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To understand just how outrageous this is, consider some facts. First, measles is a terrible disease. This is universally understood in the medical community. The Centers for Disease Control and Prevention estimates that as many as 1 in 20 children with measles progresses to pneumonia. One in 10 children develop ear infections, which can result in permanent hearing loss. About 1 in 1,000 will have the infection spread to their brain, which can lead to swelling, seizures and irreversible neurological damage.
For every 1,000 kids who contract measles, up to three will die from it. There is also a rare but terrifying neurological disease that could occur years after someone recovers from measles in which individuals go through months of personality changes and depression, followed by blindness, dementia and uncontrollable jerking and writhing. This condition progressively damages the brain, eventually affecting the parts that control breathing and blood pressure and causing coma and death.
Second, measles is one of the most contagious diseases in the world — much more transmissible than covid-19. The measles virus is airborne and can live for up to two hours after an infected person leaves the area. If exposed, an unvaccinated person has a nearly 90 percent chance of contracting it.
The reason Americans have not feared this virus for decades is, of course, thanks to vaccination. Two doses of the measles, mumps and rubella (MMR) vaccine are 97 percent effective at preventing measles. One dose is about 93 percent effective, and if given during an outbreak to an exposed person who it not yet vaccinated, it can substantially reduce the chance of that individual contracting the virus and then passing it on to others.
The MMR vaccine is so effective and uptake of it so high that measles was considered eliminated in the United States in 2000. Because of how contagious the virus is, the CDC estimates that 95 percent of the population must have immunity to keep measles from spreading. That so many of today’s practicing physicians, including myself, have never diagnosed measles is one of the greatest public health victories.
But this doesn’t mean that the threat is gone. Every year, there are infections as a result of travelers carrying the virus. Some have led to notable outbreaks. In 2019, there were more than 900 infections in New York predominantly occurring within Orthodox Jewish communities. In 2022, an outbreak in Ohio resulted in 85 confirmed cases of locally-acquired measles. Most of those infected were unvaccinated toddlers, and nearly half were hospitalized.
These outbreaks were brought under control because health officials took necessary actions. In Ohio, health officials urged unvaccinated, exposed children to receive the MMR vaccine. Those who received the shot had a reduced quarantine, from 21 days to just three. Parents who still refused to get their kids vaccinated were asked to keep their exposed kids out of day care, school and other public settings for 21 days. The New York City health commissioner went further and issued an ordinance that anyone who lived, worked or went to school in areas most affected by the outbreak must get vaccinated or face a fine of $1,000.
These decisions were not made lightly. Officials knew they would face angry opposition from people who viewed these actions as government overreach and an affront to their personal freedoms. But they also knew that as disruptive it was to keep a small group of people out of school and work temporarily, it would have been far worse to have uncontrollable spread. As draconian as these steps might have seemed, they were only taken because it was necessary stop an extremely contagious and highly devastating disease from resurging.
This alternate reality seems to be the path that Florida has chosen. Instead of trying to increase uptake of the MMR vaccine, Ladapo’s letter is silent on encouraging the parents of the nearly three dozen unvaccinated students in the elementary school to get immunized. Instead of reinforcing the 21-day isolation for unvaccinated, exposed students, he is “deferring to parents or guardians to make decisions about school attendance.” Instead of using the public health tools that have been proven time and time again to stop outbreaks, he is resisting them.
Maybe we will get lucky. Maybe parents will do the right thing anyway and Florida’s outbreak will get under control. More likely than not, though, it will get a lot worse. What a devastating — and preventable — tragedy that would be.
