As measles outbreaks go, this one started out as small potatoes.  Investigators currently believe this one started with an infected visitor to California’s Disneyland over the December holidays. One infected person exposing (probably unknowingly) other vulnerable people in a crowded place, same people coming and going (mostly going, far away to other counties, states, and countries), and boom! — you have the LA Times reporting on one big whopper of a measles epidemic:

A measles outbreak centered in California has sickened 71 people in North America and is still spreading. It is the state’s worst measles outbreak in 15 years, officials say.


The measles virus sickened five Disneyland employees and hasn’t stopped there:

There have been 62 measles cases reported in California and nine outside the state: three in Utah, two in Washington state, one in Arizona, one in Colorado, one in Oregon and one in Mexico.


Very few young and middle-aged pediatricians have ever seen a case of measles.  This highly contagious viral infection begins about one or two weeks after exposure with a sudden onset of symptoms referred in historical textbooks as the “3 C’s” — cough, coryza (runny nose), and conjunctivitis.  These symptoms are accompanied by high fevers and short-lived, diagnosis-clinching “Koplik” spots on the inside of the mouth.  Then the rash occurs, typically covering the entire body, with its itchiness adding to the misery.  Most patients recover completely and uneventfully within 10 days or so.  Some people (mostly, but not all, the usual suspects: children, people with health problems, those living in poverty) develop severe, permanent or life-threatening complications such as pneumonia and encephalitis (brain inflammation).  The CDC recalls the history of measles before vaccines:

In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also each year an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles.


Rong-Gong Lin II fills us in on a particularly bad measles outbreak 25 years ago:

Measles ravaged California from 1989 to 1990, when more than 15,000 cases were reported, causing about 70 deaths in the state. That outbreak prompted health authorities to recommend a second dose to the measles vaccine schedule.

“For every 500 cases, there will be a death, and there will be two cases of encephalitis — inflammation of the brain — and many of those will end up with permanent brain damage,” said Dr. James Cherry, a UCLA pediatric infectious diseases expert.


The vast majority of infected persons in the current measles outbreak are either unvaccinated or undervaccinated (children who’ve started but haven’t yet completed full vaccination), a situation we discovered in October that’s not unique to Southern California:

The bad news, at least in states like Oregon, where 7.1% of parents opt out of vaccines, is that there are pockets of areas where the refusal rates are much, much higher than the national rate of 1.8%. Some areas in Southern California, says Gary Baum, have vaccination rates so abysmally low that, “according to World Health Organization data, such numbers are in line with immunization rates in developing countries like Chad and South Sudan” (my emphasis).


High school students whose parents have chosen for them not to be vaccinated against measles with MMR vaccine have been ordered to stay home and not come to school for the rest of the month.  Alicia Chang says they shouldn’t be going to Disneyland, either (my emphasis):

Disneyland Resorts spokeswoman Suzi Brown said officials agreed with the advice that “it’s absolutely safe to visit if you’re vaccinated.


Internist Dr. Peter Lipson understands why measles — once declared “eliminated” in the U.S. — is now making a comeback — and takes “dangerous” doctors like California pediatrician “Dr. Bob” [Sears] to task:

The Disneyland outbreak, which appears to have started in December, probably began with a case imported from abroad. Once it reached Disneyland, in the unvaccinated heart of Southern California, the result was inevitable. Nearly every susceptible person exposed to measles will get it. It is one of the most contagious diseases known. This, and its ability to sicken, disable, and kill children is what makes vaccination vital.

It shouldn’t take watching a child suffer and die to convince people to follow basic vaccination recommendations that have been found safe and effective, with decades of experience and science. I pity parents who make bad choices regarding vaccines. I fault the people who spread this deadly advice. And doctors who participate in this dangerous fantasy are, in my opinion, a threat to public health and should be stripped of the privilege of practicing medicine.