Array ( [0] => {{short description|Viral disease affecting humans}} [1] => {{cs1 config|name-list-style=vanc|display-authors=6}} [2] => {{About|the disease}} [3] => {{Distinguish|text=either [[rubella]] or [[roseola]], which are also viral diseases with comparable features}} [4] => {{pp-semi|small=yes}} [5] => {{Use dmy dates|date=October 2019}} [6] => {{Infobox medical condition (new) [7] => | name = Measles [8] => | image = RougeoleDP.jpg [9] => | alt = [10] => | caption = A child showing a day-four measles rash [11] => | field = [[Infectious disease (medical specialty)|Infectious disease]] [12] => | synonyms = Morbilli, rubeola, red measles, English measles [13] => | symptoms = Fever, cough, runny nose, inflamed eyes, rash [14] => | complications = [[Pneumonia]], [[seizure]]s, [[encephalitis]], [[subacute sclerosing panencephalitis]], [[immunosuppression]], hearing loss, blindness [15] => | onset = 10–12 days after exposure [16] => | duration = 7–10 days [17] => | causes = [[Measles virus]] [18] => | risks = [19] => | diagnosis = [20] => | differential = [21] => | prevention = [[Measles vaccine]] [22] => | treatment = [[supportive treatment|Supportive care]] [23] => | medication = [24] => | frequency = 20 million per year [25] => | deaths = 140,000+ (2018){{cite web| title = More than 140,000 die from measles as cases surge worldwide| author = Joint News Release| work = who.int| date = 2019-12-05| access-date = 4 September 2020| url = https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide| archive-date = 6 August 2020| archive-url = https://web.archive.org/web/20200806185302/https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide| url-status = live}}{{cite web| title = Global Measles Outbreaks| work = cdc.gov| date = 2020-08-17| access-date = 4 September 2020| url = https://www.cdc.gov/globalhealth/measles/globalmeaslesoutbreaks.htm| archive-date = 7 September 2020| archive-url = https://web.archive.org/web/20200907110447/https://www.cdc.gov/globalhealth/measles/globalmeaslesoutbreaks.htm| url-status = live}} [26] => }} [27] => [28] => '''Measles''' is a highly contagious, [[Vaccine-preventable diseases|vaccine-preventable]] [[infectious disease]] caused by [[Measles morbillivirus|measles virus]].{{cite web |title=Measles |website=Merck Manual Professional |publisher=Merck Sharp & Dohme Corp. |date=September 2013 |access-date=23 March 2014 |url=https://www.merckmanuals.com/professional/pediatrics/miscellaneous_viral_infections_in_infants_and_children/measles.html |editor=Caserta, MT |url-status=live |archive-url=https://web.archive.org/web/20140323104756/http://www.merckmanuals.com/professional/pediatrics/miscellaneous_viral_infections_in_infants_and_children/measles.html |archive-date=23 March 2014 }}{{cite journal|vauthors=Guerra FM, Bolotin S, Lim G, Heffernan J, Deeks SL, Li Y, Crowcroft NS|date=December 2017|title=The basic reproduction number (R0) of measles: a systematic review|url=https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30307-9/fulltext|journal=The Lancet Infectious Diseases|volume=17|issue=12|pages=e420–e428|doi=10.1016/S1473-3099(17)30307-9|pmid=28757186|url-access=subscription|access-date=29 January 2022|archive-date=10 April 2020|archive-url=https://web.archive.org/web/20200410031025/https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30307-9/fulltext|url-status=live}}{{cite web|title=Measles (Red Measles, Rubeola)|url=http://www.health.gov.sk.ca/red-measles|website=Dept of Health, Saskatchewan|access-date=10 February 2015|url-status=dead|archive-url=https://web.archive.org/web/20150210111358/http://www.health.gov.sk.ca/red-measles|archive-date=10 February 2015 }} Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days.{{cite web|date=November 2014|title=Measles Fact sheet N°286|url=https://www.who.int/mediacentre/factsheets/fs286/en/|url-status=live|archive-url=https://web.archive.org/web/20150203144905/http://www.who.int/mediacentre/factsheets/fs286/en/|archive-date=3 February 2015|access-date=4 February 2015|website=[[World Health Organization]]}}{{cite book|last1=Bope|first1=Edward T.|url=https://books.google.com/books?id=Hv8fBQAAQBAJ&pg=PT189|title=Conn's Current Therapy 2015|last2=Kellerman|first2=Rick D.|date=2014|publisher=Elsevier Health Sciences|isbn=978-0-323-31956-0|pages=153|archive-url=https://web.archive.org/web/20170908140851/https://books.google.com/books?id=Hv8fBQAAQBAJ&pg=PT189|archive-date=2017-09-08|url-status=live}} Initial symptoms typically include [[fever]], often greater than {{cvt|40|C|0}}, cough, [[Rhinitis|runny nose]], and [[conjunctivitis|inflamed eyes]]. Small white spots known as [[Koplik's spots]] may form inside the mouth two or three days after the start of symptoms. A red, flat rash which usually starts on the face and then spreads to the rest of the body typically begins three to five days after the start of symptoms.{{cite web|date=3 November 2014|title=Measles (Rubeola) Signs and Symptoms|url=https://www.cdc.gov/measles/about/signs-symptoms.html|url-status=live|archive-url=https://web.archive.org/web/20150202192809/http://www.cdc.gov/measles/about/signs-symptoms.html|archive-date=2 February 2015|access-date=5 February 2015|website=[[Centers for Disease Control and Prevention]]}} Common complications include [[diarrhea]] (in 8% of cases), [[Otitis media|middle ear infection]] (7%), and [[pneumonia]] (6%). These occur in part due to measles-induced [[immunosuppression]].{{cite journal | vauthors = Rota PA, Moss WJ, Takeda M, de Swart RL, Thompson KM, Goodson JL | title = Measles | journal = Nature Reviews. Disease Primers | volume = 2 | pages = 16049 | date = July 2016 | pmid = 27411684 | doi = 10.1038/nrdp.2016.49 | doi-access = free }} Less commonly [[seizure]]s, [[blindness]], or [[encephalitis|inflammation of the brain]] may occur. Other names include ''morbilli'', ''rubeola'', ''red measles'', and ''English measles''.{{cite book|last=Milner|first=Danny A.|title=Diagnostic Pathology: Infectious Diseases E-Book|year=2015|publisher=Elsevier Health Sciences|isbn=978-0-323-40037-4 | pages = 24|url=https://books.google.com/books?id=YJ_uCQAAQBAJ&pg=PA24|url-status=live|archive-url=https://web.archive.org/web/20170908140851/https://books.google.com/books?id=YJ_uCQAAQBAJ&pg=PA24|archive-date=2017-09-08}}{{cite book|last=Stanley|first=Jacqueline|title=Essentials of Immunology & Serology|year=2002|publisher=Cengage Learning|isbn=978-0-7668-1064-8 | pages = 323|url=https://books.google.com/books?id=nuCT5RVToN4C&pg=PA323|url-status=live|archive-url=https://web.archive.org/web/20170908140851/https://books.google.com/books?id=nuCT5RVToN4C&pg=PA323|archive-date=2017-09-08}} Both [[rubella]], also known as ''German measles'', and [[roseola]] are different diseases caused by unrelated viruses.{{cite book|last=Marx|first=John A.|title=Rosen's emergency medicine: concepts and clinical practice|year=2010|publisher=Mosby/Elsevier|location=Philadelphia|isbn=978-0-323-05472-0|pages=1541|edition=7th|url=https://books.google.com/books?id=u7TNcpCeqx8C&pg=PA1541|url-status=live|archive-url=https://web.archive.org/web/20170908140851/https://books.google.com/books?id=u7TNcpCeqx8C&pg=PA1541|archive-date=2017-09-08}} [29] => [30] => Measles is an [[airborne disease]] which [[Human-to-human transmission|spreads easily from one person to the next]] through the [[cough]]s and [[sneeze]]s of infected people. It may also be spread through direct contact with mouth or [[mucus|nasal secretions]]. It is extremely contagious: nine out of ten people who are not immune and share living space with an infected person will be infected. Furthermore, measles's [[reproductive number]] estimates vary beyond the frequently cited range of 12 to 18.{{Cite journal|last1=Guerra|first1=Fiona M.|last2=Bolotin|first2=Shelly|last3=Lim|first3=Gillian|last4=Heffernan|first4=Jane|last5=Deeks|first5=Shelley L.|last6=Li|first6=Ye|last7=Crowcroft|first7=Natasha S.|date=December 2017|title=The basic reproduction number (R0) of measles: a systematic review|url=https://pubmed.ncbi.nlm.nih.gov/28757186|journal=The Lancet. Infectious Diseases|volume=17|issue=12|pages=e420–e428|doi=10.1016/S1473-3099(17)30307-9|issn=1474-4457|pmid=28757186|access-date=7 December 2020|archive-date=30 March 2023|archive-url=https://web.archive.org/web/20230330134017/https://pubmed.ncbi.nlm.nih.gov/28757186/|url-status=live}} The NIH quote this 2017 paper saying: "[a] review in 2017 identified feasible measles R{{sub|0}} values of 3.7–203.3".{{cite journal | title = Complexity of the Basic Reproduction Number (R0) | year = 2019 | publisher = NIH website | pmc = 6302597 | quote = [a] review in 2017 identified feasible measles R0 values of 3.7–203.3 | last1 = Delamater | first1 = P. L. | last2 = Street | first2 = E. J. | last3 = Leslie | first3 = T. F. | last4 = Yang | first4 = Y. T. | last5 = Jacobsen | first5 = K. H. | journal = Emerging Infectious Diseases | volume = 25 | issue = 1 | pages = 1–4 | doi = 10.3201/eid2501.171901 | pmid = 30560777 }} People are infectious to others from four days before to four days after the start of the rash.{{cite book|last=Atkinson|first=William|title=Epidemiology and Prevention of Vaccine-Preventable Diseases|year=2011|publisher=Public Health Foundation|isbn=978-0-9832631-3-5|pages=301–23|edition=12|url=https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html|access-date=5 February 2015|url-status=live|archive-url=https://web.archive.org/web/20150207061223/http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html|archive-date=7 February 2015}} While often regarded as a childhood illness, it can affect people of any age.{{cite report |last1=Selina|first1=SP|last2=Chen|first2=MD|date=6 June 2019 |title=Measles |url=https://emedicine.medscape.com/article/966220-overview |url-access=registration|publisher=Medscape |url-status=live|archive-url=https://web.archive.org/web/20110925023230/http://emedicine.medscape.com/article/966220-overview |archive-date=25 September 2011 }} Most people do not get the disease more than once. Testing for the measles virus in suspected cases is important for public health efforts. Measles is not known to occur in other animals. [31] => [32] => Once a person has become infected, no specific treatment is available, although [[supportive care]] may improve outcomes. Such care may include [[oral rehydration solution]] (slightly sweet and salty fluids), healthy food, and medications to control the fever. [[Antibiotics]] should be prescribed if secondary bacterial infections such as ear infections or pneumonia occur. [[Vitamin A]] supplementation is also recommended for children. Among cases reported in the U.S. between 1985 and 1992, death occurred in only 0.2% of cases, but may be up to 10% in people with [[malnutrition]]. Most of those who die from the infection are less than five years old. [33] => [34] => The [[measles vaccine]] is effective at preventing the disease, is exceptionally safe, and is often delivered [[MMR vaccine|in combination]] with other vaccines.{{cite journal |last1=Russell |first1=SJ |last2=Babovic-Vuksanovic |first2=D |last3=Bexon |first3=A |last4=Cattaneo |first4=R |last5=Dingli |first5=D |last6=Dispenzieri |first6=A |last7=Deyle |first7=DR |last8=Federspiel |first8=MJ |last9=Fielding |first9=A |last10=Galanis |first10=E |title=Oncolytic Measles Virotherapy and Opposition to Measles Vaccination. |journal=Mayo Clinic Proceedings |date=September 2019 |volume=94 |issue=9 |pages=1834–39 |doi=10.1016/j.mayocp.2019.05.006 |pmid=31235278|pmc=6800178 }} [[Vaccination]] resulted in an 80% decrease in deaths from measles between 2000 and 2017, with about 85% of children worldwide having received their first dose as of 2017.{{cite web|title=Measles fact sheet|url=https://www.who.int/news-room/fact-sheets/detail/measles|url-status=live|archive-url=https://web.archive.org/web/20190601173915/https://www.who.int/news-room/fact-sheets/detail/measles|archive-date=2019-06-01|access-date=2019-05-20|website=[[World Health Organization]]}} [35] => Measles affects about 20 million people a year, primarily in the developing areas of Africa and Asia. It is one of the leading vaccine-preventable disease causes of death.{{cite journal | vauthors = Kabra SK, Lodha R | title = Antibiotics for preventing complications in children with measles | journal = The Cochrane Database of Systematic Reviews | volume = 8 | issue = 8 | pages = CD001477 | date = August 2013 | pmid = 23943263 | doi = 10.1002/14651858.CD001477.pub4 | pmc = 7055587 }}{{cite web |title=Despite the availability of a safe, effective and inexpensive vaccine for more than 40 years, measles remains a leading vaccine-preventable cause of childhood deaths. |url=https://www.who.int/immunization/newsroom/MI_Fact%20Sheet_17_jan_2007.pdf |access-date=16 February 2019 |archive-date=12 December 2019 |archive-url=https://web.archive.org/web/20191212171454/https://www.who.int/immunization/newsroom/MI_Fact%20Sheet_17_jan_2007.pdf |url-status=live }} In 1980, 2.6 million people died from measles, and in 1990, 545,000 died due to the disease; by 2014, global vaccination programs had reduced the number of deaths from measles to 73,000.{{cite journal | vauthors = ((GBD 2015 Mortality and Causes of Death Collaborators)) | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/S0140-6736(16)31012-1 }}{{cite journal | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–71 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 | vauthors = ((GBD 2013 Mortality Causes of Death Collaborators)) }} Despite these trends, rates of disease and deaths increased from 2017 to 2019 due to a decrease in immunization.{{cite web |title=Measles cases spike globally due to gaps in vaccination coverage |url=https://www.who.int/news-room/detail/29-11-2018-measles-cases-spike-globally-due-to-gaps-in-vaccination-coverage |website=[[World Health Organization]] (WHO) |access-date=21 December 2018 |date=29 November 2018 |archive-date=24 December 2018 |archive-url=https://web.archive.org/web/20181224020216/https://www.who.int/news-room/detail/29-11-2018-measles-cases-spike-globally-due-to-gaps-in-vaccination-coverage |url-status=live }}{{cite news |title=U.S. measles cases surge nearly 20 percent in early April, CDC says |url=https://www.reuters.com/article/us-usa-measles/measles-cases-in-u-s-surge-nearly-20-in-early-april-cdc-says-idUSKCN1RR1H4 |access-date=16 April 2019 |work=Reuters |date=16 April 2019 |archive-date=15 April 2019 |archive-url=https://web.archive.org/web/20190415160142/https://www.reuters.com/article/us-usa-measles/measles-cases-in-u-s-surge-nearly-20-in-early-april-cdc-says-idUSKCN1RR1H4 |url-status=live }}{{cite web |title=Measles – European Region |url=https://www.who.int/csr/don/06-may-2019-measles-euro/en/ |archive-url=https://web.archive.org/web/20190508120456/https://www.who.int/csr/don/06-may-2019-measles-euro/en/ |url-status=dead |archive-date=8 May 2019 |website=[[World Health Organization]] (WHO) |access-date=8 May 2019}} [36] => [[File:En.Wikipedia-VideoWiki-Measles.webm|thumb|thumbtime=1:30|upright=1.4|Video summary ([[Wikipedia:VideoWiki/Measles|script]])]] [37] => {{TOC limit}} [38] => [39] => ==Signs and symptoms== [40] => [[File:Morbillivirus measles infection.jpg|thumb|upright=1.3|[[Maculopapular rash]] on the abdomen after 3 days of measles infection]] [41] => Symptoms typically begin 10–14 days after exposure. The classic symptoms include a four-day fever (the four Ds) and the three Cs—[[cough]], [[coryza]] (head cold, fever, sneezing), and [[conjunctivitis]] (red eyes)—along with a [[maculopapular rash]].{{cite journal | vauthors = Biesbroeck L, Sidbury R | title = Viral exanthems: an update | journal = Dermatologic Therapy | volume = 26 | issue = 6 | pages = 433–8 | date = November 2013 | pmid = 24552405 | doi = 10.1111/dth.12107 | s2cid = 10496269 | doi-access = free }} Fever is common and typically lasts for about one week; the fever seen with measles is often as high as {{cvt|40|C}}. [42] => [43] => [[Koplik's spots]] seen inside the mouth are diagnostic for measles, but are temporary and therefore rarely seen. Koplik spots are small white spots that are commonly seen on the inside of the cheeks opposite the molars. They appear as "grains of salt on a reddish background."{{cite journal | vauthors = Steichen O, Dautheville S | title = Koplik spots in early measles | journal = CMAJ | volume = 180 | issue = 5 | pages = 583 | date = March 2009 | pmid = 19255085 | pmc = 2645467 | doi = 10.1503/cmaj.080724 }} Recognizing these spots before a person reaches their maximum infectiousness can help reduce the spread of the disease.{{cite journal | vauthors = Baxby D | author-link = Derrick Baxby|title = The diagnosis of the invasion of measles from a study of the exanthema as it appears on the buccal mucous membraneBy Henry Koplik, M.D. Reproduced from Arch. Paed. 13, 918-922 (1886) | journal = Reviews in Medical Virology | volume = 7 | issue = 2 | pages = 71–74 | date = July 1997 | pmid = 10398471 | doi = 10.1002/(SICI)1099-1654(199707)7:2<71::AID-RMV185>3.0.CO;2-S | s2cid = 42670134}} [44] => [45] => The characteristic measles [[rash]] is classically described as a generalized [[erythema|red]] maculopapular rash that begins several days after the fever starts. It starts on the back of the ears and, after a few hours, spreads to the head and neck before spreading to cover most of the body. The measles rash appears two to four days after the initial symptoms and lasts for up to eight days. The rash is said to "stain", changing color from red to dark brown, before disappearing.{{cite web |url=http://www.nhs.uk/Conditions/Measles/Pages/Symptoms.aspx |title=Symptoms of measles |publisher=National Health Service (NHS) |date=2010-01-26 |archive-url=https://web.archive.org/web/20110131164435/http://www.nhs.uk/Conditions/Measles/Pages/Symptoms.aspx |archive-date=2011-01-31 |url-status=unfit }} Overall, measles usually resolves after about three weeks. [46] => [47] => People who have been vaccinated against measles but have incomplete protective immunity may experience a form of modified measles.{{Cite book|url=https://www.worldcat.org/oclc/915815516|title=Epidemiology and prevention of vaccine-preventable diseases|editor=Hamborsky, Jennifer|editor2=Kroger, Andrew|editor3=Wolfe, Charles |year=2015|isbn=978-0-9904491-1-9|edition=13th|publisher= Centers for Disease Control and Prevention|location=Atlanta, GA|pages=211|oclc=915815516}} Modified measles is characterized by a prolonged [[incubation period]], milder, and less characteristic symptoms (sparse and discrete rash of short duration). [48] => {{Further|Stimson line}} [49] => [50] => [51] => File:Measles child Philippines.jpg|A Filipino baby with measles [52] => File:Koplik spots, measles 6111 lores.jpg| [[Koplik's spots]] on the third pre-eruptive day [53] => File:Koplik spots, measles 2019.jpg|Koplik's spots on the day of measles [[rash]] [54] => [55] => [56] => ===Complications=== [57] => Complications of measles are relatively common, ranging from mild ones such as [[diarrhea]] to serious ones such as [[pneumonia]] (either direct [[viral pneumonia]] or secondary [[bacterial pneumonia]]), [[laryngotracheobronchitis]] (croup) (either direct viral laryngotracheobronchitis or secondary bacterial bronchitis), [[otitis media]],{{cite journal | last1 = Gardiner | first1 = W. T. | title = Otitis Media in Measles | journal = The Journal of Laryngology & Otology | volume = 39 | issue = 11 | pages = 614–17 | year = 2007 | doi = 10.1017/S0022215100026712 | s2cid = 71376401 }} acute [[encephalitis|brain inflammation]],{{cite journal | vauthors = Fisher DL, Defres S, Solomon T | title = Measles-induced encephalitis | journal = QJM | volume = 108 | issue = 3 | pages = 177–82 | date = March 2015 | pmid = 24865261 | doi = 10.1093/qjmed/hcu113 | doi-access = free }} [[corneal ulcer]]ation (leading to [[corneal abrasion|corneal scarring]]),{{cite journal | vauthors = Semba RD, Bloem MW | title = Measles blindness | journal = Survey of Ophthalmology | volume = 49 | issue = 2 | pages = 243–55 | date = March 2004 | pmid = 14998696 | doi = 10.1016/j.survophthal.2003.12.005 }} and in about 1 in 600 unvaccinated infants under 15 months while more rarely in older children and adults, [[subacute sclerosing panencephalitis]], which is progressive and eventually lethal.{{Cite book | author = Anlar B | title = Pediatric Neurology Part II | volume = 112 | pages = 1183–89 | year = 2013 | pmid = 23622327 | doi = 10.1016/B978-0-444-52910-7.00039-8 | series = Handbook of Clinical Neurology | isbn = 978-0-444-52910-7 | chapter = Subacute sclerosing panencephalitis and chronic viral encephalitis }} [58] => [59] => In addition, measles can suppress the immune system for weeks to months, and this can contribute to bacterial superinfections such as otitis media and bacterial pneumonia.{{cite book|vauthors=Gupta P, Menon PS, Ramji S, Lodha R, Rakesh|title=PG Textbook of Pediatrics: Volume 2: Infections and Systemic Disorders|date=2015|publisher=JP Medical Ltd|isbn=978-93-5152-955-2|pages=1158|url=https://books.google.com/books?id=krlEDwAAQBAJ&pg=PA1158|access-date=22 August 2020|archive-date=2 May 2023|archive-url=https://web.archive.org/web/20230502182537/https://books.google.com/books?id=krlEDwAAQBAJ&pg=PA1158|url-status=live}}{{cite journal | vauthors = Griffin DE | title = Measles virus-induced suppression of immune responses | journal = Immunological Reviews | volume = 236 | pages = 176–89 | date = July 2010 | pmid = 20636817 | pmc = 2908915 | doi = 10.1111/j.1600-065X.2010.00925.x }}{{cite web |last=Griffin |first=Ashley Hagen |title=Measles and Immune Amnesia |url=https://asm.org/Articles/2019/May/Measles-and-Immune-Amnesia |website=asm.org |publisher=American Society for Microbiology |access-date=18 January 2020 |archive-url=https://archive.today/20200118042959/https://asm.org/Articles/2019/May/Measles-and-Immune-Amnesia |archive-date=18 January 2020 |date=18 May 2019 |url-status=live}} Two months after recovery there is a 11–73% decrease in the number of antibodies against other bacteria and viruses.{{cite journal|title=Measles erases immune 'memory' for other diseases|url=https://www.nature.com/articles/d41586-019-03324-7|journal=Nature|access-date=3 November 2019|date=31 October 2019|doi=10.1038/d41586-019-03324-7|last=Guglielmi|first=Giorgia|pmid=33122832|s2cid=208489179|archive-date=2 November 2019|archive-url=https://web.archive.org/web/20191102065033/https://www.nature.com/articles/d41586-019-03324-7|url-status=live}} [60] => [61] => The death rate in the 1920s was around 30% for measles pneumonia.{{cite journal | vauthors = Ellison JB | title = Pneumonia in Measles | journal = Archives of Disease in Childhood | volume = 6 | issue = 31 | pages = 37–52 | date = February 1931 | pmid = 21031836 | pmc = 1975146 | doi = 10.1136/adc.6.31.37 }} People who are at high risk for complications are infants and children aged less than 5 years; adults aged over 20 years; pregnant women; people with compromised immune systems, such as from [[leukemia]], HIV infection or innate immunodeficiency;{{cite web|title=Measles |url=https://www.cdc.gov/measles/hcp/index.html|website=[[Centers for Disease Control and Prevention]]|access-date=22 October 2016|url-status=live|archive-url=https://web.archive.org/web/20161023051702/https://www.cdc.gov/measles/hcp/index.html|archive-date=23 October 2016 }} and those who are [[malnutrition|malnourished]] or have [[vitamin A deficiency]].{{cite web|url=http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/|title=Vitamin A|author=National Institutes of Health Office of Dietary Supplements|year=2013|publisher=U.S. Department of Health & Human Services|access-date=11 March 2015|url-status=dead|archive-url=https://web.archive.org/web/20150311000932/http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/|archive-date=11 March 2015}} Complications are usually more severe in adults.{{cite journal | vauthors = Sabella C | title = Measles: not just a childhood rash | journal = Cleveland Clinic Journal of Medicine | volume = 77 | issue = 3 | pages = 207–13 | date = March 2010 | pmid = 20200172 | doi = 10.3949/ccjm.77a.09123 | s2cid = 4743168 | doi-access = free }} Between 1987 and 2000, the case fatality rate across the United States was three deaths per 1,000 cases attributable to measles, or 0.3%.{{cite journal | vauthors = Perry RT, Halsey NA | title = The clinical significance of measles: a review | journal = The Journal of Infectious Diseases | volume = 189 Suppl 1 | issue = S1 | pages = S4-16 | date = May 2004 | pmid = 15106083 | doi = 10.1086/377712 | doi-access = free }} In [[developing country|underdeveloped nations]] with high rates of malnutrition and poor [[healthcare]], fatality rates have been as high as 28%. In immunocompromised persons (e.g., people with [[AIDS]]) the fatality rate is approximately 30%.{{cite journal | vauthors = Sension MG, Quinn TC, Markowitz LE, Linnan MJ, Jones TS, Francis HL, Nzilambi N, Duma MN, Ryder RW | title = Measles in hospitalized African children with human immunodeficiency virus | journal = American Journal of Diseases of Children | volume = 142 | issue = 12 | pages = 1271–2 | date = December 1988 | pmid = 3195521 | doi = 10.1001/archpedi.1988.02150120025021 }} [62] => [63] => Even in previously healthy children, measles can cause serious illness requiring hospitalization. One out of every 1,000 measles cases progresses to acute [[encephalitis]], which often results in permanent brain damage. One to three out of every 1,000 children who become infected with measles will die from respiratory and neurological complications. [64] => [65] => ==Cause== [66] => [[File:Measles virus.JPG|thumb|upright=1.3|An electron micrograph of the measles virus]] [67] => Measles is caused by the [[measles virus]], a single-stranded, [[Sense (molecular biology)#RNA sense in viruses|negative-sense]], [[Viral envelope|enveloped]] [[RNA virus]] of the genus ''[[Morbillivirus]]'' within the family ''[[Paramyxoviridae]]''. [68] => [69] => The virus is highly contagious and is spread by coughing and sneezing via close personal contact or direct contact with secretions. Measles is the most contagious virus known. It remains infective for up to two hours in that airspace or nearby surfaces.{{cite web|title=Measles|url=https://www.cdc.gov/measles/hcp/index.html|website=[[Centers for Disease Control and Prevention]]|access-date=6 May 2018|date=2 April 2018|archive-date=23 October 2016|archive-url=https://web.archive.org/web/20161023051702/https://www.cdc.gov/measles/hcp/index.html|url-status=live}} Measles is so contagious that if one person has it, 90% of non-immune people who have close contact with them (e.g., household members) will also become infected.{{cite journal | vauthors=Banerjee E, Griffith J, Kenyon C, Christianson B, Strain A, Martin K | display-authors=etal | title=Containing a measles outbreak in Minnesota, 2017: methods and challenges. | journal=Perspect Public Health | year=2020 | volume=140 | issue=3 | pages=162–171 | pmid=31480896 | doi=10.1177/1757913919871072 | pmc= | s2cid=201829328 | url=https://pubmed.ncbi.nlm.nih.gov/31480896 | archive-date=2 May 2023 | archive-url=https://web.archive.org/web/20230502182530/https://journals.sagepub.com/doi/10.1177/1757913919871072?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed | url-status=live }} Humans are the only natural hosts of the virus, and no other animal [[Natural reservoir|reservoirs]] are known to exist, although mountain gorillas are believed to be susceptible to the disease.{{cite journal |vauthors=Spelman LH, Gilardi KV, Lukasik-Braum M, Kinani JF, Nyirakaragire E, Lowenstine LJ | display-authors=etal | title=Respiratory disease in mountain gorillas (Gorilla beringei beringei) in Rwanda, 1990-2010: outbreaks, clinical course, and medical management. | journal=J Zoo Wildl Med | year=2013 | volume=44 | issue=4 | pages=1027–35 | pmid=24450064 | doi=10.1638/2013-0014R.1 | pmc= | url=https://pubmed.ncbi.nlm.nih.gov/24450064| archive-date=2 May 2023 | archive-url=https://web.archive.org/web/20230502182527/https://bioone.org/journals/journal-of-zoo-and-wildlife-medicine/volume-44/issue-4/2013-0014R.1/RESPIRATORY-DISEASE-IN-MOUNTAIN-GORILLAS-GORILLA-BERINGEI-BERINGEI-IN-RWANDA/10.1638/2013-0014R.1.short | url-status=live }} [70] => Risk factors for measles virus infection include [[immunodeficiency]] caused by [[HIV/AIDS]],{{cite journal | vauthors = Gowda VK, Sukanya V | title = Acquired immunodeficiency syndrome with subacute sclerosing panencephalitis | journal = Pediatric Neurology | volume = 47 | issue = 5 | pages = 379–81 | date = November 2012 | pmid = 23044024 | doi = 10.1016/j.pediatrneurol.2012.06.020 }} [[immunosuppression]] following receipt of an [[Organ transplantation|organ]] or a [[hematopoietic stem cell transplantation|stem cell transplant]],{{cite journal | vauthors = Waggoner JJ, Soda EA, Deresinski S | title = Rare and emerging viral infections in transplant recipients | journal = Clinical Infectious Diseases | volume = 57 | issue = 8 | pages = 1182–8 | date = October 2013 | pmid = 23839998 | doi = 10.1093/cid/cit456 | pmc = 7107977 | doi-access = free }} [[Alkylation|alkylating agents]], or [[Corticosteroid#Medical uses|corticosteroid therapy]], regardless of immunization status; travel to areas where measles commonly occurs or contact with travelers from such an area; and the loss of passive, inherited antibodies before the age of routine immunization. [71] => [72] => ==Pathophysiology== [73] => [[File:MeaslesOsmosisPic5.jpg|thumb|upright=1.4|Drawing of the measles virus attaching to the lining of the trachea]] [74] => [[File:Morbillo.jpg|thumb|Photomicrograph of a [[lung]] tissue specimen, showing the [[histopathology|histopathologic]] changes encountered in a case of measles [[pneumonia]]. Included in this view are numerous [[leukocyte]]s and a [[multinucleated giant cell]]. Normal alveolar [[cytoarchitecture]] has been obliterated.{{cite web |title=This photomicrograph of a lung tissue specimen, reveals the histopathologic changes encountered in a case of measles pneumonia. Included in this view, are numerous leukocytes, and a multinucleated giant cell. Normal alveolar cytoarchitecture has been obliterated. |id=859 |url=https://phil.cdc.gov/details.aspx?pid=859 |website=CDC, Public Health Image Library |publisher=U.S. Government |access-date=16 January 2024 |date=1972 |first1=Edwin P. |last1=Ewing Jr. |url-status=live |archive-url=https://web.archive.org/web/20231210152253/https://phil.cdc.gov/details.aspx?pid=859 |archive-date= Dec 10, 2023 }}]] [75] => [76] => Once the measles virus gets onto the [[Mucous membrane|mucosa]], it infects the [[epithelial cell]]s in the trachea or bronchi.{{cite journal | vauthors = Moss WJ, Griffin DE | title = Measles | journal = Lancet | volume = 379 | issue = 9811 | pages = 153–64 | date = January 2012 | pmid = 21855993 | doi = 10.1016/S0140-6736(10)62352-5 | s2cid = 208794084 }}{{cite book|title=Textbook of Microbiology & Immunology|date=2009|publisher=Elsevier India|isbn=978-81-312-2163-1|pages=535|url=https://books.google.com/books?id=HcgGLfxDJSQC&pg=PA535|access-date=22 August 2020|archive-date=2 May 2023|archive-url=https://web.archive.org/web/20230502182531/https://books.google.com/books?id=HcgGLfxDJSQC&pg=PA535|url-status=live}} Measles virus uses a protein on its surface called [[hemagglutinin]] (H protein), to bind to a target receptor on the host cell, which could be [[CD46]], which is expressed on all nucleated human cells, [[CD150]], ''aka'' signaling lymphocyte activation molecule or SLAM, which is found on immune cells like B or T cells, and antigen-presenting cells, or [[nectin-4]], a cellular adhesion molecule.{{cite book|last1=Kaslow|first1=Richard A.|last2=Stanberry|first2=Lawrence R.|last3=Le Duc|first3=James W.|title=Viral Infections of Humans: Epidemiology and Control|date=2014|publisher=Springer|isbn=978-1-4899-7448-8|pages=540|url=https://books.google.com/books?id=sxakBAAAQBAJ&pg=PA540|access-date=22 August 2020|archive-date=2 May 2023|archive-url=https://web.archive.org/web/20230502182524/https://books.google.com/books?id=sxakBAAAQBAJ&pg=PA540|url-status=live}} Once bound, the fusion, or F protein helps the virus fuse with the membrane and ultimately get inside the cell. [77] => [78] => As the virus is a [[Negative-sense single-stranded RNA virus|single-stranded negative-sense RNA virus]], it includes the enzyme [[RNA-dependent RNA polymerase]] (RdRp) which is used to transcribe its genome into a positive-sense mRNA strand. [79] => [80] => After entering a cell, it is ready to be translated into viral proteins, wrapped in the cell's lipid envelope, and sent out of the cell as a newly made virus.{{cite book|title=Schaechter's Mechanisms of Microbial Disease|date=2012|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-8744-4|pages=357|url=https://books.google.com/books?id=OM2rujts8P0C&pg=PA357|access-date=22 August 2020|archive-date=2 May 2023|archive-url=https://web.archive.org/web/20230502182526/https://books.google.com/books?id=OM2rujts8P0C&pg=PA357|url-status=live}} Within days, the measles virus spreads through local tissue and is picked up by [[dendritic cells]] and [[alveolar macrophages]], and carried from that local tissue in the lungs to the local lymph nodes. From there it continues to spread, eventually getting into the blood and spreading to more lung tissue, as well as other organs like the intestines and the brain.{{cite web|title=Pinkbook Measles Epidemiology of Vaccine Preventable Diseases|url=https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html|website=[[Centers for Disease Control and Prevention]]|access-date=6 May 2018|date=15 November 2016|archive-date=7 February 2015|archive-url=https://web.archive.org/web/20150207061223/http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html|url-status=live}} Functional impairment of the infected dendritic cells by the measles virus is thought to contribute to measles-induced immunosuppression. [81] => [82] => ==Diagnosis== [83] => Typically, clinical [[diagnosis]] begins with the onset of [[fever]] and [[malaise]] about 10 days after exposure to the measles virus, followed by the emergence of [[cough]], [[coryza]], and [[conjunctivitis]] that worsen in severity over 4 days of appearing.{{Citation|last1=Rainwater-Lovett|first1=Kaitlin|title=Measles (Rubeola)|date=2018|url=http://accessmedicine.mhmedical.com/content.aspx?aid=1155970732|work=Harrison's Principles of Internal Medicine|editor-last=Jameson|editor-first=J. Larry|edition=20|place=New York, NY|publisher=McGraw-Hill Education|access-date=2020-12-07|last2=Moss|first2=William J.|editor2-last=Fauci|editor2-first=Anthony S.|editor3-last=Kasper|editor3-first=Dennis L.|editor4-last=Hauser|editor4-first=Stephen L.}} Observation of Koplik's spots is also diagnostic. Other possible condition that can result in these symptoms include [[parvovirus]], [[dengue fever]], [[Kawasaki disease]], and [[scarlet fever]]. Laboratory confirmation is, however, strongly recommended.{{cite web|title=Measles|url=https://www.cdc.gov/measles/hcp/index.html|website=[[Centers for Disease Control and Prevention]]|access-date=8 May 2018|date=2 April 2018|archive-date=23 October 2016|archive-url=https://web.archive.org/web/20161023051702/https://www.cdc.gov/measles/hcp/index.html|url-status=live}} [84] => [85] => ===Laboratory testing=== [86] => Laboratory diagnosis of measles can be done with confirmation of positive measles [[IgM antibodies]] or detection of measles virus RNA from throat, nasal or urine specimen by using the [[reverse transcription polymerase chain reaction]] assay.{{cite web|url=https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html|title=Surveillance Manual {{!}} Measles {{!}} Vaccine Preventable Diseases {{!}} CDC|date=2019-05-23|website=www.cdc.gov|access-date=2019-11-25|archive-date=4 August 2020|archive-url=https://web.archive.org/web/20200804015227/https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html|url-status=live}} This method is particularly useful to confirm cases when the IgM antibodies results are inconclusive. For people unable to have their [[phlebotomy|blood drawn]], saliva can be collected for salivary measles-specific [[IgA]] testing.{{cite journal | vauthors = Friedman M, Hadari I, Goldstein V, Sarov I | title = Virus-specific secretory IgA antibodies as a means of rapid diagnosis of measles and mumps infection | journal = Israel Journal of Medical Sciences | volume = 19 | issue = 10 | pages = 881–4 | date = October 1983 | pmid = 6662670 }} Salivary tests used to diagnose measles involve collecting a saliva sample and testing for the presence of measles antibodies.{{Cite journal|last1=Dimech|first1=Wayne|last2=Mulders|first2=Mick N.|date=July 2016|title=A review of testing used in seroprevalence studies on measles and rubella|journal=Vaccine|volume=34|issue=35|pages=4119–4122|doi=10.1016/j.vaccine.2016.06.006|pmid=27340096}}{{cite journal |last1=Simon |first1=Jakub K. |last2=Ramirez |first2=Karina |last3=Cuberos |first3=Lilian |last4=Campbell |first4=James D. |last5=Viret |first5=Jean F. |last6=Muñoz |first6=Alma |last7=Lagos |first7=Rosanna |last8=Levine |first8=Myron M. |last9=Pasetti |first9=Marcela F. |title=Mucosal IgA Responses in Healthy Adult Volunteers following Intranasal Spray Delivery of a Live Attenuated Measles Vaccine |journal=Clinical and Vaccine Immunology |date=March 2011 |volume=18 |issue=3 |pages=355–361 |doi=10.1128/CVI.00354-10 |pmid=21228137 |pmc=3067370 }} This method is not ideal, as saliva contains many other fluids and proteins which may make it difficult to collect samples and detect measles antibodies. Saliva also contains 800 times fewer antibodies than blood samples do, which makes salivary testing additionally difficult. Positive contact with other people known to have measles adds evidence to the diagnosis. [87] => [88] => ==Prevention== [89] => {{further|Measles vaccine|MMR vaccine|MMRV vaccine}} [90] => [[File:Measles vaccination coverage world.svg|thumb|upright=1.4|Rates of measles vaccination worldwide]] [91] => Mothers who are immune to measles pass antibodies to their children while they are still in the womb, especially if the mother acquired immunity through infection rather than vaccination.{{cite journal | vauthors = Leuridan E, Sabbe M, Van Damme P | title = Measles outbreak in Europe: susceptibility of infants too young to be immunized | journal = Vaccine | volume = 30 | issue = 41 | pages = 5905–13 | date = September 2012 | pmid = 22841972 | doi = 10.1016/j.vaccine.2012.07.035 }} Such antibodies will usually give newborn infants some immunity against measles, but these antibodies are gradually lost over the course of the first nine months of life.{{cite web|title=Measles|url=https://www.merckmanuals.com/professional/pediatrics/miscellaneous-viral-infections-in-infants-and-children/measles|website=Merck Manuals Professional Edition|access-date=6 May 2018|date=January 2018|archive-date=16 May 2018|archive-url=https://web.archive.org/web/20180516085043/https://www.merckmanuals.com/professional/pediatrics/miscellaneous-viral-infections-in-infants-and-children/measles|url-status=live}} Infants under one year of age whose maternal anti-measles antibodies have disappeared become susceptible to infection with the measles virus. [92] => [93] => In developed countries, it is recommended that children be immunized against measles at 12 months, generally as part of a three-part [[MMR vaccine]] (measles, [[mumps]], and [[rubella]]). The vaccine is generally not given before this age because such infants respond inadequately to the vaccine due to an immature immune system. A second dose of the vaccine is usually given to children between the ages of four and five, to increase rates of immunity. Measles vaccines have been given to over a billion people. Vaccination rates have been high enough to make measles relatively uncommon. Adverse reactions to vaccination are rare, with fever and pain at the injection site being the most common. Life-threatening adverse reactions occur in less than one per million vaccinations (<0.0001%).{{cite journal | vauthors = Galindo BM, Concepción D, Galindo MA, Pérez A, Saiz J | title = Vaccine-related adverse events in Cuban children, 1999-2008 | journal = MEDICC Review | volume = 14 | issue = 1 | pages = 38–43 | date = January 2012 | pmid = 22334111 | doi = 10.37757/MR2012V14.N1.8| url = http://www.medicc.org/mediccreview/index.php?issue=19&id=237&a=vahtml | url-status = live | archive-url = https://web.archive.org/web/20120224083721/http://www.medicc.org/mediccreview/index.php?issue=19&id=237&a=vahtml | archive-date = 2012-02-24 | doi-access = free }} [94] => [95] => In developing countries where measles is [[Endemic (epidemiology)|common]], the [[World Health Organization]] (WHO) recommends two doses of [[vaccine]] be given, at six and nine months of age. The vaccine should be given whether the child is HIV-infected or not.{{cite journal | vauthors = Helfand RF, Witte D, Fowlkes A, Garcia P, Yang C, Fudzulani R, Walls L, Bae S, Strebel P, Broadhead R, Bellini WJ, Cutts F | title = Evaluation of the immune response to a 2-dose measles vaccination schedule administered at 6 and 9 months of age to HIV-infected and HIV-uninfected children in Malawi | journal = The Journal of Infectious Diseases | volume = 198 | issue = 10 | pages = 1457–65 | date = November 2008 | pmid = 18828743 | doi = 10.1086/592756 | doi-access = free }} The vaccine is less effective in HIV-infected infants than in the general population, but early treatment with antiretroviral drugs can increase its effectiveness.{{cite journal | vauthors = Ołdakowska A, Marczyńska M | title = [Measles vaccination in HIV infected children] | journal = Medycyna Wieku Rozwojowego | volume = 12 | issue = 2 Pt 2 | pages = 675–80 | year = 2008 | pmid = 19418943 }} Measles vaccination programs are often used to deliver other child health interventions as well, such as bed nets to protect against [[malaria]], antiparasite medicine and vitamin A supplements, and so contribute to the reduction of child deaths from other causes.{{cite press release|url=http://www.unicef.org/media/media_38076.html|title=Global goal to reduce measles deaths in children surpassed|publisher=UNICEF|year=2007|access-date=11 March 2015|url-status=live|archive-url=https://web.archive.org/web/20150204152400/http://www.unicef.org/media/media_38076.html|archive-date=4 February 2015 }} [96] => [97] => The [[Advisory Committee on Immunization Practices]] (ACIP) recommends that all adult international travelers who do not have positive evidence of previous measles immunity receive two doses of MMR vaccine before traveling, although birth before 1957 is presumptive evidence of immunity.{{cite journal | vauthors = McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS | title = Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR. Recommendations and Reports | volume = 62 | issue = RR-04 | pages = 2, 19 | date = June 2013 | pmid = 23760231 | url = https://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf|url-status=live|archive-url=https://web.archive.org/web/20200413110343/https://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf |archive-date= 13 April 2020}} Those born in the United States before 1957 are likely to have been naturally infected with measles virus and generally need not be considered susceptible.{{cite web |title=Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) |website=cdc.gov |date=29 December 1989 |access-date=13 November 2020 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm |archive-date=15 May 2012 |archive-url=https://web.archive.org/web/20120515055632/http://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm |url-status=live }} [98] => [99] => There have been false claims of an association between the measles vaccine and [[autism]]; this incorrect concern has reduced the rate of vaccination and increased the number of cases of measles where immunization rates became too low to maintain [[herd immunity]]. Additionally, there have been false claims that measles infection protects against cancer. [100] => [101] => Administration of the MMR vaccine may prevent measles after exposure to the virus (post-exposure prophylaxis).{{cite journal |last1=Di Pietrantonj |first1=Carlo |last2=Rivetti |first2=Alessandro |last3=Marchione |first3=Pasquale |last4=Debalini |first4=Maria Grazia |last5=Demicheli |first5=Vittorio |title=Vaccines for measles, mumps, rubella, and varicella in children |journal=The Cochrane Database of Systematic Reviews |date=22 November 2021 |volume=2021 |issue=11 |pages=CD004407 |doi=10.1002/14651858.CD004407.pub5 |pmid=34806766 |pmc=8607336 |issn=1469-493X}} Post-exposure prophylaxis guidelines are specific to jurisdiction and population. [[Immunization|Passive immunization]] against measles by an [[intramuscular injection]] of antibodies could be effective up to the seventh day after exposure.{{Cite journal|last1=Young|first1=Megan K|last2=Nimmo|first2=Graeme R|last3=Cripps|first3=Allan W|last4=Jones|first4=Mark A|date=2014-04-01|title=Post-exposure passive immunisation for preventing measles|url=https://doi.org/10.1002/14651858.CD010056.pub2|journal=Cochrane Database of Systematic Reviews|volume=2014|issue=4|pages=CD010056|doi=10.1002/14651858.cd010056.pub2|pmid=24687262|issn=1465-1858|hdl=10072/65474|hdl-access=free}} Compared to no treatment, the risk of measles infection is reduced by 83%, and the risk of death by measles is reduced by 76%. However, the effectiveness of passive immunization in comparison to active measles vaccine is not clear. [102] => [103] => The MMR vaccine is 95% effective for preventing measles after one dose if the vaccine is given to a child who is 12 months or older; if a second dose of the MMR vaccine is given, it will provide immunity in 99% of children.{{Cite journal|last=Bester|first=Johan Christiaan|date=2016-12-01|title=Measles and Measles Vaccination: A Review|url=http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2016.1787|journal=JAMA Pediatrics|language=en|volume=170|issue=12|pages=1209–1215|doi=10.1001/jamapediatrics.2016.1787|pmid=27695849|issn=2168-6203|access-date=7 December 2020|archive-date=23 March 2022|archive-url=https://web.archive.org/web/20220323101150/http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2016.1787|url-status=live}} [104] => [105] => There is no evidence that the measles vaccine virus can be transmitted to other persons.{{Cite journal|last1=Greenwood|first1=Kathryn P.|last2=Hafiz|first2=Radwan|last3=Ware|first3=Robert S.|last4=Lambert|first4=Stephen B.|date=2016-05-17|title=A systematic review of human-to-human transmission of measles vaccine virus|url=https://pubmed.ncbi.nlm.nih.gov/27083423/|journal=Vaccine|volume=34|issue=23|pages=2531–2536|doi=10.1016/j.vaccine.2016.03.092|issn=1873-2518|pmid=27083423|access-date=5 January 2021|archive-date=20 October 2021|archive-url=https://web.archive.org/web/20211020060437/https://pubmed.ncbi.nlm.nih.gov/27083423/|url-status=live}} [106] => [107] => ==Treatment== [108] => There is no specific [[antiviral treatment]] if measles develops. Instead the medications are generally aimed at treating superinfections, maintaining good hydration with adequate fluids, and pain relief. Some groups, like young children and the severely malnourished, are also given [[vitamin A]], which acts as an [[Immunotherapy#Immunomodulators|immunomodulator]] that boosts the antibody responses to measles and decreases the risk of serious complications.{{cite journal |last=Bester |first=Johan Christiaan |title=Measles and Measles Vaccination |journal=JAMA Pediatrics |date=1 December 2016 |volume=170 |issue=12 |pages=1209–1215 |doi=10.1001/jamapediatrics.2016.1787 |pmid=27695849 }}{{cite journal | vauthors = ((World Health Organization)) | title = Measles vaccines: WHO position paper – April 2017 | journal = Weekly Epidemiological Record | volume = 92 | issue = 17 | pages = 205–27 | date = April 2017 | pmid = 28459148 | hdl=10665/255377 | hdl-access=free }} [109] => [110] => ===Medications=== [111] => Treatment is [[supportive treatment|supportive]], with [[ibuprofen]] or [[paracetamol|paracetamol (acetaminophen)]] to reduce fever and pain and, if required, a fast-acting [[bronchodilator|medication to dilate the airways]] for cough.{{cite news |last=Rezaie |first=Salim R. |title=Measles: The Sequel |url=https://epmonthly.com/article/measles-the-sequel/ |access-date=7 June 2019 |work=Emergency Physicians Monthly |archive-date=7 June 2019 |archive-url=https://web.archive.org/web/20190607174307/https://epmonthly.com/article/measles-the-sequel/ |url-status=live }} As for [[aspirin]], some research has suggested a correlation between children who take aspirin and the development of [[Reye syndrome]].{{cite journal | vauthors = Schrör K | title = Aspirin and Reye syndrome: a review of the evidence | journal = Paediatric Drugs | volume = 9 | issue = 3 | pages = 195–204 | year = 2007 | pmid = 17523700 | doi = 10.2165/00148581-200709030-00008 | s2cid = 58727745 | quote = The suggestion of a defined cause-effect relationship between aspirin intake and Reye syndrome in children is not supported by sufficient facts. Clearly, no drug treatment is without side effects. Thus, a balanced view of whether treatment with a certain drug is justified in terms of the benefit/risk ratio is always necessary. Aspirin is no exception. }}{{NINDS|Reyes-Syndrome|Reye's Syndrome}} "Epidemiologic evidence indicates that aspirin (salicylate) is the major preventable risk factor for Reye's syndrome. The mechanism by which aspirin and other salicylates trigger Reye's syndrome is not completely understood." [112] => [113] => The use of [[vitamin A]] during treatment is recommended to decrease the risk of blindness; however, it does not prevent or cure the disease.{{cite web | url = https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Measles/FrequentlyAskedQuestions | title = Frequently Asked Questions about Measles | publisher = Washington State Department of Health | quote = [Vitamin A] cannot prevent or cure the measles | access-date = 10 February 2019 | archive-date = 5 August 2019 | archive-url = https://web.archive.org/web/20190805214034/https://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/Measles/FrequentlyAskedQuestions | url-status = live }} A [[systematic review]] of trials into its use found no reduction in overall mortality, but two doses (200,000 [[International unit|IU]]) of [[vitamin A]] was shown to reduce mortality for measles in children younger than two years of age.{{cite journal | vauthors = Huiming Y, Chaomin W, Meng M | title = Vitamin A for treating measles in children | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD001479 | date = October 2005 | volume = 2005 | pmid = 16235283 | doi = 10.1002/14651858.CD001479.pub3 | editor1-last = Yang | editor1-first = Huiming | pmc = 7076287 }} It is unclear if [[zinc]] supplementation in children with measles affects outcomes as it has not been sufficiently studied.{{cite journal | vauthors = Awotiwon AA, Oduwole O, Sinha A, Okwundu CI | title = Zinc supplementation for the treatment of measles in children | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD011177 | date = June 2017 | issue = 6 | pmid = 28631310 | pmc = 6481361 | doi = 10.1002/14651858.CD011177.pub3 }} There are no adequate studies on whether Chinese medicinal herbs are effective.{{Cite journal|last1=Chen|first1=Shou|last2=Wu|first2=Taixiang|last3=Kong|first3=Xiangyu|last4=Yuan|first4=Hao|date=2011-11-09|title=Chinese medicinal herbs for measles|journal=The Cochrane Database of Systematic Reviews|volume=2011 |issue=11|pages=CD005531|doi=10.1002/14651858.CD005531.pub4|issn=1469-493X|pmc=7265114|pmid=22071825}} [114] => [115] => ==Prognosis== [116] => Most people survive measles, though in some cases, complications may occur. About 1 in 4 individuals will be hospitalized and 1–2 in 1,000 will die. Complications are more likely in children under age 5 and adults over age 20.{{cite web |title=Measles Complications |url=https://www.cdc.gov/measles/symptoms/complications.html |website=[[Centers for Disease Control and Prevention]] |access-date=14 May 2019 |date=25 February 2019 |archive-date=19 November 2019 |archive-url=https://web.archive.org/web/20191119142611/https://www.cdc.gov/measles/symptoms/complications.html |url-status=live }} [[Pneumonia]] is the most common fatal complication of measles infection and accounts for 56–86% of measles-related deaths.{{Cite journal |last1=Di Pietrantonj |first1=Carlo |last2=Rivetti |first2=Alessandro |last3=Marchione |first3=Pasquale |last4=Debalini |first4=Maria Grazia |last5=Demicheli |first5=Vittorio |date=2021-11-22 |title=Vaccines for measles, mumps, rubella, and varicella in children |journal=The Cochrane Database of Systematic Reviews |volume=2021 |issue=11 |pages=CD004407 |doi=10.1002/14651858.CD004407.pub5 |issn=1469-493X |pmc=8607336 |pmid=34806766}} [117] => [118] => Possible consequences of measles virus infection include [[laryngotracheobronchitis]], [[sensorineural hearing loss]],{{cite journal | vauthors = Cohen BE, Durstenfeld A, Roehm PC | title = Viral causes of hearing loss: a review for hearing health professionals | journal = Trends in Hearing | volume = 18 | pages = 2331216514541361 | date = July 2014 | pmid = 25080364 | pmc = 4222184 | doi = 10.1177/2331216514541361 }} and—in about 1 in 10,000 to 1 in 300,000 cases{{cite journal | vauthors = Noyce RS, Richardson CD | title = Nectin 4 is the epithelial cell receptor for measles virus | journal = Trends in Microbiology | volume = 20 | issue = 9 | pages = 429–39 | date = September 2012 | pmid = 22721863 | doi = 10.1016/j.tim.2012.05.006 }}—[[Subacute sclerosing panencephalitis|panencephalitis]], which is usually fatal.{{cite web |url=http://www.ninds.nih.gov/disorders/subacute_panencephalitis/subacute_panencephalitis.htm |title=NINDS Subacute Sclerosing Panencephalitis Information Page |access-date=2018-03-26 |url-status=live |archive-url=https://web.archive.org/web/20141017073411/http://www.ninds.nih.gov/disorders/subacute_panencephalitis/subacute_panencephalitis.htm |archive-date=2014-10-17 }} "NINDS Subacute Sclerosing Panencephalitis Information Page" Acute measles encephalitis is another serious risk of measles virus infection. It typically occurs two days to one week after the measles [[exanthem|rash]] breaks out and begins with very high fever, severe headache, [[convulsion]]s and altered mentation. A person with measles encephalitis may become [[coma]]tose, and death or brain injury may occur.{{MerckManual|14|193|b}} [119] => [120] => For people having had measles, it is rare to ever have a symptomatic reinfection.{{cite journal | title = Recommendation of the Immunization Practices Advisory Committee (ACIP). Measles prevention | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 31 | issue = 17 | pages = 217–24, 229–31 | date = May 1982 | pmid = 6804783 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/00001090.htm | author1 = Centers for Disease Control (CDC) | access-date = 10 May 2019 | archive-date = 23 February 2021 | archive-url = https://web.archive.org/web/20210223235542/http://www.cdc.gov/mmwr/preview/mmwrhtml/00001090.htm | url-status = live }} [121] => [122] => The measles virus can deplete previously acquired [[Immunological memory|immune memory]] by killing cells that make antibodies, and thus weakens the immune system, which can cause deaths from other diseases.{{cite journal | vauthors = Mina MJ, Kula T, Leng Y, Li M, de Vries RD, Knip M, Siljander H, Rewers M, Choy DF, Wilson MS, Larman HB, Nelson AN, Griffin DE, de Swart RL, Elledge SJ | title = Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens | journal = Science | volume = 366 | issue = 6465 | pages = 599–606 | date = 1 November 2019 | pmid = 31672891 | doi = 10.1126/science.aay6485 | pmc = 8590458 | issn = 0036-8075 | url = https://www.nytimes.com/2019/10/31/health/measles-vaccine-immune-system.html | bibcode = 2019Sci...366..599M | hdl = 10138/307628 | doi-access = free | access-date = 1 November 2019 | archive-date = 5 August 2020 | archive-url = https://web.archive.org/web/20200805211150/https://www.nytimes.com/2019/10/31/health/measles-vaccine-immune-system.html | url-status = live }} Suppression of the immune system by measles lasts about two years and has been epidemiologically implicated in up to 90% of childhood deaths in [[Third World|third world]] countries, and historically may have caused rather more deaths in the United States, the UK and Denmark than were directly caused by measles.{{cite journal |title=Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality |journal=Science |date=May 2015 |doi=10.1126/science.aaa3662 |pmid=25954009 |pmc=4823017 |bibcode=2015Sci...348..694M |vauthors=Mina MJ, Metcalf CJ, de Swart RL, Osterhaus AD, Grenfell BT |volume=348 |issue=6235 |pages=694–9 |doi-access=free |url=http://well.blogs.nytimes.com/2015/05/07/measles-may-increase-susceptibility-to-other-infections |access-date=7 June 2015 |archive-date=10 May 2015 |archive-url=https://web.archive.org/web/20150510032648/http://well.blogs.nytimes.com/2015/05/07/measles-may-increase-susceptibility-to-other-infections/ |url-status=live }} Although the measles vaccine contains an attenuated strain, it does not deplete immune memory. [123] => [124] => ==Epidemiology== [125] => {{Main|Epidemiology of measles}} [126] => [127] => [[File:Measles world map-Deaths per million persons-WHO2012.svg|thumb|upright=1.4|Deaths from measles per million persons in 2012 {{Div col|small=yes|colwidth=10em}}{{legend|#b3b3b3|no data}}{{legend|#ffff20|0}}{{legend|#ff9a20|1–8}}{{legend|#f08015|9–26}}{{legend|#e06815|27–38}}{{legend|#d85010|39–73}}{{legend|#d02010|74–850}}{{div col end}}]] [128] => [[File:Measles world map - DALY - WHO2004.svg|thumb|upright=1.4|[[Disability-adjusted life year]] for measles per 100,000 inhabitants in 2004{{Div col|small=yes|colwidth=10em}} [129] => {{legend|#b3b3b3|no data}} [130] => {{legend|#ffff65|≤ 10}} [131] => {{legend|#fff200|10–25}} [132] => {{legend|#ffdc00|25–50}} [133] => {{legend|#ffc600|50–75}} [134] => {{legend|#ffb000|75–100}} [135] => {{legend|#ff9a00|100–250}} [136] => {{legend|#ff8400|250–500}} [137] => {{legend|#ff6e00|500–750}} [138] => {{legend|#ff5800|750–1000}} [139] => {{legend|#ff4200|1000–1500}} [140] => {{legend|#ff2c00|1500–2000}} [141] => {{legend|#cb0000|≥ 2000}} [142] => {{div col end}}]] [143] => [144] => Measles is extremely infectious and its continued circulation in a community depends on the generation of susceptible hosts by birth of children. In communities that generate insufficient new hosts the disease will die out. This concept was first recognized in measles by Bartlett in 1957, who referred to the minimum number supporting measles as the [[critical community size]] (CCS).{{cite journal|last=Bartlett|first=M.S.|title=Measles periodicity and community size|journal=J. R. Stat. Soc.|year=1957|series=Ser. A|issue=120|pages=48–70}} Analysis of outbreaks in island communities suggested that the CCS for measles is around 250,000.{{cite journal | vauthors = Black FL | title = Measles endemicity in insular populations: critical community size and its evolutionary implication | journal = Journal of Theoretical Biology | volume = 11 | issue = 2 | pages = 207–11 | date = July 1966 | pmid = 5965486 | doi = 10.1016/0022-5193(66)90161-5 | bibcode = 1966JThBi..11..207B }} To achieve [[herd immunity]], more than 95% of the community must be vaccinated due to the ease with which measles is transmitted from person to person. [145] => [146] => In 2011, the WHO estimated that 158,000 deaths were caused by measles. This is down from 630,000 deaths in 1990.{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, Abraham J, Adair T, Aggarwal R, Ahn SY, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Barker-Collo S, Bartels DH, Bell ML, Benjamin EJ, Bennett D, Bhalla K, Bikbov B, Bin Abdulhak A, Birbeck G, Blyth F, Bolliger I, Boufous S, Bucello C, Burch M, Burney P, Carapetis J, Chen H, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahodwala N, De Leo D, Degenhardt L, Delossantos A, Denenberg J, Des Jarlais DC, Dharmaratne SD, Dorsey ER, Driscoll T, Duber H, Ebel B, Erwin PJ, Espindola P, Ezzati M, Feigin V, Flaxman AD, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabriel SE, Gakidou E, Gaspari F, Gillum RF, Gonzalez-Medina D, Halasa YA, Haring D, Harrison JE, Havmoeller R, Hay RJ, Hoen B, Hotez PJ, Hoy D, Jacobsen KH, James SL, Jasrasaria R, Jayaraman S, Johns N, Karthikeyan G, Kassebaum N, Keren A, Khoo JP, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lipnick M, Lipshultz SE, Ohno SL, Mabweijano J, MacIntyre MF, Mallinger L, March L, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGrath J, Mensah GA, Merriman TR, Michaud C, Miller M, Miller TR, Mock C, Mocumbi AO, Mokdad AA, Moran A, Mulholland K, Nair MN, Naldi L, Narayan KM, Nasseri K, Norman P, O'Donnell M, Omer SB, Ortblad K, Osborne R, Ozgediz D, Pahari B, Pandian JD, Rivero AP, Padilla RP, Perez-Ruiz F, Perico N, Phillips D, Pierce K, Pope CA, Porrini E, Pourmalek F, Raju M, Ranganathan D, Rehm JT, Rein DB, Remuzzi G, Rivara FP, Roberts T, De León FR, Rosenfeld LC, Rushton L, Sacco RL, Salomon JA, Sampson U, Sanman E, Schwebel DC, Segui-Gomez M, Shepard DS, Singh D, Singleton J, Sliwa K, Smith E, Steer A, Taylor JA, Thomas B, Tleyjeh IM, Towbin JA, Truelsen T, Undurraga EA, Venketasubramanian N, Vijayakumar L, Vos T, Wagner GR, Wang M, Wang W, Watt K, Weinstock MA, Weintraub R, Wilkinson JD, Woolf AD, Wulf S, Yeh PH, Yip P, Zabetian A, Zheng ZJ, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | hdl = 10536/DRO/DU:30050819 | s2cid = 1541253 | url = https://zenodo.org/record/2557786 | hdl-access = free | access-date = 14 March 2020 | archive-date = 19 May 2020 | archive-url = https://web.archive.org/web/20200519152712/https://zenodo.org/record/2557786 | url-status = live }} As of 2018, measles remains a leading cause of vaccine-preventable deaths in the world.{{cite web |title=Measles Data and Statistics |url=https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf |access-date=15 August 2019 |archive-date=10 August 2019 |archive-url=https://web.archive.org/web/20190810103234/https://www.cdc.gov/measles/downloads/MeaslesDataAndStatsSlideSet.pdf |url-status=live }} In developed countries the mortality rate is lower, for example in England and Wales from 2007 to 2017 death occurred between two and three cases out of 10,000.{{cite web |title=Measles notifications and deaths in England and Wales: 1940 to 2017 |url=https://www.gov.uk/government/publications/measles-deaths-by-age-group-from-1980-to-2013-ons-data/measles-notifications-and-deaths-in-england-and-wales-1940-to-2013 |website=GOV.UK |access-date=1 October 2019 |archive-date=25 July 2019 |archive-url=https://web.archive.org/web/20190725233131/https://www.gov.uk/government/publications/measles-deaths-by-age-group-from-1980-to-2013-ons-data/measles-notifications-and-deaths-in-england-and-wales-1940-to-2013 |url-status=live }} In children one to three cases out of every 1,000 die in the United States (0.1–0.2%).{{cite web |url=https://www.cdc.gov/measles/about/complications.html |title=Complications of measles |date=3 November 2014 |publisher=[[Centers for Disease Control and Prevention]] |access-date=7 November 2014 |url-status=live |archive-url=https://web.archive.org/web/20150103130249/http://www.cdc.gov/measles/about/complications.html |archive-date=3 January 2015 }} In populations with high levels of malnutrition and a lack of adequate healthcare, mortality can be as high as 10%.{{cite web|url=https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html|title=Pinkbook {{!}} Measles {{!}} Epidemiology of Vaccine Preventable Diseases {{!}} CDC|date=2019-09-25|website=www.cdc.gov|language=en-us|access-date=2019-12-12|archive-date=7 February 2015|archive-url=https://web.archive.org/web/20150207061223/http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html|url-status=live}} In cases with complications, the rate may rise to 20–30%.{{medcn|date=November 2019}} In 2012, the number of deaths due to measles was 78% lower than in 2000 due to increased rates of immunization among [[UN member states]]. [147] => [148] => {| class="wikitable" style="text-align:right; font-size:88%; float:right; clear:right; margin-left:1em" [149] => |+ style="margin-left:1em;" | Reported cases{{Cite web |title=GHO {{!}} By category {{!}} Measles - Reported cases by WHO region |url=https://apps.who.int/gho/data/view.main.1520_62?lang=en |access-date=2023-10-06 |website=WHO}} [150] => |- [151] => ! WHO-Region [152] => ! 1980 [153] => ! 1990 [154] => ! 2000 [155] => ! 2010 [156] => ! 2020 [157] => |- [158] => | align="left" | African Region || 1,240,993 || 481,204 || 520,102 || 199,174 || 115,369 [159] => |- [160] => | align="left" | Region of the Americas || 257,790 || 218,579 || 1,754 || 247 || 9,996 [161] => |- [162] => | align="left" | Eastern Mediterranean Region || 341,624 || 59,058 || 38,592 || 10,072 || 6,769 [163] => |- [164] => | align="left" | European Region || 492,660 || 185,818 || 37,421 || 30,625 || 10,945 [165] => |- [166] => | align="left" | Southeast Asia Region || 199,535 || 224,925 || 78,558 || 54,228 || 9,389 [167] => |- [168] => | align="left" | Western Pacific Region || 1,319,640 || 155,490 || 177,052 || 49,460 || 6,605 [169] => |- [170] => | align="left" | Worldwide || 3,852,242 || 1,325,074 || 853,479 || 343,806 || 159,073 [171] => |} [172] => [173] => Even in countries where vaccination has been introduced, rates may remain high. Measles is a leading cause of vaccine-preventable childhood mortality. Worldwide, the fatality rate has been significantly reduced by a vaccination campaign led by partners in the [[Measles Initiative]]: the [[American Red Cross]], the United States [[Centers for Disease Control and Prevention|CDC]], the [[United Nations Foundation]], [[UNICEF]] and the WHO. Globally, measles fell 60% from an estimated 873,000 deaths in 1999 to 345,000 in 2005.{{cite web|url=http://www.unicef.org/media/media_38076.html|archive-url=https://web.archive.org/web/20150204152400/http://www.unicef.org/media/media_38076.html|url-status=dead|title=UNICEF Joint Press Release|archive-date=4 February 2015}} Estimates for 2008 indicate deaths fell further to 164,000 globally, with 77% of the remaining measles deaths in 2008 occurring within the Southeast Asian region.{{cite journal | vauthors = ((World Health Organization)) | title = Global reductions in measles mortality 2000-2008 and the risk of measles resurgence | journal = Weekly Epidemiological Record | volume = 84 | issue = 49 | pages = 509–16 | date = December 2009 | pmid = 19960624 | hdl = 10665/241466 | hdl-access=free }} There were 142,300 measles related deaths globally in 2018, of which most cases were reported from African and eastern Mediterranean regions. These estimates were slightly higher than that of 2017, when 124,000 deaths were reported due to measles infection globally.{{Cite press release|url=https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide|title=More than 140,000 die from measles as cases surge worldwide|website=[[World Health Organization]] (WHO)|date=5 December 2019|access-date=2019-12-12|archive-date=6 August 2020|archive-url=https://web.archive.org/web/20200806185302/https://www.who.int/news-room/detail/05-12-2019-more-than-140-000-die-from-measles-as-cases-surge-worldwide|url-status=live}} [174] => [175] => In 2000, the WHO established the Global Measles and Rubella Laboratory Network (GMRLN) to provide laboratory surveillance for measles, [[rubella]], and [[congenital rubella syndrome]].{{cite journal |last1=Brown |first1=Kevin E. |last2=Rota |first2=Paul A. |last3=Goodson |first3=James L. |last4=Williams |first4=David |last5=Abernathy |first5=Emily |last6=Takeda |first6=Makoto |last7=Mulders |first7=Mick N. |title=Genetic Characterization of Measles and Rubella Viruses Detected Through Global Measles and Rubella Elimination Surveillance, 2016–2018 |journal=MMWR. Morbidity and Mortality Weekly Report |date=5 July 2019 |volume=68 |issue=26 |pages=587–591 |doi=10.15585/mmwr.mm6826a3 |pmid=31269012 |pmc=6613570 }} Data from 2016 to 2018 show that the most frequently detected measles virus [[genotype]]s are decreasing, suggesting that increasing global population immunity has decreased the number of chains of transmission. [176] => [177] => Cases reported in the first three months of 2019, were 300% higher than in the first three months of 2018, with outbreaks in every region of the world, even in countries with high overall vaccination coverage where it spread among clusters of unvaccinated people.{{cite press release |title=New measles surveillance data for 2019 |url=https://www.who.int/immunization/newsroom/measles-data-2019/en/ |access-date=4 June 2019 |publisher=[[World Health Organization]] (WHO) |date=15 April 2019 |archive-date=3 June 2019 |archive-url=https://web.archive.org/web/20190603203116/https://www.who.int/immunization/newsroom/measles-data-2019/en/ |url-status=live }} The numbers of reported cases as of mid-November is over 413,000 globally, with an additional 250,000 cases in DRC (as reported through their national system), similar to the increasing trends of infection reported in the earlier months of 2019, compared to 2018. In 2019, the total number of cases worldwide climbed to 869,770. The number of cases reported for 2020 is lower compare to 2019.{{Cite journal|last1=Patel|first1=Minal K.|last2=Goodson|first2=James L.|last3=Alexander|first3=James P.|last4=Kretsinger|first4=Katrina|last5=Sodha|first5=Samir V.|last6=Steulet|first6=Claudia|last7=Gacic-Dobo|first7=Marta|last8=Rota|first8=Paul A.|last9=McFarland|first9=Jeffrey|last10=Menning|first10=Lisa|last11=Mulders|first11=Mick N.|date=2020-11-13|title=Progress Toward Regional Measles Elimination — Worldwide, 2000–2019|url=http://www.cdc.gov/mmwr/volumes/69/wr/mm6945a6.htm?s_cid=mm6945a6_w|journal=MMWR. Morbidity and Mortality Weekly Report|volume=69|issue=45|pages=1700–1705|doi=10.15585/mmwr.mm6945a6|issn=0149-2195|pmc=7660667|pmid=33180759|access-date=7 December 2020|archive-date=19 March 2023|archive-url=https://web.archive.org/web/20230319203951/http://www.cdc.gov/mmwr/volumes/69/wr/mm6945a6.htm?s_cid=mm6945a6_w|url-status=live}} According to the WHO, the [[COVID-19 pandemic]] hindered [[Measles vaccination|vaccination campaigns]] in at least 68 countries, including in countries that were experiencing outbreaks, which caused increased risk of additional cases.{{cite web | title=At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF | website=WHO | date=2020-05-22 | url=https://www.who.int/news/item/22-05-2020-at-least-80-million-children-under-one-at-risk-of-diseases-such-as-diphtheria-measles-and-polio-as-covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef | access-date=2022-06-25 | archive-date=5 April 2023 | archive-url=https://web.archive.org/web/20230405232933/https://www.who.int/news/item/22-05-2020-at-least-80-million-children-under-one-at-risk-of-diseases-such-as-diphtheria-measles-and-polio-as-Covid-19-disrupts-routine-vaccination-efforts-warn-gavi-who-and-unicef | url-status=live }} [178] => [179] => In February 2024, the World Health Organization said more than half of the world was at risk of a measles outbreak due to Covid-19 pandemic-related disruptions in that month. All the world regions have reported such outbreaks with the exception of the [[Americas]], though these could still be expected to become hotspots in the future. Death rates during the outbreaks tend to be higher among poorer countries but middle income nations are also heavily impacted, according to the WHO.{{Cite news |date=2024-02-21 |title=More than half the world faces high measles risk, WHO says |url=https://www.straitstimes.com/world/more-than-half-the-world-faces-high-measles-risk-who-says |access-date=2024-02-21 |work=The Straits Times |language=en |issn=0585-3923}} [180] => [181] => ===Europe=== [182] => [[File:Measles in England & Wales1940-2017.png|thumb|350px|Incidence of and deaths due to measles in England and Wales between 1940 and 2017]] [183] => In England and Wales, though deaths from measles were uncommon, they averaged about 500 per year in the 1940s. Deaths diminished with the improvement of medical care in the 1950s but the incidence of the disease did not retreat until vaccination was introduced in the late 1960s. Wider coverage was achieved in the 1980s with the measles, [[mumps]] and [[rubella]], [[MMR vaccine]].{{cite web |title=50 years of measles vaccination in the UK |url=https://publichealthengland.exposure.co/50-years-of-measles-vaccination-in-the-uk |website=Public Health England |access-date=15 May 2020 |archive-date=4 November 2020 |archive-url=https://web.archive.org/web/20201104095511/https://publichealthengland.exposure.co/50-years-of-measles-vaccination-in-the-uk |url-status=dead }} [184] => [185] => In 2013–14, there were almost 10,000 cases in 30 European countries. Most cases occurred in unvaccinated individuals and over 90% of cases occurred in Germany, Italy, Netherlands, Romania, and United Kingdom. Between October 2014 and March 2015, a measles outbreak in the German capital of [[Berlin]] resulted in at least 782 cases.{{cite web|url=http://www.ibtimes.com/who-stefan-lanka-court-orders-german-measles-denier-pay-100000-euros-1846078|title=Who Is Stefan Lanka? Court Orders German Measles Denier To Pay 100,000 Euros|author=Elizabeth Whitman|website=[[International Business Times]]|date=2015-03-13|access-date=2015-03-31|url-status=live|archive-url=https://web.archive.org/web/20150402182617/http://www.ibtimes.com/who-stefan-lanka-court-orders-german-measles-denier-pay-100000-euros-1846078|archive-date=2015-04-02}} In 2017, numbers continued to increase in Europe to 21,315 cases, with 35 deaths.{{cite press release|title=Europe observes a 4-fold increase in measles cases in 2017 compared to previous year|url=http://www.euro.who.int/en/media-centre/sections/press-releases/2018/europe-observes-a-4-fold-increase-in-measles-cases-in-2017-compared-to-previous-year|website=[[World Health Organization]] (WHO)|access-date=22 February 2018|date=19 February 2018|archive-date=21 February 2018|archive-url=https://web.archive.org/web/20180221204224/http://www.euro.who.int/en/media-centre/sections/press-releases/2018/europe-observes-a-4-fold-increase-in-measles-cases-in-2017-compared-to-previous-year|url-status=live}} In preliminary figures for 2018, reported cases in the region increased 3-fold to 82,596 in 47 countries, with 72 deaths; Ukraine had the most cases (53,218), with the highest incidence rates being in Ukraine (1209 cases per million), Serbia (579), Georgia (564) and Albania (500).{{cite web |url=http://www.euro.who.int/__data/assets/pdf_file/0004/394060/2019_01_Epi_Data_EN_Jan-Dec-2018.pdf?ua=1 |title=WHO EpiData |publisher=[[World Health Organization]] (WHO) |date=February 2019 |access-date=27 March 2019 |archive-date=29 March 2019 |archive-url=https://web.archive.org/web/20190329133545/http://www.euro.who.int/__data/assets/pdf_file/0004/394060/2019_01_Epi_Data_EN_Jan-Dec-2018.pdf?ua=1 |url-status=live }}{{cite press release |url=http://www.euro.who.int/en/media-centre/sections/press-releases/2019/measles-in-europe-record-number-of-both-sick-and-immunized |title=Measles in Europe: record number of both sick and immunized |publisher=[[World Health Organization]] (WHO) |date=7 February 2019 |access-date=27 March 2019 |archive-date=10 February 2019 |archive-url=https://web.archive.org/web/20190210022729/http://www.euro.who.int/en/media-centre/sections/press-releases/2019/measles-in-europe-record-number-of-both-sick-and-immunized |url-status=live }} The previous year (2017) saw an estimated measles vaccine coverage of 95% for the first dose and 90% for the second dose in the region, the latter figure being the highest-ever estimated second-dose coverage. [186] => [187] => In 2019, the United Kingdom, Albania, the Czech Republic, and Greece lost their measles-free status due to ongoing and prolonged spread of the disease in these countries.{{cite press release |title=European Region loses ground in effort to eliminate measles |url=http://www.euro.who.int/en/media-centre/sections/press-releases/2019/european-region-loses-ground-in-effort-to-eliminate-measles |website=[[World Health Organization]] (WHO) |access-date=31 August 2019 |date=29 August 2019 |archive-url=https://web.archive.org/web/20200414065648/http://www.euro.who.int/en/media-centre/sections/press-releases/2019/european-region-loses-ground-in-effort-to-eliminate-measles | archive-date=14 April 2020}} In the first 6 months of 2019, 90,000 cases occurred in Europe. [188] => [189] => ===Americas=== [190] => As a result of widespread vaccination, the disease was declared eliminated from the [[Americas]] in 2016.{{cite web|title=Region of the Americas is declared free of measles|url=https://www.paho.org/hq/index.php?option=com_content&view=article&id=12528:region-americas-declared-free-measles&Itemid=1926&lang=en |website=Pan American Health Organization |access-date=30 September 2016 |date=29 September 2016 |url-status=live |archive-url=https://web.archive.org/web/20160930044745/http://www.paho.org/hq/index.php?option=com_content&view=article&id=12528%3Aregion-americas-declared-free-measles&Itemid=1926&lang=en |archive-date=30 September 2016 }} However, there were cases again in 2017,{{cite news |title=Measles spreads again in the Americas |url=https://en.mercopress.com/2018/03/28/measles-spreads-again-in-the-americas |access-date=4 July 2018 |work=MercoPress |date=28 March 2018 |archive-date=4 July 2018 |archive-url=https://web.archive.org/web/20180704182714/http://en.mercopress.com/2018/03/28/measles-spreads-again-in-the-americas |url-status=live }} 2018, 2019, and 2020 in this region. [191] => [192] => ====United States==== [193] => {{see also|Measles resurgence in the United States}} [194] => [[File:Measles US 1938-2019.png|thumb|Measles cases in the U.S. from 1938 to 2019]] [195] => In the United States, measles affected approximately 3,000 people per million in the 1960s before the vaccine was available. With consistent widespread childhood vaccination, this figure fell to 13 cases per million by the 1980s, and to about 1 case per million by 2000.{{cite journal | vauthors = Orenstein WA, Papania MJ, Wharton ME | title = Measles elimination in the United States | journal = The Journal of Infectious Diseases | volume = 189 | issue = Supplement 1 | pages = S1-3 | date = May 2004 | pmid = 15106120 | doi = 10.1086/377693 | quote = Figure 1: Reported US measles incidence, 1950–2001. | doi-access = free }} [196] => [197] => In 1991, an [[1990–1991 Philadelphia measles outbreak|outbreak of measles in Philadelphia]] was centered at the Faith Tabernacle Congregation, a faith healing church that actively discouraged parishioners from vaccinating their children. Over 1400 people were infected with measles and nine children died.{{cite web|url=https://6abc.com/504818/|title=1991: The Philly measles outbreak that killed 9 children|date=6 February 2015|website=6abc Philadelphia|access-date=7 August 2021|archive-date=25 November 2020|archive-url=https://web.archive.org/web/20201125033257/https://6abc.com/504818/|url-status=live}} [198] => [199] => Before immunization in the United States, between three and four million cases occurred each year. The United States was declared free of circulating measles in 2000, with 911 cases from 2001 to 2011. In 2014 the CDC said endemic measles, rubella, and [[congenital rubella syndrome]] had not returned to the United States.{{cite journal | vauthors = Papania MJ, Wallace GS, Rota PA, Icenogle JP, Fiebelkorn AP, Armstrong GL, Reef SE, Redd SB, Abernathy ES, Barskey AE, Hao L, McLean HQ, Rota JS, Bellini WJ, Seward JF | title = Elimination of endemic measles, rubella, and congenital rubella syndrome from the Western hemisphere: the US experience | journal = JAMA Pediatrics | volume = 168 | issue = 2 | pages = 148–55 | date = February 2014 | pmid = 24311021 | doi = 10.1001/jamapediatrics.2013.4342 | doi-access = }} Occasional measles outbreaks persist, however, because of cases imported from abroad, of which more than half are the result of unvaccinated U.S. residents who are infected abroad and infect others upon return to the United States. The CDC continues to recommend measles vaccination throughout the population to prevent outbreaks like these.{{cite journal | title = Multistate measles outbreak associated with an international youth sporting event--Pennsylvania, Michigan, and Texas, August-September 2007 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 57 | issue = 7 | pages = 169–73 | date = February 2008 | pmid = 18288074 | url = https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5707a1.htm | author1 = Centers for Disease Control Prevention (CDC) | access-date = 1 February 2018 | archive-date = 18 October 2020 | archive-url = https://web.archive.org/web/20201018010756/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5707a1.htm | url-status = live }} [200] => [201] => In 2014, an outbreak was initiated in Ohio when two unvaccinated [[Amish]] men harboring asymptomatic measles returned to the United States from missionary work in the Philippines.{{cite journal | vauthors = Gastañaduy PA, Budd J, Fisher N, Redd SB, Fletcher J, Miller J, McFadden DJ, Rota J, Rota PA, Hickman C, Fowler B, Tatham L, Wallace GS, de Fijter S, Parker Fiebelkorn A, DiOrio M | title = A Measles Outbreak in an Underimmunized Amish Community in Ohio | journal = The New England Journal of Medicine | volume = 375 | issue = 14 | pages = 1343–1354 | date = October 2016 | pmid = 27705270 | doi = 10.1056/NEJMoa1602295 | doi-access = free }} Their return to a community with low vaccination rates led to an outbreak that rose to include a total of 383 cases across nine counties. Of the 383 cases, 340 (89%) occurred in unvaccinated individuals. [202] => [203] => From 4 January, to 2 April 2015, there were 159 cases of measles reported to the CDC. Of those 159 cases, 111 (70%) were determined to have come from an earlier exposure in late December 2014. This outbreak was believed to have originated from the [[Disneyland]] [[theme park]] in California. The Disneyland outbreak was held responsible for the infection of 147 people in seven U.S. states as well as Mexico and Canada, the majority of which were either unvaccinated or had unknown vaccination status.{{cite web |url=https://blogs.cdc.gov/publichealthmatters/2015/12/year-in-review-measles-linked-to-disneyland/ |title=Year in Review: Measles Linked to Disneyland |date=2 December 2015 |access-date=2017-05-26 |url-status=live |archive-url=https://web.archive.org/web/20170519211805/https://blogs.cdc.gov/publichealthmatters/2015/12/year-in-review-measles-linked-to-disneyland/ |archive-date=2017-05-19 }} Of the cases 48% were unvaccinated and 38% were unsure of their vaccination status.{{cite journal | vauthors = Clemmons NS, Gastanaduy PA, Fiebelkorn AP, Redd SB, Wallace GS | title = Measles - United States, January 4-April 2, 2015 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 64 | issue = 14 | pages = 373–6 | date = April 2015 | pmid = 25879894 | pmc = 5779542 | url = https://www.cdc.gov/mmwr/pdf/wk/mm6414.pdf | access-date = 1 November 2019 | archive-date = 13 July 2020 | archive-url = https://web.archive.org/web/20200713221937/https://www.cdc.gov/mmwr/pdf/wk/mm6414.pdf | url-status = live }} The initial exposure to the virus was never identified.{{cite web|title=Measles Outbreak — California, December 2014–February 2015|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm|access-date=2022-01-08|website=www.cdc.gov|archive-date=10 December 2020|archive-url=https://web.archive.org/web/20201210053113/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm|url-status=live}} [204] => [205] => In 2015, a U.S. woman in Washington state died of [[pneumonia]], as a result of measles. She was the first fatality in the U.S. from measles since 2003.{{cite news |title=Measles kills first patient in 12 years |url=https://www.usatoday.com/story/news/2015/07/02/measles-death-washington-state/29624385/ |access-date=2 July 2015 |newspaper=USA Today |date=2 July 2015 |url-status=live |archive-url=https://web.archive.org/web/20150702200945/http://www.usatoday.com/story/news/2015/07/02/measles-death-washington-state/29624385/ |archive-date=2 July 2015}} The woman had been vaccinated for measles and was taking [[immunosuppressive drug]]s for another condition. The drugs suppressed the woman's immunity to measles, and the woman became infected with measles; she did not develop a rash, but contracted pneumonia, which caused her death.{{cite web |title= First Measles Death in US Since 2003 Highlights the Unknown Vulnerables – Phenomena: Germination |website= [[National Geographic Society]] |url= https://www.nationalgeographic.com/science/phenomena/2015/07/02/measles-death-us/ |access-date= 2020-05-13 |date= 2015-07-02 |archive-date= 31 May 2020 |archive-url= https://web.archive.org/web/20200531020834/https://www.nationalgeographic.com/science/phenomena/2015/07/02/measles-death-us/ |url-status= dead }}{{cite web |title=First Measles Death In 12 Years Renews Vaccination Concerns |website=[[NPR]] |date=6 July 2015 |url=https://www.npr.org/2015/07/06/420594973/first-measles-death-in-12-years-renews-vaccination-concerns |access-date=23 April 2019 |archive-url= https://web.archive.org/web/20191224204938/https://www.npr.org/2015/07/06/420594973/first-measles-death-in-12-years-renews-vaccination-concerns |archive-date= 24 December 2019}} [206] => [207] => In June 2017, the Maine Health and Environmental Testing Laboratory confirmed a case of measles in Franklin County. This instance marks the first case of measles in 20 years for the state of Maine.{{cite web|title=Maine confirms its first case of measles in 20 years |url=https://www.cbsnews.com/news/maine-confirms-first-case-measles-20-years/ |website=CBS News |date=27 June 2017 |access-date=28 June 2017 |url-status=live |archive-url=https://web.archive.org/web/20170628021043/http://www.cbsnews.com/news/maine-confirms-first-case-measles-20-years/|archive-date=28 June 2017 }} In 2018, one case occurred in Portland, Oregon, with 500 people exposed; 40 of them lacked immunity to the virus and were being monitored by county health officials as of 2 July 2018.{{Cite news|url=http://katu.com/news/local/measles-case-confirmed-in-portland-about-500-people-exposed|title=Measles case confirmed in Portland, about 500 people possibly exposed|work=KATU|access-date=2018-07-03|archive-date=7 August 2020|archive-url=https://web.archive.org/web/20200807014127/https://katu.com/news/local/measles-case-confirmed-in-portland-about-500-people-exposed|url-status=live}} There were 273 cases of measles reported throughout the United States in 2018,{{cite web|url=https://wonder.cdc.gov/nndss/static/2018/52/2018-52-table1.html|title=TABLE 1. Weekly cases* of selected infrequently reported notifiable diseases (|website=wonder.cdc.gov|access-date=2019-01-12|archive-date=22 October 2020|archive-url=https://web.archive.org/web/20201022112034/https://wonder.cdc.gov/nndss/static/2018/52/2018-52-table1.html|url-status=live}} including an outbreak in [[Brooklyn]] with more than 200 reported cases from October 2018 to February 2019. The outbreak was tied with population density of the [[Orthodox Jewish]] community, with the initial exposure from an unvaccinated child that caught measles while visiting Israel.{{Cite news|url=https://www.cnn.com/2019/01/08/health/measles-outbreak-ny-bn/index.html|title=New York tackles 'largest measles outbreak' in state's recent history as cases spike globally|last=Howard|first=Jacqueline|date=9 January 2019|work=CNN|access-date=12 January 2019|archive-date=11 January 2019|archive-url=https://web.archive.org/web/20190111093850/https://www.cnn.com/2019/01/08/health/measles-outbreak-ny-bn/index.html|url-status=live}} [208] => [209] => A resurgence of measles occurred during 2019, which has been generally tied to [[Vaccine hesitancy|parents choosing not to have their children vaccinated]] as most of the reported cases have occurred in people 19 years old or younger.{{cite web|url=https://www.nbcnews.com/storyline/measles-outbreak/measles-outbreak-southwestern-washington-rises-50-cases-n966751|title=Washington state is averaging more than one measles case per day in 2019|website=NBC News|date=4 February 2019 |access-date=5 February 2019|archive-date=5 February 2019|archive-url=https://web.archive.org/web/20190205011950/https://www.nbcnews.com/storyline/measles-outbreak/measles-outbreak-southwestern-washington-rises-50-cases-n966751|url-status=live}}{{cite web|url=https://www.msn.com/en-ph/lifestyle/family/amid-measles-outbreak-anti-vaxx-parents-have-put-others-e2-80-99-babies-at-risk/ar-BBTbIBq|title=Amid Measles Outbreak, Anti-Vaxx Parents Have Put Others' Babies At Risk|website=MSN|access-date=5 February 2019|archive-url=https://web.archive.org/web/20190330170245/https://www.msn.com/en-ph/lifestyle/family/amid-measles-outbreak-anti-vaxx-parents-have-put-others-e2-80-99-babies-at-risk/ar-BBTbIBq|archive-date=30 March 2019|url-status=dead}}{{cite web|url=https://www.vox.com/2019/1/27/18199514/measles-outbreak-2018-clark-county-washington|title=Washington declared a public health emergency over measles. Thank vaccine-refusing parents.|first=Julia|last=Belluz|date=27 January 2019|website=[[Vox (website)|Vox]]|access-date=5 February 2019|archive-date=5 February 2019|archive-url=https://web.archive.org/web/20190205005311/https://www.vox.com/2019/1/27/18199514/measles-outbreak-2018-clark-county-washington|url-status=live}}{{cite web|url=https://www.newsweek.com/dangerous-anti-vaxx-warning-issued-washington-officials-cases-measles-1306997|title="Dangerous" anti-vaxx warning issued by Washington officials as cases in measles outbreak continue to rise|first=Kashmira|last=Gander|date=28 January 2019|website=[[Newsweek]]|access-date=5 February 2019|archive-date=4 February 2019|archive-url=https://web.archive.org/web/20190204224837/https://www.newsweek.com/dangerous-anti-vaxx-warning-issued-washington-officials-cases-measles-1306997|url-status=live}} Cases were first reported in Washington state in January, with an [[2019 Pacific Northwest measles outbreak|outbreak of at least 58 confirmed cases]] most within [[Clark County, Washington|Clark County]], which has a higher rate of vaccination exemptions compared to the rest of the state; nearly one in four kindergartners in Clark did not receive vaccinations, according to state data.{{cite news | url = https://www.usatoday.com/story/news/health/2019/02/11/measles-spread-anti-vaccination-communities-new-york-clar-county-washington/2812667002/ | title = A quarter of all kindergartners in Washington county aren't immunized. Now there's a measles crisis | first = Ken | last = Alltucker | date = 11 February 2019 | access-date = 11 February 2019 | work = [[USA Today]] | archive-date = 11 February 2019 | archive-url = https://web.archive.org/web/20190211160944/https://www.usatoday.com/story/news/health/2019/02/11/measles-spread-anti-vaccination-communities-new-york-clar-county-washington/2812667002/ | url-status = live }} This led Washington state governor [[Jay Inslee]] to declare a state of emergency, and the state's congress to introduce legislation to disallow vaccination exemption for personal or philosophical reasons.{{cite web | url = https://www.seattletimes.com/seattle-news/amid-measles-outbreak-legislation-proposed-to-ban-vaccine-exemptions/ | title = Amid measles outbreak, legislation proposed to ban vaccine exemptions | first = Jake | last = Goldstein-Street | date = 28 January 2019 | access-date = 28 January 2019 | work = [[The Seattle Times]] | archive-date = 29 January 2019 | archive-url = https://web.archive.org/web/20190129011001/https://www.seattletimes.com/seattle-news/amid-measles-outbreak-legislation-proposed-to-ban-vaccine-exemptions/ | url-status = live }} In April 2019, New York Mayor [[Bill de Blasio]] declared a public health emergency because of "a huge spike" in [[2019 New York measles outbreak|cases of measles]] where there were 285 cases centred on the Orthodox Jewish areas of Brooklyn in 2018, while there were only two cases in 2017. There were 168 more in neighboring [[Rockland County, New York|Rockland County]].{{cite journal |vauthors=Tanne JH |title=New York City mayor declares measles public health emergency |journal=BMJ |volume=365 |pages=l1724 |date=April 2019 |pmid=30971409 |doi=10.1136/bmj.l1724 |s2cid=145979493 }} Other outbreaks have included Santa Cruz County and Butte County in California, and the states of New Jersey and Michigan.{{cite web | url = https://www.cnn.com/2019/04/24/health/measles-outbreak-record-us-bn/index.html | title = US measles outbreak is largest since disease was declared eliminated in 2000 | first1 = Jacqueline | last1 = Howard | first2 = Debra | last2 = Goldschmidt | date = 24 April 2019 | access-date = 24 April 2019 | website = [[CNN]] | archive-date = 24 April 2019 | archive-url = https://web.archive.org/web/20190424160923/https://www.cnn.com/2019/04/24/health/measles-outbreak-record-us-bn/index.html | url-status = live }} {{As of|April 2019}}, there have been 695 cases of measles reported in 22 states. This is the highest number of measles cases since it was declared eradicated in 2000.{{cite press release |title=CDC Media Statement: Measles cases in the U.S. are highest since measles was eliminated in 2000 |url=https://www.cdc.gov/media/releases/2019/s0424-highest-measles-cases-since-elimination.html |website=[[Centers for Disease Control and Prevention]] |date=2019-04-26 |access-date=2 May 2019 |archive-date=15 July 2020 |archive-url=https://web.archive.org/web/20200715061619/https://www.cdc.gov/media/releases/2019/s0424-highest-measles-cases-since-elimination.html |url-status=live }} From 1 January, to 31 December 2019, 1,282 individual cases of measles were confirmed in 31 states.{{cite web | title=Measles Cases and Outbreaks |website=[[Centers for Disease Control and Prevention]] | date=6 January 2020 | url=https://www.cdc.gov/measles/cases-outbreaks.html | archive-url=https://web.archive.org/web/20191101062347/https://www.cdc.gov/measles/cases-outbreaks.html | archive-date=1 November 2019 | url-status=live | access-date=6 January 2020}} {{PD-notice}} This is the greatest number of cases reported in the U.S. since 1992. Of the 1,282 cases, 128 of the people who got measles were hospitalized, and 61 reported having complications, including pneumonia and encephalitis. [210] => [211] => Following the end of the 2019 outbreak, reported cases have fallen to pre-outbreak levels: 13 cases in 2020, 49 cases in 2021, and 121 cases in 2022.{{Cite web |last=CDC |date=2023-09-29 |title=Measles Cases and Outbreaks |url=https://www.cdc.gov/measles/cases-outbreaks.html |access-date=2023-10-06 |website=Centers for Disease Control and Prevention |language=en-us}} [212] => [213] => ====Brazil==== [214] => The spread of measles had been interrupted in Brazil in 2016, with the last-known case twelve months earlier.{{cite web|first=Mariana|last=Lenharo|url=http://g1.globo.com/bemestar/noticia/2016/07/sarampo-esta-eliminado-do-brasil-segundo-comite-internacional.html|title=Sarampo está eliminado do Brasil, segundo comitê internacional|publisher=[[G1 (website)|G1]]|date=26 July 2016|access-date=26 July 2016|language=pt|archive-date=27 July 2016|archive-url=https://web.archive.org/web/20160727142754/http://g1.globo.com/bemestar/noticia/2016/07/sarampo-esta-eliminado-do-brasil-segundo-comite-internacional.html|url-status=live}} This last case was in the state of [[Ceará]].{{Cite journal|date=2016-07-26|title=Sarampo está eliminado do Brasil, segundo comitê internacional|url=http://g1.globo.com/bemestar/noticia/2016/07/sarampo-esta-eliminado-do-brasil-segundo-comite-internacional.html|journal=Bem Estar|language=pt-BR|access-date=19 December 2018|archive-date=27 July 2016|archive-url=https://web.archive.org/web/20160727142754/http://g1.globo.com/bemestar/noticia/2016/07/sarampo-esta-eliminado-do-brasil-segundo-comite-internacional.html|url-status=live}} [215] => [216] => Brazil won a measles elimination certificate by the [[Pan American Health Organization]] in 2016, but the [[Ministry of Health (Brazil)|Ministry of Health]] has proclaimed that the country has struggled to keep this certificate, since two outbreaks had already been identified in 2018, one in the state of [[Amazonas (Brazilian state)|Amazonas]] and another one in [[Roraima]], in addition to cases in other states ([[Rio de Janeiro (state)|Rio de Janeiro]], [[Rio Grande do Sul]], [[Pará]], [[São Paulo (state)|São Paulo]] and [[Rondônia]]), totaling 1,053 confirmed cases until 1 August 2018.{{Cite journal|title=Brasil já tem mais de mil casos de sarampo em 2018, segundo Ministério da Saúde|url=https://g1.globo.com/bemestar/noticia/2018/08/02/brasil-ja-tem-mais-de-mil-casos-de-sarampo-em-2018-segundo-ministerio-da-saude.ghtml|journal=[[G1 (website)|G1]]|date=2 August 2018 |language=pt-BR|access-date=19 December 2018|archive-date=9 November 2020|archive-url=https://web.archive.org/web/20201109021531/https://g1.globo.com/bemestar/noticia/2018/08/02/brasil-ja-tem-mais-de-mil-casos-de-sarampo-em-2018-segundo-ministerio-da-saude.ghtml|url-status=live}}{{cite web|url=http://portalms.saude.gov.br/noticias/agencia-saude/43946-ministerio-da-saude-atualiza-casos-de-sarampo-2|title=Ministério da Saúde atualiza casos de sarampo|access-date=2018-08-02|work=portalms.saude.gov.br|last=Saúde|first=Ministério da|language=pt-br|archive-date=20 April 2019|archive-url=https://web.archive.org/web/20190420130416/http://portalms.saude.gov.br/noticias/agencia-saude/43946-ministerio-da-saude-atualiza-casos-de-sarampo-2|url-status=live}} In these outbreaks, and in most other cases, the contagion was related to the importation of the virus, especially from Venezuela. This was confirmed by the genotype of the virus (D8) that was identified, which is the same that circulates in Venezuela. [217] => [218] => ===Southeast Asia=== [219] => In the Vietnamese measles epidemic in spring of 2014, an estimated 8,500 measles cases were reported as of 19 April, with 114 fatalities;{{cite web|url=http://www.thanhniennews.com/health/vietnam-minister-calls-for-calm-in-face-of-8500-measles-cases-114-fatalities-25423.html|title=Vietnam minister calls for calm in face of 8,500 measles cases, 114 fatalities|author=Lien Chau|publisher=Thanh Niên|date=18 April 2014|access-date=19 April 2014|archive-url=https://web.archive.org/web/20140418220953/http://www.thanhniennews.com/health/vietnam-minister-calls-for-calm-in-face-of-8500-measles-cases-114-fatalities-25423.html|archive-date=18 April 2014|url-status=live}} as of 30 May, 21,639 suspected measles cases had been reported, with 142 measles-related fatalities.{{cite web|url=http://tuoitre.vn/Chinh-tri-Xa-hoi/610133/bo-y-te--vn-da-phan-ung-rat-nhanh-doi-voi-dich-soi.html|title=Bộ Y tế: "VN đã phản ứng rất nhanh đối với dịch sởi"|trans-title=Ministry of Health: "Vietnam has responded very quickly to measles"|author=Quốc Thanh|language=vi|publisher=Tuổi Trẻ|date=30 May 2014|access-date=19 April 2014|archive-url=https://web.archive.org/web/20140531233458/http://tuoitre.vn/Chinh-tri-Xa-hoi/610133/bo-y-te--vn-da-phan-ung-rat-nhanh-doi-voi-dich-soi.html|archive-date=31 May 2014|url-status=live}} In the [[Naga Self-Administered Zone]] in a remote northern region of [[Myanmar]], at least 40 children died during a measles outbreak in August 2016 that was probably caused by lack of vaccination in an area of poor health infrastructure.{{cite web|url=https://www.easternmirrornagaland.com/who-doctors-in-myanmars-naga-areas-identify-mystery-disease/|title=WHO doctors in Myanmar's Naga areas identify 'mystery disease'|publisher=Eastern Mirror Nagaland|date=6 August 2016|access-date=8 August 2016|archive-url=https://web.archive.org/web/20170819065303/http://www.easternmirrornagaland.com/who-doctors-in-myanmars-naga-areas-identify-mystery-disease/|archive-date=19 August 2017|url-status=live}}{{cite web|url=http://www.promedmail.org/post/4398118|title=Myanmar (02): (SA) fatal, measles confirmed|website=www.promedmail.org (Archive Number: 20160806.4398118)|publisher=International Society for Infectious Diseases|access-date=8 August 2016|archive-url=https://web.archive.org/web/20160820090754/http://www.promedmail.org/post/4398118|archive-date=20 August 2016|url-status=dead}} Following the [[2019 Philippines measles outbreak]], 23,563 measles cases have been reported in the country with 338 fatalities.{{cite web |url=http://outbreaknewstoday.com/philippines-measles-update-nearly-600-cases-2-days-76902/ |title=Philippines measles update: Nearly 600 cases in 2 days |publisher=Outbreak News Today |date=26 March 2019 |access-date=30 August 2019 |archive-url=https://web.archive.org/web/20190830010007/http://outbreaknewstoday.com/philippines-measles-update-nearly-600-cases-2-days-76902/ |archive-date=30 August 2019 |url-status=live}} A [[2019 Kuala Koh measles outbreak|measles outbreak]] also happened among the Malaysian [[Orang Asli]] sub-group of [[Batek people]] in the state of [[Kelantan]] from May 2019, causing the deaths of 15 from the tribe.{{cite web |last=Oon |first=Alyssa J. |date=17 June 2019 |title=A Measles Outbreak Is The Cause of 15 Orang Asli Deaths In Kelantan |url=https://says.com/my/news/mysterious-illness-causing-deaths-of-kampung-kuala-koh-orang-asli-identified-as-measles |url-status=live |archive-url=https://web.archive.org/web/20190827033231/https://says.com/my/news/mysterious-illness-causing-deaths-of-kampung-kuala-koh-orang-asli-identified-as-measles |archive-date=27 August 2019 |access-date=30 August 2019 |publisher=Says.com}}{{cite web |last=Tay |first=Rachel |date=18 June 2019 |title=The mysterious illness that caused 15 deaths in a Malaysian tribe has been linked to a measles outbreak |url=https://www.businessinsider.my/the-mysterious-illness-that-caused-15-deaths-in-a-malaysian-tribe-has-been-linked-to-a-measles-outbreak/ |url-status=live |archive-url=https://web.archive.org/web/20190830005853/https://www.businessinsider.my/the-mysterious-illness-that-caused-15-deaths-in-a-malaysian-tribe-has-been-linked-to-a-measles-outbreak/ |archive-date=30 August 2019 |access-date=30 August 2019 |publisher=Business Insider Malaysia}} In 2024, a measles outbreak was declared in the [[Bangsamoro]] region in the Philippines with at least 592 cases and 3 deaths.{{cite news |last1=Unson |first1=John |title=Measles outbreak declared in BARMM |url=https://qa.philstar.com/nation/2024/03/24/2342863/measles-outbreak-declared-barmm |access-date=24 March 2024 |work=The Philippine Star |date=24 March 2024}} [220] => [221] => ===South Pacific=== [222] => A [[2019–2020 New Zealand measles outbreak|measles outbreak in New Zealand]] has 2193 confirmed cases and two deaths. A [[2019 Tonga measles outbreak|measles outbreak in Tonga]] has 612 cases of measles. [223] => [224] => ==== Samoa ==== [225] => A [[2019 Samoa measles outbreak|measles outbreak in Samoa]] in late 2019 has over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,000. Over three percent of the population were infected, and a state of emergency was declared from 17 November to 7 December. A vaccination campaign brought the measles vaccination rate from 31 to 34% in 2018 to an estimated 94% of the eligible population in December 2019.{{cite web|url=https://www.facebook.com/samoagovt/posts/2835748539789483|title=National Emergency Operation Centre, update on the measles outbreak: (press release 36) 22 December, 2019|author=Government of Samoa|date=22 December 2019|website=@samoagovt|url-status=live|archive-url=https://archive.today/20200316000531/https://www.facebook.com/samoagovt/posts/2835748539789483|archive-date=16 March 2020|access-date=22 December 2019}} [226] => [227] => ===Africa=== [228] => [229] => The Democratic Republic of the Congo and Madagascar have reported the highest numbers of cases in 2019. However, cases have decreased in Madagascar as a result of nationwide emergency measles vaccine campaigns. As of August 2019 outbreaks were occurring in Angola, Cameroon, Chad, Nigeria, South Sudan and Sudan.{{cite web|url=https://www.who.int/immunization/newsroom/new-measles-data-august-2019/en/|archive-url=https://web.archive.org/web/20190812222426/https://www.who.int/immunization/newsroom/new-measles-data-august-2019/en/|url-status=dead|archive-date=12 August 2019|title=New measles surveillance data from WHO|website=[[World Health Organization]] (WHO)|access-date=2019-11-23}} [230] => [231] => ==== Madagascar ==== [232] => An [[2018 Madagascar measles outbreak|outbreak of measles]] in 2018 has resulted in well beyond 115,000 cases and over 1,200 deaths.{{cite news|url=https://www.apnews.com/0cd4deb8141742b5903fbef3cb0e8afa|title=Measles outbreak kills more than 1200 in Madagascar|last=Bezain|first=Laetitia|date=14 April 2019|access-date=13 May 2019|publisher=Associated Press}} [233] => [234] => ==== Democratic Republic of Congo ==== [235] => An [[2019–2020 measles outbreak in the Democratic Republic of the Congo|outbreak of measles]] with nearly 5,000 deaths and 250,000 infections occurred in 2019, after the disease spread to all the provinces in the country.{{cite news |url=https://www.bbc.com/news/world-africa-50506743 |title=Nearly 5,000 dead in world's worst measles outbreak |date=2019-11-21 |access-date=2019-11-23 |archive-url=https://web.archive.org/web/20200211233419/https://www.bbc.com/news/world-africa-50506743 |archive-date=2020-02-11}} Most deaths were among children under five years of age.{{cite news |url=https://www.theguardian.com/global-development/2019/nov/22/children-bear-the-brunt-as-the-worlds-biggest-measles-epidemic-sweeps-congo |title=Children bear the brunt as the world's biggest measles epidemic sweeps Congo |last=Ratcliffe |first=Rebecca |date=2019-11-22 |work=The Guardian |access-date=2019-11-23 |issn=0261-3077 |archive-url=https://web.archive.org/web/20200507233821/https://www.theguardian.com/global-development/2019/nov/22/children-bear-the-brunt-as-the-worlds-biggest-measles-epidemic-sweeps-congo | archive-date=2020-05-07 }} The World Health Organization (WHO) has reported this as the world's largest and fastest-moving epidemic.{{cite web |url=https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/ |title=Measles and Rubella Surveillance Data |website=[[World Health Organization]] (WHO) |access-date=2019-11-23 |archive-url=https://web.archive.org/web/20200503130400/https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/ |archive-date=3 May 2020}} [236] => [237] => ==History== [238] => [[File:Measles Aztec drawing.jpg|left|thumb|16th-century [[Aztec]] drawing of someone with measles]] [239] => Measles is of [[zoonotic]] origin, having evolved from [[rinderpest]], which infects cattle. A precursor of the measles began causing infections in humans as early as the 4th century BC{{cite journal|last1=Düx|first1=Ariane|last2=Lequime|first2=Sebastian|last3=Patrono|first3=Livia Victoria|last4=Vrancken|first4=Bram|last5=Boral|first5=Sengül|last6=Gogarten|first6=Jan F.|last7=Hilbig|first7=Antonia|last8=Horst|first8=David|last9=Merkel|first9=Kevin|last10=Prepoint|first10=Baptiste|last11=Santibanez|first11=Sabine|date=30 December 2019|title=The history of measles: from a 1912 genome to an antique origin|journal=bioRxiv|pages=2019.12.29.889667|doi=10.1101/2019.12.29.889667|doi-access=free|last15=Widulin|first20=Philippe|last12=Schlotterbeck|first12=Jasmin|first13=Marc A.|last14=Ulrich|first14=Markus|first21=Sébastien|last21=Calvignac-Spencer|last20=Lemey|first15=Navena|first19=Thomas|last19=Schnalke|first18=Kyle|last18=Harper|first17=Fabian H.|last17=Leendertz|first16=Annette|last16=Mankertz|last13=Suchard}}{{cite journal|last=Kupferschmidt|first=Kai|date=30 December 2019|title=Measles may have emerged when large cities rose, 1500 years earlier than thought|journal=Science|doi=10.1126/science.aba7352|s2cid=214470603}} or as late as after 500 AD. The [[Antonine Plague]] of 165–180 AD has been speculated to have been measles, but the actual cause of this plague is unknown and smallpox is a more likely cause.H. Haeser's conclusion, in ''Lehrbuch der Geschichte der Medicin und der epidemischen Krankenheiten'' III:24–33 (1882), followed by Zinsser in 1935. The first systematic description of measles, and its distinction from smallpox and [[chickenpox]], is credited to the [[Medicine in medieval Islam|Persian]] physician [[Rhazes|Muhammad ibn Zakariya al-Razi]] (860–932), who published ''The Book of Smallpox and Measles''.{{cite journal | vauthors = Cohen SG | title = Measles and immunomodulation | journal = The Journal of Allergy and Clinical Immunology | volume = 121 | issue = 2 | pages = 543–4 | date = February 2008 | pmid = 18269930 | doi = 10.1016/j.jaci.2007.12.1152 | url = https://zenodo.org/record/1259085 | access-date = 6 September 2019 | archive-date = 4 December 2020 | archive-url = https://web.archive.org/web/20201204201500/https://zenodo.org/record/1259085 | url-status = live | doi-access = free }} At the time of Razi's book, it is believed that outbreaks were still limited and that the virus was not fully adapted to humans. Sometime between 1100 and 1200 AD, the measles virus fully diverged from rinderpest, becoming a distinct virus that infects humans.{{cite journal | vauthors = Furuse Y, Suzuki A, Oshitani H | title = Origin of measles virus: divergence from rinderpest virus between the 11th and 12th centuries | journal = Virology Journal | volume = 7 | pages = 52 | date = March 2010 | pmid = 20202190 | pmc = 2838858 | doi = 10.1186/1743-422X-7-52 | doi-access = free }} This agrees with the observation that measles requires a susceptible population of over 500,000 to sustain an epidemic, a situation that occurred in historic times following the growth of medieval European cities. [240] => [241] => [[File:Hilleman-Walter-Reed.jpeg|thumb|upright=1|[[Maurice Hilleman]]'s measles vaccine is estimated to prevent one million deaths per year.{{cite news | last=Sullivan | first=Patricia | title=Maurice R. Hilleman Dies; Created Vaccines |newspaper=[[The Washington Post]] | date=13 April 2005 | url=https://www.washingtonpost.com/wp-dyn/articles/A48244-2005Apr12.html | access-date=7 January 2020 | archive-url=https://web.archive.org/web/20121020102622/http://www.washingtonpost.com/wp-dyn/articles/A48244-2005Apr12.html |archive-date=2012-10-20 |url-status=live }}]] [242] => Measles is an [[endemic disease]], meaning it has been continually present in a community and many people develop resistance. In populations not exposed to measles, exposure to the new disease can be devastating. In 1529, a measles outbreak in [[Cuba]] killed two-thirds of those indigenous people who had previously survived smallpox. Two years later, measles was responsible for the deaths of half the population of [[Honduras]], and it has ravaged [[Mexico]], [[Central America]], and the [[Inca]] civilization.{{Cite book | first = Joseph Patrick | last = Byrne | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = https://books.google.com/books?id=5Pvi-ksuKFIC&pg=PA413 | publisher = ABC-CLIO | year = 2008 | pages = 413 | isbn = 978-0-313-34102-1 | url-status=live | archive-url = https://web.archive.org/web/20131113180934/http://books.google.com/books?id=5Pvi-ksuKFIC&pg=PA413&dq | archive-date = 2013-11-13 }} [243] => [244] => [245] => Between roughly 1855 and 2005, measles is estimated to have killed about 200 million people worldwide.{{cite book |last=Greger |first=Michael |title=Bird Flu: A Virus of Our Own Hatching |date=November 2006 |publisher=Lantern Books |isbn=1-59056-098-1 |chapter=Most and probably all of the distinctive infectious diseases of civilization have been transferred to human populations from animal herds. |chapter-url=http://www.birdflubook.org/a.php?id=40 |archive-url=https://web.archive.org/web/20091003164005/http://www.birdflubook.com/a.php?id=40 |archive-date=2009-10-03 }} [246] => [247] => The [[1846 measles outbreak]] in the [[Faroe Islands]] was unusual for being well studied.{{Cite magazine|last=Harper|first=Kyle|date=11 March 2020|title=What Makes Viruses Like COVID-19 Such a Risk for Human Beings? The Answer Goes Back Thousands of Years|url=https://time.com/5800558/coronavirus-human-civilization/|access-date=2020-11-18|magazine=Time|archive-date=7 March 2023|archive-url=https://web.archive.org/web/20230307093708/https://time.com/5800558/coronavirus-human-civilization/|url-status=live}} Measles had not been seen on the islands for 60 years, so almost no residents had any acquired immunity. Three-quarters of the residents got sick, and more than 100 (1–2%) died from it before the epidemic burned itself out. [[Peter Ludvig Panum]] observed the outbreak and determined that measles was spread through direct contact of contagious people with people who had never had measles. [248] => [249] => Measles killed 20 percent of [[Hawaii]]'s population in the 1850s.[https://web.archive.org/web/20090101183418/http://www.digitalhistory.uh.edu/database/article_display.cfm?HHID=422 Migration and Disease]. ''Digital History.'' In 1875, measles killed over 40,000 [[Fiji]]ans, approximately one-third of the population.{{Cite web |title=Our History |url=http://www.fsm.ac.fj/index.php?option=com_content&view=article&id=114&Itemid=148 |url-status=dead |archive-url=https://web.archive.org/web/20150410002823/http://www.fsm.ac.fj/index.php?option=com_content&view=article&id=114&Itemid=148 |archive-date=April 10, 2015 |website=Fiji National University}} In the 19th century, the disease killed more than half of the [[Great Andamanese]] population.{{cite news |url=http://news.bbc.co.uk/2/hi/south_asia/4987406.stm |title=Measles hits rare Andaman tribe |first= Subir |last=Bhaumik |archive-url=https://web.archive.org/web/20110823054811/http://news.bbc.co.uk/2/hi/south_asia/4987406.stm |archive-date=2011-08-23 |url-status=live |publisher=[[BBC News Online]] |date=16 May 2006}}{{Better source needed|date=December 2020}} Seven to eight million children are thought to have died from measles each year before the vaccine was introduced.{{cite journal | vauthors = Ludlow M, McQuaid S, Milner D, de Swart RL, Duprex WP | title = Pathological consequences of systemic measles virus infection | journal = The Journal of Pathology | volume = 235 | issue = 2 | pages = 253–65 | date = January 2015 | pmid = 25294240 | doi = 10.1002/path.4457 | doi-access = free }} [250] => [251] => In 1914, a statistician for the [[Prudential Insurance Company]] estimated from a survey of 22 countries that 1% of all deaths in the temperate zone were caused by measles. He observed also that 1–6% of cases of measles ended fatally, the difference depending on age (0–3 being the worst), social conditions (e.g. overcrowded tenements) and pre-existing health conditions.{{cite journal |last=Crum |first=Frederick S |title=A Statistical Study of Measles |journal=American Journal of Public Health |date=April 1914 |volume=IV |issue=4 |pages=289–309 |doi=10.2105/AJPH.4.4.289-a |pmid=18009016 |pmc=1286334 |doi-access=free }} [252] => [253] => In 1954, the virus causing the disease was isolated from a 13-year-old boy from the United States, David Edmonston, and adapted and propagated on [[chicken|chick]] [[embryo]] [[tissue culture]].{{cite journal |title=Live attenuated measles vaccine. |journal=EPI Newsletter |date=February 1980 |volume=2 |issue=1 |pages=6 |pmid=12314356 }} The World Health Organization recognizes eight [[clade]]s, named A, B, C, D, E, F, G, and H. Twenty-three strains of the measles virus have been identified and designated within these clades.{{cite journal |vauthors=((World Health Organization)) |title=New genotype of measles virus and update on global distribution of measles genotypes |journal=Weekly Epidemiological Record |date=7 October 2005 |volume=80 |issue=40 |pages=347–51 |pmid=16240986 | hdl=10665/232911 | hdl-access=free }} While at [[Merck & Co.|Merck]], [[Maurice Hilleman]] developed the first successful vaccine.{{cite book |author=Offit PA |title=Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases |location=Washington, D.C. |publisher=Smithsonian |isbn=978-0-06-122796-7 |year=2007 }} Licensed [[vaccine]]s to prevent the disease became available in 1963."[https://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP)] {{webarchive|url=https://web.archive.org/web/20120515055632/http://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm |date=2012-05-15 }}". Centers for Disease Control and Prevention (CDC). An improved measles vaccine became available in 1968.{{cite web |url=http://www.immunize.org/catg.d/p4209.pdf |title=Measles: Questions and Answers |publisher=Immunization Action Coalition |archive-url=https://web.archive.org/web/20130124052237/http://www.immunize.org/catg.d/p4209.pdf |archive-date=2013-01-24 |url-status=unfit}} Measles as an endemic disease was [[List of diseases eliminated from the United States|eliminated from the United States]] in 2000, but continues to be reintroduced by international travelers.{{cite web |title=Measles Frequently Asked Questions about Measles in U.S |url=https://www.cdc.gov/measles/about/faqs.html |website=[[Centers for Disease Control and Prevention]] |date=28 August 2018 |access-date=16 December 2018 |archive-date=16 May 2019 |archive-url=https://web.archive.org/web/20190516231712/https://www.cdc.gov/measles/about/faqs.html |url-status=live }} In 2019 there were at least 1,241 cases of measles in the United States distributed across 31 states, with over three quarters in New York.{{cite news |title=In 2000, measles had been officially 'eliminated' in the U.S. Will that change? |url=https://www.washingtonpost.com/health/in-2000-measles-had-been-officially-eliminated-in-the-us-will-that-change/2019/09/27/56ac487a-deed-11e9-b199-f638bf2c340f_story.html |date=28 September 2019 |access-date=28 January 2020 |archive-date=5 November 2020 |archive-url=https://web.archive.org/web/20201105090547/https://www.washingtonpost.com/health/in-2000-measles-had-been-officially-eliminated-in-the-us-will-that-change/2019/09/27/56ac487a-deed-11e9-b199-f638bf2c340f_story.html |url-status=live }} [254] => [255] => ==Society and culture== [256] => German anti-vaccination campaigner and [[HIV/AIDS denialism|HIV/AIDS denialist]]{{cite web|url=http://www.virusmyth.com/aids/hiv/slartefact.htm|title=HIV; Reality or artefact?|last=Lanka|first=Stefan|publisher=Virusmyth.com|date=April 1995|access-date=2015-03-31|url-status=dead|archive-url=https://web.archive.org/web/20150326075413/http://www.virusmyth.com/aids/hiv/slartefact.htm|archive-date=26 March 2015|author-link=:de:Stefan Lanka}} Stefan Lanka posed a challenge on his website in 2011, offering a sum of €100,000 for anyone who could scientifically prove that measles is caused by a virus and determine the diameter of the virus.{{cite web|url=http://magonia.com/files/stefan-lanka-sarampion.pdf|title=Das Masern-Virus 100.000 € Belohnung! WANTeD Der Durchmesser|language=de|date=2011-11-24|access-date=2015-03-31|url-status=dead|archive-url=https://web.archive.org/web/20150402163126/http://magonia.com/files/stefan-lanka-sarampion.pdf|archive-date=2 April 2015}} He posited that the illness is [[psychosomatic illness|psychosomatic]] and that the measles virus does not exist. When provided with overwhelming scientific evidence from various medical studies by German physician [[David Bardens]], Lanka did not accept the findings, forcing Bardens to appeal in court. The initial legal case ended with the ruling that Lanka was to pay the prize.{{Cite news|url=https://www.bbc.com/news/world-europe-31864218|title=Germany court orders measles sceptic to pay 100,000 euros|publisher=[[BBC News Online]]|date=2015-03-12|access-date=2015-03-31|url-status=live|archive-url=https://web.archive.org/web/20150331020314/http://www.bbc.com/news/world-europe-31864218|archive-date=2015-03-31}} However, on appeal, Lanka was ultimately not required to pay the award because the submitted evidence did not meet his exact requirements.{{cite web|url=http://www.pepijnvanerp.nl/2017/01/disappointing-outcome-of-bardens-vs-lanka-measles-proven-to-exist-but-anti-vaxxer-lanka-keeps-his-money/|title=Disappointing outcome of Bardens vs. Lanka: measles proven to exist, but anti-vaxxer Lanka keeps his money|date=23 January 2017|archive-url=https://web.archive.org/web/20170701211525/http://www.pepijnvanerp.nl/2017/01/disappointing-outcome-of-bardens-vs-lanka-measles-proven-to-exist-but-anti-vaxxer-lanka-keeps-his-money/|archive-date=1 July 2017}} The case received wide international coverage that prompted many to comment on it, including [[neurologist]], well-known [[skeptic]] and [[science-based medicine]] advocate [[Steven Novella]], who called Lanka "a crank".{{cite web|url=http://theness.com/neurologicablog/index.php/yes-dr-lanka-measles-is-real/|title=Yes, Dr. Lanka, Measles is Real|last=Novella|first=Steven|publisher=NeuroLogica Blog|date=2015-03-13|access-date=2015-03-31|url-status=dead|archive-url=https://web.archive.org/web/20150331035815/http://theness.com/neurologicablog/index.php/yes-dr-lanka-measles-is-real/|archive-date=31 March 2015|author-link=Steven Novella}} [257] => [258] => As outbreaks easily occur in under-vaccinated populations, the disease is seen as a test of sufficient vaccination within a population.{{cite book |last=Abramson |first=Brian |title=Vaccine, vaccination, and immunization law |date=2018 |publisher=[[Bloomberg Law]] |isbn=978-1-68267-583-0 |pages=10–30}} Measles outbreaks have been on the rise in the United States, especially in communities with lower rates of vaccination. A different vaccine distribution within a single territory by age or social class may define different general perceptions of vaccination efficacy.{{Cite journal |last=Scirè |first=Giovanni |date=2021-01-01 |title=Modelling and assessing public health policies to counteract Italian measles outbreaks |url=https://www.inderscienceonline.com/doi/abs/10.1504/IJSPM.2021.118832 |journal=International Journal of Simulation and Process Modelling |volume=16 |issue=4 |pages=271–284 |doi=10.1504/IJSPM.2021.118832 |hdl=10447/513505 |issn=1740-2123 |hdl-access=free |access-date=6 May 2022 |archive-date=20 November 2022 |archive-url=https://web.archive.org/web/20221120173734/https://www.inderscienceonline.com/doi/abs/10.1504/IJSPM.2021.118832 |url-status=live }} It is often introduced to a region by travelers from other countries and it typically spreads to those who have not received the measles vaccination. [259] => [260] => ===Alternative names=== [261] => Other names include morbilli, rubeola, red measles, and English measles. [262] => [263] => ==Research== [264] => In May 2015, the journal [[Science (journal)|''Science'']] published a report in which researchers found that the measles infection can leave a population at increased risk for mortality from other diseases for two to three years. Results from additional studies that show the measles virus can kill cells that make antibodies were published in November 2019. [265] => [266] => A specific drug treatment for measles, [[ERDRP-0519]], has shown{{when|date=January 2020}} promising results in animal studies, but has not yet{{when|date=January 2020}} been tested in humans.{{cite journal | vauthors = White LK, Yoon JJ, Lee JK, Sun A, Du Y, Fu H, Snyder JP, Plemper RK | title = Nonnucleoside inhibitor of measles virus RNA-dependent RNA polymerase complex activity | journal = Antimicrobial Agents and Chemotherapy | volume = 51 | issue = 7 | pages = 2293–303 | date = July 2007 | pmid = 17470652 | pmc = 1913224 | doi = 10.1128/AAC.00289-07 }}{{cite journal | vauthors = Krumm SA, Yan D, Hovingh ES, Evers TJ, Enkirch T, Reddy GP, Sun A, Saindane MT, Arrendale RF, Painter G, Liotta DC, Natchus MG, von Messling V, Plemper RK | title = An orally available, small-molecule polymerase inhibitor shows efficacy against a lethal morbillivirus infection in a large animal model | journal = Science Translational Medicine | volume = 6 | issue = 232 | pages = 232ra52 | date = April 2014 | pmid = 24739760 | pmc = 4080709 | doi = 10.1126/scitranslmed.3008517 | url = https://www.newscientist.com/article/dn25432-will-an-antiviral-drug-put-paid-to-measles/ | access-date = 5 February 2017 | archive-date = 5 February 2017 | archive-url = https://web.archive.org/web/20170205101341/https://www.newscientist.com/article/dn25432-will-an-antiviral-drug-put-paid-to-measles/ | url-status = live }} [267] => [268] => == References == [269] => [270] => [271] => == External links == [272] => {{Wikiquote}} [273] => {{Commons category|Measles}} [274] => * [https://web.archive.org/web/20030803054546/http://www.who.int/vaccine_research/diseases/measles/en/ Initiative for Vaccine Research (IVR): Measles], [[World Health Organization]] (WHO) [275] => * [https://www.cdc.gov/measles/about/faqs.html Measles FAQ] U.S. [[Centers for Disease Control and Prevention]] (CDC) [276] => * [http://news.bbc.co.uk/1/hi/health/7385020.stm Case of an adult male with measles (facial photo)] [277] => * [http://www.skinsight.com/child/rubeolaMeasles.htm Pictures of measles] {{Webarchive|url=https://web.archive.org/web/20100726230724/http://www.skinsight.com/child/rubeolaMeasles.htm |date=26 July 2010 }} [278] => * [http://www.viprbrc.org/brc/home.do?decorator=paramyxo Virus Pathogen Database and Analysis Resource (ViPR): Paramyxoviridae] [279] => [280] => {{Medical condition classification and resources [281] => | ICD10 = {{ICD10|B|05||b|00}} [282] => | ICD9 = {{ICD9|055}} [283] => | DiseasesDB = 7890 [284] => | MedlinePlus = 001569 [285] => | eMedicineSubj = derm [286] => | eMedicineTopic = 259 [287] => | eMedicine_mult = {{eMedicine2|emerg|389}} {{eMedicine2|ped|1388}} [288] => | MeshID = D008457 [289] => }} [290] => {{Viral cutaneous conditions}} [291] => {{Diseases of Poverty}} [292] => {{Numbered Diseases of Childhood}} [293] => {{Eradication_of_infectious_disease}} [294] => {{Authority control}} [295] => {{Portal bar|Medicine|Viruses}} [296] => [297] => [[Category:Measles| ]] [298] => [[Category:Atypical pneumonias]] [299] => [[Category:Airborne diseases]] [300] => [[Category:Infectious diseases with eradication efforts]] [301] => [[Category:Pediatrics]] [302] => [[Category:Vaccine-preventable diseases]] [303] => [[Category:Virus-related cutaneous conditions]] [304] => [[Category:Wikipedia emergency medicine articles ready to translate]] [305] => [[Category:Wikipedia medicine articles ready to translate]] [306] => [[Category:Articles containing video clips]] [] => )
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Measles

Measles is a highly contagious viral infection caused by the measles virus. It primarily affects children but can also affect adults who are not immune.

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It primarily affects children but can also affect adults who are not immune. The virus is transmitted through respiratory droplets and spreads rapidly in areas with low vaccination rates or poor healthcare infrastructure. The symptoms of measles typically include high fever, cough, runny nose, conjunctivitis, and a characteristic rash that starts on the face and spreads to the rest of the body. In severe cases, complications can arise, such as pneumonia, encephalitis, or even death. Measles can be prevented through immunization, with two doses of the measles, mumps, and rubella (MMR) vaccine being highly effective in preventing infection. Historically, measles was a common childhood illness around the world. However, with the introduction of vaccines and global immunization programs, the incidence of measles has dramatically reduced in many countries. Nevertheless, measles remains a public health issue, particularly in areas with inadequate vaccination coverage or during outbreaks. The World Health Organization, along with other health organizations, have set goals to eliminate measles globally. Efforts to achieve elimination involve increasing vaccination rates, conducting surveillance for early detection, and implementing outbreak response measures. Despite these efforts, challenges such as vaccine hesitancy and vaccine supply chain issues continue to hinder progress. The history of measles dates back centuries, with recorded outbreaks and epidemics throughout human history. The development of a safe and effective vaccine in the 1960s revolutionized the control of the disease. Modern measles vaccination campaigns have had significant success in reducing morbidity and mortality worldwide. The Wikipedia page on measles provides comprehensive information about the disease, including its causes, symptoms, diagnosis, treatment, prevention, and global efforts for its control. It also covers topics such as the history of measles, notable outbreaks, the impact of vaccination, and ongoing research in the field. The page serves as a valuable resource for individuals seeking information on measles, healthcare professionals, policymakers, and researchers working towards the eradication of this infectious disease.

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