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| ©New York Times |
Most of the cases have occurred in people who were never vaccinated.
Comment: Yet, as the reader will see further on, 17 of the cases were infected in clinics and doctors' offices, in 1 case while the baby was there to get its measles shot! Measles is not a dangerous disease. It is a mild, self-limiting viral disease of childhood. Symptoms are red spots on the skin and mouth, fatigue and fever, usually resolving itself in a week. It is only deadly among malnourished children in unsanitary conditions seen in poor, third world countries. It is most likely caused by a Vitamin A and D deficiency and not from an infection by itself:
"If a child is admitted to hospital with measles, we give them a treatment of vitamin A."
There were 64 cases from January through April 25, more than in all of 2006 and the highest number during that four-month period since 2001. None have yet proved fatal, but officials said they expected the total to keep rising.
"We haven't seen the end of this," said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.
Fourteen patients, or 22 percent, have been hospitalized, mostly for pneumonia.
The largest outbreak, 22 cases, is under way in New York City, mainly in the Borough Park section of Brooklyn, where it was most likely introduced by travelers from other countries, including Israel and Belgium.
"There may be more cases," said Dr. Jane R. Zucker, assistant commissioner for the Bureau of Immunization in the city's Department of Health and Mental Hygiene. Dr. Zucker said the New York outbreak was still being investigated.
As in New York, the other outbreaks are occurring because travelers bring the measles virus in from other countries - worldwide there are 20 million cases a year - and spread it to unvaccinated people. The unvaccinated include babies under a year old, who are too young to receive the vaccine, and children and young adults from families who refuse vaccination for personal or religious reasons.
The disease can then keep spreading. Dr. Schuchat said doctors were finding clusters with as many as five generations of transmission. She said many of today's parents, doctors and nurses were unfamiliar with measles and not on the lookout for it.
In 17 cases, patients were infected in clinics and doctors' offices, including a year-old baby who contracted the disease in a pediatrician's office during a routine visit - for a measles shot.
Health officials are warning doctors and nurses to take special precautions to avoid spreading the disease in clinics. Children with fevers and rashes should not sit in waiting rooms, and other children should not be brought into an examining room that a child suspected of having measles has just left, because the virus can linger and remain infectious for about two hours.
In the current outbreak, 13 patients were under a year old and therefore too young to have been vaccinated, and 7 others were 12 to 15 months old, with parents who had not yet taken them for their first vaccination, which is due at 1 year. Sixteen others, who were older, came from families that refused vaccination. Fourteen more had what officials described as "unknown or undocumented vaccination status." Only one person had proof of having received the standard two doses of measles vaccine.
In one family in Washington State, eight siblings came down with measles, and three of them had signs of pneumonia, a serious complication. These cases were reported after April 25 and so are in addition to the 64 described by the disease centers on Thursday.
The eight siblings are believed to have contracted measles at a religious conference attended by about 2,000 people from 5 countries and 19 states. None of the eight had been vaccinated. Forty-eight states allow exemptions from vaccine requirements for religious reasons, and 21 for personal beliefs, the C.D.C. said.
Growing numbers of parents in the United States and other countries have begun refusing to vaccinate their children because of unproven fears that vaccines cause autism or other illnesses. Health officials blame the trend for the resurgence of measles in many regions. Israel, Switzerland, Austria, Ireland and Britain have had large outbreaks recently, linked to pockets of people who shun vaccination.
Comment: "Unproven" fears doesn't mean it's proven that it does not cause autism. There are many studies which have shown the vaccine-autism link which anyone can find from a search of the internet. However, the one study the CDC has never funded is one in which they compare the unvaccinated cases with the vaccinated cases. One doesn't find a connection where one doesn't look.
Given the outbreaks overseas, travelers need to be immunized, Dr. Schuchat emphasized, acknowledging that many people do not think of Europe or Israel as places where they have to worry about catching infectious diseases. Babies who are going to be taken on trips can be given a measles shot at 6 months instead of 1 year, officials said.
People who have not been immunized and have been exposed to measles can often be protected with a vaccination or treatment with immune globulin, but the treatment must be given soon after the exposure. Health departments are supposed to track all the contacts of infected people and advise them about what to do, officials said.
Counting the Washington occurrence, 10 states have measles cases, though only seven have three or more, the disease centers' definition of an outbreak. Besides New York City, the highest numbers are in Pima County in southern Arizona, with 15, and San Diego, with 11. The San Diego and Arizona cases have been traced to travelers from Switzerland. Cases in other states have come from Italy, India and probably China.
The remaining states with cases are Hawaii, Illinois, Michigan, Wisconsin, Pennsylvania and Virginia.
"I think it's important for states who aren't on that list to have their alerts up," Dr. Schuchat said. "We know there are unimmunized people out there, and measles is extremely infectious. Not being on the list shouldn't be reassuring."
Before 1963, when the vaccine became available in this country, there were three million to four million cases of measles annually. The disease killed 400 to 500 children a year and put 48,000 in the hospital.
The vaccine wiped out transmission here by 2000, but the disease can easily be imported because there are so many cases overseas. Worldwide, measles still kills 242,000 children a year.
A report on the outbreaks is online at cdc.gov.
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