Measles Morbidity and Mortality in the Developed World are Greater than the Public Perceives

Abstract

Background. Measles mortality and morbidity are staggering in the developing world partly because of widespread malnutrition. In the U.S. and other developed countries, individuals with compromised cellular immunity from immune-suppres-sive treatments and HIV are also at increased risk of measles complications; however measles is perceived by many as a routine childhood illness of little consequence. Misinformation about alleged risks of measles containing vaccines (MCV) has led to continued endemic and epidemic measles in the developed world. Methods. Present CDC data and data published by one of us (JDC) are reviewed for measles morbidity and mortality. The categories examined included: deaths, encephalitis, subacute sclerosing panencephalitis (SSPE) and post measles immune amnesia (PMIA). Data are presented as rates per 100,000 per year and are stratifed by age, sex and degree of immune competence. Results. The following approximate numbers per 100,000 cases in immunocom-petent persons were determined: deaths-200; encephalitis-100; SSPE-100; PMIA-12. Ratios for death and SSPE were higher in males and in infants. The infant with measles will have an overall risk of a severe outcome (death, SSPE or encephalitis of 1:215). Similarly, the risk in an older child would be 1:379. The risk in males is greater than in females. The risk for death due to PMIA is small; however, the risk of specifc diseases such as pneumonia and meningitis are considerable. Conclusion. Measles is endemic and epidemic in Europe, much of Asia, and in Africa. Terefore, importations into the U.S. will continue to occur and non-immune persons will get measles. To prevent the extended morbidity and mortality as described, and to protect those who cannot receive a MCV, extended immunization efforts need to be carried out in the U.S. These efforts include: giving the second dose of a measles, mumps, rubella (MMR) vaccine at 15 months rather than 4-6 years, fll immunization gaps by seeing that they all have received 2 doses of a MCV or have demonstrated serum antibody to measles virus in adults, and discourage travel to measles endemic and epidemic areas by all persons who are not immune (infants < 1 yr of age and persons who have not received 2 doses of vaccine or have evidence of measles serum antibody).