IMMUNE SYSTEM STAYS DEPLETED UP TO 3 YEARS AFTER MEASLES

IMPORTANCE OF MEASLES VACCINE TO PREVENT DAMAGING INFECTIONS

FRIDAY, May 8, 2015 (HealthDay News) -- Children who survive a measles infection remain vulnerable to other potentially deadly infections for as long as two or three years after the measles infection, according to research published in the May 8 issue of Science.

Michael Mina, Ph.D., of Princeton University in New Jersey, and colleagues analyzed public health data from before and after mass measles vaccinations began in Denmark, England, Wales, and the United States. They verified that the childhood mortality rate in those countries did indeed fall by about 50 percent following the introduction of the measles vaccine. Further, they found that children in those countries who contracted and survived the measles were more likely to subsequently die from another infectious disease.

Children's immune systems in England and Wales appeared to be weakened for as long as 28 months following a measles infection, during which time they were at increased risk for death from a viral or bacterial disease, the researchers reported. In the United States, the effect lasted about 31 months, and in Denmark, about 26 months.

"These results provide population evidence for a generalized prolonged (roughly two- to three-year) impact of measles infection on subsequent mortality from other infectious diseases," the authors write. The effect appears specific to measles. The research team conducted a similar analysis on pertussis, and found no association between a country's pertussis rate and subsequent childhood deaths due to other infectious diseases.

Measles Journey Highlights Risk to Unvaccinated Kids

Minnesota outbreak began with a toddler traveling overseas, study says

MONDAY, June 9, 2014 (HealthDay News) -- A measles outbreak in Minnesota offers a case study of how the disease is transmitted in the United States today: An unvaccinated person travels abroad, brings measles back and infects vulnerable people -- including children who are unprotected because their parents chose not to vaccinate them.

That's the conclusion of a report published online June 9 in Pediatrics that details the 2011 outbreak that sickened 19 children and two adults in the state.

It began when an unvaccinated 2-year-old was taken to Kenya, where he contracted the measles virus. After returning to the United States, the child developed a fever, cough and vomiting. However, before measles was diagnosed, he passed the virus on to three children in a drop-in child care center and another household member. Contacts then multiplied, with more than 3,000 people eventually exposed.

Nine of the children ultimately infected were old enough to have received the measles-mumps-rubella (MMR) vaccine but had not.

In most of those cases, the child's parents feared the MMR vaccine could cause autism, according to researchers at the Minnesota Department of Health.

That idea -- first raised in 1998, by a British doctor named Andrew Wakefield -- has been discredited, said Pam Gahr, an epidemiologist who led the new research.

"But I think that as long as autism remains unexplained, the idea [that the MMR is a cause] will persist," Gahr said.

In the Minnesota outbreak, the child infected in Kenya was of Somali descent, as were most of the children whose parents had declined the MMR vaccine because of safety fears.

And that's consistent, Gahr said, with a striking decline in MMR acceptance among Minnesota's relatively large Somali population. In 2004, the number of Somali children in the state who were on schedule with their MMR topped 90 percent.

"By 2010, that was down to just 54 percent," Gahr said.

From what the health department learned in parent interviews, the decline seemed to stem from misinformation about an MMR-autism link.

Despite the unique circumstances of the Minnesota outbreak, though, measles can happen anywhere people are unvaccinated, said Dr. Andrew Pavia, chief of pediatric infectious diseases at the University of Utah in Salt Lake City.

"These outbreaks occur in all types of settings," said Pavia, who was not involved in the current study.

U.S. measles cases are at a 20-year high this year, the U.S. Centers for Disease Control and Prevention reported last week. As of May 30, the agency had received reports of 334 measles cases in 18 states.

Nearly all of the outbreaks involved unvaccinated people who brought measles back after a trip overseas, the CDC said.

The hardest-hit state is Ohio, where people in several Amish communities were infected after unvaccinated missionaries traveled to the Philippines and carried the measles virus back.

Amish communities have historically had low vaccination rates. And a 2011 survey of Amish parents who refused to vaccinate found that nearly all cited safety fears.

According to Pavia, the safety concerns of parents in the Minnesota outbreak illustrate the "power of bad information."

The MMR-autism link proposed by Wakefield was later found to be based on fraudulent data, and many studies since have found no connection between the vaccine and autism.

"Wakefield has been thoroughly debunked," Pavia said.

Gahr noted that these days, most parents never had or even saw a case of the measles. So some might dismiss it as just another childhood infection, she said.

But measles can prove serious, or even deadly. About 30 percent of people with measles develop a complication such as ear infection, diarrhea or pneumonia, the CDC says. Among children, one in 1,000 suffers brain inflammation, and one or two out of every 1,000 die.

"Even if you don't develop complications," Pavia said, "the disease is miserable."

Measles typically begins with a fever, cough, runny nose and "pink eye." After several days, a rash emerges around the face and neck, then spreads to the rest of the body.

"The thing is, we have the power to prevent it," Pavia said.

In the case of the Minnesota outbreak, he added, "the first infection that spread in the community was misinformation. The second was measles."

Measles Vaccine Refusal Helps Make 2014 a Record Year

Robert Lowes

May 29, 2014

The number of measles cases in 2014 through May 23, the highest year-to-date total since 1994, has the Centers for Disease Control and Prevention (CDC) worried that the virus may become endemic again on US soil as it spreads from overseas travelers to pockets of vaccine refusers.

The CDC has received reports of 288 confirmed cases of measles — none fatal — from January 1 through May 23, with 280 associated with importation from at least 18 countries, according to an article published online May 29 in the Morbidity and Mortality Weekly Report. Most of the 45 individuals who actually imported the virus were US travelers returning from abroad.

In 69% of the 288 cases, the person was unvaccinated. In another 20%, vaccination status was unknown. For 195 US residents who had measles and were unvaccinated, 165, or 85%, declined a shot for religious, philosophical, or personal reasons.

The United States had 764 measles cases in 1994 through May 23, and 963 by year's end, according to data released at a press conference today.

The CDC declared in 2000 that the United States had eliminated measles as an indigenous disease, meaning there was no longer any year-round endemic transmission of the virus. Although this country's status has not changed, other countries such as the Philippines are rife with the disease.

Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, warned at the press conference that the findings are a "wake-up call."

"Measles anywhere in the world can reach our country, and unvaccinated Americans are at risk," said Dr. Schuchat. "Measles can really get out of control quite quickly. You can get indigenous spread if you can't break the chain of transmission."

As of now, 15 scattered US outbreaks that account for 79% of all cases are "being contained," said Dr. Schuchat. The largest outbreak, involving 138 cases, has hit unvaccinated Amish communities in Ohio that had dispatched aid workers to the Philippines, which is recovering from last year's Typhoon Haiyan.

Vaccinate Before Takeoff

One key to lowering the measles case count, said Dr. Schuchat, is for Americans with international travel plans to get 2 doses of the measles, mumps, and rubella (MMR) vaccine if they haven't been vaccinated or don't know their immunization status. The 2-dose regimen also applies to healthcare workers and childcare attendants who are catching up on measles protection. As always, pregnant women and individuals with suppressed immune systems should not receive the vaccine.

Dr. Schuchat noted that individuals born before 1957 probably had measles at some point, which relieves them from getting the shot. The vaccine debuted in 1963. She described it as "very safe and effective."

Routine vaccination for children consists of a first dose at 12 to 15 months of age and a second dose at 4 to 6 years of age. If someone is traveling internationally with a child aged under 12 months, however, the CDC recommends a single dose before departure. Such a child should receive a second dose at 12 to 15 months and a third at least 28 days later. Children aged 12 months or older should have 2 doses separated by at least 28 days.

More information on the CDC's recommendations for measles vaccination is available on the agency's Web site.

Morb Mortal Wkly Rep. Published online May 29, 2014. Full text