By Marina Canalejo, Public Policy Assistant, Canadian Cancer Survivor Network
A new series of outbreaks worldwide has seen the return of a serious and deadly infectious disease: measles. Measles is a highly contagious disease that is transmitted via the air when you are in contact with someone who has the disease. The main cause of death is from complications, such as pneumonia or acute encephalitis.
Before 1963, 300,000 to 400,000 cases of measles were reported annually in Canada. Since the measles vaccine was developed, the incidence of measles decreased by more than 95%. In 1998, Canada achieved measles eradication due to the introduction of a second dose to the routine immunization schedule. In 2015 and 2016, the total number of reported cases of measles in Canada was 196 and 11 respectively.
Nevertheless, imported cases of measles continue to be reported. According to the World Health Organization (WHO), travel increases the risk of exposure to measles in susceptible populations if they are not vaccinated. The WHO recommends two doses of measles vaccine for all children and at least one dose prior to international travel for those unsure of their immunity status.
More than 68,000 cases of measles have been documented worldwide, with 553 deaths confirmed and another 373 suspected since the current outbreak began in September 2018. In 2015, 25,000 children died of measles in India. In Europe, where 33 countries reported outbreaks in 2011, 6,500 persons contracted the disease. The numbers have been more severe in Southeast Asia due to a lack of immunization and healthcare in poorer regions of these countries. In Madagascar, measles has caused 900 deaths. In the Philippines, 136 people have died. The epidemic is a result of an immunization rate lower than 60%, and depleted health services.
Severe complications can develop in adults who develop measles. Diarrhea, middle ear infection, or bronchopneumonia can have debilitating effects. Encephalitis occurs in approximately one out of every 1,000 cases, leaving survivors with severe brain damage. Death occurs in one or two cases out of 1,000. Subacute sclerosing panencephalitis (SSPE) is a rare degenerative disease of the central nervous system associated with the measles virus, and it may appear years after measles infection.
Studies indicate that vaccination is the most effective way to deal with measles. If the first dose is administered no earlier than the first birthday, more than 99% of persons who receive two doses will develop immunity. Although lower than natural disease, both serologic (blood tests) and epidemiologic evidence indicate that the vaccine induces long-term, probably life-long, immunity.
The measles vaccine is not recommended for persons already severely immunocompromised because the vaccine itself might increase illness. This can include individuals with cancer, recipients of organ translants, those with inherited diseases that affect the immune system, and many more. Conversely, people not severely compromised who have shown low levels of immunity in blood tests might benefit from the vaccine.
As a general rule, the Centers for Disease Control and Prevention (CDC) indicate that persons can be presumed immune to measles if they have documented their vaccination regime either in a laboratory or with their physician, if they had measles or if they were born before 1957. In Canada, all adults born before 1970 are generally assumed to have acquired natural immunity, as there were high levels of measles circulating before that time.
According to the CDC, measles “can be severe and prolonged among immunocompromised persons, particularly those who have certain leukemias, lymphomas, or human immunodeficiency virus (HIV) infection.”  In these cases, measles can appear without the typical symptom of a rash and it may remain contagious for several weeks after the onset of the acute illness.
There is very little that can be done in terms of treatment.
Immune globulin (IG) is indicated for susceptible contacts of measles patients, particularly those for whom the risk for complications is increased (i.e., infants aged less than a year old, pregnant women, or immunocompromised persons). IGs elevate the level of immune response and can help to reduce the complications of the disease. If administered within six days of exposure, a doses of IG can prevent or modify measles in a non-immune person.
There is a very small risk that serious problems could occur after getting vaccinated. However, the potential risks associated with measles are much greater than the potential risks associated with the vaccine.
The National Foundation for Infectious Diseases (USA) points out a number of facts about measles that should be taken into consideration:
FACT: Measles can be prevented with a safe and effective vaccine.
FACT: The risk of death from measles is higher for adults and infants than for children.
FACT: 45% of measles cases in the US were in unvaccinated adults age 20 years and older.
FACT: Pregnant women who get measles have an increased risk for early labour, miscarriage, or low birth weight infants.
FACT: Measles is contagious from four days before until four days after the rash appears.
FACT: Measles can cause life-threatening pneumonia and brain inflammation, middle-ear infection, severe diarrhea, and sometimes death.
FACT: Outbreaks of measles primarily affected those who were not vaccinated with MMR (measles-mumps-rubella) vaccine.
FACT: Most cases of measles result from infections acquired in other countries or are linked to imported cases.
FACT: Globally, measles continues to be
endemic, resulting in 164,000 deaths each year.
 CTV News at https://www.ctvnews.ca/health/measles-epidemic-in-madagascar-kills-more-than-900-says-who-1.4306391
 Centers for Disease Control and Prevention, USA at https://www.cdc.gov/mmwr/preview/mmwrhtml/00053391.htm
 National Foundation for Infectious Diseases at http://www.adultvaccination.org/vpd/measles/adultvaccination-facts-about-measles-for-adults.html