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Measles on the Upswing

April 30, 2014

Measles on the Upswing

  1. Deborah Lehman, MD

The number of measles cases continues to increase in California and nationwide.

  1. Deborah Lehman, MD

In 2000, continuous transmission of measles in the U.S. was declared stopped and an expert CDC panel recently confirmed sustained elimination of measles in the U.S. through 2011 (NEJM JW Pediatr Adolesc Med Jan 1 2014). However, the U.S. has had several measles outbreaks during the past decade that have resulted in local transmission to susceptible individuals (http://www.cdc.gov/media/releases/2013/t1205-measles-threat.html and NEJM JW Pediatr Adolesc Med Sep 27 2006).

The California Department of Public Health has confirmed 58 cases of measles from January 1 to April 18, 2014. Twelve patients required hospitalization and no deaths were reported. Patient age ranged from 5 months to 60 years, and 43% were unvaccinated. Most (76%) unvaccinated patients reported philosophical objection to vaccination. Three patients were too young for vaccination (age, <12 months). Eleven patients had two doses of MMR vaccine documented.

During the same period, 129 measles cases have been reported in the U.S. Most U.S. and California cases were linked to travel, with an increase in imported cases from the Philippines.

Comment

Image 1: Measles rash. From the Centers for Disease Control and Prevention.
Reprinted with permission from the New England Journal of Medicine, 2006 Aug 3; 10.1056/NEJMp068149
Image 1: Measles rash. From the Centers for Disease Control and Prevention. Reprinted with permission from the New England Journal of Medicine, 2006 Aug 3; 10.1056/NEJMp068149
Image 2: Measles rash. From the Centers for Disease Control and Prevention.
Reprinted with permission from the New England Journal of Medicine , 2006 Aug 3; 10.1056/NEJMp068149
Image 2: Measles rash. From the Centers for Disease Control and Prevention. Reprinted with permission from the New England Journal of Medicine , 2006 Aug 3; 10.1056/NEJMp068149

The development of measles vaccine 50 years ago has almost eliminated this once common childhood illness, but the hope of global eradication of measles has not been achieved. According to World Health Organization data, 330 children die of measles worldwide every day. Continuous transmission has been interrupted in the U.S., but not in many developed countries, and measles remains rampant in the developing countries. This recent increase in cases in California and nationwide demonstrates the importance of early recognition of measles and of maintaining high vaccination rates to ensure herd immunity. Measles is a highly contagious, sometimes fatal disease, and unvaccinated individuals put everyone at risk for continued transmission. For young physicians who have never seen a case of measles, here are two images of the measles rash: Image 1 and Image 2.

 

 

 

 

 

 

  • Disclosures for Deborah Lehman, MD at time of publication Nothing to disclose

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