Internet and Psychiatry
  • Home
    • Editorials
    • Research news
    • Research papers
    • Interviews with eminent psychiatrists
    • Ten years ago
    • Fifteen years ago
  • Topics
    • Alcohol and Drug Abuse
    • Anxiety Disorders
    • Biomedical Science
    • Compulsive gambling
    • Disaster Medicine
    • Education
    • General Medicine
      • Acupuncture
      • Physical medicine and Rehabilitation
    • Human Rights
    • Interviews with eminent psychiatrists
    • Mood Disorders
      • Bipolar Disorder
      • Depression
      • Seasonal Affective Disorder
    • Neurological Disorders
    • Other Psychiatric Disorders
    • Posttraumatic Stress Disorder
    • Sexual Behavior
  • Books
    • Comorbidity of Depression and Alcohol Use Disorders
    • “Immigration and Mental Health” chapter abstracts
    • “Internet and Suicide” chapter abstracts
    • “Neurobiology of PTSD” chapter abstracts
    • “Suicidal Behavior in Alcohol…” chapter abstracts
    • “Suicide in the Military” chapter abstracts
    • “Terror and Suicide” chapter abstracts
    • “War and Suicide” chapter abstracts
  • Editors
    • Leo Sher, M.D.
    • Alexander Vilens, M.S.
  • Guests
    • Distinguished Guests
    • Our Contributors
  • Reflections
    • Poetry
    • Quotes

Editorials

Waiting to eliminate measles?

August 13, 2019

Safoora Fatima, M.D., Pavani Nathala, M.D., Steven Lippmann, M.D.

Introduction

Measles is a highly contagious disease transmitted via respiratory droplets from person-to-person. Before the advent of the measles vaccination, there were over half million cases reported annually in the United States, with 500 measles related deaths each year (1).  

Clinical

Measles starts with a 2-4 days prodrome of fever, anorexia, conjunctivitis, coryza, and cough (2). Temperatures can rise up to 104 degrees F, late in the prodrome. Koplik spots are pathognomic signs of measles and appear 1-2 days before the rash onset, as bluish-gray specks on an erythematous base at the buccal mucosa of the second molar (2). They last only about two days, often disappearing early in the disease course (2).  

The classic measles rash is an erythematous, maculopapular eruption lasting for 4-5 days, beginning on the head and face and then spreading to the entire body (2). The rash then fades in the same order as its appearance.

Elimination

Measles immunizations began in the United States in 1963. Serious epidemics prompted an illness elimination initiative in 1978. By the early 1980s, measles was nearly eradicated in this country; however, there was a recurrent epidemic with 17,850 measles cases reported in 1989 (3).

Subsequently, there was a new vaccination effort to increase immunization coverage. A second dose of measles vaccination for children was recommended to protect those who did not respond to the initial vaccination (4). Nevertheless, lack of herd immunity resulted in new epidemics among unimmunized preschool age children, especially in communities honoring religious or philosophical vaccination exemptions (5).  

By 2000, measles was considered to be eliminated because of high population immunity and broad vaccination coverage (6). Concern about this disease was fading.

Outbreaks

Between January-July 3, 2019, there were 1,109 cases of measles reported; the highest number since 1994 (8). The greatest percentages of these outbreaks occurred in communities with many vaccination-refusals, individuals who travel internationally, and/or others who were unvaccinated (7). States most affected include Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Texas, Tennessee, and Washington (8).  

The 2018 epidemics in Washington and New York states are among the largest and also the longest lasting (9). The Williamsburg area of Brooklyn, in New York City, experienced the largest outbreak, with nearly 300 cases concentrated in an Orthodox Jewish community (10). Their first measles-infected person had recently travelled internationally, in an under-vaccinated community (11).

When imported into a highly vaccinated population, measles yields only a few cases and no epidemic. However, when such a person enters an undervaccinated group, the disease spreads widely (9).

Cause

New measles epidemics are most common among people who claim that vaccines are dangerous or even causing autism (12). In New York and many other states, children are sometimes exempted from vaccinations because of medical, religious, or philosophical reasons (12). Exemptions are sometimes granted because of perceived fear of vaccine-induced harm. These include that vaccines cause illnesses, overload the immune system, perceptions of not being at risk, that measles is not dangerous, or that vaccines might not be effective.

Ethical, moral, and/or religious beliefs include vaccine preparation with aborted cells and/or the use of fetal or blood tissue. Testing in animals is another reason (13). Some people object to governmental interference into their personal lives and/or fear dangerous conspiracies.

Currently, the New York epidemic is due to vaccination refusals because of perceived religious and/or safety concerns (14). In Washington, parents reportedly opted out of immunizations because of the mistrust in health officials and/or pharmaceutical companies (14).  

Unvaccinated people who develop measles are contagious to their community, especially to infants too young for vaccination and others with contraindications to immunization. To protect them from exposure, these persons depend on high vaccination coverage among those around them (15). Measles vaccinations are first administered at the age of 12-15 months and followed by a second dose between 4-6 years.

Viral importations are likely to continue causing measles in unvaccinated groups, despite global control and elimination efforts. To prevent further epidemics, broad vaccination coverage is necessary. To maintain a disease-free population, high-density immunization should continue (16).

Conclusion

Universal childhood immunization and vaccination of all susceptible individuals is indicated. Measles vaccination is effective and safe. Disease outbreaks may occur because of immunity gaps, despite vaccine coverages. Vaccine refusal remains problematic and accounts for current epidemics.

References

  1. McLean HQ, Fiebelkorn AP, Temte JL, et al. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report: Recommendations and Reports. 2013; 62(4):1-34
  2. Sabella C. Measles: not just a childhood rash. Cleve Clin J Med. 2010; 77(3):207-213
  3. Cutts FT, Henderson RH, Clements CJ, et al. Principles of measles control. Bulletin of the World Health Organization. 1991; 69(1):1
  4. Measles prevention: recommendations of the Immunization Practices Advisory Committee (ACIP). Morbidity and Mortality Weekly report. 1989; 38 (S-9):1-13. Accessed on May 1,2019
  5. Novogny, T. Jennings CE, Doran M, et al. Measles outbreaks in religious groups exempt from immunization laws. Public Health Reports. 1988; 103:49-54
  6. Papania MJ, Wallace GS, Rota PA, et al. Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western hemisphere: the US experience. JAMA Pediatrics. 2014; 168(2):148-155
  7. Patel M, Lee AD, Redd SB, et al. Increase in Measles Cases—United States, January 1–April 26, 2019. Morbidity and Mortality Weekly Report. 2019; 68(17):402–404 https://www.cdc.gov/mmwr/volumes/68/wr/mm6817e1.htm?s_cid=mm6 817e1_e. Accessed on May 1, 2019
  8. https://www.cdc.gov/measles/cases-outbreaks.html Accessed on July 9, 2019
  9. Centers for Disease Control and Prevention. Measles cases in the US are highest since measles was eliminated in 2000. April, 2019. https://www.cdc.gov/media/releases/2019/s0424-highest-measles-casessince- elimination.html Accessed on May 1, 2019
  10. Koenig D. 2019 Measles outbreak: what you should know. 2019 https://www.webmd.com/children/news/20190411/2019-measlesoutbreak-what-you-should-know Accessed on May 1, 2019
  11. Scutti S. Measles outbreaks in Washington and New York challenge public health systems, CNN. 2019 https://www.cnn.com/2019/01/30/health/measles-outbreak-new-yorkwashington-update-bn/index.html Accessed on May 1, 2019
  12. Andrews M. Why Measles Hits So Hard Within N.Y. Orthodox Jewish Community. 2019 https://khn.org/news/why-measles-hits-so-hard-within-n-y-orthodoxjewish-community/ Accessed on May 1, 2019
  13. Salmon DA, Moulton LH, Omer SB, et al. Factors associated with refusal of childhood vaccines among parents of school-aged children: a case-control study. Archives of Pediatrics & Adolescent Medicine. 2005; 159(5):470-476.
  14. Belluz J. The era of religious and moral vaccine exemptions needs to end — and fast. 2019 https://www.vox.com/science-and-health/2019/2/16/18223764/measlesoutbreak-2019-vaccines-anti-vax Accessed on May 1, 2019
  15. Centers for Disease Control and Prevention. Measles: United States, January–May 20, 2011. Morbidity and Mortality Weekly Report. 2011; 60(20):666 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6020a7.htm?s_cid= mm6020a7_w Accessed on May 1, 2019
  16. Centers for Disease Control and Prevention. Measles-United States, January 1-August 24, 2013. Morbidity and Mortality Weekly Report. 2013; 62(36):741

Related Posts

Editorials /

Suicide medical malpractice

Editorials /

Dr. Slavko Ziherl, an eminent Slovenian psychiatrist

Editorials /

Prevention of suicidal behavior in individuals with diabetes

‹ Neural correlates of suicidal ideation in veterans with posttraumatic stress disorder › Cell phones and brain breaks

Editorials

  • Suicide medical malpractice
  • Dr. Slavko Ziherl, an eminent Slovenian psychiatrist
  • Prevention of suicidal behavior in individuals with diabetes
  • National Respect Day

Research Papers

  • COVID-19 mortality in Europe and the ’Iron Curtain’ between East and West
  • Examination of depressive signs and symptoms among 803 University students in seven Universities and Colleges. Hungary, Romania, Serbia.
  • Examination of spirituality and the dimensions of spirituality among 803 students in seven different Universities. Hungary, Romania and Serbia.
  • Examination of depressive signs and symptoms among 932 students in eight different secondary schools in Hungary

Research News

  • Mortality in patients with schizophrenia: a review and meta-analysis
  • Long COVID, psychiatric disorders and suicidality
  • Mortality rates for buprenorphine versus methadone treatments
  • Brain-derived neurotrophic factor levels in combat veterans with or without a history of suicide attempt

Latest News

  • Best universities in the world
  • Geriatric Psychiatry Fellowship
  • 2022 National Veteran Suicide Prevention Annual Report
  • Long COVID and suicide

Interviews with eminent psychiatrists

  • Interview with Professor Shih-Ku Lin
  • Interview with Professor Masahito Fushimi
  • Interview with Professor Maurizio Pompili
  • Interview with Professor Marco Sarchiapone

Ten Years Ago

  • Plasma testosterone levels in bipolar suicide attempters
  • Teaching medical professionals and trainees about suicide prevention
  • Suicidal ideation in depressed patients with or without comorbid posttraumatic stress disorder treated with selective serotonin reuptake inhibitors
  • Treatment of suicide attempters with bipolar disorder: a randomized clinical trial

Back to Top

  • About
  • Contact
  • Privacy Policy
  • Terms and Conditions
Copyright © 2022 AVCalc LLC. All rights reserved worldwide.