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Which of the following contagious diseases spreads most easily?
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Ebola
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Influenza
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Measles
If your answer was c. Measles, you can go to the top of the class of infectious diseases.
"It's very easy to spread," said Dr. Rajesh Prabhu, infectious disease specialist at Essentia Health in Duluth. "It's more than the Ebola virus, more than the flu.
"He could stay in the air for at least two hours. Thus, a person (who is infected) could cross a space and enter to enter the same space and potentially catch measles.
Measles is virtually unique among contagious diseases, said Dr. Harmony Tyner, an infectious disease specialist at St. Luke in Duluth, as it is truly suspended in the air.
You could think that the flu is airborne, but it is actually transmitted by tiny droplets. The measles virus hovers in the air we breathe, waiting for an unfortunate victim to jump on.
Scary. But the question might arise: why does a newspaper located more or less in the heart of the United States devote room to measles? Is it not true that the Pan American Health Organization declared in 2000 that measles had been eliminated in the United States?
Yes, that's it. And for a disease that was once a childhood rite, affecting between 3 and 4 million people a year in the United States, the numbers are today infinitesimal by comparison.
But, alarming, they are on the rise. US Centers for Disease Control and Prevention have notified 764 cases of measles in the United States since May 3rd.
That's almost double the number of cases in 2018. That's more cases than in a whole year since 1994, according to the CDC. Twenty-two states have reported at least one case of measles so far this year. Last week, nine epidemics (three or more cases) were under way, including hundreds of cases in the orthodox Jewish community in New York attributed to travelers to Israel who had brought the virus back.
The situation in and around the United States seemed to come almost daily last week:
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Hundreds of people have been confined in a cruise ship off the Caribbean island of St. Lucia after confirmation of a case of measles on board, the Washington Post reported.
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Health officials from Orange County, California, warned moviegoers that they might have been exposed to measles during the screening of the movie "Avengers: Endgame" in a theater in Fullerton, according to The Hill.
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Merck & Co., a manufacturer of the measles vaccine, has announced an increase in its production to meet increased demand in the United States, reported the New York Times.
Last week, no case of measles had been reported in Minnesota this year, said Ellen Hill, an epidemiologist with the Minnesota Department of Health for the seven counties in the northeast.
But at least one case is reported in the state most years, Hill said.
And sometimes more. "A few years ago, a small epidemic occurred in the Somali community of twin cities," she said.
This outbreak totaled 75 cases, according to the CDC.
In the era of "measles suppression," the virus entered the United States from people who contracted it in other countries, Tyner said.
But now, "sustained transmission" is happening, she said.
"People give it to themselves," said Tyner. "These are not just cases from other countries."
Why does this happen? Tyner and Prabhu both reported lower vaccination rates. And while Prabhu said that parents can not get their children vaccinated for a variety of reasons, it is often because parents make an active choice.
Much of the opposition to MMR vaccine – mumps, measles, rubella – appears to stem from an article published in 1998 in the British medical journal The Lancet suggesting a link between MMR vaccine and autism . The Lancet retracted the newspaper in 2010 and the link between autism and the MMR "has been debunked by many studies," Prabhu said.
More recently, a Danish study of more than 650,000 children born in Denmark from 1999 to 2010 "strongly supports that MMR vaccination does not increase the risk of autism," reported the authors in Annals of Internal Medicine last month.
But a vigorous anti-vaccination movement addresses these concerns and its advocates also argue that measles is not that bad anyway. Part of the evidence: a 1969 episode of the Brady Bunch sitcom, in which Brady's six children catch measles and move up a gear. "If you have to get sick, you will certainly not be able to conquer measles," said her eldest daughter, Marcia, cheerfully.
The actress who played Marcia Brady reacted angrily last week to the use of her character in the same anti-vaccination. Maureen McCormick, 62 – Wait. Marcia Brady is 62 years old? – said that measles that she experienced in real life was not a trivial affair and that she made sure that her own daughter was vaccinated against the disease.
Measles is characterized by a high fever accompanied by a rash that usually begins on the face or neck and spreads downward, said Tyner.
Most cases are mild, she said, but serious complications can occur or even death. She cites a particular example: Olivia, the daughter of author Roald Dahl, catches measles in 1962, at the age of 7 years. The child seems to recover, but when Dahl tries to show her how to shape animals with pipe cleaners, she suddenly falls asleep. was unable to make her fingers do what she wanted them to do.
"In an hour, she was unconscious," Dahl wrote 24 years later. "In 12 hours she was dead. Measles had become a terrible thing called measles encephalitis and the doctors could do nothing to save her. "
Although most people recover from measles without lasting effects, Tyner noted that there was no cure for this disease. "It's not like we have drugs," she said. "(You) isolate them and you support them and hope they're better."
A patient with measles at the hospital would be placed in a specially adapted room that would trap air inside, Tyner said.
The vaccine, on the other hand, is extremely effective, according to Prabhu and Tyner: coverage at 93% from one dose and 97% if the second recommended dose is added. This means that there is a small chance that you will receive both doses and still contract measles, Tyner said. But the infection would probably be less serious.
Both specialists said that a return to the times of widespread measles outbreaks was unlikely. That's because the vast majority of us have been vaccinated – just over 94% in Minnesota and just under 90% in Wisconsin, according to the 2017 CDC figures.
But most of the United States falls short of so-called "collective immunity", defined as a point where so much of the population is vaccinated that it is difficult, if not impossible, to transmit the virus. According to the European Division of the World Health Organization, the measles vaccination rate must be at least 95% to obtain collective immunity. In the United States, rates range from less than 86% in Missouri to over 98% in Massachusetts.
According to the CDC, measles outbreaks in the United States tend to occur in segments of the population with lower vaccination rates.
Tyner would like to see anyone who does not have a medical barrier vaccinated, she said, but the problem is so emotional that she does not try to debate those who doubt. It focuses more on a segment of the older population who would like to be fully covered but may not be.
The current recommendation is that a child receive the first dose of MMR between 12 and 15 months and the second dose between 4 and 6 years.
But between 1963 and 1989, only one dose was recommended, Tyner said. This means that people who remember seeing the Brady Bunch when it was new may not be covered as completely as they should be.
If you do not know if you have received this second dose, you can take certain steps, said Tyner. First, you can check your child immunization records. If these records are not available, a blood test will tell you if you have measles antibodies. Or you could simply get a second dose of MMR. It will probably cost less than the blood test, Tyner said, and even if it's your third dose, "it will not hurt to get another dose."
The renewed concern over measles makes this virus an unusual virus in the United States. Tyner, 38, said she had never seen a case of the disease.
Until there.
"My feeling is that I am going to see a case of measles in my practice," Tyner said.
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