Take it from someone who almost died: The resurgence of measles is terrifying

My mother tells me I almost died from measles at age 7. I don’t know if I really was in mortal danger, but the misery of the illness remains one of my most vivid childhood memories. Angry red splotches covered me from face to feet. I burned with fever for days. My inflamed eyes could not tolerate light, and both ears seared in pain from infection. An ear specialist showed up early one morning and, right there in my bedroom, lanced my eardrums to drain the pus, while I screamed in anguish. I missed a month of second grade.

The first measles vaccine was licensed the following year, in 1963. I found it wondrous to think that no more kids would get sick, as I had. 

In the years before the vaccine became available, the Centers for Disease Control and Prevention (CDC) documented more than a half-million cases annually but estimated the real toll at 3 to 4 million people. Although 400 to 500 Americans died each year, most patients — overwhelmingly children — got through a bout of measles with a rash and a few days of discomfort. As the public embraced vaccination and measles virtually disappeared from the United States, it was easy to think of the ailment as a bygone relic. This year’s surge in cases, driven by outbreaks in communities with low vaccination rates, serves as a reminder that measles is highly contagious and can cause serious complications. It also raises an urgent question: How can government effectively counter vaccine refusal or complacency and make sure enough of the population is immunized so infection can’t spread?

“We are in a way the victims of our own success,” said Alison M. Buttenheim, an associate professor of nursing at the University of Pennsylvania. “Very few clinicians in practice or parents of young children have ever seen a case of measles face to face. It's easy then to assume the disease isn't that common and it isn't that severe. If you add those two incorrect perceptions into a vaccine decision-making algorithm for an individual parent, you can see how you might end up thinking vaccination wasn't that important or that effective. At the same time, if you have any concerns about vaccine safety, it would be easy to feel like not vaccinating was the rational choice.”

Experts say at least 95 percent of the population needs to be fully vaccinated against a highly contagious illness like measles to achieve what’s known as herd immunity, when outbreaks are eliminated because the virus can’t find enough susceptible people to infect. Only 23 states hit that mark on vaccine rates among kindergartners in 2017-2018, a CDC study found. Washington D.C. reported the nation’s lowest rate: 81.3 percent of kindergartners had the required two doses of the combined measles, mumps and rubella vaccine. Colorado, Kansas and Idaho also had vaccination rates below 90 percent.

The World Health Organization lists the unwillingness to vaccinate, despite the availability of safe and effective vaccines, among the top 10 threats to global health. This refusal, WHO says, is a major factor in the 30 percent increase in measles cases globally. Vaccine antipathy has combined with robust international travel to push the U.S. measles case count this year to the highest level in a quarter-century. As of May 17, 880 cases had been reported to CDC, and that’s surely an undercount because families and doctors often don’t report the illness, especially if it is mild.

Large outbreaks in ultra-Orthodox Jewish communities in Brooklyn and suburban Rockland County, New York, began after several unvaccinated people contracted the virus in Israel and then returned home. In Washington state, health officials linked a three-county outbreak earlier this month to at Seattle-Tacoma International Airport.

A study published earlier this month uses the combination of non-medical exemptions to school vaccine requirements and proximity to international airports to predict future measles hotspots. Chicago, Los Angeles and Miami ranked as the places at highest risk. The study, published in The Lancet Infectious Diseases, is in line with the Los Angeles County Health Department’s assessment of the local risk. Health officials estimate that more than 1 million people in L.A. County are unvaccinated or under-vaccinated.

Buttenheim, who studies vaccine refusal, says the latest outbreaks and the resulting barrage of news stories aren’t likely to sway vaccine opponents. “I wouldn't expect that a lot of parents who didn't want to vaccinate would suddenly say, "Oh look, more than 700 cases of measles, we should probably vaccinate!” she told me in an email.

In fact, some research has shown that public health messages about the dangers of measles — including dramatic narratives of children who almost died — turn out to be counterproductive. They somehow reinforce the false perception that the vaccine itself isn’t safe, and particularly the idea of a vaccine-autism link, which scientists have roundly debunked. Educational campaigns about the very real risks of measles seem only to harden some parents’ resolve not to vaccinate.

The only proven remedy for vaccine refusal is policy. All states require children to be vaccinated to attend school, and all allow exemptions in the rare instances that a vaccine would endanger the health of a child — for example, if a child has a weakened immune system because of cancer or chemotherapy. But for more than three decades, all but two states also allowed exemptions for religious, philosophical or other non-medical reasons. Mississippi and West Virginia, which did not permit non-medical exemptions, have consistently reported exceptionally high vaccination rates among kindergarteners — 99.4 percent and 98.4 percent, respectively, in the most recent CDC study.

After a measles outbreak at Disneyland in late 2014 into 2015, California became the third state to ban non-medical exemptions. The state also strengthened requirements for vaccination in public and private schools and day care centers. The number of medical exemptions have tripled since the law took effect, somewhat blunting its impact. Still, vaccine rates among kindergartners have increased significantly. Newly proposed legislation would crack down on medical exemptions by requiring the state health department to review each case. 

The American Academy of Pediatrics has made the elimination of non-medical exemptions its top priority this year. But progress across the country is spotty. A new law in Washington state, to take effect in July, eliminates personal exemptions. In New York state, bills to abolish religious exemptions have languished in the legislature.

The Los Angeles Unified District has confirmed no measles cases this year, said Rosina Franco, senior physician for student medical services and student health and human services in the District. But the continuing outbreaks across the country have her “on high alert,” she said. 

“I personally have never seen a case of measles. And I really don’t want to see it.”