Eradicating Measles in the 21st Century

In the late 1990s a coalition of leading health organizations declared that it was feasible, technically, to eradicate measles worldwide by 2010.

While there have been many successes against the deadly airborne virus, including widespread vaccination campaigns, a resurgence of the disease began around 2008. Since then there have been measles outbreaks in the United States, including the 2014 outbreak that started with an infected visitor to Disneyland.

“It’s a stealthy virus,” Diane Griffin, M.D., told a gathering at the Yale School of Public Health on Thursday as she delivered the Frank Black Memorial Lecture. Griffin is a professor at the Johns Hopkins Bloomberg School of Public Health.

While measles has traditionally been a childhood disease, unvaccinated adults are also vulnerable. Known for its distinctive rash, measles is highly contagious and attacks the lymphatic system and liver. Many deaths from the disease result from complicating infections such as diarrhea, otitis media and pneumonia acquired in the period of recovery while the immune system is suppressed. In 2014, there were approximately 115,000 measles-related deaths worldwide, according to the World Health Organization.

What went wrong with the push for eradication?

It’s a stealthy virus.

Dr. Diane Griffin

The obstacles to eradication differ in developing and developed countries, Griffin said. In the developing world, decreases in funding have undermined many countries’ strategy of mass immunization of all children under the age of 15. While such campaigns drove progress against the disease until 2008, the blanket approach is expensive to sustain with a syringe-administered vaccine that requires trained personnel.

In the developed world, meanwhile, the success of vaccination left a generation of parents unfamiliar with the disease and its dangers. In addition, many parents remain concerned about administering too many shots to their children and over perceived safety issues, she said.

A vaccine has been available since 1971 and it is 95 percent effective in small children. But over time those without immunity, as well as those who have not received the vaccine at all, creates a large number of people who are susceptible, said Griffin, who is also vice president, of the U.S. National Academy of Sciences

Griffin expressed optimism that new approaches—such as delivery of the vaccine through aerosols or dry powders that don’t require refrigeration or medical personnel— will overcome many of these obstacles in a way that is cost effective.

Only two viruses have ever been eradicated — small pox and rinderpest, a virus related to measles that affects livestock. The international community is close to eradicating polio, as well, she said.

Frank Black, Ph.D., was a member of the Yale School of Public Health faculty from 1955 until his retirement in 1996. He was only the third scientist to use the measles vaccine in humans. He pioneered the in-vitro cultivation of the virus and tested the efficacy of measles vaccines in susceptible populations in both the United States and abroad. Black was the founding head of the Division of Microbiology, now part of the Department of Epidemiology of Microbial Diseases. The school honors his contributions to public health annually with a memorial lecture.

This article was submitted by Denise L Meyer on February 26, 2016.