Measles on the March: A Call to Action

T he New York Times reported on March 24 that an adult with contagious measles infected two other people on a flight from Asia to San Francisco. This was not an isolated case. According to the Centers for Disease Control and Prevention (CDC) there have been six outbreaks (defined as three or more cases) in six states in 2019. In Rockland County in New York, the current outbreak is so severe that the county declared a state of emergency that bars children and teenagers who are not vaccinated against measles from public places. All of the outbreaks in 2019 have been linked to travelers from overseas where measles vaccination rates are low. The overall toll of measles is much higher. The CDC reports that from January 1 to March 21, 2019, there have been 314 individual cases of measles confirmed in 15 states.

The measles virus is a single-stranded negative-sense enveloped nonsegmented RNA virus that infects the respiratory system and causes flu-like symptoms along with a generalized rash. In most cases, the disease resolves after several weeks, but in some instances severe complications can result, including an encephalitis that can cause convulsions and brain damage. Approximately 1 in every 500 children that contracts the disease will die. This is a very serious public health problem.

Although it may not be possible to prevent travelers from abroad importing the measles, we do know that it is possible to prevent outbreaks of the disease. A very safe and effective vaccine is available that has saved countless lives. Because measles is highly contagious, its control in the general population requires at least 90% (but preferably 95%) vaccine coverage. This level of coverage should generate herd immunity, which protects those individuals who have not yet been vaccinated or who cannot be vaccinated for one reason or another. Yet current coverage with at least one dose of the measles, mumps, rubella (MMR) vaccine in the United States has dropped to 91%, with several states below this level. In an attempt to boost vaccination rates, many states have ended the ability of parents to opt out of vaccines because of personal, moral, or other beliefs. Indeed, there is currently a bill to end vaccination exemptions that is passing through the Washington state legislature. The bill will require vaccinations for all children and students attending day cares and education facilities in the state and was prompted by the state's measles outbreak, with 74 confirmed cases as of March 22, 2019.

One component of the public heath response to measles is scientific research. In this regard, Viral Immunology has published many articles on measles and the measles vaccine over the years. I draw your attention to two highly informative reviews published over the last year in the Journal. Griffin has published a detailed review that discusses multiple aspects of the current measles vaccine and progress to developing improved vaccines that can be delivered by inhalation (1). Simplifying the delivery of the vaccine has the potential to greatly increase vaccination rates. For those interested in the epidemiological aspects of vaccination in general, including the MMR vaccine, there is an excellent review by Higgs and colleagues on vaccine dynamics (2).

In addition to the Journal's efforts in reporting research advances in vaccine development, we call for more support for public health education, workers, and research (especially in vaccine development and epidemiology). We also call on all relevant authorities to spread the word about the importance of vaccination and to fight for higher levels of vaccination against measles and many other important diseases in the United States and across the globe.