A school-aged child who was unvaccinated has died in the Texas measles outbreak that has affected at least 124 people in that state.
The death is the first from measles in the United States since 2015, but pediatrician and infectious disease specialist Dr. Adam Ratner, author of Booster Shots: The Urgent Lessons of Measles and the Uncertain Future of Children’s Health, tells PEOPLE that the outbreak is part of a “disturbing” trend, one that’s tied to a decline in vaccination rates since the pandemic.
“This is emblematic of trends in childhood vaccination, but also in how people think about public health, that are disturbing and are worrisome even for people who aren’t directly involved in this outbreak,” says Ratner, whose new book addresses the history of the disease and of the measles vaccine, which was introduced in the U.S. in 1963.
Prior to the vaccine, between 3 million and 4 million people were infected with measles in the U.S. each year, according to the CDC, and 400 to 500 people died annually. In 2000, measles was declared eliminated in the U.S.
With vaccination rates dropping since the COVID-19 pandemic, Dr. Ratner says that measles outbreaks like in Texas are a “harbinger” of what’s to come. He answers PEOPLE’s questions about the disease and the vaccine.
Why should we be worried about measles?
“It’s the most contagious virus we know of, more contagious than flu, or covid, or polio, or Ebola. And it moves through susceptible populations, meaning people who aren’t either vaccinated or haven’t had measles in the past, very quickly and efficiently. Before we had a vaccine, just about every kid got measles in childhood.”
How serious is the disease?
“For most kids, measles is about a week of being sick. It’s fever, it’s rash, it’s bright red eyes, and pain in the eyes. And most kids get better after that. But there are rare outcomes from measles that are severe. Up to 20% of kids will develop pneumonia and may need to be hospitalized. About one in a thousand kids can get encephalitis, which is swelling of the brain, which can give kids deafness or blindness or seizure disorders, which can be permanent. And about one to two per thousand kids will die from measles. It’s a disease that is worth preventing and we’ve done a good job over the last several decades of controlling it in the United States.”
Why are we seeing this outbreak in Texas now?
“We’re seeing slipping rates of vaccine coverage in the US. And we’re seeing how quickly in an under-vaccinated population measles can move through. Because measles is so contagious, you need a pretty high vaccination rate to make sure you don’t have spread. The target we pediatricians talk about is about 95% of the population. Prior to covid, in this country we had 96-ish% of kids in kindergarten vaccinated. That number has slipped since the pandemic. It’s now under 93% and falling. And if you look at Gaines County Texas, where the outbreak is centered, that rate is about 80%. That’s much too low to keep an outbreak from starting and from continuing. We had built this wall of immunity. What we’re seeing in Gaines County is what happens when you don’t have that wall of immunity.”
People have the right to choose not to vaccinate. But how can that affect the larger population?
“The problem is often the person who’s making the choice not to vaccinate is not the person who’s getting sick. It’s not the child’s fault. And I don’t even want it to be a sense of it’s a parent’s fault. Parents who question vaccines, parents who are anti-vaccine, these are people who love their children. These aren’t people who want harm to come to their kids. But there’s a tragedy if a child is sick or if a child dies, and we should try to prevent that. Also, the measles vaccine, like any vaccine, is not 100% effective. And not everyone can get vaccinated. So anyone under age one in the US hasn’t been vaccinated because that’s when we start in kids. And people who are pregnant, people who have immunodeficiencies, people who are getting chemotherapy, all of these people can’t get live virus vaccines like measles vaccine. The way we protect them is we vaccinate everyone around them and we stop measles from circulating in the country.”
Do adults need to get a booster?
“There’s not a one-size-fits-all answer for this. It’s worth talking to your doctor about it. If you’re a healthcare worker and at higher risk of exposure to measles and you got vaccinated at a time when we were only giving one dose of MMR instead of two—anytime before late 1990— those are folks who should get a second dose. And in almost all healthcare institutions, that’s just the policy. Most people probably won’t need a booster unless they’re in an area with an outbreak, but it’s an individual kind of thing.”
Why does these sorts of outbreaks concern you from a broader public health perspective?
“It’s emblematic of a much larger problem. When vaccine rates fall and when people have lost faith in public health and in prevention, measles is the first thing you see because it’s so contagious. But it’s sort of a harbinger of other vaccine-preventable diseases and other things that you’re going to see down the line.”
Read the full article here
