A woman in Clallam County, Washington has died of measles. It is the first U.S. death since 2003 to be attributed to the highly infectious disease. State health officials say the woman’s case “illustrates the importance of immunizing as many people as possible to provide a high level of community protection against measles.”
The Washington State Department of Health provided details about the woman’s case in a press release issued this morning, the entirety of which is reprinted below. The woman, who suffered from a compromised immune system, was probably exposed to the virus at a local medical facility during a recent measles outbreak in Clallam County. She did not die knowing she had contracted measles. The infection was discovered after the fact, during autopsy.
The woman’s immunocompromised state could explain her belated diagnosis. It’s easy to overlook the first signs of measles, which include vague symptoms like fever, cough, a runny nose, and watery eyes. But it’s hard to miss measles’ tell-tale rash. A hallmark symptom of the disease, a measles rash typically breaks out three-to-five days after initial symptoms, and quickly envelopes the entire body in splotchy, reddish-brown hives. But according to Washington health officials, the Clallam County woman had neither a rash, nor “some of the [other] common symptoms of measles... so the infection wasn’t discovered until after her death.” Instances of rash-less measles infections are rare, but according to a review of measles’ clinical significance, published in The Journal of Infectious Diseases by researchers from the CDC and Johns Hopkins Bloomberg School of Public Health, they are known to occur in immunocompromised patients.
The Washington State Department of health says the cause of death was pneumonia due to measles. This, too, fits with what we know about the virus. Complications from measles can affect nearly every one of the body’s organ systems, but the respiratory tract is especially vulnerable. Pneumonia, an infection of the lungs, “is the most common severe complication of measles and accounts for most measles-associated deaths,” write the researchers in the review linked to above. In the subsection titled “Measles pneumonia in immunocompromised patients,” the authors add: “Among immunocompromised persons, diffuse progressive pneumonitis caused by the measles virus is the most common cause of death.”
Around the world, measles kills roughly 150,000 people annually, most of them young, unvaccinated children. In spite of this, the U.S. managed to avoid a measles death for a little over twelve years. But the streak has ended.
Measles may be the most infectious virus known to science, but it is largely preventable through highly effective vaccines. Vaccination campaigns that began in the sixties led to the elimination of measles from the U.S. in 2000—but vaccine refusal, spurred in large part by a small but vocal contingent of anti-vaccination advocates, has, in recent years, driven measles infections in the United States to record levels. Measles outbreaks like the one recently centered in Disneyland highlight how vaccine refusal has chipped away at herd immunity, leaving pockets of unvaccinated people susceptible to this preventable illness. So, too, does the case of this woman in Clallam County; the immunocompromised, like young children, are especially vulnerable to disease outbreaks. Both circumstances underline how someone’s “personal” decision to forego vaccination can have far-reaching and, yes, deadly consequences.
Below is the press release issued by the Washington State Department of Health this morning.
For immediate release: July 2, 2015 (15-119)
Contacts: Donn Moyer, Communications Office 360-236-4076
Tragic outcome for immunocompromised patient shows need for community protection
OLYMPIA ¾ The death of a Clallam County woman this spring was due to an undetected measles infection that was discovered at autopsy.
The woman was most likely exposed to measles at a local medical facility during a recent outbreak in Clallam County. She was there at the same time as a person who later developed a rash and was contagious for measles. The woman had several other health conditions and was on medications that contributed to a suppressed immune system. She didn’t have some of the common symptoms of measles such as a rash, so the infection wasn’t discovered until after her death. The cause of death was pneumonia due to measles.
This tragic situation illustrates the importance of immunizing as many people as possible to provide a high level of community protection against measles. People with compromised immune systems often cannot be vaccinated against measles. Even when vaccinated, they may not have a good immune response when exposed to disease; they may be especially vulnerable to disease outbreaks. Public health officials recommend that everyone who is eligible for the measles, mumps, and rubella (MMR) vaccine get vaccinated so they can help protect themselves, their families, and the vulnerable people in their community.
Measles is highly contagious even before the rash starts, and is easily spread when an infected person breathes, coughs, or sneezes. If you’re not protected, you can get measles just by walking into a room where someone with the disease has been in the past couple of hours.
Children should be vaccinated with two doses of MMR vaccine, with the first dose between 12 and 15 months and the second at four-to-six years. Adults born after 1956 should have at least one measles vaccination; some people need two. The state Department of Health immunization programhas online information about measles and measles vaccine.
The measles diagnosis for the Clallam County woman brings the state’s case count to 11, and is the sixth in Clallam County for the year. The last active case of measles in Washington this year was reported in late April. Within about three weeks of exposure to someone with measles, it’s possible to develop the disease. Since more than three weeks has already passed since the last active measles case, no one who had contact with one of the known cases is any longer at risk for developing measles from those exposures.
The last confirmed measles death in the United States was reported in 2003. More information about measles nationwide is available on the Centers for Disease Control and Prevention (CDC) website.