Measles

MEASLES VIRUS

The 'lessor of two evils' argument is only valid when the merits of the two evils being compared have been arrived at based solely upon what is proven to be true and in the absence of speculation. The importance of this criteria rings especially true when it comes to issues of public health. We must remain diligent in our efforts to avoid the tendency toward false-causality fallacy. No good has ever come from it.

MEASLES is a viral infection of the respiratory system, immune system, and skin caused by a paramyxovirus of the genus Morbillivirus.[1][2]

MEASLES is highly contagious—90% of people without immunity sharing space with an infected person will catch it.[3]

MEASLES is an airborne disease spread by coughing and sneezing, close personal contact or direct contact with infected nasal or throat secretions.[4]

MEASLES infects the mucous membranes, then spreads throughout the body.[4]

MEASLES remains active and contagious in the air and on infected surfaces for up to 2 hours.[4]

MEASLES can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts.[4]

MEASLES is one of the leading causes of death of children worldwide.[42]

MEASLES is a human disease and is not known to occur in animals.[4]

PREVENTION

Measles can be prevented with the MMR (measles, mumps, and rubella) vaccine.[5]

• In 1954, John Franklin Enders and Thomas Chalmers Peebles isolated measles virus from an 11-year-old boy, David Edmonston.[7][25]

• Maurice Ralph Hilleman was an American microbiologist who developed over 36 vaccines.[6] 
• He is credited with saving more lives than any other medical scientist of the 20th century.[10]
• While working at Merck, Hilleman developed the first successful measles vaccine.[8]
• Licensed vaccines to prevent the disease became available in 1963.[9]

Life-threatening adverse reactions to the MMR vaccination (measles, mumps, and rubella) occur in less than 1 per million vaccinations (<0.0001%).[11]

One dose of measles vaccine is about 93% effective at preventing measles if exposed to the virus and two doses is about 97% effective.[42]

Fully vaccinated people who get measles (the 0.3%) are much more likely to have a milder illness, and they are also less likely to spread the disease to other people, including people who can’t get vaccinated because they are too young or have weakened immune systems.[42]

Before the measles vaccination program started in 1963, it is estimated that about 3 to 4 million people got measles each year in the United States alone. Of those people, 400 to 500 died, 48,000 were hospitalized, and 4,000 developed encephalitis (brain swelling) from measles.[13][42]

In 1980, before global vaccination programs, measles caused an estimated 2.6 million deaths each year.[5]

Accelerated immunization activities have reduced global measles deaths by ~75%, from an estimated 630 000 in 1990, to 544 200 in 2000 to 158 000 in 2011 to 145 700 in 2013 (mostly children under the age of 5).[5][12][16]

SYMPTOMS

An asymptomatic incubation period occurs 9 to 12 days from initial exposure.[17]

10-12 days after exposure to the measles virus, an infected person will experience a high grade fever lasting about 4 to 7 days.[5]

Koplik's spots

INITIAL STAGE: runny nose, a cough, red and watery eyes, and small white spots (Koplik's spots) inside the cheeks.[5]

The RASH usually appears 2-3 days after the onset of illness.[18]

COMPLICATIONS

Children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications,[5] which may include:

CORNEAL ULCERATION which can lead to corneal scarring.[19]

SWELLING OF THE BRAIN(encephalitis)[20][21] 

• ~1 child out of every 1,000 who get measles will develop encephalitis which can lead to convulsions and leave the child deaf &/or mentally impaired.[5]

SEVERE DIARRHEA and related dehydration

• Diarrhea is reported in less than 1 out of 10 people with measles.[5]

EAR INFECTIONS[22] 

• Ear infections occur in about 1 out of every 10 children with measles, and can result in permanent hearing loss.[5]

SEVERE RESPIRATORY INFECTIONS such as pneumonia[23] 

• ~1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.[5]

For every 1,000 children who get measles, 1 or 2 will die from it.[5][15]

RISK FACTORS

Any NON-IMMUNE PERSON (who has not been vaccinated or was vaccinated but did not develop immunity) can become infected.[5]

In populations with HIGH LEVELS OF MALNUTRITION, and a LACK OF ADEQUATE HEALTHCARE, mortality can be as high as 10%. In cases of measles involving complications, the rate may rise to 20–30%.[14][24][27][29]

In IMMUNOCOMPROMISED PERSONS, the fatality rate is approximately 30%.[25][27][28]

Persons with LEUKEMIA,[26] are at risk, regardless of immunization status.[27] 

Measles poses several risks to women who are PREGNANT, including: miscarriage, stillbirth or pre-term delivery.[27][30] 

VITAMIN A DEFICIENCY[27][31]

• Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%.[5]
• A systematic review of trials into the use of Vitamin A, found no significant reduction in overall mortality, but it did reduce mortality in children aged under two years.[32-37]

MEASLES CASES & OUTBREAKS 

The CRITICAL COMMUNITY SIZE (CCS) is the minimum number of new hosts required before a disease dies out.[38]

The CCS for measles is estimated to be 250,000-500,000, “based on both theoretical and empirical investigation."[39]

Measles ELIMINATION is defined as the absence of continuous disease transmission for 12 months or more in a specific geographic area.[40] 

In the Region of the Americas (North, Central and South America and the Caribbean), measles has been eliminated; however, outbreaks continue to occur when the virus is imported from other countries (Africa, Asia, Europe, Oceania) where measles is present (endemic).[42]

2015: From January 1 to January 30, 2015, 102 people from 14 U.S. states were reported to have measles.[41] Outbreak linked to an amusement park in California

2014: Brazilian health authorities reported a significant increase in the number of cases as compared to the same time period in 2013.[42]

2014: In the Philippines there is an ongoing outbreak affecting Manila and other regions of the country.[42]

2014: Vietnam is currently experiencing an outbreak; there have been a high number of measles cases reported throughout the country since the beginning of 2014.[42] 

2014: In China,  health authorities reported a significant increase in the number of cases as compared to those reported in 2013.[42] 

2014: The U.S. experienced 23 measles outbreaks, including one large outbreak of 383 cases, occurring primarily among unvaccinated Amish communities in Ohio.[41]

2013: The U.S. experienced 11 outbreaks, 3 of which had more than 20 cases, including an outbreak with 58 cases.[41]

2011: More than 30 countries in the WHO European Region reported an increase in measles; France, in particular experienced a large outbreak.[41]

2008: The U.S. experienced several outbreaks, including 3 large outbreaks. The increase in cases in 2008 was the result of spread in communities with groups of unvaccinated people.[41]

LINK TO THE WHO WORLDWIDE MEASLES STATS:

REPORTED MEASLES CASES & INCIDENCE RATES BY WHO MEMBER STATES 2013, 2014 AS OF JAN. 20, 2015

***

FIN

UPDATES

Measles Weakens The Immune System For Years DISCOVERMAGAZINE.COM MAY 7, 2015

Measles Vaccine Not Linked With Autism, Even in High Risk Kids LIVESCIENCE APRIL 21, 2015

U.S. Measles Tally For 2015 Now at 121 Cases   SCIENCE NEWS FEB. 11, 2015

Autism community's leaders make it crystal clear: Vaccinations do not cause autism  AMERICANHEALTHREVIEW.COM  FEB. 11, 2015

How Quickly Would Measles Spread If Too Few People Were Vaccinated [video] SCIENTIFIC AMERICAN  MARCH 9, 2015






REFERENCES

[1] Chen, SSP; Fennelly, G; Burnett, M; Domachowske, J; Dyne, PL; Elston, DM; DeVore, HK; Krilov, LR; Krusinski, P; Patterson, JW; Sawtelle, S; Taylor, GA; Wells, MJ; Wilkes, G; Windle, ML; Young, GM (31 January 2014). Steele, RW, ed."Measles". Medscape Reference. WebMD.

[2] Caserta, MT, ed. (September 2013)."Measles". Merck Manual Professional. Merck Sharp & Dohme Corp.

[3] "Measles Fact sheet N°286".who.int. November 2014

[4] http://www.who.int/mediacentre/factsheets/fs286/en/

[5] http://www.cdc.gov/measles/vaccination.html

[6]  Offit PA (2007). Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases. Washington, DC: Smithsonian. ISBN 0-06-122796-X.

[7]  Tyrrell, D. A. J. (1987). "John Franklin Enders. 10 February 1897-8 September 1985". Biographical Memoirs of Fellows of the Royal Society 33: 212–226. doi:10.1098/rsbm.1987.0008. JSTOR 769951. edit

[8] Offit PA (2007). Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases. Washington, DC: Smithsonian.ISBN 0-06-122796-X.

[9] "Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP)". Centers for Disease Control and Prevention (CDC).

[10] Maugh, Thomas H. II (2005-04-13). "Maurice R. Hilleman, 85; Scientist Developed Many Vaccines That Saved Millions of Lives".Los Angeles Times.

[11] Njayou M, Balla A, Kapo E (1991). "Comparison of four techniques of measles diagnosis: Virus isolation, immunofluorescence, immunoperoxidase & ELISA". The Indian Journal of Medical Research 93: 340–344. PMID 1797639.

[12]  Bartlett, M.S. (1957). "Measles periodicity and community size". J. Roy. Stat. Soc. Ser. A (120): 48–70.

[13] Black FL (1966). "Measles endemicity in insular populations; critical community size and its evolutionary implications". Journal of Theoretical Biology 11 (2): 207–11.doi:10.1016/0022-5193(66)90161-5.PMID 5965486.

[14] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, et al. (Dec 15, 2012). "Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet 380 (9859): 2095–128. doi:10.1016/S0140-6736(12)61728-0. PMID 23245604.

[15] "Complications of measles". CDC. November 3, 2014. RetrievedNovember 7, 2014.

[16] Measles, World Health Organization Fact sheet N°286. Updated February 2014

[17] Risk of infection East and Southwest Asia (Report). Occucare International. May 16, 2012. p. 6.

[18] "Measles".

[19] Fisher DL, Defres S, Solomon T (2014)."Measles-induced encephalitis". QJM. Epub ahead of print.doi:10.1093/qjmed/hcu113.PMID 24865261.

[20] Yasunaga H, Shi Y, Takeuchi M, Horiguchi H, Hashimoto H, Matsuda S, Ohe K (2010). "Measles-related hospitalizations and complications in Japan, 2007-2008". Internal Medicine (Tokyo, Japan) 49 (18): 1965–1970.doi:10.2169/internalmedicine.49.3843.PMID 20847499.

[21] Gardiner, W. T. (2007). "Otitis Media in Measles". The Journal of Laryngology & Otology 39 (11): 614.doi:10.1017/S0022215100026712.

[22] NHS UK: Symptoms of measles. Last reviewed: 26/01/2010.

[23] Baxby D (1997). "Classic Paper: Henry Koplik. The diagnosis of the invasion of measles from a study of the exanthema as it appears on the buccal membrane". Reviews in Medical Virology7 (2): 71–4. doi:10.1002/(SICI)1099-1654(199707)7:2<71::AID-RMV185>3.0.CO;2-S.PMID 10398471.

[24] Sabella C (2010). "Measles: Not just a childhood rash". Cleveland Clinic Journal of Medicine 77 (3): 207–213.doi:10.3949/ccjm.77a.09123.PMID 20200172.

[25] "Vitamin A".

[26] Enders JF, Peebles TC (1954). "Propagation in tissue culture of cytopathogenic agents from patients with measles". Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine (New York, N.Y.) 86 (2): 277–86.doi:10.3181/00379727-86-21073.PMID 13177653.

[27] Perry RT, Halsey NA (May 1, 2004). "The Clinical Significance of Measles: A Review". The Journal of Infectious Diseases 189 (S1): S4–16.doi:10.1086/377712. PMID 15106083

[28]Ellison, J.B (1931). "Pneumonia in Measles". 1931 Archives of Disease in Childhood 6 (31). pp. 37–52.PMC 1975146.

[29] Sension MG, Quinn TC, Markowitz LE, Linnan MJ, Jones TS, Francis HL, Nzilambi N, Duma MN, Ryder RW (1988). "Measles in hospitalized African children with human immunodeficiency virus".American Journal of Diseases of Children (1960) 142 (12): 1271–2.doi:10.1001/archpedi.1988.02150120025021. PMID 3195521.

[30] http://www.nhs.uk/chq/pages/1105.aspx?categoryid=54&subcategoryid=137

[31] Polonsky JA, Ronsse A, Ciglenecki I, Rull M, Porten K (2013). "High levels of mortality, malnutrition, and measles, among recently-displaced Somali refugees in Dagahaley camp, Dadaab refugee camp complex, Kenya, 2011".Conflict and Health 7 (1): 1.doi:10.1186/1752-1505-7-1.PMC 3607918. PMID 23339463.

[32] "Surgeon General's advisory on the use of salicylates and Reye syndrome".MMWR. Morbidity and Mortality Weekly Report 31 (22): 289–90. June 1982.PMID 6810083.

[33] Reye's Syndrome at NINDS"Epidemiologic evidence indicates that aspirin (salicylate) is the major preventable risk factor for Reye's syndrome. The mechanism by which aspirin and other salicylates trigger Reye's syndrome is not completely understood."

[34] Huiming Y, Chaomin W, Meng M (2005). Yang, Huiming, ed. "Vitamin A for treating measles in children". The Cochrane Database of Systematic Reviews (4): CD001479.doi:10.1002/14651858.CD001479.pub3. PMID 16235283.

[35] D'Souza RM, D'Souza R (2002). "Vitamin A for treating measles in children". The Cochrane Database of Systematic Reviews (1): CD001479.doi:10.1002/14651858.CD001479.PMID 11869601.

[36] D'Souza RM, D'Souza R (April 2002)."Vitamin A for preventing secondary infections in children with measles—a systematic review". Journal of Tropical Pediatrics 48 (2): 72–7.doi:10.1093/tropej/48.2.72.PMID 12022432.

[37] White LK, Yoon JJ, Lee JK, Sun A, Du Y, Fu H, Snyder JP, Plemper RK (2007)."Nonnucleoside Inhibitor of Measles Virus RNA-Dependent RNA Polymerase Complex Activity". Antimicrobial Agents and Chemotherapy 51 (7): 2293–303.doi:10.1128/AAC.00289-07.PMC 1913224. PMID 17470652.

[38] "NINDS Subacute Sclerosing Panencephalitis Information Page"

[39] 14-193b. at Merck Manual of Diagnosis and Therapy Professional Edition

[40] http://www.cdc.gov/measles/about/faqs.html

[41] http://www.cdc.gov/measles/cases-outbreaks.html#outbreaks
[42] http://travel.gc.ca/travelling/health-safety/travel-health-notices/measles

IMAGE CREDITS

"Measles virus" by Photo Credit: Cynthia S. GoldsmithContent Providers(s): CDC/ Courtesy of Cynthia S. Goldsmith; William Bellini, Ph.D. - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #8429.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.English | Slovenščina | +/−. Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Measles_virus.JPG#mediaviewer/File:Measles_virus.JPG

"Koplik spots, measles 6111 lores" by CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg. Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Koplik_spots,_measles_6111_lores.jpg#mediaviewer/File:Koplik_spots,_measles_6111_lores.jpg

"RougeoleDP" by CDC/NIP/Barbara Rice - http://phil.cdc.gov/phil/ (ID#: 132). Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:RougeoleDP.jpg#mediaviewer/File:RougeoleDP.jpg

"Hilleman-Walter-Reed" by Walter Reed Army Medical Center - The photo is a cropped version of the original, which is Order Number B014616 in the National Library of Medicine. The date and author (below) are taken from the NLM's MARC record. The photograph was published in 1958 by Walter Reed Army Medical Center. The photo has been cropped, healed to fix minor defects, and converted to JPEG (quality level 88), with the GIMP 2.6.6.. Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Hilleman-Walter-Reed.jpeg#mediaviewer/File:Hilleman-Walter-Reed.jpeg