Vaccines and Preventing Outbreaks of Measles, Rubella

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February 14, 2019


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Over the past decade, news organizations have reported on outbreaks of viruses that were once thought to be eliminated in the United States and other developed countries. So far, in 2019, measles and rubella outbreaks in the U.S. have made headlines and have placed public health officials in the spotlight to remind people of the benefits of vaccinations against these deadly infections that are resurging.

State health officials in Washington, New York, California, Oregon, Pennsylvania, Connecticut, Colorado, and Georgia have reported measles cases exceeding the number of cases they usually see in a year. Washington has declared a state of emergency to get resources to the area to help contain the outbreak, while New York has kept 6,000 unvaccinated children from attending schools for more than  two months.

Additionally, someone with the rubella virus attended the North American International Auto Show in Detroit last month, exposing potentially thousands of people to that virus, which has its greatest impact on unborn babies.

Public health officials say an anti-vaccination movement among some parents has fueled the resurgence or spread of these diseases. Publicity years ago stemming from a now-discredited and retracted study about a possible link between vaccines and autism had increased worries among some parents about potential side effects. However, the U.S. Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA) and the National Institutes of Health (NIH) have reiterated the safety of vaccines. The CDC states that “studies have shown that there is no link between receiving vaccines and developing ASD (Autism Spectrum Disorder).”

Measles

The CDC says the virus that causes measles spreads quickly through the air when an infected person coughs or sneezes and others breathe in the virus. Signs of measles include a fever, cough, runny nose, red eyes and the signature rash of tiny red spots that spread from the head to the rest of the body. Serious complications such as pneumonia, encephalitis and premature birth have been documented with measles, as has one to two deaths out of every 1,000 cases, the CDC reports. But since the measles vaccine became available in 1963 and has been widely used in the U.S. since, the CDC was able to declare the infection “eliminated” in 2000, indicating no continuous transmission of the virus during a 12-month period in a specific geographic area. That elimination ended when a resurgence of cases, like the latest outbreaks, began to show up.

Rubella

The virus that causes rubella, commonly called “German measles,” causes similar symptoms to measles, including a fever, cough, runny nose and red eyes. But, with rubella, the first sign is usually the rash that lasts about three days, according to the CDC. A sore throat may also be present.

For many children and adults who contract rubella, symptoms are mild, and serious complications are rare. But for pregnant women, rubella can cause miscarriage, infant death after birth or serious birth defects, such as heart problems, deafness, blindness, intellectual disability and liver or spleen damage.

Like with the measles, a vaccine for rubella was developed in the 1960s and has been widely used in the U.S. since, leading to the CDC to also declare it eliminated in 2004. Most cases of rubella in the U.S. today originate in areas of the world where the vaccine isn’t available.

Travelers Bring the Infections

The measles outbreaks in Washington and New York have both been traced to travelers coming from countries where vaccines aren’t readily available or used, health officials say. But these travelers’ contact with unvaccinated individuals in the U.S., likely fueled the rapid spread, they say.

As for the rubella case at the Detroit car show, less is known about the individual who exposed people there, but health department officials have warned people who attended to be on the lookout for symptoms of the infection.

MMR Vaccine

Mario Zambrano, M.D., a pediatric emergency physician at Homestead Hospital, says the best way to protect against measles and rubella is through vaccinations. The MMR vaccine, which combines the vaccinations against measles, mumps and rubella into one shot, became available in the United States in the 1970s and is credited for the decline in cases in developed countries, Dr. Zambrano says.

MMRV Vaccine

Another vaccine, MMRV, which combines MMR with a vaccine for varicella, the virus that causes chickenpox, may be used instead to prevent these infections. Both MMR and MMRV are given first between 12 and 15 months of age, with a booster shot recommended between 4-6 years, according to the CDC, to enhance the expected lifetime protection against these viruses. The MMRV is as effective as the MMR shot and eliminates the need for an extra shot at 12 months of age. It’s only licensed for use between 12 months and up to 12 years, though.

Adult Vaccinations

Dr. Zambrano says that adults who are under vaccinated or who did not receive either the MMR or MMRV vaccines as children can benefit from getting the MMR vaccine as adults. The CDC says that often during outbreaks of these illnesses, public health officials recommend anyone who doesn’t have evidence of immunity – that is, a record of a previous vaccination – get vaccinated.

‘Vaccine Hesitancy’

Dr. Zambrano notes that vaccination rates steadily improved after it became a requirement to enroll in school in the early 70s. This time-frame corresponds to the declining number of cases of measles and rubella. He further notes that these illnesses are returning at rates in line with the increasing number of vaccine exemptions for religious or political reasons.

The World Health Organization (WHO) recently listed “vaccine hesitancy” as one of the top 10 global health threats for 2019.  This reluctance or refusal to be vaccinated, WHO says, threatens to reverse strides made to eliminating vaccine-preventable diseases, like measles and rubella. WHO notes that vaccination currently prevents between two and three million deaths annually and is “one of the most cost-effective ways of avoiding disease” throughout the world.

“I wish some vaccines were mandatory,” Dr. Zambrano said, “but we live in a society that cannot force people to believe what you believe.”

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