26 June 2012


A little more than a generation ago measles was a devastating worldwide disease that claimed the lives of over one million children each year.  Pediatric wards in developing countries were filled with cases of measles, and many of the survivors were left with serious complications such as encephalopathy and blindness. Beginning in the ‘60s, effective immunization gradually became widespread, and the number of cases and deaths correspondingly decreased.  In 2000 measles was eliminated as an endemic disease in the entire Western Hemisphere.  Unfortunately routine immunization stagnated in many developing nations, particularly in Sub-Saharan Africa, in the ‘90s, causing a sharp upsurge in both the number of cases and the number of deaths. In 2000, a campaign by the World Health Organization and the UN with cooperation of many countries sharply reduced the number of deaths from 535,000 in year 2000 to 153,000 in 2010.  Of importance during this period was the rise in cases of measles in Europe and parts of Asia due to sensationalized reports of an association of the MMR Vaccine with autism.  Although these reports were later proven to be fabricated, fears about the vaccine persisted, causing a resurgence of disease and subsequent deaths.  This thwarted the possible elimination of measles in these areas In spite of the massive WHO vaccination campaign, an estimated 20 million cases of measles occur each year.  Plans are now in place to further increase the vaccination rate to 92% over the next decade. As travelers to developing countries, we need to be aware of our continued risk of exposure to measles.  We can contract the disease, and we can also transmit it to our families and others when we return.  Make sure that your measles vaccine protection is up to date.   All of those who are called on to diagnose and treat measles in developing countries must be aware of its manifestations and complications, particularly in malnourished children.  They also need to be aware of the critical role of vitamin A in preventing measles related death and blindness. Submitted by Roger Boe Ref: Mulholland E Kim et al. Measles in the 21st Century; NEJM 2012; 366, 1755-1757.

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