COMMENTARY

Measles Outbreaks in the US: Why Now?

Paul A. Offit, MD

Disclosures

June 10, 2014

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Hi. I am Paul Offit, and I am speaking to you from the Vaccine Education Center at the Children's Hospital of Philadelphia.

Today I want to talk about the measles outbreaks that are currently occurring in the United States. The Centers for Disease Control and Prevention (CDC) recently released data showing that in the first 5 months of this year, we have had 288 cases of measles.[1] The major clusters have been in California, Ohio, and New York City. Of those 288 cases, about 1 in 7 people who were infected were hospitalized. They were hospitalized with pneumonia, hepatitis, pancytopenia, and thrombocytopenia. No one has had encephalitis, nor has anyone died yet -- but if we get more cases, that will happen.

What is interesting is how this current epidemic came to be. Basically, it began with unvaccinated people who traveled overseas. The first cases all were brought into the United States initially by someone who traveled to 1 of 18 countries, the most prominent of which was the Philippines. During the past year, the Philippines has had 32,000 cases of measles and 41 related deaths.[1]

The unvaccinated person visits this country, then returns to the United States and begins to spread it among a cluster of other unvaccinated people. Of interest, about 90% of those who got this infection were unvaccinated; also of interest, those people were not unvaccinated because of medical reasons. In virtually all cases, they were unvaccinated because of nonmedical reasons. Those people knew about the vaccine and chose not to get it because of philosophical reasons or religious reasons, but they had chosen not to be vaccinated. They chose to put themselves at risk.

The Global Sea of Measles

Last year there were 20 million cases of measles in the world and 122,000 deaths.[1] We need to realize that we are not alone here. We are not isolated in the United States. International travel is common, and if you choose not to vaccinate yourself or your child, you put yourself at risk because international travel is common and because, frankly, we live in a global sea of measles.

For this reason, the CDC now recommends that anyone who is over 6 months of age and is traveling to a potentially endemic country should receive the measles, mumps, and rubella (MMR) vaccine. For those who are over 12 months of age, CDC recommends that they receive 2 doses of vaccine separated by at least 28 days, instead of waiting for that booster dose to occur at 4-6 years of age.

So, be careful. Because measles is still common in the world, and as international travel is also common, we are at risk. Please make sure that you and your children are vaccinated against measles. Thank you.

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