Officially, the U.S. eliminated measles 19 years ago.
While there was the occasional case, brought in by a traveller that could be spread to a few nearby people, outbreaks of the infectious disease have usually been relatively limited.
That is, until this year.
Ongoing measles outbreaks in New York State, and another that just ended in Texas, have put the U.S. in jeopardy of losing that “measles-elimination status.”
There have been 1,241 cases of measles in the U.S. so far this year, according to the Centers for Disease Control and Prevention — the highest number since 1992, though there were no new cases reported this week.
And, the CDC says, if the outbreak in New York State continues after Oct. 2, even with just a single associated case, the U.S. would lose its status and join other countries like the United Kingdom and Greece, which also lost their status this year.
“It would be a very big deal,” said Dr. Isaac Bogoch, an infectious diseases specialist at Toronto General Hospital. “And the reason it would be a big deal is because it just shows that we are headed in the wrong direction from a public health standpoint.”
It also sends the wrong message to the rest of the world, said Dr. Walter Orenstein, associate director of the Emory Vaccine Center at Emory University. “We’ll find out in early October whether we did lose it but if we did then we have to go another whole year without measles or ongoing transmission. And to the world, it may say, ‘See this may be too difficult to do.’
“And I think it’s important because I believe eventually measles should be eradicated.”
WATCH (Aug. 29, 2019): ‘We are backsliding’ WHO says measles cases nearly triple worldwide
Canadians should care too, Bogoch said.
“We should care in Canada because we are seeing similar trends here.”
Canada’s measles outbreaks are sparked by travellers from other countries, which is another reason to care, said Dr. Joanne Langley, a vaccine researcher and professor of pediatrics and epidemiology at Dalhousie University. “You have to think about it from a global perspective. If measles is uncontrolled in Europe and there’s people travelling from Europe to Canada or the United States and we don’t have vaccine coverage, then there’s a risk of measles transmission.”
It’s hard to know how good Canada’s vaccination coverage is, she said, because there is no national registry.
Measles might also be just the tip of the iceberg.
“Measles is probably at the top of the list for contagiousness among vaccine-preventable diseases,” Orenstein said.
“So if you have a problem in your immunization program, the first disease you’re likely to see is measles.”
As the percentage of the population receiving regular vaccinations drops, you could expect to see other vaccine-preventable diseases popping up, he said.
“If you’re seeing problems with measles and lack of vaccination you need to then take a look at your whole immunization program and not just the measles part.”
The measles vaccine is often bundled with immunization against mumps and rubella in the MMR shot, for example. So Orenstein says we could see cases of those diseases as well as things like whooping cough, chickenpox, diphtheria, polio and other diseases that we vaccinate against.
Whooping cough cases in the U.S. have been rising since the 1990s, according to data from the CDC.
WATCH (Sept. 7, 2019): Possible consequences for not vaccinating for measles
“I think if it’s happening for measles it can happen for any vaccines that are on the childhood or adult immunization schedule,” Langley said. “Measles may be more in the public discourse because it’s so infectious.”
With things like the HPV vaccine, which helps prevent cervical and some other cancers, it could be decades before we saw the effects of a drop in immunization rates, she said.
In countries like Canada and the U.S., it’s unlikely that people aren’t getting vaccinated because they can’t access vaccination programs, she said.
“The issue is people getting the vaccine. And we’re seeing people questioning whether they should get vaccines and making individual decisions about whether they take vaccines that actually affect the whole population.”
Changing people’s minds about vaccination is hard, she said.
“We know that conversations are very important. We know that factual information is important, and providing the opportunity to have questions answered.”
Some people are misled by unscientific information they find online or hear elsewhere, she said.
“But you can increase people’s capacity to be good critical appraisers of information and to know how to find the right information to make the best health choices for their family.”
WATCH (Aug. 14, 2019): U.S. experiencing worst measles outbreak since 1992
It’s great that people are so engaged and interested in their health, Bogoch said. But if they read and believe misinformation, they might make bad choices for their health.
“Quite frankly, if you poll any frontline health-care provider, they would have a very recent anecdote of an individual they were working with who was perhaps headed in the wrong direction because of some misinformation that they read about their condition online.”
It’s important to keep up vaccine coverage, Langley said. While smallpox is completely gone, most diseases aren’t. “We have to keep the coverage rates up all the time. It’s not something that’s done, that you put behind you on a population level.”
“It’s just like cutting the grass. We’ve cut it this week but we have to cut it in another week.”