Teddy Rosenbluth at NYT:
A measles outbreak in Utah has sickened more than 670 people, including many children whose parents have chosen not to vaccinate them. But new data shows that people who can’t be vaccinated for various health reasons are also falling ill.
Since the outbreak began last summer, measles has infected 23 babies under age 1, the age when children typically receive the first dose of the measles, mumps and rubella shot. Twelve pregnant women have also been infected, including one who passed the virus on to her newborn, according to data from the state health department.
While the state keeps only limited data on the number of immunocompromised residents who have fallen ill, pediatric infectious disease doctors also say they have cared for several immunocompromised children hospitalized with measles infections.
These patients still represent a minority of the unvaccinated people who have been sickened. Still, these findings are concerning because many of the groups who can’t get the vaccine are also at high risk of developing severe complications from the virus. Pregnant women, for example, are 10 times more likely to die from measles than those who are not pregnant. The virus can also cause women to miscarry or go into labor prematurely.
Young children are more likely to suffer severe complications from the virus. And babies who contract measles before their first birthday are at much higher risk of developing a rare condition called subacute sclerosing panencephalitis that can occur years after an initial infection. Dr. Andrew Pavia, a pediatric infectious disease specialist in Utah, described the complication — which can cause seizures, motor issues and eventually death — as “one of the most horrible things I’ve witnessed.”
When measles outbreaks occur, persons with compromised immunity, such as malnourished children, immunocompromised persons (e.g., persons who have human immunodeficiency virus [HIV] or are receiving cancer treatment), and pregnant persons are particularly vulnerable. Persons with HIV who are not immune to measles are at increased risk for more severe measles infection with pneumonia or encephalitis.
In a series of 23 pediatric cancer patients in China who had measles infection, 5 underwent ventilation, 1 had liver failure, and 4 died. These outcomes occurred even though 20 of the 23 patients had been vaccinated (including the 4 who died) and 21 had been treated with intravenous immune globulin.19
Malnutrition and measles have a historical link, particularly in the context of humanitarian relief efforts. The bidirectional relationship between measles and malnutrition was described decades ago.20 Malnutrition is a primary contributor to death in 45% of fatal measles cases.21 Measles is worse in children who are already malnourished, and postmeasles effects can lead to malnutrition in children who were not malnourished before they were infected with measles.13 Measles can lead to or exacerbate vitamin A deficiency22 or a persistent nutritional deficit.23 Malnourished children have a poor response to measles vaccine and other vaccines.24,25
Although measles virus is not teratogenic, measles in pregnant persons can lead to fetal loss, intrauterine growth retardation, and premature delivery.26 The case fatality rate among pregnant persons with measles can range from 5% in areas where measles is endemic, such as in Asia and in sub-Saharan Africa, to 20 to 30% among fragile populations, such as refugee populations.27
