Measles makes unwelcome return

While the uproar continues over a potential swine flu pandemic, there is a quiet controversy brewing about the return of an old disease that had once been nearly eradicated in the United States.

Last month, Maryland health officials said at least four people had been diagnosed with measles in Montgomery County - including an 8-month-old infant who contracted the disease in a hospital waiting room. Virginia officials were also warning that an infected Prince William County man may have exposed hundreds of people to the disease as he visited grocery stores and restaurants from McLean to the District.

Last year, 131 cases of measles were reported nationally, the most since 1996, according to the U.S. Centers for Disease Control and Prevention. In the first seven years of the decade, 63 cases were reported.

The rise could be an indicator that measles is making a comeback in the United States, said Paul A. Offit, chief of infectious disease at the Children’s Hospital of Philadelphia.

“This could be the sign of something bigger,” Dr. Offit said. “Do I think this is a trend? Yes.”

Dr. Offit said the U.S. may be seeing the crest of the vocal anti-vaccine movement, which has gained momentum over the past decade. The movement has been spurred by a feared link between vaccines and autism and the crowded vaccination schedule for infants and toddlers.

The vast majority of American children get the series of vaccines recommended by the CDC and the American Academy of Pediatrics against infectious diseases such as measles, mumps, rubella, polio and meningitis. More than 77 percent of American children get the full slate of vaccines, and fewer than 1 percent of children are going completely unvaccinated.

The CDC said that as of 2006, the most recent year numbers are available, 93 percent of American children had received the measles vaccine. The vaccine, which is given along with the mumps and rubella vaccine, is administered in two doses, one at 12-to-18 months and the other between ages 4 and 6. One worry for public health officials is that infants who have not yet been vaccinated - as was the case with the baby in Maryland - could contract the disease if the number of cases continues to rise.

Infectious disease experts say a vaccination rate of 95 percent is necessary to keep highly contagious diseases such as measles from becomine re-established in the United States. Vaccine rates are much lower in many countries, even developed European countries. As a result, measles is an ongoing public health threat that kills more than 250,000 people annually.

In this era of quick, global travel, that means yesterday’s outbreak in Macedonia could be tomorrow’s illness in Maryland.

“It’s simply a plane ride away,” Mark H. Sawyer, a pediatric infectious disease specialist in San Diego, said at a congressional briefing on vaccinations last week. “Many people have the impression it is not a serious disease, but it kills three out of 1,000 people who develop it.”

In the decade before the U.S. measles vaccine program began in 1963, an estimated 3 million to 4 million people in this country were infected annually. Between 400 and 500 people died, 48,000 were hospitalized and another 1,000 developed a chronic disability from measles-related encephalitis, according to the CDC.

All 50 states have vaccination laws for school entry. However, 48 states allow exemptions for religious reasons and 20 for philosophical reasons.

“Personal beliefs are affecting people who do not share those beliefs,” Dr. Sawyer said.

Barbara Loe Fisher, co-founder of the National Vaccine Information Center, a Virginia-based nonprofit, said parents deserve the right to be fully informed of the potential risks of vaccines before consenting to the schedule prescribed by the CDC and AAP, which includes 36 shots by age 6, up from a recommended 10 in 1983.

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