Dr. Schaffner

William Schaffner, MD
Professor of Preventive Medicine, Department of Health Policy
Professor of Medicine, Division of Infectious Diseases
Vanderbilt University Medical Center
Nashville, TN 37203

Dr. Schaffner discusses the recent increase in the incidence of measles infections.

MedicalResearch.com: What is the background for this study?

Response:  The fundamental reason leading to the increase in measles cases in the US is that some parents are withholding their children from routine measles vaccination: Failure to vaccinate.  As a result, there are neighborhoods, schools, and communities that now have vaccination rates substantially below the 92% to 95% needed to prevent outbreaks of infection.  Measles is the most contagious virus we know, so it takes very high vaccination rates to prevent transmission and to avert outbreaks.

 Vaccine hesitancy has many causes:  Lack of knowledge of the severity of measles, concern over vaccine side-effects, low trust in public health, a desire to do things more “naturally” and it can also have political overtones, among others.

The measles vaccine is extraordinarily effective; the routine two-dose series confers 97% to 98% protection for life.  The rare “breakthrough” infections that occur in vaccinated persons are generally milder, with fewer complications than in persons who are unvaccinated.

 The US was certified as having eliminated measles in 2000 because of high vaccination rates across the country.  Sadly, the US is likely to lose that designation because of sustained measles transmission, reverting us back to the bad old days.  It is particularly sad for any of our children to have to endure measles and its consequences.  All these cases could have been prevented by vaccination.

MedicalResearch.com: What roles do a decrease in US immunization rates and/or increased immigration from under-vaccinated area play in this increase?  

Response:  The substantial majority of unimmunized children in the US were born and raised in this country.  They usually are members of middle- or upper-income families.  The most frequent importers of measles into the US are our own unimmunized children who travel abroad, encounter measles virus and bring it back to their homes where the virus then spreads among the child’s schoolmates and playmates, creating an outbreak.

Koplik spots- Measles-CDC image

MedicalResearch.com:  Since many, especially younger, health care providers have never seen a case of measles, are there characteristic features clinicians should be aware of?

Response:   Measles vaccination has been so successful that many young and middle-aged doctors have never seen a case.  Beginning 7-21 days after exposure, the onset of illness is characterized by high fever and malaise.  Shortly thereafter the classic “three Cs” occur: Coryza, conjunctivitis and cough.  Inside both cheeks white papules (Koplik spots) appear. The characteristic rash soon follows – it is erythematous, blanching, starting on the face and moving down the body, becoming darker over time.  The rash may be quite subtle in dark-skinned persons.

The common complications of measles include diarrhea, otitis media as well as viral and bacterial pneumonia. More serious complications include encephalitis which occurs approximately once per thousand infections.

Measles rash: CDC image

MedicalResearch.com:  Are there areas, i.e. airports, sporting venues etc. where measles transmission is more likely? 

Response:  Measles is readily transmitted among susceptible persons indoors.  As most of the cases are in children, daycare, schools, religious services, birthday parties, and such are common venues for transmission although other sites such as airports and sporting events occasionally have been implicated.

MedicalResearch.com: What should clinicians do if they have a suspected case of measles? 

Response:  All cases of suspected measles should be reported immediately to the local health department.

Disclosures: I have no relevant disclosures.