Remember 1999? Of course you do. That was the year the euro was established, Clinton was acquitted, and Bill Gates became the richest man on Earth. But wait, there’s more.
1999 was the year that Napster debuted. Remember Napster? 1999 also brought us The Phantom Menace, The Matrix, and The Sixth Sense. He was a ghost the whole time!
Any music fans out there? In 1999, a sassy teenager from Kentwood, LA named Britney Spears arrived on the scene. Lauryn Hill won all the Grammys and Cher made a huge comeback with “Believe”, becoming the oldest woman to top the Billboard Top 100. And Gary Glitter was arrested for downloading child pornography.
A lot of things happened in 1999, ranging from the very bad (Columbine) to the very good (Bran the Broken was born. Too soon?). In regards to science-based medicine, however, 1999 is particularly important to me, not only because it was the year that I entered medical school but because it marked the last year that measles was considered to be endemic to the United States. And in early 2000, the CDC made it official: measles was eliminated.
This didn’t mean that there wouldn’t be the occasional case, or even small outbreak, involving foreign travel. But with vaccination rates at record high levels, we were confident that measles was no longer something we would need to worry about here in the United States. Soon after, the entirety of the Americas were declared free of continuously circulating measles virus. Elimination of measles from the world was within our sights, similar to the way we rid ourselves of smallpox.
Sadly, the tide began to turn as the anti-vaccine propaganda that has been well documented on the pages of SBM took its toll on vaccination rates. Over the past several years we have seen significant increases in European measles cases, and more recently huge outbreaks in places like Madagascar and the Philippines. After years of steadily declining worldwide deaths caused by the infection, we have begun to see an increase. We haven’t been spared here in the United States as more and more children are not being vaccinated.
In medical school, I learned about the clinical manifestations of measles, but it was taught largely as a historical disease. My education on measles primarily involved discussion of the safety and incredible effectiveness of the vaccine. Wherever the measles vaccine is made available, and uptake is high, measles cases decrease dramatically. Millions of lives have been saved.
So I learned about the way patients ill with measles present, but I never thought it was particularly important information to keep readily available as I progressed through my general medical and then pediatric training. I figured that the likelihood of encountering a patient with measles was essentially zero. I’ve had to adjust my expectations.
The United States is currently experiencing multiple outbreaks, largely occurring in predicted hot spots. In just the first 5 months of 2019, a mere two decades after the declaration of its eradication here, we have had more measles cases than in any year since 1993, officially eclipsing the number of cases in 1994 as of May 30th. We now sit at 971 total cases.
According to the CDC, we are close to a huge lurch backwards in our fight against ending this deadly disease:
If these outbreaks continue through summer and fall, the United States may lose its measles elimination status. That loss would be a huge blow for the nation and erase the hard work done by all levels of public health. The measles elimination goal, first announced in 1963 and accomplished in 2000, was a monumental task. Before widespread use of the measles vaccine, an estimated 3 to 4 million people got measles each year in the United States, along with an estimated 400 to 500 deaths and 48,000 hospitalizations.
A few weeks ago I found myself in our pediatric emergency department admitting a child with fever and a rash to the hospital. For the first time in my medical career, I felt the need to seriously consider the possibility that I was seeing my first case of measles. After a thorough history and physical exam I was able to rule it out, but I did take the opportunity to teach a group of students about the condition. I shouldn’t have had to do that. The experience made me angry. Okay…angrier.
There have been two recent cases of measles in the Boston area so far this year. I’m worried that there will be more. Despite what is often spouted by anti-vaccine propagandists, measles is not a benign disease. It is a big deal. It has killed millions of children worldwide, sometimes in horrific ways.
I’ve been reading a lot about measles over the past few weeks, and learning more about its history, epidemiology, and the myriad ways it effects the human body than I ever wanted to. It’s fascinating, and more than a bit scary. And again, it makes me angry. More to come in two weeks.