Philadelphia, December 2023: An unvaccinated person returned from overseas travel infected with measles. They went to Children’s hospital of Philadelphia and infected three unvaccinated individuals there. Two of those were a mother and her child. The mother then defied quarantine recommendations and sent her child to daycare. Two other children from the daycare were hospitalized with measles.
Washington, DC, January 2024: An unvaccinated traveler, infected with measles overseas, traveled through Dulles and Ronald Reagan airports.
Washington state, January 2024: 6 adult members of the same family, all unvaccinated, are infected with measles. No community spread reported as all sick people quarantined.
Ireland, January 2024: An unvaccinated adult dies of measles. It is the first case of measles in Ireland this year, although Europe has seen a 45-fold increase in measles infections over the last year.
What the hell is happening with measles???
Overall, routine vaccinations are down. Part of this is due to the COVID pandemic. A lot of people failed to show up to their children’s routine pediatric appointments as they were social distancing. Some COVID-vaccine hesitancy and fear have bled over to other vaccines as well. And an increase in distrust of school boards, politicians and government in general has led to a decrease in trust of all vaccines and vaccine mandates. In Georgia, only 83% of kindergarteners are fully vaccinated for measles. Alaska is really ‘killing it’ at 78%. There’s a cool interactive map here to see the state of your state.
More and more parents are filing for vaccine exemptions for their kids. Some are even calling for the end of school-required vaccinations all together. Bills have been introduced in Georgia, Wisconsin, Montana and Iowa to water down or remove school-vaccine mandates. Presidential candidate RFK Jr has spoken out against school vaccine mandates in the past and has stoked vaccine fears with crazy conspiracy theories.
But measles doesn’t care about your politics.
Measles is the most contagious disease of man. EVER. If an infected person walks into a room of unvaccinated people and coughed, at least 15 of them would become infected themselves. It’s so contagious that 95% of the population needs to be vaccinated in order to stop measles outbreaks. Are you listening, ALASKA????
Measles is spread through coughs and sneezes. The virus transmits in respiratory droplets and can hang in the air for up to two hours. Measles virus then lands in the eyes, nose or mouth of the new person, infects their upper respiratory tract and then drains into their bloodstream via the lympatic system. Once in the bloodstream, it causes the characteristic rash.
This is when most people know they have measles… however…. they’ve already been spreading it via their infected respiratory droplets for four days before the rash appeared. You are contagious before you even know you are sick. Tricky tricky.
Most people will just have a rash and a fever and will recover with no complications. However, complications can be very severe. Complications are more likely in children under 5, adults over 20, pregnant women and those with immunodeficiencies.
Ear infections (10%)
Diarrhea (10%)
Hospitalization (20%)
Pneumonia (5% and the most common cause of death in kids)
Encephalitis (0.1% and can cause brain damage or deafness)
But there are some really scary things measles can do:
Sub-acute sclerosing panencephalitis.
SSPE, its easier to say that way. SSPE is a rare complication of measles infection, but it’s a doosey. When measles was rampant, about 10/100,000 kids would get SSPE. Now, its about 4 cases a year in America. In some children, for no apparant reason why, the measles virus migrates to the brain after their regular rash/fever disease is complete. Neurons are not particularly hospitable for measles viruses and initially, they don’t replicate well there. But they replicate a little, and that is enough.
Viruses have a remarkable ability to become adapted to their surroundings, as long as they can replicate at least a little. With every round of replication, they accumulate random mutations. If a virus appears with a mutation that makes it better able to replicate, then it starts to overtake the rest of the population: survival of the fittest. That superior virus then continues to mutate, and may become better and better at replicating in its new environment.
After years of adapting to life inside the skull, the measles virus actually becomes well adapted to infect the brain. At this point, I hesitate to even call it “measles” anymore. If you took the virus out of the brain after the years of adapation (and they’ve done this in animal experiments) it wont cause measles disease when you put it in a fresh animal host. It’s become a brain-infecting virus only.
The symptoms of SSPE start usually when the child is a teenager (7-10 years after measles disease). The first round of symptoms (called Stage 1) is mostly marked by personality changes: lethargy, depression, social withdrawal, irritability. It is most often diagnosed as “being a teenager”. If allowed to progress into Stage 2, more damage to the brain occurs and symptoms become more alarming: muscles twtiches, tremors and involuntary movements. Stage 3: Rigid and twisting movements of the body, seizures. Stage 4: Paralysis, loss of consciousness, persistant vegetative state.
The average life span after the symptoms start is 3.8 years. 95% of patients die from SSPE and the ones who survive are typically diagnosed early (in Stage 1) and have to stay on antiviral medication for the rest of their lives.
There has never been a case of SSPE in someone vaccinated for measles.
Immune amnesia
Measles virus infects several different types of cells in the body, one of which is the “memory cell”. You know how when you get an infection or a vaccine, you are now “immune” to that disease? Much of that immunity resides in the memory cells. These are very long-lived cells in the body that retain the “memory” of how to fight that particular disease so that your body is better equipped to protect you from future infections.
Welp. Because measles can infect these memory cells, often the memory cells are either killed by the virus, or by the immune system attempting to kill the virus inside (kinda like blowing up a building in which you know the enemy is hiding). As these memory cells die, so dies the memory of how to protect yourself from infections….. and you lose your immunity. The vaccines you received in the past? Like you never had them. All the infections you have had in the past? Like it never happened. You are now susceptible to every disease all over again, like you are a newborn baby.
It is estimated that it takes at least 2, and up to 5, years to restore the lost immunity. During that time, the person is highly susceptible to infections and more likely to die from them. In one statistical analysis of children in Brazil, 50% of non-measles infectious disease deaths could be attributed to immune amnesia. If these children had not had their immunity wiped out, they would have survived infections with other pathogens. The silver lining of this story is this: if we eradicate measles out of an area, deaths from other infections will go down too.
Do I need a measles vaccine?
The measles vaccine is given as the MMR: Measles, Mumps and Rubella vaccine. This is a live vaccine, containing active but mutated measles viruses. Capable of a limited amount of replication but not enough to make you sick. Do you need one? Depends on who you are.
I was born before 1957. Since measles was so prevalent before the vaccine was introduced, it is assumed anyone born before 1957 probably had measles disease. You are fully immune and do not need vaccination.
I received a measles vaccine between 1963-1967. During these years, a killed measles vaccine was on the market which was discovered to be not as effective as the live MMR vaccine. You may need to be revaccinated with the more effective vaccine. See your doctor.
I recieved at least one dose of MMR after my first birthday. You are most likely immune and do not need to be re-vaccinated. If you are at high risk of infection (health care workers, travellers, school/college aged folks) make sure you had two MMR shots in order to be fully protected.
I am currently pregnant. Since the MMR is a live vaccine that can cause fever as a side effect, pregnant women should not get vaccinated. High fevers can result in miscarriage.
I (or someone close to me) am immunocompromised. Live vaccines are typically not given to those without healthy immune systems as it may be dangerous. It is even possible to “spread” the vaccine virus to close contacts, so you may need to delay vaccination to protect close contacts that are immunocompromised. Talk to your doctor about your specific situation.
My baby is less than 1 year old. MMR should not be given to children less than 1 year old. Not because its unsafe, but rather because the vaccine is not as effective in the very young… for kind of a cool reason! Moms transfer their antibodies to their babies via the placenta and by breast feeding. Those antibodies give the baby a short term “donated” immune system. Since MMR contains LIVE measles viruses, the donated antibodies in the baby will actually attack and destroy the vaccine viruses, making it ineffective. By age 1, those antibodies are long gone and live vaccines (MMR, chicken pox, etc) can be given.
I am a healthy person, over age 1, but have not received MMR. Get it. Both doses. Talk to your doctor about it.
Stay happy, healthy and Measles-free,
Jessica at TCA
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DC Health. DC Cautions Residents of a Potential Measles Exposure 2024.
Gregory, J. Ireland measles: Adult dies in hospital after contracting disease. BBC. 2024
Laksono, B. et al. Measles Virus Host Invasion and Pathogenesis. Viruses. 2016.
CDC. Complications of Measles.
The Associated Press. In Trenton, RFK Jr. speaks against mandatory school vaccinations. 2015.
Rocke, Z and Belyayeva, M. Subacute sclerosing panencephalitis. StatPearls. 2023.
Hagen, A. Measles and Immune Amnesia. American Society for Microbiology. 2024.
CDC. Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know