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Distinguishing the Virus
Measles, a highly contagious viral disease spread through contact with infected nasal or throat secretions through sneezing and coughing causes a variety of symptoms to include high fever, runny nose, coughing, and a rash all over the body [1]. This disease was strikingly similar to smallpox; however, these diseases became distinctly separated in the 9th century by a Persian physician named Abū Bakr Muhammad Zakariyyā Rāzī (known as “Rhazes” in the Western World)[2]. -
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Widespread Outbreak
Several measles epidemics were reported in Europe during the 11th and 12th centuries. The disease was also widespread in South and East Asia, India, and China during the Middle Ages. Most fatalities involved children less than 5 years old[3]. -
Experimentations Leading to Pathogenicity
Francis Home, a physician from Scotland, discovered that the Measles virus was an infectious agent found in the blood of patients. He inoculated healthy individuals with blood samples from infected individuals and found that the healthy individuals acquired symptoms of the disease. This concluded it was a bloodborne pathogen. He attempted to inoculate children with measles to prevent the disease but isolating the virus at the proper time proved to be too difficult [3]. -
Routine Reporting
Measles became a reportable disease, which required healthcare providers and laboratories to report all diagnosed cases. An average of 6,000 deaths were reported each year in the first decade of reporting. Before a vaccine was developed, nearly all children became infected by the time they were 15 years old, and it was estimated that 3-4 million people in the United State were infected each year[4]. -
Vaccine Development
A measles outbreak in a boarding school in Boston, Massachusetts allowed Thomas Peebles, MD and John Franklin Enders an opportunity to isolate the virus by taking throat swabs and blood samples from the infected individuals. They were able to cultivate the virus obtained from a sample from an 11-year-old boy named David Edmonston. This led to the development of the first measles vaccine[5]. -
Vaccine Licensure for Public Use
First licensed measles vaccine for public use was created by Enders and his team from the ‘Edmonston-B’ strain that was initially isolated from David Edmonston. Prior to licensure the vaccine was tested on small groups of children and eventually moved to clinical trials on thousands of children in New York City and Nigeria, where it was proven to be 100% effective [5]. -
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Decreasing Infection Rates
The infection rate dropped by more than 97% after the development of the vaccine, but required a safer vaccine to avoid unwanted symptoms [6]. -
New Formulation
An improved, more attenuated measles vaccine was developed by Maurice Hileman and his colleagues at Merck Co. [3]. -
Invention of the MMR Vaccine
A combination vaccine that protected against mumps, measles, and rubella was developed. This vaccine is widely known as the MMR vaccine. Recommended to have a single dose at 9–12 months and then a booster before 18 months. Not recommended to have any earlier as maternal antibodies would interfere with vaccine efficacy [3]. -
More Vaccine Options
A single-dose vaccination was introduced for school entry; however, it was not mandatory. This led to 90% decrease in measle cases, but epidemics still occurred every 3-5 years due to lack of vaccination in preschool children and failure of the one-dose vaccination [3]. -
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Rise in Measles Cases
Measles cases spiked in the United States with about 55,000 reported cases and 123 deaths. This resurgence sparked the implementation of a national two-dose measles program, where the first dose was given at age 2 and the second dose administered between the ages of 5-6 [3]. -
Fraudulent Claims
Andrew Wakefield and 12 of his colleagues published a research paper in the Lancet that suggested that the MMR vaccine is linked to autism, but these claims were immediately disputed [7]. Consequently, the influence of this paper led to a reduction in vaccination rates [5]. -
Measles Elimination in US
Measles was declared eliminated from the United States, which means there was no spread of the disease for over 12 months [4]. -
Retraction of Fraudulent Claims
The Lancet retracted the study that suggested the MMR vaccine was linked to autism, stating that there were inaccuracies within the paper [7]. -
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Outbreak in US
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Outbreak in Samoa
A significant measles outbreak emerged in American Samoa. There were 5,707 cases reported along with 83 measles-related fatalities with most of them being under the age of 5. This epidemic was fueled by declining MMR vaccine coverage due to vaccine hesitancy that stemmed from two vaccine-related pediatric deaths. The vaccines were mixed improperly and resulted in the fatalities. This worsened community mistrust and further contributed to vaccine reluctance [8]. -
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Vaccination Rates Continue to Decline Due to COVID-19
COVID-19 interrupted childhood vaccination (MMR included) efforts. The vaccination rate for MMR and is still below the recommended 95% to prevent outbreaks within communities. Many children either missed their first dose or were unable to get subsequent doses making them more susceptible to infection [9]. -
Measles in Present Day
As of November 22, 2024 there are 280 reported cases, which is increased from 59 in the previous year. Vaccination rates remain low with most states under the recommended 95% [10].
