Experts Warn of Health Risks, Stress Vaccines Amid Measles Resurgence

A Minnesota mother who was traveling to Somalia took her family to the local travel clinic to get necessary vaccines before their trip, including the MMR vaccine, which protects against measles, mumps, and rubella. The youngest member of the family, a 9-month old boy, did not get vaccinated because he was sleeping.

“I didn’t want to wake him up,” the mother told pediatrician nurse practitioner Patsy Stinchfield, who shared the story during a July 10 American Community Media news briefing.

According to Stinchfield, the family traveled to Somalia, where the child got infected with measles before returning home, infectious, via plane.

“This little guy ended up on a ventilator in our children’s hospital in Minnesota for 15 days,” said Stinchfield, who has worked extensively with the Somali community in Minnesota, amid 2 outbreaks.

“His mom invited me in and asked me to take photos of her son on the ventilator with all the machines,” Stinchfield added. “She said: ‘Please share this with people. I didn’t know that measles could be this dangerous, this severe.’”

Misinformation

‘“I wanted to not wake him up, and now I stand at his bedside just praying one day that he’ll wake up,’” Stinchfield recalled the mother telling her.

The baby did survive his brutal case of measles. But Stinchfield noted his lungs will likely never be the same again. Measles is a leading cause of severe respiratory complications including pneumonia and bronchitis.

Within the Somali community in Minnesota, just about 24% of children under 2 have received their first dose of the MMR vaccine. During an outbreak in the state in 2017, the community was aggressively targeted by anti-vaccine groups spreading false information about unproven links between vaccines and autism.

Autism

“Parents told me things like: ‘I didn’t know that the M in MMR was for measles. In Somalia, my sister died of measles. Had I known that M was measles, I would never have skipped it,’” Stinchfield shared. “Another parent told me, ‘I was told not to get the triple shot, the MMR, because it causes autism.’ Which of course is not true.”

“Some moms said, ‘Well, measles is gone in America, so we don’t have to vaccinate for that anymore.’ So you can see there was a lot of misunderstanding,” said Stinchfield, adding that many parents waited until their children were 5 before getting them the 1st MMR shot.

Fatalities, brain swelling, pneumonia

Between one and three people out of 1,000 with measles will die, even with the best care, notes the National Foundation for Infectious Diseases. Fatalities occur primarily in unvaccinated children, reported the foundation.

One out of every 1,000 people with measles will develop brain swelling, which could lead to brain damage. And 1 in 20 children with measles will get pneumonia, notes the NFID, which on July 1 launched the Measles Collaborative, naming Stinchfield its executive director.

Measles in one of the most contagious childhood illnesses; prior to the introduction of the MMR vaccine in 1971, 3-4 million children per year were infected with the illness. The infection was considered eliminated in the US in the year 2000.

But over the last 18 months, the country has experienced outbreaks in several states, most notably Texas, Utah, and South Carolina. In the past 18 months, the Centers for Disease Control and Prevention has reported a total of 4,520 cases. Last year, 11% of measles cases resulted in hospitalizations, and 3 people died, according to CDC data.

And though measles are considered a pediatric illness, more than one third of reported infections — 1332 — in the last 18 months are of adults ages 20 and over. Adults and children under 5 are the most likely to need hospitalization during an infection.

Vaccines remain highly effective

Despite the virus’s resurgence, today’s measles vaccine remains highly effective because the virus has changed very little over the past 70 years, said Dr. Benjamin Neuman, professor of biology and former chief virologist at the Global Health Research Complex at Texas A&M University.

People often assume measles behaves like influenza or COVID-19, which mutate rapidly enough to require updated vaccines. But measles is fundamentally different, said Neuman.

The measles portion of the MMR vaccine is based on the live Moraten — also known as Mora10 — strain, first isolated by researchers in 1954. Currently, noted Neuman, the D8 strain of measles is circulating in the US and the B3 strain is circulating in the rest of the world.

But though the Moraten strain is 72 years old, it is still effective against the newer strains, stated Neuman, adding that it has few side effects. Scientists can make a copy of the Moraten strain and swap out the proteins that are mutating in the current strains, but there is little need to do that, said Neuman. The virus has remained relatively stable in the years since it was identified, he added.

“Right now, ‘if it ain’t broke, don’t fix it’ seems to be the calculation, and I can get behind that,” he said.

Virus vs. vaccine

The real danger, Neuman said, comes from infection with the “wild” virus rather than from the vaccine itself.

“Normally, the measles virus seeks out cells from the immune system. The cells that should be cleaning up the problem become infected and are no longer able to help,” he explained. “This causes a loss of immunological memory, meaning that if you get cells infected that were immune to something that you encountered earlier in life, those can effectively be erased. So, that’s serious.”

The vaccine, by contrast, has naturally occurring genetic changes that prevent it from suppressing the immune system, allowing the body to build long-lasting protection safely, he said.

Adult infections

Utah has struggled with a year-long measles outbreak, with 704 identified cases. Dr. Andrew Pavia, Professor and Chief, Division of Pediatric Infectious Diseases at University of Utah noted that about 1/3 of reported infections in the state were adults.

Utah has a pretty good vaccination rate within most of the state, said Pavia. But a small community on the Utah-Arizona border, home to many members of the Fundamentalist Church of Jesus Christ of Latter-Day Saints — FLDS — has vaccination rates of just 30-40%. Leaders of FLDS have pushed hard against vaccination, noted Pavia.

“People had moved to this beautiful desert community because they wanted to be away from civilization and government interference. So what you had was a community with low vaccination rates and with poor trust of government and of public health authorities,” said Pavia.

Undercount of cases

The number of cases reported by the CDC likely represents an undercount, said Pavia. True numbers are likely 2-4 times higher, he said, noting that many people don’t get their children tested when measles symptoms appear.

“They may live far away from a healthcare center. It may cost them a tank of gas to drive in and get a test, and they can’t afford that. Or they may distrust government and not want to have their kids’ names on a list.”

“What we heard over and over again was when a child was sick enough to need to come to the hospital, we would hear that the rest of the family had measles,” said Pavia.

Pregnant women

In a scenario that is often overlooked, unvaccinated pregnant women are at risk of getting very severely ill with measles, said Pavia. He noted that if they’re infected with measles in the last two weeks of their pregnancy, they have a chance of transmitting it to their infant.

“This can be very serious and even deadly,” said Pavia. The researcher noted that recently in Ontario, three infants died because their mothers had measles just prior to delivery.

“In Utah, we had 12 pregnant women who developed measles close to delivery. We were lucky. The children of these mothers all survived and did well. But that’s only a matter of luck. The next time it could turn out much worse.”

“So, for women who are considering pregnancy, being immune to measles is absolutely critical. You can’t get the vaccine when you’re pregnant, so you have to know whether you need it before you decide to become pregnant,” said Pavia.

ACIP

Dr. José Romero, who chaired the CDC’s Advisory Committee on Immunization Practices (ACIP) from 2018 to 2021 and served as Arkansas’ secretary of health, said the current ACIP differs sharply from the committee he led, particularly in how members are selected.

Shortly after taking office last year, Health and Human Services Secretary Robert F Kennedy Jr., fired the entire board and replaced them with 8 hand-picked members, many of whom have expressed concerns about vaccines at large.

Traditionally, ACIP members go through a lengthy nomination and review process that includes evaluations by CDC officials, letters of support, review of candidates’ expertise and a detailed conflict-of-interest disclosure, said Romero.

“You have to disclose your holdings for financial assets, who your funding is, who you have provided consultations to as an advisor or consultant that could impact your ability to give really free-of-any-influence advice,” he said.

Underserved communities

Romero added that the committee traditionally seeks geographic, gender, racial and ethnic diversity to ensure that members reflect the public they serve.

“The composition of the committee is that of the American public,” he stressed, adding Kennedy’s ACIP does not reflect that diversity.

Declining confidence in vaccines could have particularly serious consequences for immigrant and underserved communities, where misinformation can spread quickly and access to trusted health information may be limited.

“We will see outbreaks of diseases that we have not seen for many, many years,” Romero said. He noted that many countries have strong immunization programs, but those communities are also vulnerable to misinformation and disinformation.

“We’re seeing that more and more in Latin America as we get into this outbreak of measles,” he said.

“I would advise people traveling to check their immunization records of everyone in their family traveling: not just internationally, but nationally as well, because there are international travelers at national airports. So pack all of your clothes you need and pack your antibodies,” said Romero.