Reappearance of measles in Michigan prompts new concerns

Measles, a disease long thought eradicated or brought under control in the United States thanks to effective vaccinations, appears to be making a comeback, with three cases now identified in southeast Michigan.

The first case of measles reported in Michigan since 2019 was confirmed in Oakland County in late February. Since then, two more cases have been reported, one each in Wayne and Washtenaw counties.

The U.S. Centers for Disease Control and Prevention, as of March 7, reported a total of 45 measles cases, with reports in Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York City, Ohio, Pennsylvania, Virginia and Washington. The CDC reported a total of 58 cases in the U.S. in 2023, none of them in Michigan.

We asked Teena Chopra, M.D., M.P.H., professor of Internal Medicine, Infectious Diseases, for the Wayne State University School of Medicine, and co-director of the WSU Center for Emerging and Infectious Diseases, to answer questions about measles, its effects and preventive steps necessary to contain the disease.

What is measles, how does it manifest, and what does it do?

Measles is an acute viral respiratory illness. It is characterized by fever (as high as 105°F) and malaise, cough, coryza and conjunctivitis - the three Cs, a pathognomonic enanthema (Koplik spots) followed by a maculopapular rash. The rash usually appears about 14 days after a person is exposed. The rash spreads from the head to the trunk to the lower extremities. Patients are considered contagious from four days before to four days after the rash appears. Sometimes immunocompromised patients do not develop the rash.

Is the measles vaccine safe?

The measles vaccine is very safe. Like other vaccines, it can cause mild effects, including soreness, fever and mild rash, etc., but serious side effects are rare. The risk of infection outweighs the risk of the vaccine.

Can my primary care provider or pediatrician provide the vaccination?

Absolutely. Primary care providers, pediatricians and health departments can provide the measles vaccine.

When should parents ideally have their children vaccinated?

The Centers for Disease Control and Prevention recommends routine childhood immunization for the measles-mumps-rubella, or MMR, vaccine starting with the first dose at 12 through 15 months of age, and the second dose at four through six years of age, or at least 28 days following the first dose. The measles-mumps-rubella-varicella, or MMRV, vaccine is also available to children 12 months through 12 years of age; the minimum interval between doses is three months.

If parents missed that window, can their children still be vaccinated?

Yes, they can still give them the vaccine at any time in consultation with their pediatrician.

For Americans of a certain generation, say Baby Boomers and older, measles seemed to be a routine part of childhood. You caught the disease, suffered through it, and seemed to gain an immunity. Was it less of a threat then?

Measles is the most contagious infectious disease we know of. A single case in a community has the potential to infect 14 to 18 others. Measles had the same infectivity for the Baby Boomers, but as the community ages they forget about the severity of the disease.

Measles is no joke. Whereas most people recover after the illness, it can cause serious morbidity and mortality in children and other high-risk patients.

Measles cases today are far less severe than they were in the 1960s thanks to vaccination. However, given the recent outbreaks from falling immunization rates, we are not off to a great start.

If you had measles as a child, are you immune, or should you still be vaccinated?

If you had measles as a child, you are immune and don’t need to be vaccinated.

Should adults who have never been vaccinated do so now?

Yes, people who are born during or after 1957 who do not have evidence of immunity against measles should get at least one dose of MMR vaccine. If born before 1957, it is assumed you had measles, so you are fully protected and can skip the measles vaccine unless you are immunocompromised.

How long does the vaccination last? Is it essentially a lifetime vaccination?

Yes, it is a lifetime vaccination. The measles vaccine works incredibly well, better than influenza and COVID-19 vaccines. The reason for this is that the measles virus doesn’t mutate like SARS Cov2 or the influenza virus. The 1960 measles virus is still the same and hasn’t mutated.

Having said that, there can still be breakthrough cases, but they are very rare, and when present, the disease is milder.

What damage can measles cause?

Common complications from measles include otitis media, bronchopneumonia, laryngotracheobronchitis and diarrhea.
Severe complications include acute encephalitis, which often results in permanent brain damage and can be seen in one out of every 1,000 measles cases. One to three of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.

Subacute sclerosing panencephalitis is a rare but fatal degenerative disease of the central nervous system characterized by behavioral and intellectual deterioration and seizures that generally develop seven to 10 years after measles infection.

Who is more likely to contract measles, children or adults? Can children spread it to adults?

Yes, children can infect unvaccinated adults. As many as nine out of 10 susceptible persons with close contact to a measles patient will develop measles. The virus is transmitted by direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs or sneezes. The measles virus can remain infectious in the air for up to two hours after an infected person leaves an area.

Who or what age groups are more susceptible to the more damaging aspects?

People at high risk for severe illness and complications from measles include:
Infants and children younger than 5
Adults 20 and older years
Pregnant women
People with compromised immune systems, such as from leukemia and HIV infection

What is the risk of decreasing vaccination rates to the population as a whole?

This will make measles endemic (constant presence of disease in an area) in the United States, which can be very dangerous. Measles can easily be eliminated through increasing vaccination rates, particularly in community pockets that tend to have lower rates.

Not taking the measles vaccination is not an individual decision, it is a community and public health decision.

How high must vaccination rates be to provide so-called “herd immunity?"

Because measles is highly contagious and has a very high reproductive rate, 90 percent to 95 percent of the population needs to be vaccinated to achieve herd immunity.