According to the best evidence we have, measles makes its appearance somewhere between the 11th and 12th Centuries when the measles virus diverged (separated) from the rinderpest virus (a sort of measles of cattle that has been eradicated through vaccination). This probably happened when cattle herders spent just a little too much time with their cattle somewhere in the Middle East.
Before we go any further, you need to understand that measles is highly infectious. It’s, like, really infectious. One person can infect up to 18 other people, and the virus floats in the air for up to two (maybe four) hours where an infectious person has been. What’s worse, a person is infectious 3 to 5 days before the onset of the typical measles rash, and 1 to 2 days before the onset of fever. This means that a perfectly healthy-looking person can go around spreading measles and not even know they’re sick.
Because of this, measles likely spread as people with the disease came into contact with population centers, and then as trade occurred between those population centers. Soon enough, measles was found worldwide, with some of the first accounts of it in the Americas in the 1600s. That said, the descriptions of some of the plagues brought to the Americas by Columbus and subsequent invasions do resemble measles. It’s hard to pinpoint when the exact introduction of measles to the Americas was since the invaders and explorers brought smallpox, syphilis and other plagues with them.
As worldwide travel became more accessible to more and more people, measles spread far and wide and established itself in communities where there was a cohort of children large enough born each year for it to continue to spread. It wasn’t just the children that suffered, however. Measles in adults has always had more serious consequences. During the Civil War, about 20,000 cases were reported in Union Soldiers, with about 500 deaths.
By the time the 1900s rolled around, this translated into hundred of thousands of cases worldwide, with thousands of deaths. It was only when better medical treatment became more available in the mid-1900s in the United States that deaths in American children began to decline. Measles cases, however, did not decline until the arrival of a vaccine in 1963. From then on, cases and deaths declined to very low levels in the United States and everywhere the vaccine was licensed and administered. However, outbreaks would still occur, concentrated mostly in the unimmunized.
In 1978, the Centers for Disease Control and Prevention (CDC) targeted measles for elimination. The initiative was soon followed by the Pan American Health Organization (PAHO). It wouldn’t be until the year 2000 that the goal was achieved of eliminating measles from the United States, and it would not be until 2015 that the entire continent was declared to have eliminated measles.
Elimination doesn’t mean eradication, though. As we know, there continue to be measles outbreaks in the United States and elsewhere, albeit for different reasons. In Venezuela and Brazil, for example, there have been measles outbreaks due to the collapse of the public health infrastructure in Venezuela. The political instability there then drove people to emigrate to Brazil, bringing measles with them.
In Madagascar, off the eastern coast of Africa, the low vaccine supply has triggered an outbreak that has seen tens of thousands sick and hundreds dead. In Europe, a measles outbreak that started in Ukraine has spread to the rest of the continent. And in the Philippines, bad reporting on some adverse events over a vaccine against dengue fever scared parents away from vaccinating altogether, triggering an outbreak that has killed dozens of children from measles.
In New York City in 2018, a measles outbreak happened among Orthodox Jewish community members whose religious practice is to not immunize. Across the country, in Washington State, an outbreak is still going on (in early 2019) in a community where anti-vaccine sentiment runs high and misinformation about the Measles Mumps and Rubella (MMR) vaccine is widespread… Misinformation that really got going in 1998.
Back in 1998, a researcher in the UK published a since-retracted paper whose conclusion read: “We did not prove an association between measles, mumps, and rubella vaccine and the syndrome described. Virological studies are underway that may help to resolve this issue.” Nevertheless, the principal investigator in the study held on to the idea that the MMR vaccine caused autism, saying, “Again, this was very contentious and you would not get consensus from all members of the group on this, but that is my feeling, that the, the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines.”
The study has since been denounced as a fraud, with the paper retracted and the principal investigator being struck off the medical register in the UK. In essence, he cannot practice medicine anymore. However, based on his “feeling” that the MMR vaccine caused autism, millions of parents around the world have declined the MMR vaccine — and other vaccines — out of a fear of their children becoming autistic. (This, as the evidence points more and more toward autism being a normal variation in the anatomy and physiology of human brains and human development and heavily influenced on genetics.)
As you can see, we are dealing with a virus that can be easily eradicated with a well-coordinated approach from health agencies around the world. This is because the vaccine confers long-term immunity, and having the disease or getting vaccinated both mean that you’re immune for a long time. If we were to vaccinate absolutely everyone for whom the vaccine is recommended (children age 1 and then before they start elementary education), and we did this the world over, measles would join smallpox and rinderpest as a virus that is wiped off the face of the planet. (Polio will likely be the next one, instead.)
Instead of that, we are faced with more and more epidemics around the world, many of them fueled by bad information or health inequalities, or a combination of both. A disease that we could eradicate is instead killing thousands, and the fight against it is taking more than just immunizing. It’s taking educating and fighting the spectre of misinformation that is being spread at the speed of light through social media and the internet.
Will we still be writing about measles in present-day terms one hundred years from now? The odds are we will… Measles outbreaks are turning out to be caused as much by the human condition as by the virus’ characteristics themselves.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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