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What is the History of Measles in America and Other Countries?

History of measles in America
Image source: CDC PHIL

Measles was first described in the 9th century by Persian physician-philosopher Zakariya Razi. His accurate description of measles was recognized by the World Health Organization in 1970 and recognized as the first written account of the condition.1

In 1757, Scottish physician Francis Home determine that measles was an infection of the respiratory tract and could be found in the blood of affected individuals.2 Home attempted to develop a measles vaccine, however, his vaccine experiments were not successful as the measles virus had not yet been isolated.3 It wasn’t until an outbreak occurred among Boston Massachusetts students in 1954 that researchers Dr. Thomas C Peebles and Dr. John F. Enders were successful in isolating the virus. Measles vaccine development began soon after discovery.4

Prior to 1912, measles was not a reportable disease in the United States, therefore, accurate numbers of cases are not available before this time. In 1920, the United States had 469,924 recorded cases of measles and 7,575 deaths associated with measles.5 From 1958 to 1962, the U.S. averaged 503,282 cases and 432 death associated with measles each year.6 Before the first measles vaccine was licensed in the U.S. in 1963, measles increases were seen generally in late winter and spring7 every two to three years.8

Prior to the introduction of the measles vaccine in 1963, the CDC admits there was massive underreporting of measles cases and that “because virtually all children acquired measles, the number of measles cases probably approached 3.5 million per year (.i.e., an entire birth cohort).”9 Other doctors reports that up to 5 million cases of measles occurring every year in the United States. 10 In 1960, three years before the first measles vaccine was put on the market in the U.S., there were about 442,000 reported measles cases and 380 related deaths11, 12 among the 3.5 to 5 million Americans who likely were infected with measles. 13 14 In 1969, measles deaths were estimated at 1 in 10,000 cases.15

The CDC attributes the drop in reported measles cases and deaths in the U.S. to use of the measles vaccine beginning in the mid-1960’s,16 however, published measles morbidity and mortality data give evidence that death rates for measles had dropped significantly in the U.S. before the measles vaccine was introduced in 1963.17 18 

In 1967, public health officials announced that measles could be eradicated from the United States within a few months, with the introduction and use of measles vaccines.19 However, mass vaccination of infants beginning at approximately one year of age and the push for all children entering school to receive a dose of measles vaccine, did not result in eradication and outbreaks of measles continue to occur in highly vaccinated populations.20 21 However, by the end of 1968, 22,231 measles cases had been reported to the CDC.22

In 1979, public health officials launched an effort to eliminate measles in the United States through vaccination, with a goal of eradication by October 1st, 1982.23 In 1982, there were a record low 1,697 reported cases of measles in the United States 24 and while public health officials conceded that the goal of elimination had not been met, they publicly stated that it was “right around the corner”.25

A resurgence of measles in the United States occurred between 1989 and 1991, when reported measles cases increased 6- to 9-fold over the previously studied period between 1985 and 1988. During this resurgence, more than 53,000 cases of measles occurred as the result of 815 separate outbreaks.26  132 deaths in the U.S. were suspected to be associated with measles during this outbreak.27 As a result of the large increase in number of reported measles cases, the CDC’s Advisory Committee on Immunization Practices changed its measles recommendation, and all children were advised to receive an additional dose of measles vaccine prior to school entry.28

Reported measles cases dropped by the early 1990’s and in an eight-year period between 1993 and 2001, there were 1804 cases of measles reported in 120 outbreaks. 29 After only 15 measles cases were reported between 1999 and 2001, public health officials declared that measles was no longer endemic in the United States.30 In 2000, with only 86 reported cases of measles, 31 the CDC declared measles to be eliminated in the United States.32

Between 2000 and 2007, the U.S. recorded an average of 63 cases of measles a year. The numbers increased again in 2008 to 140 reported cases33 before decreasing again in 200934 and 2010.35 Measles cases increased again in 2011 to 220, with the majority linked to travelers returning from, or visiting, other countries, including those in Europe and Southeast Asia.36 

In 2014, there were 667 reported measles infections in the United States with the CDC reporting many to be associated with a large outbreak in the Philippines.37 An Amish community in Ohio experienced an outbreak that included 383 cases. 38

In January 2015, a multi-state measles outbreak linked to a California amusement park occurred, affecting 147 individuals. No known outbreak source was determined, however, the CDC believed the infection to have resulted from an international traveler as the particular strain was reported by the CDC to be identical to a strain that caused a large outbreak in the Philippines in 2014.39

The 2015 measles outbreak prompted a media firestorm, with newspapers and health officials blaming the parents of unvaccinated children, calling them ignorant, anti-science, and worse.40 State legislators quickly began introducing vaccine legislation, with many bills aimed at eliminating or severely restricting religious and conscientious/philosophical vaccine exemptions. Vaccine choice advocates were highly successful in defeating many of these bills, however, California lost its personal belief exemption and Vermont lost its philosophical exemption but retained its religious exemption.41

During the 2015 California measles outbreak, many suspected cases actually occurred in persons who were recently vaccinated. 194 measles virus sequences were collected in 2015, with 73 cases found to have actually been vaccine strain measles.42 While referred to by the CDC as a vaccine reaction, a rash and fever occurring 10-14 days following vaccination is indistinguishable from wild type measles and requires confirmation by genotyping.43 Multiple studies have been published on vaccine strain measles and the inability of physicians to differentiate between wild and vaccine strain measles without genotyping.44 45 46 47 48 49

In 2017, a 75 case outbreak occurred, affecting mainly Somalian Americans living in Minnesota.50 A total of 122 cases of measles were reported in 2017.51

Between January 1 and December 29, 2018, 349 cases of measles cases have been reported to the CDC and linked to 17 separate outbreaks. Measles cases have been reported in 26 states and the District of Columbia.52

“Modified” measles can also occur in persons with some degree of immunity, as well as in previously vaccinated persons, who get a milder form of measles. “Atypical” measles can occur in a person, who was previously vaccinated with a killed-virus vaccine used from 1963 to 1967, and who is exposed to wild-type measles. 53The course of atypical measles is generally longer than natural measles.54 

Measles is a common infection seen in many developing countries, especially in Asia and Africa. The World Health Organization estimates that 7 million measles infection occurred in 2016 and reported 89,780 measles related deaths. Measles complications more frequently affect young children who are malnourished and are insufficient in vitamin A. Children with immunosuppressive disease such as HIV are also more likely to suffer from complications.55

IMPORTANT NOTE: NVIC encourages you to become fully informed about Measles and the Measles vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

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1 Modanlou HD A tribute to Zakariya Razi (865 - 925 AD), an Iranian pioneer scholar. Arch Iran Med. 2008 Nov; 11(6):673-7.

2 Plotkin SA. Vaccination against measles in the 18th century. Clin Pediatr (Phila). 1967 May;6(5):312-5.

3 Enders JF Vaccination Against Measles: Francis Home Redivivus Yale J Biol Med. Dec –Feb 1961-2; 34(3-4): 239–260.

4 CDC Measles History Mar. 19, 2018

5 CDC Achievements in Public Health, 1900-1999 Impact of Vaccines Universally Recommended for Children -- United States, 1990-1998 MMWR April 02, 1999 / 48(12);243-248

6 Ibid

7 CDC Measles – Epidemiology Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

8 WHO Measles. Sep. 20, 2018

9 CDC. Measles, Mumps and Rubella – Vaccine Use and Strategies for Elimination of Measles, Rubella and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR May 22, 1998; 47(RR-8): 1-57. 

10 Wood DJ, Brunell PA. Measles Control in the United States: Problems of the Past and Challenges for the Future. Clin Microbiol Rev 1995; 8(2): 260-267.

11 CDC Reported incidence of notifiable diseases in the United States 1962. MMWR Sep. 16, 1963; 11(53): 1-29

12 National Center for Health Statistics. U.S. Vital Statistics Mortality Data. National Vital Statistics System. 

13 CDC. Measles, Mumps and Rubella – Vaccine Use and Strategies for Elimination of Measles, Rubella and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR May 22, 1998; 47(RR-8): 1-57. 

14 Wood DJ, Brunell PA. Measles Control in the United States: Problems of the Past and Challenges for the Future. Clin Microbiol Rev 1995; 8(2): 260-267. 

15 CDC SUPPLEMENT – Collected Recommendations of the Public Health Service Advisory Committee on Immunization Practices MMWR Oct. 25, 1969; 18(43) : 1-31

16 CDC Measles, Mumps, and Rubella—Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. May 22, 1997; 47(RR-8); 1-57.

17 Grove RD, Hetzel AM. Vital Statistics Rates in the United States 1940-1960 U.S. Public Health Service National Center for Health Statistics 1968.

18 McKinlay JB, McKinlay SM. The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century. MMFQ. Health and Society. Summer 1977. P. 421.

19 Sencer DJ, Dull HB, Langmuir AD Epidemiologic basis for eradication of measles in 1967. Public Health Rep. 1967 Mar; 82(3): 253–256.

20 Baratta RO, Ginter MC, Price MA et al. Measles (rubeola) in previously immunized children. Pediatrics. 1970 Sep; 46(3):397-402.

21 Wood DL, Brunell PA Measles control in the United States: problems of the past and challenges for the future. Clin Microbiol Rev. 1995 Apr; 8(2): 260–267.

22 CDC Reported incidence of notifiable diseases in the United States, 1968 MMWR 17(53): 1-60

23 Hinman AR, Brandling-Bennett AD, Nieburg PI. The opportunity and obligation to eliminate measles from the United States. JAMA. 1979 Sep 14; 242(11):1157-62.

24 CDC Current Trends Measles -- United States, 1982 MMWR Feb. 04, 1983; 32(4);49-51

25 Associated Press U.S. Cases of Measles Are Almost Eradicated. The New York Times. Oct. 3, 1982

26 Hutchins S, Markowitz L, Atkinson W, et al. Measles Outbreaks in the United States, 1987 through 1990. Pediatr Infect Dis J. 1996; 15:31-38.

27 CDC Measles -- United States, 1992 MMWR May 21, 1993; 42(19);378-381

28 CDC Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR Dec 29, 1989; 38(S-9);1-18

29 Yip FY, Papania MJ, Redd SB. Measles Outbreak Epidemiology in the United States, 1993-2001. J Infect Dis. May 1, 2004; 189 Suppl 1:S54-60.

30 Ibid

31 CDC Measles --- United States, 2000 MMWR Feb. 15, 2002; 51(06);120-3

32 CDC Measles History Mar. 19, 2018

33 CDC Update: Measles—United States, January-July 2008. MMWR. Aug. 22, 2008; 57(33); 893-896.

34 CDC Summary of Notifiable Diseases --- United States, 2009. MMWR. May 13, 2011; 58(53);1-100

35 CDC Summary of Notifiable Diseases — United States, 2010. MMWR. Jun. 1, 2012; 59(53);1-111

36 CDC Summary of Notifiable Diseases — United States, 2011. MMWR. July 5, 2013; 60(53);1-117

37 CDC Summary of Notifiable Infectious Diseases and Conditions — United States, 2014 MMWR. Oct. 14, 2016; 63(54);1-152

38 CDC Measles Cases and Outbreaks. Nov. 15, 2018

39 Ibid

40 NVIC Measles in Disneyland: Third MMR Shot and Vaccine Exemption Ban? Jan 28, 2015

41 NVIC State Vaccine Legislation in America 2015-2017. Oct 25, 2017

42 Roy F, Mendoza L, Hiebert J et al. Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR. J Clin Microbiol. 2017 Mar;55(3):735-743.

43 CDC Measles (Rubeola) Genetic Analysis of Measles Viruses Jun. 5, 2018

44 Tramuto F, Dones P, D Angelo C et al. Post-vaccine measles in a child with concomitant influenza, Sicily, Italy, March 2015. Euro Surveill. 2015 May 21;20(20). pii: 21134.

45 Murti M, Krajden M, Petric M et al. Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013. Euro Surveill. 2013 Dec 5;18(49). pii: 20649.

46 Kaic B, Gjenero-Margan I, Aleraj B, et al. Spotlight on measles 2010: excretion of vaccine strain measles virus in urine and pharyngeal secretions of a child with vaccine associated febrile rash illness, Croatia, March 2010. Euro Surveill. 2010 Sep 2;15(35). pii: 19652.

47 Morfin F, Beguin A, Lina B, et al. Detection of measles vaccine in the throat of a vaccinated child. Vaccine. 2002 Feb 22; 20(11-12):1541-3.

48  Nestibo L, Lee BE, Fonseca K et al. Differentiating the wild from the attenuated during a measles outbreak Paediatr Child Health. 2012 Apr; 17(4): e32–e33.

49 Roy F, Mendoza L, Hiebert J et al. Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR. J Clin Microbiol. 2017 Mar;55(3):735-743.

50 CDC Measles Outbreak — Minnesota April–May 2017 MMWR Jul. 14, 2017 / 66(27);713–717

51 CDC Notifiable Diseases and Mortality Tables MMWR Jan. 5, 2018; 66(52)

52 CDC Measles Cases and Outbreaks. Jan. 10, 2019

53 CDC Measles - Complications Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book). 13th ed. 2015.

54 Sabella C. Measles: Not just a childhood rash Cleve Clin J Med 2010 Mar. 77(3):207-213

55WHO Measles Sep. 20, 2018

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