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Meet the Measles

Story by Brennen Jensen

Measles is a viral infection marked primarily by cough, high fever and rash.

In the industrialized world, measles is fatal in one of every 1,000 to 2,000 people who contract it. Approximately one in every 1,000 people who contract measles develops encephalitis, which can lead to death or lifelong neurologic complications, including retardation. Measles can rarely cause the progressive neurological disorder known as subacute sclerosing panencephalitis (SSPE), which, 6 to 10 years after exposure, is invariably fatal after many years of suffering. Hospitalization is required in about a quarter of cases, though there is no specific treatment for the viral infection. Vitamin A has been shown to reduce complications and mortality in developing countries. Other therapy for complications such as pneumonia can reduce mortality.

“Measles is also an immunosuppressive virus, so one of the things that can happen is that people are more susceptible to other types of infectious diseases for a month or two,” Diane Griffin says. Indeed, most measles deaths in the developing world are the result of diarrhea, pneumonia or other—usually bacterial—diseases acquired in the wake of measles.

Measles is also among the most contagious viruses known. “It can be maintained in the air for a fairly long period of time, so you don’t have to be in the same room at the same time to get it,” Griffin says. (Most people with measles are contagious for eight days or so, starting a few days before the telltale rash appears.) So a child with measles can cough in a pediatrician’s waiting room and an unvaccinated child there can become infected two hours later.

Before the measles vaccine was licensed in 1963, more than 500,000 measles cases and 500 deaths were reported each year (with unreported cases probably in the millions). After the vaccine was rolled out, cases plunged by 98 percent.

An improved vaccine was introduced in 1968. And in 1978 a national push was made to eliminate the disease from U.S. altogether. By 1983, annual measles cases hit a record low: fewer than 1,500.

But elimination remained elusive. Measles resurged between 1989 and 1991 with 55,000 cases, 11,000 hospitalizations and 123 deaths. Most of the outbreaks occurred among the urban poor where vaccination rates for pre-school children were very low.

Surprisingly more than 80 percent of sufferers were covered by Medicaid and had been visiting pediatricians and health clinics. Poor recordkeeping and sloppy practices meant kids weren’t always getting their shots on time or even having their vaccination status checked.

“The failure to immunize was because of the poor primary health care system, not because mothers were against immunizing their children,” says Bernard Guyer, MD, a Population, Family and Reproductive Health professor emeritus who led some of the studies in Baltimore. “The problem was corrected when pediatricians and others recognized how often they missed opportunities to vaccinate kids, and also, when better record-keeping systems came into common use.”

A smaller subset of those stricken during the outbreak early on were college students, including some who had been vaccinated against measles as children. This led to the 1989 recommendation for the now-standard practice of administering two doses of measles vaccine by the time a child is six.

In 2004 there were only 37 cases of measles in the U.S. but measles would come back yet again. 

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