Measles deaths, United States, 1999-2013

Over the last several weeks I've read comments in op-ed pieces and on social media about the measles epidemic that began at Disneyland. There is one comment that I have read several times that troubles me:

"No one has died."

That may be true, but 20% of people with measles have been hospitalized with measles or complications of measles so far during this outbreak. During the first five months of 2011, 40% of people with measles were hospitalized. Measles is not a benign disease. Complications include pneumonia, encephalitis, otitis media (middle ear infection), seizures, and diarrhea.

Another claim that I have heard is that no one has died from measles in the U.S. in the last ten years. That is not true. The data aren't easy to find, but measles deaths are reported in the National Vital Statistics Reports and in the CDC's summaries of notifiable diseases. Another source of data on measles deaths is the CDC's Wide-ranging Online Data for Epidemiologic Research (WONDER). That's where I retrieved the following data.

There were a dozen measles deaths reported in the U.S. between 1999 and 2013. Five of those deaths were measles complicated with encephalitis, 3 were measles complicated with pneumonia, and 4 were reported as measles without complications. The last column is deaths from subacute sclerosing panencephalitis (SSPE).

Measles deaths, United States, 1999-2013

Year	Encephalitis	Pneumonia	Uncomplicated measles	Measles total	SSPE
1999		1	1	2	5
2000		1		1	5
2001	1			1	2
2002					5
2003			1	1
2004					1
2005	1			1	2
2006					3
2007					3
2008					3
2009	1	1		2	2
2010	2			2
2011					4
2012			2	2	1
2013					1
Total	5	3	4	12	37

Subacute sclerosing panencephalitis (SSPE) is a rare and almost always fatal complication of measles. It is caused by persistent measles virus infection in the brain. The virus fails to complete replication and release from infected neurons and glial cells. The onset of SSPE usually occurs around 7 years after the person had measles, but can occur as soon as 2 years later or as long as 15 years later. The symptoms begin with personality changes, behavioral changes, and poor scholastic performance. The symptoms can be subtle and only recognized when more severe symptoms begin. The disease progresses with muscle jerking and twitching (myoclonus), seizures, and other movement and muscular disorders; difficulty controlling movements, difficulty walking, uncontrollable movements, and spasticity. The final stage SSPE is characterized by weakness in all four limbs, inability to speak, blindness, uncontrolled sweating, and uncontrolled changes in blood pressure, heart rate, and temperature. Death usually occurs 1 to 3 years after the onset of symptoms. The risk of SSPE is highest in people who had measles as infants. Wild-type measles viruses cause SSPE. There is no evidence that measles vaccine virus causes SSPE.

A couple of deaths every year or so might not seem like a lot, but let's set the record straight: people in the U.S. are hospitalized with measles and people in the U.S. die from measles.

References

Beckham, J. D., Solbrig, M. V., & Tyler, K. L. (2012). Infections of the central nervous system: viral encephalitis and meningitis. In R. B. Daroff, G. M. Fenichel, J. Janjovic, & J. C. Mazziotta (Eds.). Bradley's neurology in clinical practice, 6th Ed. [Electronic version]. Philadelphia: Saunders.

Beckham, J. D. & Tyler, K. L. (2015). Encephalitis. In J. E. Bennett, R. Dolin, & M. J. Blaser (Eds.). Mandell, Douglass, and Bennett's principles and practice of infectious diseases, 8th Ed. [Electronic version]. Philadelphia: Saunders.

 

Berger, J. R. & Nath, A. (2012). Cytomegalovirus, Epstein-Barr virus, and slow virus infections of the central nervous system. In L. Goldman & A. L. Schafer (Eds.). Goldman's Cecil medicine, 24th Ed. [Electronic version]. Philadelphia: Saunders.

 

Buchanan, R. & Bonthius, D. J. (2012). Measles virus and associated central nervous system sequelae. Seminars in Pediatric Neurology, 19(3). doi:10.1016/j.spen.2012.02.003. http://www.sempedneurjnl.com/article/S1071-9091(12)00004-6/abstract.

 

Campbell, H., Andrews, N., Brown, K. E., & Miller, E. (2007). Review of the effect of measles vaccination on the epidemiology of SSPE. International Journal of Epidemiology, 36(6). doi:10.1093/ije/dym207. http://ije.oxfordjournals.org/content/36/6/1334.short.

 

Centers for Disease Control and Prevention. (2011). Measles – United States, January – May 20, 2011. Morbidity and Mortality Weekly Report, 60(20), 666-668. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6020a7.htm.

 

Centers for Disease Control and Prevention. (2015). Measles outbreak – California, December 2014-February 2015. Morbidity and Mortality Weekly Report, 64(6), 153-154. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm.

 

Centers for Disease Control and Prevention, National Center for Health Statistics. (2015). Multiple Cause of Death 1999-2013 on CDC WONDER Online Database. Accessed February 22, 2015 at http://wonder.cdc.gov/mcd-icd10.html.

 

Gershon, A. A. (2015). Measles virus (rubeola). In J. E. Bennett, R. Dolin, & M. J. Blaser (Eds.). Mandell, Douglass, and Bennett's principles and practice of infectious diseases, 8th Ed. [Electronic version]. Philadelphia: Saunders.