MANILA, Philippines — Measles should not be a public health concern today. People have access to an easy-to-administer and effective vaccine, and it is possible to eliminate almost all cases in a region. Yet, the world continues to struggle with this potentially fatal disease.
In 2012, 122,000 people — mostly children — died from measles worldwide. This number is lower than it has been from past years, but it is still substantial, particularly in low-income regions where vaccinations are hard to come by. While the disease is rare in places like the United States and Australia, it remains an important public health concern globally.
Each year, about 20 million people get the disease. Most of these are children under five. Among this population, one-in-ten measles patients gets an ear infection, and one-in-twenty develops pneumonia.
Recent outbreaks across the world in 2014 are proving that measles is still a significant a health concern. Many of these cases originated in the Philippines, which is experiencing a large-scale measles outbreak in at least nine cities. There have been 9,149 confirmed cases already this year, with another 31,508 suspected cases. Between January 1 and May 20, 2014, the Philippines has seen 70 measles-related deaths, which is a spike relative to recent years. The country continues to struggle to control the outbreak.
Because measles is contagious, it is difficult to contain the disease in a single city or nation. The outbreak in the Philippines has already spread, with cases of the same strain cropping up in Australia, Canada, Japan, Singapore, New Zealand, the United Kingdom and the United States. Most of the measles cases in these countries can be traced back to unvaccinated travelers who visited the Philippines.
According to the National Institute of Infectious Disease in Japan, the country’s outbreak is the result of weak vaccination programs in need of restructuring. Japan was late to implement a program that required two vaccinations per person when it made this change in 2006, but this outbreak proves that there are still problems in the system. Japan saw 46 measles cases before January 26 of this year, compared to 18 in the same period in 2013. This grew to 171 cases by mid-March, though so far, there have been no deaths in the country.
Singapore is experiencing a similar situation. According to the Ministry of Health, half of the 49 local cases occurred among young children who had not been vaccinated properly. On top of this, 23 more cases have come from unvaccinated travelers to the Philippines. This indicates that the vaccination program in Singapore could use remodeling as well. The Ministry of Health is encouraging parents to vaccinate their children immediately to avoid further spread of the disease.
The United States stands apart from Japan and Singapore. In 2000, measles was considered domestically eliminated in the country, meaning that there is no reservoir for the disease and no home-grown strain. All cases in the United States since then come from outside and are brought in by unvaccinated travelers. These are the circumstances that typically produce the roughly 60 cases that still occur each year.
However, already in 2014, the U.S. Center for Disease Control and Prevention (CDC) predicts that unvaccinated travelers returning from abroad have brought in 97 percent of the 288 current measles cases in the country. 22 of those cases can be traced back to the outbreak in the Philippines. The outbreak in the United States is concentrated around 15 sites, with most cases occurring in Ohio, California and New York City. This outbreak is the largest number of cases the country has seen in almost 20 years.
The case is similar in Australia, where measles was declared eliminated in March of 2014. Since then, cases have come in from outside the country and infected about 13 people in Western Australia. Eight of these cases can be traced back to the Philippines. This is the highest rate of cases in the region since 2006.
So what does this recent outbreak across the world signify? In most places, herd immunity — the phenomenon that occurs when the majority are vaccinated, thus decreasing an individual’s likelihood of contracting or spreading the disease — has been weakened because of a lapse in the use of vaccines or because of insufficient vaccination programs. The rise in measles cases coming from outside nations suggests that vaccination programs need to be restructured and more emphasis needs to be placed on vaccinating children and travelers.
Measles needs to remain a focus for global health campaigns as we work toward stopping the spread from endemic regions and eliminating the disease from others. In short, measles is preventable through effective vaccination programs, and these should be implemented with full force in both developing and wealthy nations.