Measles as The New “Normal”

Steven J. Goldstein, MD, FAAP

Steven J. Goldstein, MD, FAAP

Dr. Steven J. Goldstein, MD, FAAP is a pediatrician in Brooklyn and Queens. He is president of the NYS AAP Chapter and serves as co-chair of its Pediatric Council and Committee on Environmental Health.

With cases of measles appearing in 23 states and counting and well over 800 cases nationwide, Americans will have to adjust to life with possible exposure to measles as the new “normal”.   This is after measles was declared eliminated from the United States in the year 2000.

People of my generation dreaded getting the measles when we were children in the 1950s, but it was a rite of passage in that pre-vaccine era along with the other childhood diseases of mumps, rubella, and chickenpox.  The worst of those illnesses, however, was measles, which can lead to pneumonia and brain infections, and the residual effects of which include immune suppression which in turn leads to a greater likelihood of illness for two to three years after the illness.  And on top of that, children who have measles under the age of two years are at increased risk for subacute sclerosing panencephalitis (SSPE), a rare complication from the virus that is fatal and begins on average six to ten years after the acute illness.  One to two deaths per thousand cases occur in those afflicted by measles.

What is different today is the greatly increased number of immunosuppressed patients living in the community.  In the fifties, patients on chemotherapy in the community were rare and immunomodulator drugs used for a wide variety of chronic diseases but which suppress the immune system did not exist.  Babies have always been at risk, as the vaccine is not usually given until one year of age.  An extra dose of vaccine can be given starting at age 6 months for exposures or travel.

But what about travel by air, or train, or bus, even within the United States, with a young child, a cancer patient, or someone on immune-suppressing drugs?  Measles is extremely contagious and hard to diagnose in the four days before the rash appears, which leads to unintended exposure in schools, places of worship, airports, and even malls.  The virus persists in the environment for up to two hours after an infected individual leaves the area.  This is just another aspect of the measles issue and has the potential to change the way we live day-to-day.

Measles made its way to the Detroit area after a visitor from Brooklyn brought the unintended guest along for the visit.  And now, after a month or so without an active case, there is once again measles in the Detroit suburbs.  Mothers of young babies in affected communities are essentially being held hostage in their homes because they are afraid to expose their children to the illness.  My daughter will drive to New York to visit with her young baby rather than risk an exposure on the short flight from Detroit.

And that brings me to what we can do to deal with this problem.  Those of us in pediatric offices, hospitals, emergency departments, and urgent care clinics are dealing with this issue every day as we must decide whether a patient that needs to be seen could spread measles to others in our health care facilities.  The bottom line is that immunization with two doses of measles vaccine gives 97% of people immunity, whereas those who have opted out of vaccination due to fear, distrust, or for whatever reason, remain at risk of contracting and spreading disease.  Those with medical reasons not to get vaccine may be at higher risk of complications and need to be protected by others having immunity (this is known as herd or community immunity) so as not to allow the illness to spread.

No major religion-in fact, no religion at all known to me-prohibits immunization, and some actively promote preventative actions.  Currently, New York State grants exemptions for school entry solely for medical and religious reasons.  There is a bill in the NYS Assembly Health Committee (A02371/S2994) that would allow for only medical exemptions to immunization in the state.  The pediatricians of New York State strongly support that bill and do not feel that it impinges on anyone’s civil rights: the law would not require vaccination, only prevent unvaccinated children from putting the other children at risk.

The anti-vaccine movement sees their issue as one of personal freedom.  I see that, but society also has the right to protect itself.  I’m fine with people having the freedom not to vaccinate against their will, but not at all fine with unvaccinated children putting others at risk.  No one should have the right to spread disease to others and impede their freedom to attend school, camp, or day care, or to go shopping or to travel.

Call your NYS Assemblyman and demand that Assembly Bill 02371 to repeal religious exemptions be released from committee for open debate.