CDC: Bracing for a Measles Outbreak

Measles should not be taken lightly; they are a highly contagious acute viral disease that can be severe enough to cause hospitalization or even death. Measles can cause complications such as diarrhea, ear infections, pneumonia, and chronic disability from measles encephalitis (fever and swelling in the brain caused by inflammation).

Officials at the Center for Disease Control (CDC) are gearing up for the worst measles outbreak since 2001. Originally 64 cases were reported from nine states; Arizona (15 cases), California (12), Hawaii (3), Illinois (1), Michigan (4), New York (23,), Pennsylvania (1), Virginia (1), and Wisconsin (4). Since last week, another 8 cases in Washington State have come to light, not yet formally reported to the agency, according to Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases.

Of the original 64 patients, ages ranged from 5 months to 71 years of age; 14 patients were under the age of 12 months, which is too young for routine vaccination. Another 18 were under the age of five and had not been vaccinated due to delay or lack of opportunity, or personal choice not to immunize. Eleven were 5-19 years old, 18 were 20-49, and 3 were over the age of 50. Fourteen (21.5%) of the 64 patients have been hospitalized, but no deaths have been reported.

Prior to initiation of the measles vaccination program in 1963, approximately 3 to 4 million people in the U.S. were infected each year; about 48,000 were hospitalized, with 400 to 500 deaths being reported, and approximately 1,000 developed chronic disability from measles encephalitis. Since vaccination began, measles in the United States had been reduced to fewer than 3,500 cases in 1988. However, the number of new cases jumped to more than 18,000 in 1989 and to nearly 28,000 in 1990, with 123 deaths reported. Most of these cases occurred among inner-city preschool children and recent immigrants, but adolescents and young adults, who may have lost immunity from their childhood vaccinations, also experienced an increase. The number of new cases declined rapidly in the 1990s and early twenty-first century.

Since January 2008, there have been 72 cases of measles reported in the U.S. While this number may seem small, it's the highest number for the same time period since 2001, when there were 116 cases reported. Comparatively there were only 64 cases reported for the entire year of 2007.

Canada is also reporting about 20 cases in Toronto and Guelph, while the health unit is calling this an outbreak; the risk of infection is considered low because of the country's high immunization rates.

This outbreak in 2008 is a direct result of the disease being imported and a failure to obtain vaccination, often because of personal or religious exemption. Unvaccinated persons are at risk for acquiring measles themselves and also of transmitting the disease to others, including children too young to be vaccinated.

The vaccine against measles is highly effective in preventing infections, so maintaining a high vigilance of immunization levels in the community are imperative at preventing or drastically decreasing the size of outbreaks. In many parts of the world measles is still a common childhood disease, and in developing countries it kills as many as 30 percent of the children it infects.

Measles is characterized by small red dots appearing on the surface of the skin, irritation of the eyes (especially on exposure to light) and small white spots appearing in the mouth. About 12 days after exposure, a high fever, sneezing, coughing and swelling of the neck glands often occur, with the rash following in about 4 days.