Confronting Measles — Part 1

By Travis Jobe, Senior Specialist, Laboratory Systems & Standards – Vaccine-Preventable Diseases, APHL

I have never seen a case of measles.  I would bet most Americans today haven’t.  Yet, ironically, it’s a disease those of us in the public health field work against every day.

I get the sense Americans tend to think of measles as a relatively minor disease that – before the era of immunizations – was just a regular, ordinary childhood right-of-passage; just like many in my generation experienced chickenpox.  Chickenpox may have sickened most kids in the US before immunizations began in the mid-1990s, but serious complications were rare – less than 1% of cases.  Measles is another story.  While it’s true that measles may have been a regular right-of-passage through childhood, ordinary it wasn’t.  Measles is a bad, nasty disease.  Over one-quarter of measles cases can have complications such as diarrhea or pneumonia, many of which require hospitalization.  Before vaccine was available in 1963, measles sickened millions and killed hundreds of children every year in this country alone.

For perspective, take a country like Zambia, in southern Africa, that struggles with funding and infrastructure to provide adequate public health services.  An outbreak of measles in that country just last year (2010) sickened thousands of children, with a fatality rate of anywhere between 1-4%, depending on the region and what report you may read.  That’s hundreds of deaths in one year in a country of under 14 million people in an area just slightly larger than Texas (which has nearly 25 million people by comparison).  It seems inconceivable that a disease like measles could ever cause such death in the US.  Plus, these numbers don’t even consider the numbers of children permanently injured by the virus, causing deafness, blindness, or other neurological damage.  But this is not much different than what was experienced in the US during the pre-immunization era.

I have a personal family story that can attest to this.  As a child in the 1920s, my grandmother traveled from California by train with her mother and siblings to the Ozarks of northwestern Arkansas to visit relatives.  She and her brother and sister contracted measles either on the train or from their cousins in Arkansas, barely surviving the next few weeks before making the trip back home to California.  The fear this disease struck in the minds of my ancestors is clear from their written recollections, and the fact that none died was a huge relief to them after their weeks of uncertainty.

Whereas diseases historically spread to distant geographic regions by boat, then train, today disease transport routes have been rapidly expanded by airplanes.  In fact, two years ago I visited Victoria Falls in Zambia – the town of Livingstone, to be precise – only a couple plane rides away (and roughly 30 hours) to return from there to the US.  It’s not improbable that a traveler – amidst Zambia’s outbreak – could have crossed paths with a measles infected person before flying hone.  Thousands of people do arrive in the US every day on plane rides from overseas.  One can easily be in some far off corner of the world where there is an outbreak of measles and be back in small town America in a matter of a couple days – before you would even know you were sick.  And the reality is: it happens all the time.  In fact, there were 13 imported cases of measles in the US in just the first 2 months of this year alone.  That’s about 2 people per week!

One of those measles cases was a woman traveling back from London who decided to stop for a few days in Washington, DC, where I live, while on her way back to New Mexico.  Turns out, as I heard on the radio one morning, she had stopped for lunch at the Potbelly sandwich shop in my neighborhood just a few days earlier on the weekend.  As you’d expect, the District of Columbia epidemiologists were asking anyone who may have been exposed to be aware of the signs and symptoms of measles illness.  Twenty minutes later, as I walked past that same Potbelly on my way to work, I thought about the hundreds of other people walking by: going to school, commuting to their government jobs downtown, heading to the airport.  Any one of them could have been exposed to measles over the weekend.  But the risk of anyone, including myself, getting ill was essentially zero.  Why?  Because we’re vaccinated and thereby immune.  And as the radio broadcast proves, the District of Columbia public health department is well-organized at actively trying to identify cases and stop any further disease transmission before an outbreak can even start.  Not outwardly apparent, but that’s our public health system at work.

So where do the labs come in?  Click here for Part 2 of this post.

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