Measles was declared eliminated in 2000 in the United States, but for some strange reason there have been five recent outbreaks, for a total of more than 120 cases.

There was also an occurrence in 2014 in nine counties in Ohio, where 383 cases of measles were reported. These cases originated from two unvaccinated Amish men in whom measles was incubating at the time of their return to the United States from the Philippines. In that same country early this year, measles has caused the death of 70 children.

According to the Centers for Disease Control and Prevention, measles is still common in many parts of the world, including some countries in Europe, Asia, the Pacific and Africa. Worldwide an estimated 20 million people get measles and 146,000 people, mostly children, die from the disease each year. A recent measles epidemic in Madagascar caused more than 900 deaths. One reason has been the unwillingness of parents to vaccinate their children on time. Those most at risk are infants from 9 to 11 months old.

Measles is an infection of the respiratory and immune systems and the skin caused by the measles virus. Measles is exceptionally contagious, with a substantial degree of morbidity and mortality. It can be transmitted by droplets from the infected person's nose or mouth. If you are in a room with someone infected with measles, you can inhale their virus when they cough, sneeze or even talk.

Infected people can transmit measles virus starting four days before they develop a rash, and thus they may be contagious before they realize they have the disease and remain able to spread the virus for about four days after the rash appears. Ninety percent of people not immune against the virus but sharing living space with an infected person will catch it.

Measles causes serious respiratory symptoms (asthma, breathing problems), fever and rash. In some cases, especially in babies and young children, the consequences can be severe. About 1 in 4 people in the U.S. who get measles will be hospitalized. One of every 1,000 people with measles will develop brain swelling, which could lead to brain damage. One in 20 children with measles develops pneumonia. Pregnant women with measles are at greater risk of having premature or low-birth rate babies. One or two out of 1000 people with measles will die, even with the best of care.

The symptoms usually develop 7-14 days after exposure to the virus. The initial symptoms usually include high fever (often greater than 104 F), Koplik spots (spots in the mouth that usually appear 2-3 days prior to the rash and last 3-5 days), weakness, loss of appetite, red eyes, runny nose and sometimes cough. The telltale red dots appear on the skin, beginning on the face, then spreading down the body. Complications are usually more severe in adults who catch the virus, in malnourished and immune-compromised individuals.

Measles remains a rare event in pregnancy in developing countries since most women of childbearing age acquired measles at a young age. However, in industrialized countries the age distribution of measles is changed by immunization, resulting in measles infection in young adults.

Measles was described by Muhannad ibn Zakariya ar-Razi (860-932), a Persian philosopher and physician in the 10th century A.D. as a disease more dreaded than smallpox. A Scottish physician, Francis Home, demonstrated in 1757 that measles was caused by an infectious agent present in the patient's blood. The virus that causes measles was isolated by Drs. John Enders and Thomas Peebles in Boston in 1954. Humans are the primary host, but non-human primates can also be a host, and measles is a threat to their conservation.

Even if your family does not travel internationally, you could come into contact with measles anywhere in your community. Every year measles is brought into the United States by unvaccinated travelers (Americans or foreign visitors) who get measles while they are in other countries.

The best protection against measles is measles-mumps-rubella (MMR) vaccine, it provides long-lasting protection against all strains of measles. Your child needs two doses of MMR vaccine for best protection: the first dose at 12 through 15 months of age and the second dose 4 through 6 years of age.

If your family is traveling overseas, the vaccine recommendations are somewhat different. If your baby is 6 through 11 months old, he or she should receive one dose of MMR vaccine before leaving. If your child is 12 months of age or older, he or she will need 2 doses of MMR vaccine (separated by at least 28 days) before departure.

Max Sherman is a medical writer and pharmacist retired from the medical device industry. He has taught courses on regulatory and compliance issues at Ivy Tech, Grace College and Butler University. Eclectic Science touches on famed doctors and scientists, human senses, aging, various diseases, and little-known facts about many species, including their contributions to scientific research. He can be reached by email at maxsherman339@