My father, like many of his generation, was hard to hear, and he was sure a childhood brush with measles in Canada was to blame. The most infectious virus known to humans, measles can also lead to blindness, brain inflammation, intellectual disability, and, in rare cases, death.
But most people who grew up in Canada and the US after a vaccine was introduced in 1963 didn't have to worry about everything. In 1978, federal health officials in America focused on virus removal scenes. As more and more people were vaccinated, measles cases dropped. By 2000, the US had declared no measles, and until recently in North America, the disease had often returned to the land of prevention.
As a result, on October 2, the US could lose its measles status. That status is granted in countries where there is no continuous transmission of measles for at least one year, in which case all measles cases can be linked back to a traveler who brought the virus from another place where it has spread. If an outbreak in the state of New York marked a one-year anniversary at the beginning of October, our removal status would follow.
America is certainly not alone. Measles has been surging worldwide and other countries – including United Kington, Greece, and Brazil – lost their elimination status last year.
So let's not run into public health measures, not in the pre-vaccine, measly world of our parents and grandparents – but we are pointing in that direction. Here's how it happened, and why it matters.
Why measles status in America is under threat
Before a measles vaccine was introduced in the US, the country had 4 million cases with 48,000 hospitals and 500 deaths in the US years. Measles is a leading killer of children around the world (and, as people in my father's generation know, a leading cause of hearing loss).
The beauty of the vaccine is that most people who get the right dose never get measles, even when they are exposed. And in 2000, due to widespread vaccination, the virus was declared abolished in the US.
But the ongoing uprising in the state of New York threatens to undermine achieved public health. "If delivery continues in New York, the elimination status for measles will end when there is any case of measles connected to the outbreak on or after October," a CDC spokesman told Vox.
More than 75 percent of the 1,200-plus cases can be tracked in New York, where measles patients are still popping up in Rockland and Wyoming counties. Although a related outbreak in New York City has officially ended and the number of reported cases in the state has waned in recent weeks, "some of them are actually recent. that is the case, "the spokesman said. And now, state health officials are still struggling to control the outbreak.
How did we get here? The CDC points the finger at travelers introducing the virus to tight, under-vaccinated communities. These communities are cohesive and conservative. They speak the same language and read or watch the same news. When the vaccine doubts the seeds themselves, it can spread like wildfire. "We think these communities are the same," Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, Nancy Messonnier, told me in March, and their lack of insularity helps " uprising. " the outbreak is traced back to Ukraine, which saw 50,000 measles cases last year. The current theory is that a boy from Israel was infected with another Israeli virus traveling to Ukraine. When the boy visited the US, he brought the virus to the Jewish Orthodox standard in New York, where a large subset of people refused vaccines because of safety concerns.
Thereafter, "There was also a lot of imports [by travelers] during the outbreak in communities that continued to proliferate," a CDC spokesman said.
So the American uprising this year, like all the years after the measles had disappeared, began with a traveler. But if vaccine coverage rates continue to drop in communities across the US, enough people can get the virus that outbreaks will start to become homegrown again.
Some vaccine experts see this coming – and they say health officials have done little to prevent it
To understand why, see New York: Even the overall coverage rate state vaccine was extremely high for measles in 2017 -2018 – at 97.2 percent – enough people rejected vaccines in these crowded, Orthodox Jewish communities whose highly contagious virus was managed such as wildfire. warning for years. In 2017, Peter Hotez, a professor and dean of the National School of Tropical Medicine at the Baylor College of Medicine, writes a New York Times warning that measles is preparing to make a comeback, in part because of many hotspots across the country. with high rates of unconscious people.
Today's article seems to be quite preserved. "Our national leader continues to teach the [vaccine coverage] averages," Hotez told me recently. "I said who cares – that's not how measles works. These are the pockets where we see a lot of children who aren't vaccinated [that matter]."
In measles, around 95 percent of people in a community need to be vaccinated to keep the disease from spreading, something called herd immunity.When vaccinated enough, even those who have not been immunized are protected from the virus. generally high because measles is contagious. (Other non-communicable diseases, such as polio, require only a coverage rate of around 80 percent.)
This means even a small incidence of the disease vaccine – and especially a large one – can help spread the virus easily.
Saad Omer, a vaccine researcher and director of Yale's Institute for Global Health, also published a warning about the resurgence of measles a few years ago. In an academic paper in 2016, he predicted a larger outbreak by showing how the national vaccine vaccine coverage rate eliminated the number of children who were actually susceptible to measles.
"When you look at people who are not fully immunized or too young to be vaccinated or [who lose immunity following childhood cancer] – those rates have been raised," Omer explained in an interview. And they are concerned enough that Omer and his colleagues have warned that these unnoticed groups of children with susceptible measles should raise "concerns that transmission of endemic measles may be can be established despite overall high levels of immunity. " Noticing these warnings, the researchers argue. "What needs to be done is a diverse national response to strengthening and developing an evidence base to address and increase vaccine acceptance," Omer said. But that did not happen.
Hotez agrees. "My feeling is that our country has not taken the steps necessary to disarm the new anti-vaccine movement. This means that measles will be a new normal again."
It certainly would not help, At the state level, there are many places that make it easy for parents who are hesitant to vaccinate vaccines by offering religious and philosophical exceptions, which have nothing to do with legitimate medical concerns. And nationwide, even at no charge, children will be given a "conditional access" to the school with the promise that they will be vaccinated, but schools do not always bother to follow up.
That was part of the New York story until this year's outbreak sparked a crackdown.The 2019-2020 school year is the first in which religious inclusion in vaccines is no longer offered in the state, you all children attending the school should start vaccinations during the first weeks of school and prove that they are fully vaccinated by the end of the school year. New law makes New York the only fifth state in the country to eliminate non-medical vaccine exemptions. So many other states still have a lot of work to do.
The measures could be "coal mine canaries"
If the New York outbreak continues in October, the loss of measles removal status will be a public health emergency.
The removal of measles took decades of work to achieve. "It's a confirmation that our immunization system is working well," Hotez said. "The fact that measles is back is a worrying sign that there is a problem with the country in our immunization system, which has been devastating."
"This is a line in the sand," says University of Pennsylvania researcher Alison Buttenheim, "to go back to having regular measles around the country." But even America manages to maintain its status. this year, we have to wonder if our children are in schools with high vaccine rates, and we should think about measles every time we travel with newborns or family members not vaccinated. (Hotez said he got a booster shot to make sure that up until now, and anyone concerned about their role in measles vaccination can get a blood test to make sure they have antibodies for virus.)
It is also possible that America will get measles control under control again soon, and that it will not lead to a full bloom of the disease again.
On the other hand, measles can also be a signal for a bigger problem. Because it tops the list of infectious diseases, cases can start to open even with a slight drop in vaccination coverage rates. And, again, the vaccine coverage rates required for vaccine vaccination are lower for other non-communicable diseases, said Walter Orenstein, an infectious disease professor at Emory University School of Medicine. "So measles can be the canary in the coal mine in terms of identifying a bigger problem with under-immunization. It has the potential to continue to worsen; it could mean other diseases are making a comeback."