Article of the Week: Measles in the 21st Century

posted by Jennifer C.

Mullholland K., et al. Measles in the 21st Century. NEJM. 20112.
Not strictly PEM but an article about measles, a disease we could see in the ED as most cases in the US are imported by travelers and recently arrived little people. And there remains the pool of susceptible children who are not vaccinated out of choice.
Interesting points made in this article: 
Measles has been a major source of childhood morbidity (hospitalizations, blindness) and mortality (at least 1 million deaths per year in the early 90s) worldwide. Resurgences in the US were noted to occur more often in older children or adults, leading to the adoption of a 2-dose immunization schedule. From 2000-2008, measles control improved markedly with this 2-dose approach.
In the second half of the decade, however, there have been worrisome trends that continue today:
- in Western Europe, there have been outbreaks related to declining immunization rates from parent refusal. In 2011 alone, France reported over 15,000 cases, including 6 deaths (qu’est ce qui se passe avec nos amis Francais?)
- in low-resource countries, polio eradication has competed with measles control efforts, leading to a shift of resources away from measles programs. Compounding this problem has been a general decline in enthusiasm for measles control. Finally, the polio campaigns, if and when they achieve their goal, will have surpassed the initial estimates of cost many times over. This fact may adversely impact measles-control funding decisions.
The effect is that the low measles death rate of 164,000 in 2008 has rebounded, with more than 172,000 deaths in Africa alone in 2010. Given that most of these deaths are in infancy, there are studies on the feasibility of giving a first dose at younger ages, even as young as 4 months, in order to protect babies during their time of greatest susceptibility.