In 2000, the US Centers for Disease Control and Prevention (CDC) declared victory over the measles. Citing no continuous transmission of the disease for more than 12 months, it affirmed the success of the MMR (measles, mumps, rubella) vaccine, which had by then become widely available and accepted as a reliable source of immunization.
“When approximately 95 percent of people in a community are vaccinated, it creates a ‘herd immunity,’ which stops the disease from being able to spread from person to person,” says Cheryl Healton, dean of the NYU College of Global Public Health and professor of public health policy and management. This collective immunity especially protects those who cannot be vaccinated for medical reasons, including patients with compromised immune systems, young babies, and pregnant women.
But in recent years, an unvaccinated population has been growing in the US and across the globe due to an aggressive anti-vaccine movement that “often operates anonymously, provides false information, and creates confusion,” Healton notes. The ease of international travel has further compounded the ability of viruses to proliferate from one side of the world to the other.
The current outbreak that inspired Mayor Bill de Blasio to declare a public health emergency for New York City on April 9, 2019, dates back to 2018 and had its origin in several European countries. Last fall, cases in New York were being traced to individuals traveling to the city after being exposed to the disease in Israel and Ukraine.
While most people in New York do get vaccinated, there are pockets of the state where immunization rates are low and measles can spread quickly within a community. Since October 2018, the vast majority of cases in the United States have occurred in Brooklyn (329), as well as in New York State counties like Rockland (186), Orange (17), Westchester (10), and Sullivan (2). The rate of new cases has increased dramatically in the first three months of 2019.
NYU News spoke to Healton about what this new outbreak means to New Yorkers and why vaccine promotion is more urgent than ever.
When was MMR first implemented and what was its impact?
The MMR vaccine became available in the United States in 1963, before which time almost all youth contracted measles before they were about 15 years old. Pre-vaccine, the CDC estimates that 3 to 4 million Americans were infected annually, resulting in 400-500 deaths, 48,000 hospitalizations, and 1,000 patients suffering encephalitis, or swelling of the brain.
Before widespread availability of the vaccine, nearly 50,000 people had to be hospitalized and 1,000 developed pneumonia and swelling of the brain (encephalitis) in the U.S. Worldwide, between 2000-2017, over 21 million deaths were averted due to measles vaccination.
Mandatory MMR vaccinations are now being implemented in parts of Brooklyn. When was the last time the city issued this kind of decree, and how can it be enforced?
In an effort to keep people healthy, Mayor de Blasio declared this measles outbreak a public health emergency on April 9. By doing so, unvaccinated children and adults are mandated to receive the measles vaccine or face fines if they refuse.
This isn’t the first time a city has decided to enact similar measures. In 1991, a Family Court Judge in Philadelphia ordered parents to vaccinate their children after a large measles outbreak there. Experts disagree as to the effectiveness of mandatory emergency measures like this one, which can drive people away from services. Voluntary efforts promoted by trusted outreach workers are most ideal.
How quickly does the MMR vaccine work for prevention once it has been administered?
The CDC advises that one dose of MMR vaccine is 93 percent effective against measles, 78 percent effective against mumps, and 97 percent effective against rubella. Two doses are 97 percent effective against measles and 88 percent effective against mumps. The vaccine provides protection within 10 days to 2 weeks.
With those high success rates, is there any reason for those who have been vaccinated to still take precautions?
Science can and must be trusted when it comes to vaccines. That said, for the 3 percent of those who are vaccinated but can still contract measles, all of us should practice simple preventative measures. Because measles can spread through sneezes or coughs, we should wash our hands frequently with soap and cough into the crook of our elbows. If you believe you have been exposed and are symptomatic, please stay away from others and call your healthcare provider for instructions before you head to your doctor’s office to help ensure you don’t put others at risk.
Typically, symptoms appear 7-14 days following exposure, but can take up to 21 days. Initial symptoms include high fever, cough, runny nose, red or watery eyes, and a rash of small, slightly raised red spots. If you have symptoms, please contact your local health department or the New York State Department of Health at 888-364-4837.
This story seems like a test case for those debating the merit and safety of vaccines. Will this episode help or hurt the anti-vaxxer movement?
How best to convince people to be vaccinated is not an exact science, especially in the face of a well-organized anti-vaccine social media effort, which is deeply ill-advised.
Simply put, measles is one of the most contagious of all infectious diseases and is completely preventable through vaccination. When people ignore the advice of their physicians and leaders in the public health community, they put not only their children at risk, but also all those with whom their unvaccinated family members come into contact.