The measles outbreak that started in New York City in February has left pediatricians all across the country facing a dilemma: should they see unvaccinated kids or turn them away so contagious diseases don't infect other patients too young to be fully vaccinated? The threat of infection isn't limited to just the youngest patients, though, and measles is one of the most contagious diseases out there. Adults with compromised immune systems and pregnant women are at heightened risk.
Measles was almost completely eradicated in the US until1998, when the prestigious British medical journal, The Lancet, carried a story that linked the MMR vaccine (measles, mumps, rubella) to autism. It was revealed later that the author of the study, Andrew Wakefield, committed enough ethical and medical errors during the faulty study that the journal retracted the fraudulent Wakefield article and Wakefield's United Kingdom medical license was revoked forever.
As a result of the Wakefield scandal, parents stopped vaccinating their children and cases of measles rose dramatically in the UK and United States. Currently, there are three US hot-spots for measles outbreaks — New York City, North Carolina, and Texas — but 16 states have reported recent cases.
Measles, the most deadly childhood illness, is so contagious that about 90% of the unvaccinated people who share a home with a measles patient will catch it. The virus concentrates in the nose and mouth, allowing person-to-person contact as well as aerosol transmission. Sneezing, coughing, and touching spreads the virus, which can remain active and contagious as long as two hours after the sick person has left the room.
The US protocol for MMR vaccination is that every child be vaccinated on or after the first birthday. A second vaccination between 4 and 6 years of age provides added protection. Many state and local governments in the US require proof of vaccination before entering day care, kindergarten, or school.
The New York City outbreak has been tracked to two adults traveling independently outside the state; they were probably infected at the same airport elsewhere in the US. Most US outbreaks originate from someone who has entered the country after travel to another country where measles vaccinations are scarce.
Measles and rubella (German measles) during pregnancy cause fetal abnormalities, miscarriage, low-birth-weight babies, premature births, and stillbirth.
In rare cases, even vaccinated adults get measles. The illness is especially severe in adults and people with certain underlying medical conditions. A measles patient of any age is at risk for complications that include deadly pneumonia, encephalitis, and corneal ulceration that permanently affects vision.
In the US in the 1920s, before the vaccine was developed, almost everyone got the measles and 30% died from measles pneumonia. By 2000, the measles death rate was 0.3%.