12 September 2019Health + Wellness
Female doctor pediatrician with baby patient. Lordn / iStock / Getty Images
By Julia Ries
- The measles virus was declared eliminated in the United States in 2000.
- But if more cases of the measles virus are detected next month, it could mean an end of that elimination status.
- There have been more than 1,200 measles cases this year so far. That's the largest number of cases since 1992.
<p>The United States was declared to have eliminated the measles virus in 2000, meaning it was no longer endemic to the country.</p><p>But now ongoing outbreaks of the measles virus threaten that elimination status. There have been <a href="https://www.cdc.gov/measles/cases-outbreaks.html" target="_blank">1,241 cases</a> of the measles in the United States since January.</p><p>The last time there was well over a thousand cases of measles was 27 years ago, in <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00020688.htm" target="_blank">1992</a>. At least 2,200 people reported having the measles that year, and, while that may seem steep, it was a 77 percent drop in the number of measles cases the United States saw the year prior.</p><p>After 1992, the measles finally started to lose steam — all the way until 2000, when a vaccination program was declared successful. Health officials were able to officially declare the United States to have eliminated measles.</p><p>This year, as measles cases continue to climb, the country may lose its elimination status by early October if the disease continues to appear.</p><p>"That loss would be a huge blow for the nation and erase the hard work done by all levels of public health," Kristen Nordlund, a spokesperson for the Centers for Disease Control and Prevention (CDC), told Healthline.</p><p>According to Nordlund, the measles elimination goal — which was first announced in 1996 — was a monumental task.</p><p>Before the vaccine came around, which successfully wiped out measles, about 3 to 4 million people contracted the virus each year, with nearly 48,000 of them being hospitalized and around 500 dying.</p>
New York State’s Measles Outbreak<p>Just last week, New York City <a href="https://www1.nyc.gov/office-of-the-mayor/news/409-19/mayor-de-blasio-health-officials-declare-end-measles-outbreak-new-york-city" target="_blank">announced</a> their 11-month <a href="https://www1.nyc.gov/site/doh/health/health-topics/measles.page" target="_blank">outbreak</a> — which infected 654 and led to the controversial <a href="https://www.nejm.org/doi/full/10.1056/NEJMp1905941" target="_blank">mandatory vaccinations</a> in Brooklyn — came to a close.</p><p>Though promising, it's not enough to keep elimination status.</p><p>"Measles elimination status is lost immediately if a chain of transmission in a given outbreak is greater than 12 months," Nordlund explained.</p><p>If transmission continues in New York state — specifically, <a href="http://rocklandgov.com/departments/health/measles-information/" target="_blank">Rockland</a> and <a href="https://www.health.ny.gov/press/releases/2019/2019-08-08_doh_wyoming_county_measles_joint_release.htm" target="_blank">Wyoming</a> counties, where there've been a combined 317 cases of the measles since October 2018 — elimination status will end.</p><p>It would just take one case to be reported in the area on or after Oct. 2, Nordlund says.</p>
Measles Is on Its Way to Becoming Endemic Again<p>Aside from being a disappointing blow to the United States, losing elimination status means measles could become endemic again.</p><p>"We can, if this continues, go back in time to before the 1960s era when 3 to 4 million cases occurred every year. So many died and developed serious consequences from this disease," said <a href="https://www.yalemedicine.org/doctors/marietta_vazquez/" target="_blank">Dr. Marietta Vazquez</a>, a pediatrician and infectious disease expert with Yale Medicine.</p><p>Granted, the virus wouldn't be quite as destructive as it was decades ago. Since many people do get the measles, mumps, and rubella (MMR) vaccine, the level of cases, hospitalizations, and deaths would likely be nowhere near what the country saw pre-vaccine, according to Nordlund.</p><p>The virus, however, is extremely contagious. It infects about <a href="https://www.cdc.gov/measles/transmission.html?CDC_AA_refVal=https://www.cdc.gov/measles/about/transmission.html" target="_blank">90 percent</a> of nonimmune people who come into contact with it.</p><p>"While many germs require skin-to-skin contact, or that someone sneezes or coughs on you, or that you consume contaminated food or water, measles is broadcast into the air so easily that merely being in the same room with an infected person — or even where that person recently spent time — is enough to cause transmission," said <a href="https://www.northwell.edu/find-care/find-a-doctor/pediatrics/dr-michael-b-grosso-md-11314712" target="_blank">Dr. Michael Grosso</a>, the chief medical officer and chair of pediatrics at Northwell Health's Huntington Hospital.</p><p>It also doesn't take many virus particles for someone to get sick. Infected people typically start spreading the virus about four days before they even begin to notice symptoms.</p><p>Because of this, the measles virus is perfectly suited to cause an epidemic, Grosso says.</p>
Here’s What It Will Take to Reclaim Elimination Status<p>If the United States loses elimination status, the country will have to restart all over again to achieve elimination status yet again. And it might not be as easy this time around.</p><p>"Honestly, it would be even harder than when [the] original measles campaign started in the U.S., given globalization and how easy it is to move from country to country," Vazquez said.</p><p>To reclaim the status, the United States will need to keep measles at bay for another year.</p><p>"Just like elimination loss is defined as greater than 12 months of endemic transmission, gaining elimination status back would be the inverse — showing that we didn't have endemic transmission for more than 12 months," Nordlund said.</p><p>Healthcare officials have made it extremely clear that to beat measles, the <a href="http://ecowatch.com/tag/vaccines" rel="noopener noreferrer">vaccination</a> rate must increase — and quickly.</p><p>"Getting control of measles again involves nothing more or less than what our nation did the first time around: Immunize enough persons to prevent the chain of transmission," Grosso said.</p><p>Right now, approximately <a href="https://www.cdc.gov/nchs/fastats/immunize.htm" target="_blank">91 percent of infants</a> are receiving the MMR vaccine. In certain close-knit communities, though, this vaccination rate is much, much lower.</p><p>About 93 to 95 percent of the population needs to be immune to prevent transmission. The big question is, how do we get there?</p><p>The anti-vaccine movement, which circulates inaccurate information and false theories about vaccines, has prevented thousands of people from getting the MMR vaccine.</p><p>For the country's immunization rate to go up and for the outbreaks to stop, these myths need to be broken down, and community attitudes need to change.</p><p>For now, all eyes are on New York. Sure, we may still have new importations or other outbreaks, Nordlund notes, but it's really that long, consistent outbreak in New York that must be stopped.</p>
The Bottom Line<p>If the New York state measles outbreak continues, the United States could lose its measles elimination status by early October.</p><p>The loss of elimination status would be a huge disappointment for the country, which fought to immunize people and wipe out the virus in 2000.</p><p>To get control of measles, vaccination rates across the country need to increase. Otherwise, measles could easily become endemic again.</p>
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