Page 109 - JSOM Summer 2019

EDITOR’S NOTE

Dan C. Godbee, MD, NREMT-P, COL, MC, FS, DMO, AL-ARNG
JSOM Medical Editor

Global Measles Immunization Update is from an ultra-Orthodox neighborhood, which is associated
with an incorrect perception that fervently religious Jews are
In the United States, as of 22 May 2019, there were 880 mea- protected from infection by the insulated nature of their com-
sles cases reported in this year’s outbreak, the largest since munities, as well as discredited rumors that the life-saving
1994. The rise in cases has been attributed to a lowered rate practice of vaccination is dangerous. 7
1
of vaccination. Reasons for the declining rate include vaccine
hesitancy or refusal and lack of vaccine availability or ability to Are all adults protected against measles? Not necessarily.
afford the vaccine. So far, there have been no confirmed cases Measles vaccines became available in 1963. If you received
of measles in 2019 among military members or their families, the standard two doses of the measles, mumps, and rubella
at least not among those treated in military treatment facilities. (MMR) vaccine after 1967, you should be protected against
All Servicemembers are required to receive the measles vaccina- the measles for life. Most people born before 1957 are thought
tion, and all family members are strongly encouraged to do so, to have been infected naturally with the virus through measles
too. Children attending Department of Defense Education Ac- outbreaks, but some are not immune. Physicians can check a
2
tivity schools must provide proof of immunization. However, patient’s immunity levels with a blood test. People born before
military treatment facilities like Naval Hospital Bremerton, 1957 who have had the lab testing that shows they are not
Washington, are monitoring the situation because Washington immune and may be at high risk should have one dose of the
is one of the states with current measles outbreaks. 3
MMR vaccine and then a second dose 28 days later. 8
Outside of the United States, in 2018, more children in the You are at a high risk if you travel during an outbreak, are
WHO European Region were vaccinated against measles than near travel hubs or destinations, or are a healthcare provider.
ever before, but progress has been uneven between and within You could be at risk if you only received one dose of the vac-
countries, leaving increasing clusters of susceptible individuals cine or if a blood test shows you are not immune. 8
unprotected and resulting in a record number of people af-
fected by the virus. During 2017–2018, a resurgence of mea- The live version of the vaccine introduced in 1963 appears to
4
sles occurred, with large-scale outbreaks in Ukraine, Serbia, have worked well, but there was another version (the “killed”
and some countries that had achieved elimination, including version) that did not. That was also administered between
France, Israel, Georgia, Greece, and Italy. In the first 4 months 1963 and 1967. Therefore, people who either received the
of 2019, 179 countries reported 168,193 cases of measles, al- killed version of the measles vaccine or do not know what
most 117,000 more cases than reported during the same pe- kind they received in the 1960s should be reimmunized. 8
riod in 2018. Actual numbers are probably much higher; the
WHO estimates that only 1 in 10 cases are reported. 5
In general, older adults are at a low risk for contracting mea-
sles. Most people born before 1957 were exposed to at least
Even after a country attains elimination—defined as the ab- two major measles outbreaks, which confers immunity. Once
sence of the continuous transmission of measles for 1 year a person has had the measles, he or she is immune for life.
or longer—maintenance programs must be relentless. The Those who received the vaccine between 1963 and 1967 are
Americas is learning this lesson the hard way. In 2016, the the exceptions. 8
region became the first to eliminate measles after its 35 coun-
tries immunized 95% or more of their populations. That’s References
the point at which herd immunity can keep safe those who 1. https://www.nbcnews.com/health/kids-health/cdc-reports-41-new-
are not immunized (often for health reasons or because they measles-cases-outbreak-continues-grow-n1007681
are too young). But across the region, vaccination rates have 2. https://www.nytimes.com/2019/05/20/health/measles-out
since dipped, and outbreaks in Brazil and Venezuela have cost break-washington-new-york.htmltinues to grow
the region its elimination status. 5 3. https://www.militarytimes.com/pay-benefits/2019/04/19/so
-far-no-measles-cases-at-military-medical-facilities-but-officials
-are-watching/
Reasons for recent failures vary across the world. Political in- 4. http://www.euro.who.int/en/media-centre/sections/press
stability, conflict, and poverty can lead to shortages of vaccines -releases/2019/measles-in-europe-record-number-of-both-sick
(which must be refrigerated) and clinic closings. When civil -and-immunized
war broke out in Côte d’Ivoire in late 2010, for example, the 5. https://www.sciencenews.org/article/measles-global
percentage of individuals getting vaccinated against measles -spread-vaccinationw
plummeted, from 70% in 2010 to 49% in 2011. In Decem- 6. https://www.cdc.gov/mmwr/volumes/68/wr/mm6817a4.htm
2
ber 2018 in Israel, a female soldier had symptoms of measles. 7. https://www.timesofisrael.com/idf-rushes-to-complete-measles
-vaccinations-after-soldier-contracts-virus/
Tests revealed that the soldier had contracted measles, which 8. https://www.healthline.com/health-news/some-adults
is making a major comeback in Israel amid a decline in some -need-to-be-revaccinated-against-measles-021115#3
communities of parents vaccinating their children. The soldier

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