Measles Cases Surge in the US
The United States is currently facing its most severe measles outbreak in over thirty years, with more than 1,300 cases reported across 40 states as of July 16. This situation brings back memories of 2019, when similar numbers put the nation’s measles elimination status at stake. Six years ago, health officials managed to contain an outbreak, but with increasing public skepticism toward vaccines, many of the strategies that worked then might not be effective today.
Measles elimination refers to a scenario where there has been no ongoing transmission within a country for more than 12 months. This nearly happened during the 2019 outbreak, predominantly affecting Orthodox Jewish communities in New York City and its neighboring areas. In late 2018, travelers from Israel tested positive for measles, leading to swift transmission in closely-knit groups, particularly among children, largely due to low vaccination rates. While the statewide vaccination rate for school-aged children reached 98 percent the year before, schools in the outbreak areas had only about 77 percent compliance. Given that measles is highly contagious, a 95 percent vaccination rate is crucial for community protection.
Consequently, the majority of measles cases have emerged among individuals aged 18 and younger, with nearly 86 percent known to be unvaccinated. Some of these individuals faced severe complications, including pneumonia, and nearly 8 percent required hospitalization.
The current increase in cases is primarily linked to an outbreak in a Mennonite community in West Texas, which has since led to cases spreading to other counties in Texas, as well as New Mexico and Oklahoma. Tragically, two unvaccinated children in Texas and one adult in New Mexico have died this year due to measles.
Neil Vora, who used to be a medical epidemiologist at the CDC and now serves as the executive director of Preventing Pandemics at the Source Coalition, remarked, “There are definitely parallels. What we saw in New York was very much the result of years and years of misinformation and disinformation surrounding vaccine safety.”
Efforts in New York ultimately quelled the outbreak after several months that utilized both traditional public health measures and changes in policy at various levels.
Oxiris Barbot, the former health commissioner of New York City, emphasized the importance of addressing the first case seriously, saying, “It’s like kindling. You never know when that fire is just going to break out.” As the disease spread, she recognized the necessity of reaching out to the sources of transmission, particularly Orthodox Jewish schools within the affected neighborhoods. In collaboration with school leaders, vaccination records were scrutinized to pinpoint unvaccinated or insufficiently vaccinated children. Following possible exposure, those children were barred from attending school and childcare for a period of 21 days, which is the incubation time for measles. Similar actions were implemented in certain counties outside of the city.
Barbot noted, “It took a lot of staff time, a lot of leg work.” In one instance, a contagious child contributed to over 25 infections among classmates, prompting further spread beyond the school. She mentioned that the health department was “heavily involved” in ensuring schools adhered to quarantine regulations.
