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Measles is so contagious that 90% of the non-immune people who are exposed to it will contract the disease, like this baby in Manila, Philippines.
Jim Goodson, CDC
It was not quite two decades since the United States had made a remarkable step in the long-standing struggle of humans against deadly infectious diseases: measles had been officially eliminated from the nation. And for the first time since then, this feat is now compromised.
When disease control and prevention centers announced yesterday that measles cases in the United States had reached 971 by 2019, noted the agency, this was the largest number of cases since 1992, before the elimination of the disease. And we have not even reached half of the year yet.
What is the elimination of the disease?
The elimination is different from eradication, which completely eliminates a disease of the planet. the single human disease that has been eradicated is smallpox, realized in 1980. Elimination means that a disease is no longer endemic in a specific region. That is, the continuous transmission of the disease from one person to the other has been stopped for at least 12 continuous months in a single region.
After elimination, the disease appears only if it comes from outside the region. Or, as I have noted beforeElimination means that measles does not live here anymore, but it can still be visited – and it's certainly an extended visit.
But when does an extended visit become a residence? We may be on the verge of knowing it. The opposite of elimination is reemergence and experts are concerned that the United States is preparing for a complete re-emergence of measles if current outbreaks, especially the two largest in Brooklyn and Rockland County, New York, are not contained.
As epidemiologist of measles Adria Lee, MSPH, of the CDC, said in a press call last week that 94% of measles cases reported this year had been contracted in the United States. wired and other publications reported. "The ongoing epidemics in united communities and the intensification of measles activity worldwide expose the United States to the risk of losing its elimination status", wired & nbsp; she quoted him saying.
Are we there already?
Paul Offit, MD, head of the Division of Infectious Diseases at the Children's Hospital of Philadelphia and co-developer of a rotavirus vaccine, says in a podcast this week that he thinks we already have. Sure Vax Talk, the podcast of the parent Voices for Vaccines parenting organization, cohost Karen Ernst, asked Offit: "And if the measles epidemic does not end in Rockland, and if it continues beyond from September? So are we losing our elimination status? Should we wear the shame cone of America because we are the country that has lost our elimination status? "
Offit did not hesitate: "I think we have lost our elimination status," he replied. He added a note of hope, adding, "I just want to say that hopefully, measles will certainly disappear when the weather warms up. It's always true. "
The question is what happens when the cool weather comes back and that Offit thinks measles will come back with it.
Measles is the most contagious disease that man has been confronted with: stays in the air until two o'clock after an infected person has left the area and that 90% of non-immune people exposed to measles develop it. No other disease is so contagious.
Scientists measure the infection of a disease by its basic reproduction number, called R0 (pronounced R null). This number tells us how many people a single infected individual will be sick in a population without any immunity. For example, if a new disease came up tomorrow and scientists finally determined that its OR was 5, one person with this disease would infect an average of five others.
Most contagious human diseases have an R0 somewhere between 2 to 7. R0 of influenza is 2-3. Ebola is 1.5 to 2.5. Smallpox, polio, rubella and mumps have ORs of 5 to 7 and HIV RO is 2 to 5. But R0 for measles is between 12 and 18, more than double that of almost all other diseases. (These are all approximate estimates because R0 calculations are complex and can vary greatly by region and other factors. Some estimates place R0 at 12-17 on pertussis, but most have adjusted it downward.)
Only vaccination can keep (or restore) the elimination
The only way to eliminate measles is to vaccinate on a large scale. The measles vaccine is one of the most effective on the market, providing 98-99% protection with two doses. When herd immunity-The inability of a disease to spread through a population because too many individuals are immunized there – is high enough, the transmission of the disease stops. But pockets of hesitation and refusal of vaccines have led to under-vaccination and this erosion of herd immunity now allows measles to develop.
Although the measles vaccine is incredibly effective, the fact that the disease is incredibly contagious means that a very high percentage of the population must be immunized to stop transmission …about 93-95%globally and within individual communities. The United States has already achieved this goal. It remains to be seen if this can again.
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Measles is so contagious that 90% of the non-immune people who are exposed to it will contract the disease, like this baby in Manila, Philippines.
Jim Goodson, CDC
It was not quite two decades since the United States had made a remarkable step in the long-standing struggle of humans against deadly infectious diseases: measles had been officially eliminated from the nation. And for the first time since then, this feat is now compromised.
When the Centers for Disease Control and Prevention announced yesterday that the number of measles cases in the United States reached 971 in 2019, the agency noted that it was the number of cases most high since 1992, before the elimination of the disease. And we have not even reached half of the year yet.
What is the elimination of the disease?
Elimination is different from eradication, which completely eliminates a disease from the planet. The only human disease that has been eradicated is smallpox, which was reached in 1980. Elimination means that a disease is no longer endemic in a given area. That is, the continuous transmission of the disease from one person to the other has been stopped for at least 12 continuous months in a single region.
After elimination, the disease appears only if it comes from outside the region. Or, as I have already noted, eliminating means that measles does not live here anymore, but it can still be visited – and it has certainly been the subject of a long visit.
But when does an extended visit become a residence? We may be on the verge of knowing it. The reverse of elimination is re-emergence, and experts are concerned that the United States may be preparing for a complete re-emergence of measles if current outbreaks, especially the larger ones in Brooklyn and Rockland County, in the US New York State are not under control.
As epidemiologist in charge of measles Adria Lee, MSPH, of the CDC, said in a press call last week that 94% of measles cases reported this year had been contracted in the United States. wired and other publications reported. "The ongoing epidemics in united communities and the intensification of measles activity worldwide expose the United States to the risk of losing its elimination status", wired quoted him saying.
Are we there already?
Paul Offit, MD, head of the Division of Infectious Diseases at the Children's Hospital of Philadelphia and co-developer of the rotavirus vaccine, said in a podcast this week that he thinks we already have it. Co-host Karen Ernst, a podcast from the parent organization Voices for Vaccines, asked Offit: "What if the measles epidemic does not end in Rockland, and if it continues beyond September?" ? So are we losing our elimination status? Should we wear the shame cone of America because we are the country that has lost our elimination status? "
Offit did not hesitate: "I think we have lost our elimination status," he replied. He added a note of hope, adding, "I just want to say that hopefully, measles will certainly disappear when the weather warms up. It's always true. "
The question is what happens when the cool weather comes back and that Offit thinks measles will come back with it.
Measles is the most contagious disease that humans have ever faced: it stays in the air until two hours after the departure of an infected person and 90% of people non-immune exposed to measles develop it. No other disease is so contagious.
Scientists measure the infection of a disease by its basic reproductive number, called R0 (pronounced R nil). This number tells us how many people a single infected individual will be sick in a population without any immunity. For example, if a new disease came up tomorrow and scientists finally determined that its OR was 5, one person with this disease would infect an average of five others.
Most contagious human diseases have an R0 between 2 and 7. The R0 of the flu is between 2 and 3. Ebola is 1.5 to 2.5. Smallpox, polio, rubella and mumps have ORs of 5 to 7 and HIV RO is 2 to 5. But R0 for measles is between 12 and 18, more than double that of almost all other diseases. (These are all approximate estimates because the R0 calculations are complex and can vary considerably by region and by other factors.Some estimates place R0 at 12-17 years, but most have adjusted this downward. )
Only vaccination can keep (or restore) the elimination
The only way to eliminate measles is to vaccinate on a large scale. The measles vaccine is one of the most effective on the market, providing 98-99% protection with two doses. When group immunity – the impossibility for a disease to cross a population because too many individuals are immunized there – is high enough, transmission of the disease stops. But pockets of hesitation and refusal of vaccines have led to under-vaccination and this erosion of herd immunity now allows measles to develop.
Although the measles vaccine is incredibly effective, the fact that the disease is incredibly contagious means that a very high percentage of the population must be immunized to be able to stop the transmission – about 93 to 95%, both in the 39, together and within communities. The United States has already achieved this goal. It remains to be seen if this can again.
