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Before the vaccine was discovered, roughly 500 children died of measles and its complications each year in the United States alone. Getty Images

So far this year, parents in 11 states have been worried about outbreaks of a disease that is a very rare reality in the day-to-day of children in 21st-century America — the measles.

From January 1 to February 28, there were a reported 206 individual cases of measles in the United States, according to the Centers for Disease Control and Prevention (CDC). Small pockets of infection have been reported in states across the country, including California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New Jersey, New York, Oregon, Texas, and Washington.

For many, the measles sounds like a relic of the past, a disease that isn’t a presence in everyday life. However, while measles has been nearly wiped out in the United States since the advent of the measles vaccine in the 1960s, it has persisted — and continues to persist — globally.

It’s a serious disease that can carry lifelong effects on the health of those who are infected and even result in death in some cases.

“I have to tell you there is this sense today that the measles isn’t that serious. I’ve even heard people today say in my own neighborhood: ‘What’s the big deal, it’s an illness with a rash, why can’t someone just easily get over it?’ Well, that’s a profound misperception of measles. It’s a nasty illness,” Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University School of Medicine told Healthline.

In addition to misperceptions about the seriousness of the disease, a small, but vocal anti-vaccination movement has encouraged some skepticism of vaccines domestically. This has resulted in lower-than-average vaccination rates in some pockets of the country and some of these areas are ones that have been hit by recent measles outbreaks.

So, how did we get here? Why is a virus that was declared “eliminated” by the CDC in 2000 beginning to spread again and why is it being met with a cavalier attitude by a number of people?

Schaffner said that in order to address the current pockets of outbreak and change misconceptions about both the virus and the vaccine, it’s important to understand the history of where we were before vaccines were developed, how things improved, and what more needs to be done to protect against measles.

He also stressed the importance of combatting disinformation floating around online and from anti-vaccination talking heads to keep the virus from spreading further in the future.

The measles disease, also known as rubeola, is a highly contagious childhood infection that can be fatal. It can cause fever, runny nose, sore throat, dry cough, conjunctivitis — or inflamed eyes — Koplik’s spots, which are small white spots found inside the mouth, and the identifiable blotchy, red skin rash that most people associate with the infection, according to Mayo Clinic.

Schaffner added that in the past, measles could commonly lead to middle ear infection, and even more seriously, pneumonia as well as encephalitis, inflammation of the brain. He said one in a 1,000 children would get encephalitis from the measles prior to the development of the vaccine.

A sneaky condition, symptoms might not appear until about 10 to 14 days after a person is exposed. This incubation period can lead the virus to spread.

It’s contagious during this time, and a child could be exposing others over the course of these two weeks without a parent even being aware of this risk.

The rash starts at the face, spreading down to the torso and arms, stretching down from the thighs to feet. An infected child’s fever can creep as high to 104 to 105.8ºF (40ºC to 41ºC), Mayo Clinic reports.

The disease first appeared in the written record way back in the 9th century by a Persian doctor. Eventually, in 1757 Scottish physician Francis Home showed that it was caused by an infectious agent in patients’ blood. By 1912, the measles became prominent in the United States, according to the CDC.

Schaffner said the measles stood as a key, sobering reality of everyday American life in the first half of the 20th century.

“Before we had the vaccine, each year in the United States, about 400 to 500 children died of measles and its complications,” Schaffner added. “That’s a stunning fact. When I tell our medical students about that their jaws drop. Listen, people who think the measles was ‘meh, trivial’ are misinformed.”

Dr. Frank Esper, of the Center for Pediatric Infectious Diseases at Cleveland Clinic, said in the 1950s, getting the measles was so common in the United States that it was a “rite of passage” of sorts.

“You had complete communities that were susceptible to the measles with it spreading throughout everybody,” Esper told Healthline. “For context, think of how today, everyone gets the common cold, you know you are going to get sick and we shrug our shoulders about the common cold. However, the big difference is, with the common cold you don’t get all these complications.”

He added, “For children, who had more serious complications, once infection gets into your blood, once it goes up to your brain, and causes brain swelling, once you got encephalitis, that is when it was serious. That is one of the reasons why measles was one of the first viruses targeted for eradication.”

Esper said it is important to take note of how the 1950s and 60s were not “terribly long ago.”

“Plenty of people remember what it was like before the vaccine, and it’s important to remember that when the vaccine was introduced, pretty much everybody was on board,” he said.

Virologist John F. Enders, PhD, and pediatrician Dr. Thomas C. Peebles took blood samples from infected children in Boston in 1954. They isolated the virus from these blood samples to develop a vaccine, successfully isolating the measles virus in a 13-year-old named David Edmonston.

Flash forward to 1963, and Enders and his team transferred this strain to a vaccine, licensing it throughout the country, the CDC reports.

Schaffner stressed just what a “social disruption” the measles can be.

“It would force parents, or grandparents, or other caretakers, to stay home and be with their children who were sick. It took parents from work — it had economic and profound social consequences,” he said. “It impacted the education system. You would have half a classroom out at one point and then the second half would get sick, teachers would complain about how they had to get everyone caught up.”

He added, “You’d hear a lot of unhappiness from schools, who very quickly liked and adopted and implemented school immunization laws that made life much easier for teachers to educate.”

Dr. Dana Hawkinson, an infectious disease specialist at the University of Kansas Health System and who is affiliated with University of Kansas Hospital, told Healthline that the measles vaccine has gone through “a number of iterations” since it was first introduced.

The CDC reports that in 1968, the Edmonston-Enders vaccine, an improved vaccine, was released and is the only version used since then.

Today, when children get vaccinated, the vaccine is often combined with mumps and rubella, or mumps, rubella, and varicella.

“The original thought was to have measles eradicated from the United States around early ’80s. By 2000, finally, we were able to say ‘we have eradication of measles in United States,” Hawkinson said of 20th-century efforts to eliminate the disease completely on domestic soil. “However, that does not include cases of measles originating from other countries.”

The World Health Organization (WHO) reports that in 2017, there were 110,000 measles deaths globally. Most of these were reported among children under five years old.

The vaccine has been a crucial tool to fight the disease around the world, accounting for a huge 80 percent drop in measles deaths between 2000 and 2017.

One encouraging statistic is that in 2017 alone, around 85 percent of children around the globe received one dose of the vaccine by the time they turned a year old. (That’s up from 72 percent 17 years earlier.)

Hawkinson said it is important to note for parents in the United States who choose not to vaccinate their children that the risk is high that a child will contract the virus from a trip abroad or being exposed to someone who has been infected abroad.

While it might seem like a no-brainer to many people to vaccinate your child — especially in an age of abundant scientifically verifiable support behind the efficacy of vaccines — Hawkinson said that the medical community has to regularly push back on the small, but vocal minority that comes in the form of the “anti-vax” movement.

“The anti-vaccine movement has helped decrease the overall immunity of many people — whether they be children or adults — from vaccine-preventable diseases,” he said. “Within states there are certain pockets or areas that do not have the best information, some places where a population might be more susceptible to this kind of anti-vaccine messaging.”

Why would anyone join the “anti-vax” movement?

Hawkinson cited the large global influence of now-discredited British doctor and anti-vaccination activist Andrew Wakefield who authored a fabricated study in 1998 that linked the measles, mumps, and rubella vaccine to autism.

In the ensuing decades the movement has seeped into pop culture and politics, with the likes of actress, model, TV host Jenny McCarthy using major television platforms to offer mainstream voices to question the efficacy and safety of common vaccines.

In the political arena, everyone from Robert F. Kennedy Jr. to current President Donald Trump, has offered critiques of vaccinations and their safety.

“Steadfastly and with a smile,” Schaffner said. “You do it firmly and persistently. In general this is a bit of an oversimplification, but, in general, there are two kinds of groups: the vaccine hesitant, which includes lots of moms and dads who might have found stuff on the internet or by talking with friends that make them concerned. This group can be brought along with the right information.”

He added, “Then, you have the much smaller group of die-hard ‘anti-vaxxers’ who are so firmly convinced of the misinformation, and you have no way to change their position.”

He urges parents to speak with their pediatrician or family doctor to address concerns and answer questions about vaccines.

“The concern obviously is particularly in those parts of the country where there are clusters and groups of parents withholding children from vaccines. If I’m a parent in that community, I would be very sure my child is appropriately vaccinated,” he stressed.

He also encouraged parents to be active in fighting misinformation in other ways in their communities.

“You could join your parent-teacher association, speak with the principal and teachers, send notes to state and local health departments, be aware of bills introduced in state legislature aimed at easing immunization requirements,” he said.

Esper said, while the latest headlines can be concerning, the outbreaks are only a small smattering across the country in very specific pockets. He said the CDC identifies a measles outbreak as only three or more cases in a community.

“The reality is, there is going to be more measles outbreaks rather than less. As more and more travel occurs, as the world gets smaller and smaller and travel gets faster and faster, measles will spread and people who resist vaccines for their children will be putting their children at risk,” Esper said. “The disease is still out there. The only one that isn’t is smallpox, and once we eradicate a disease, we stop vaccinating for it. It takes a whole world to come to terms with eradicating a disease.

He added, “We’re still trying to eradicate polio, when that happens, we will no longer vaccinate. It takes a lot of effort, but we have to keep working at it when it comes to something like measles.”

Schaffner stresses that it is a community responsibility that you and your child get all the recommended vaccinations you need in order to stay healthy and keep others safe.

“We are all participating in this, not just to protect our own children, but also to protect our neighbors who are more frail, for other people’s children,” Schaffner said. “I am unhesitant in saying we have that second responsibility just as strongly as we have the first. We are responsible for our own, but we also share the responsibility for those around us.”