Measles: A Major, Re-Emerging ConcernFree Access

Once considered eliminated in the United States, measles is back. Last week’s declaration of a public health emergency by Rockland County officials could not send a clearer message: With a lapse in vaccine protection, serious childhood diseases can come roaring back. This is not meant to scare people, but a warning should be sounded. “Pockets” of unvaccinated individuals increase the possibility that this potentially deadly, highly contagious illness will re-emerge.

We tend to forget how serious measles can be. In 2017, 110,000 people died from measles worldwide and most deaths were in children under the age of 5. This is because global vaccination rates continue to be much lower than U.S. vaccination rates. Before the vaccine was introduced in 1963, measles caused an estimated 2.6 million deaths annually around the globe.

With the introduction of the measles vaccine, American public health officials set the goal of eliminating the disease by the year 2000 and this was achieved. However, since then measles incidence in the U.S. has been on the increase. Since 2010, 53 outbreaks have occurred here, including a large, 147- case, multi-state outbreak linked to an amusement park in California. Rockland’s outbreak numbers have now surpassed this with 153 cases as of last week.

In the U.S. today, about one in every four people who get the disease will be hospitalized and one out of 1,000 sickened will develop a brain infection and swelling, which can cause permanent damage. The Centers for Disease Control and Prevention in Atlanta, our nation’s premier defender of the public’s health, estimates that even with the best medical care, one or two people from the 1,000 who are sickened will die.

There may be some reasons parents choose not to vaccinate their children that are valid. For example, children under six months are not eligible for measles vaccination. Children may also have an illness which prevents them from receiving the vaccine. Sometimes the reason may be related to limited knowledge about the danger of measles, or the safety and effectiveness of the vaccine.

Fortunately in Putnam County, our less protected communities are smaller and fewer when compared to our neighboring county of Rockland. Nonetheless the fact remains that any unprotected, unvaccinated individual presents a potential problem that could endanger populations at risk which may include friends, families and neighbors. Our youngest and most vulnerable community members are most at risk for developing serious health consequences, including death.

School vaccination rates in Putnam vary from a low of 79.3 percent to 100 percent. School-by-school statistics are available to the public online at (search “measles”), with public schools in Putnam County showing the highest rates of immunization. In general, most experts tell us that “herd immunity” protection kicks in when vaccination rates are at 93 to 95 percent. This essentially means that when at least 93 percent of the public is vaccinated, there is a level of assurance that the vaccinated portion of the community will protect those unvaccinated.

Putnam County’s two measles outbreaks in 2018 were both related to unvaccinated international travelers. There were 11 cases in total and our county health department’s communicable disease nursing staff conducted over 200 investigations to prevent spread of the disease. We identified two local venues as sites of possible exposure and quarantined more than 20 individuals. Both of these outbreaks were contained and much smaller than the current outbreak in Rockland, where there are more unvaccinated residents and therefore more local spread of disease. These outbreaks, both the large and small ones, tax the resources of local health department staff. Countless hours are spent interviewing sick individuals to determine how many other people they may have infected. Those possible cases then need to be tracked down and assessed for vaccination status or possible quarantine.

Rest assured we are on alert—always monitoring and evaluating, with active disease surveillance activities, not just within our borders but in neighboring counties as well. We cannot do this alone and we urge all residents to do their part. Check that your child’s immunizations are up to date for measles and the 13 other vaccine-preventable illnesses. Together we can make our community safer.

Michael J. Nesheiwat, MD, is the Commissioner of Health for Putnam County. He has been tracking the measles outbreak in neighboring counties closely.

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