1980s that only affected the incidence of HiB?

    4) And the incidence rate of measles? Cases most certainly were not “decreasing” – measles, as a disease, is perhaps the most infectious on the planet. It easily passes from person to person & the virus itself can remain in the air & on surfaces for hours.

    Yet we’re gone from hundreds of thousands of cases per year, to a mere handful.

    Again, this is just a fact that anti-vaxers can’t explain.

    5) And yes, the Amish both vaccinate & have an incidence rate of autism as well. And before you hold up the Amish as “paragons of health” you might want to investigate the litany of genetic problems they’ve developed – with some conditions, common in the Amish, that are so rare in the general population, that scientists didn’t even have names for them.

    If anti-vaxers were serious about having a conversation, they’d at least get their basic facts straight. But, as evidenced above, they can’t even get that right.

    Like

  5. Joel A. Harrison, PhD, MPH
    May 28, 2017 at 10:20 am

    @ Alan Butterworth:

    You write: “If measles is the killer you report, why has mankind survived?”

    Mankind survived the plague of the 14th Century though it killed an estimated 1/3 of the population of Europe. We survived smallpox though prior to the vaccine it killed up to half of all children. Measles deaths did go down with the advent of antibiotics because, though measles itself kills, the major cause of deaths was opportunistic bacterial pneumonias. In the early part of the 20th Century measles killed over 10,000 people per year in a population that was 1/3 what it is today. Prior to the vaccine, during the 1950s, on average, measles killed 400-500 kids, caused permanent disabilities in around 1,000, e.g. deafness, blindness, seizure disorders, and mental retardation, and resulted in 50,000 hospitalizations, and, of course, the suffering the kids experienced and missing of school.

    Herd immunity simply means the chain of transmission is broken, doesn’t matter how. And measles is a highly contagious airborne disease so no matter how hygienic you are, that is, unless you lock yourself permanently in an airtight room with high quality air filters, you can get it.

    The best single review of Herd Immunity, available at most university libraries is:
    Paul Fine (1993). Herd Immunity: History, Theory, Practice. Epidemiologic Reviews; Vol 15, No 2, pages 265-302.

    As for the Amish, studies show their rates of vaccination are slightly lower than others, in the 60 – 70%. Not only have they had outbreaks of measles; but in the late 1980s, an outbreak of polio which resulted in permanently paralyzed Amish children. Their response was to get their kids vaccinated. And, something I discovered when reading about the Amish is that when approached to get their kids vaccinated, the strongest argument to convince them to vaccinate was that they otherwise would be putting their non-Amish neighbors children at risk. When I hear people interviewed who say they only focus on their child, I thought the Amish admirable. Of course, if one only thinks of ones own child and others do the same, well, then we have anarchy and all hell breaks lose. The Amish care about their neighbors. They recognize that they are part of a community.

    The late Dan Olmsted, founder, owner, and chief editor of the loony toons website Age of Autism, prior to establishing it, did a series on the Amish of over 100 articles for the Washington Times, owned by the Mooneys, where he created the MYTH OF THE AMISH ANOMALY. Among other things, he was invited to a clinic that treated Amish with autism; but declined to visit. Instead, he interviewed someone at a rather newly opened clinic. He interviewed a woman who lived near the Amish, not an Amish, who had never been in an Amish home, had no psychological training; but said she had never seen a child among the Amish with Autism. Anyone knows that the diagnosis of autism requires a professional and the Amish don’t go around telling neighbors about their problems. In addition, how would someone know, for instance, if someone had Asperger’s or was just a bit eccentric. And, as Dr Reiss pointed out, the Amish have much higher rates of genetic disorders than the general population. In addition, as more and more research shows that the or, at least, a major contributor to Autism Spectrum Disorders, is genetics, the inbreeding in Autism communities that selects for the high rates of genetic disorders may not, in addition, have selected for ASD or, perhaps, the genetic disorders exhibited by Amish children are so powerful that any underlying ASD just isn’t as noticeable?

    For reading on the Amish, try:

    John A. Hostetler (1993). Amish Society (4th Ed.), Chapter 15: Health and Society. The Johns Hopkins University Press.

    Donald Kraybill et al (2013). The Amish: Chapter 18: Health and Healing. The Johns Hopkins University Press.

    I have probably another 20 articles on the Amish that I have read and several other books.

    As for measles:

    Andrew Cliff et al (1993). Measles: An Historical Geography of a Major Human Viral Disease From Global Expansion to Local Retreat, 1840-1990. Blackwell.

    It is one thing to express your opinion; but another when you write as if you are certain you are correct when in fact you are COMPLETELY WRONG!

    Like

  6. May 31, 2017 at 9:19 am

    Dorit,
    a more recent (and shorter) review of herd immunity by Dr Paul Fine can be found here:

    http://cid.oxfordjournals.org/content/52/7/911.full

    Like

  7. dingo199
    May 31, 2017 at 9:20 am

    Oops, I meant that for Joel, not Dorit, sorry.

    Like

  8. May 31, 2017 at 11:57 am

    Thanks. I actually cited this in my (not scientific) law review on this: https://law.uoregon.edu/images/uploads/entries/Reiss.pdf

    (And I know it’s not for me, but generally, I do appreciate citations too, so thank you!)

    Like

  1. May 23, 2017 at 12:13 am
  2. May 23, 2017 at 12:14 am
  3. September 1, 2017 at 2:20 pm

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