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Anti-vaxxers threaten adults too
Measles outbreaks continue, adding to the historically high 880 cases confirmed as of May 17. But measles may have had their proverbial "15 minutes of fame." Understandable, perhaps, given the news firehose we are drinking from these days. But lamentable, especially since the anti-vaxxers continue to push their dangerous nonsense, with the help of Robert F. Kennedy, Jr., no less. Make no mistake: Measles is a dangerous, even deadly, disease, for both children and adults.
"Adult measles survivor" might sound a bit dramatic. But at moments I sincerely doubted I would make it through my bout with the measles in 1984. I was a Foreign Service officer on temporary duty in Damascus, a fascinating place, but certainly taxing to one's immune system. My fever spiked dangerously high for days on end, and I was severely debilitated. Getting out of bed was a struggle. Our kitten seemed to realize something bad was going on. She barely left my side.
And it was not clear what was wrong with me. No one was thinking of measles in an adult, at least until my spots showed up, days after other severe symptoms already had. The Embassy was on the verge of ordering a medical evacuation to the U.S. Army hospital in Wiesbaden, but some things started to improve. Still, recovery was long. I had lost a lot of weight. My eyesight, never that great, was significantly impaired for a time. The measles lesions got into my lungs and seemingly reactivated a long-dormant asthma problem that requires medication to this day. But it could have been much worse.
A recent story about an adult measles victim characterized him as "something of a unicorn," but, of the 704 measles cases reported by the CDC between January 1 and April 26, almost a quarter involved people aged 20 or older.
In the Federated States of Micronesia, where measles vaccination programs follow U.S. standards, a 2014 outbreak included 393 confirmed cases, almost two-thirds of them in people older than 19. During a serious early 1991 measles outbreak centered in New York City, Philadelphia, and parts of New Jersey, health officials issued strong warnings about risks to adults as well as children. Indeed, during the 1987-1992 period, which included an outright national epidemic beginning in 1989, one third of the 165 measles deaths reported by the National Center for Health Statistics involved people aged 20 or older. (Pneumonia and encephalitis claimed most of the victims.)
I actually had been vaccinated against measles. The current rate of successful vaccination among young children, involving two doses of vaccine - the first between 12 and 15 months and the second between the ages of four and six - is very high, but the situation for adults is more complex. For those born before 1957, the common wisdom is that we carry immunity because "everybody" got the measles in those days. But I didn't, and clearly did not pick up immunity via exposure to the virus in the general population. The first vaccine came out in 1963, and the current vaccine, the Edmonston-Enders, the only one used in the United States, dates to 1968. But the two-dose system for children only started in 1989. Measles cases among once-vaccinated schoolchildren spiked in that year, leading medical authorities to mandate a second dose of vaccine.
Vaccination still doesn't always work. In the Federated States of Micronesia outbreak, for example, almost half of the adult victims had received two or more doses of measles vaccine, but the problem may have been inadequate cold storage. "Primary vaccine failure," i.e. the failure to develop any immunity in response to the vaccine, can also be due to genetics, malnutrition, or other factors. "Secondary vaccine failure," in which people lose an initially acquired immunity, is much less common, but can occur. Those vaccinated outside the U.S. should be cautious. The Schwarz-strain vaccine, for example, seems to have been markedly less effective than the vaccine strain used here.
So-called "herd immunity," the presence of large numbers of immunized individuals in a given population, is crucial for protection of victims of vaccine failure and those who cannot be immunized for health reasons.
My take-away is that adults who have not actually had the measles or had two doses of measles vaccine in accordance with the 1989 guidance could be especially at risk, now that herd immunity is diminishing. It's well worth doing some research in your medical records or simply talking to family members, to try to assess your risk. Adults who are likely to be exposed to measles might consider the readily available blood test for measles/mumps/rubella immunity, or simply get vaccinated or revaccinated.
Adult measles is no joke. It is just plain awful and can put your long-term health and even your life at risk. If you come down with measles, you will be of no use to your loved ones for a protracted period. Indeed, you will be the one needing care, and hoping beyond hope that you haven't passed the disease to those around you.
Ensuring that enough people are immunized will indeed involve a difficult political fight. But we also have an individual responsibility for our own protection, and the protection of family, colleagues, and the broader community.
Eric R. Terzuolo was a foreign service officer from 1982 to 2003, and since 2010 has been on contract to the Foreign Service Institute, the professional development unit of the Department of State, with responsibility for West European area studies. He is currently teaching at American University's School of International Service. The views expressed here are entirely his own.