Measles historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Guillermo Rodriguez Nava, M.D. [2]; Yamuna Kondapally, M.B.B.S[3]

## Overview[edit | edit source]

The measles virus was isolated in cell culture in 1954, by Jhon F. Enders and Thomas C. Peebles. This was the first step that allowed the development of a successful vaccine, licensed 9 years later, in 1963. To date, 21 strains of the measles virus have been identified.[1]

## Discovery[edit | edit source]

Reports of measles go as far back to at least 600 B.C. however, the first scientific description of the disease and its distinction from smallpox is attributed to the Persian physician Ibn Razi (Rhazes) 860-932 who published a book entitled "Smallpox and Measles" (in Arabic: Kitab fi al-jadari wa-al-hasbah). One of the earliest written descriptions of measles as a disease was provided by an Arab physician in the 9th century who described differences between measles and smallpox in his medical notes. A Scottish physician, Francis Home, demonstrated in 1757 that measles was caused by an infectious agent present in the blood of patients. In 1954, the virus that causes measles was isolated from an 11-year old boy from the US, David Edmonston, and adapted and propagated on a chick embryo tissue culture in Boston, Massachusetts, by John F. Enders and Thomas C. Peebles. .

## Development of Treatment Strategies[edit | edit source]

* Before measles vaccine, nearly all children got measles by the time they were 15 years of age. Each year in the United States about 450-500 people died because of measles, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness. Today there are only about 60 cases a year reported in the United States, and most of these originate outside the country.
* The first measles vaccines were licensed in 1963. In that year, both an inactivated and a live attenuated vaccine (Edmonston B strain) were licensed for use in the United States.
* The inactivated vaccine was withdrawn in 1967 because it did not protect against measles virus infection. Furthermore, recipients of inactivated measles vaccine frequently developed a unique syndrome, atypical measles, if they were infected with wild-type measles virus.
* The original Edmonston B vaccine was withdrawn in 1975 because of a relatively high frequency of fever and rash in recipients.
* A live, further attenuated vaccine (Schwarz strain) was first introduced in 1965 but also is no longer used in the United States.
* Another live, further attenuated strain vaccine (Edmonston-Enders strain) was licensed in 1968. These further attenuated vaccines caused fewer reactions than the original Edmonston B vaccine.
* The only measles virus vaccine now available in the United States is a live, more attenuated Edmonston-Enders strain (formerly called “Moraten”). The vaccine is available combined with mumps and rubella vaccines as MMR, or combined with mumps, rubella, and varicella vaccine as MMRV (ProQuad). Single-antigen measles vaccine is not currently available in the United States.
* Measles vaccine is prepared in chick embryo fibroblast tissue culture. MMR and MMRV are supplied as a lyophylized (freeze-dried) powder and are reconstituted with sterile, preservative-free water. The vaccines contain a small amount of human albumin, neomycin, sorbitol, and gelatin.[2]

## Impact on Cultural History[edit | edit source]

* In the decade before the live measles vaccine was licensed in 1963, an average of 549,000 measles cases and 495 measles deaths were reported annually in the United States.
* It is likely that, on average, 3 to 4 million people were infected with measles annually; most cases were not reported. Of the reported cases, approximately 48,000 people were hospitalized from measles and 1,000 people developed chronic disability from acute encephalitis caused by measles annually.
* In 2000, measles was declared eliminated from the United States. Elimination is defined as the absence of endemic measles virus transmission in a defined geographic area, such as a region or country, for 12 months or longer in the presence of a well-performing surveillance system.
* However measles cases and outbreaks still occur every year in the United States because measles is still commonly transmitted in many parts of the world, including countries in Europe, Asia, the Pacific, and Africa. An estimated 20 million people become infected with measles worldwide each year, of whom 164,000 die.
* Between 2000- 2013, a range of 37 to 220 cases were reported annually in the United States. The majority of cases have been among people who are not vaccinated against measles.
* Measles cases in the United States occur as a result of importations by people who were infected while in other countries and from transmission that may occur from those importations.
* Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated.
* Outbreaks in countries to which Americans often travel can directly contribute to an increase in measles cases in the United States. In the recent years, measles importations have come from frequently visited countries, including, but not limited to, England, France, Germany, India, and the Philippines, where large outbreaks were reported.[3]

* Region of the Americas is declared free of measles
* On September 27,2016 , PAHO (Pan American Health Organisation)/WHO declared regions of Americas free of measles.

## References[edit | edit source]

1. ↑ Rima BK, Earle JA, Yeo RP, Herlihy L, Baczko K, ter Muelen V, Carabana J, Caballero M, Celma ML, Fernandez-Munoz R 1995 Temporal and geographical distribution of measles virus genotypes. J Gen Virol 76:11731180.
2. ↑ "Measles: Epidemiology and Prevention of Vaccine-Preventable Disease".
3. ↑ "Measles: For Healthcare Professionals".

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