MEASLES

The latest resurgence of Measles in Texas has brought this dangerous disease back to the forefront of our attention. In 2000, the CDC declared Measles “eliminated” from the United States. While the disease was not eradicated worldwide, the high compliance rate nationally with the MMR (Measles-Mumps-Rubella) vaccine had provided a protective shield to our country’s population. But with more parents refusing or delaying vaccines, we have (as of the end of February 2025) over 160 confirmed cases of Measles across nine states: Alaska, California, Georgia, Kentucky, New Jersey, New Mexico, New York, Rhode Island, and Texas (where one child recently died of Measles infection).

Measles is caused by the Rubeola virus, first described in the 1700s. In 1912, the US began to mandate reporting of Measles cases, and in the first decade of recording, an average of 6,000 Measles-related deaths per year were documented. In the 1950s, Measles was so prevalent that it was assumed nearly all children had contracted it by age fifteen. Across all ages, up to four million Measles infections per year were reported. Of those, about 500 cases were fatal, nearly 50,000 required the support of an acute hospital setting, and 1,000 deteriorated into encephalitis (swelling of the brain). Development of a Measles vaccine began in 1954 with a disease outbreak in Boston, and by 1963 the US began distributing the first Measles vaccine. This was replaced with 1968 with the vaccine we still use today, where Measles immunity is combined with that of Mumps and Rubella.

Measles symptoms include a telltale rash, high fever, nasal congestion, cough, appetite loss, and red watery eyes. The timeline of this infection is often predictable, starting with 5-6 days of rash that proceeds from the hairline down the body. Secondary symptoms of Measles include diarrhea and ear infections. Complications from a Measles infection are not uncommon and can be severe. For instance, one in 20 cases will result in pneumonia, the most common cause of death from Measles in young children. One in 1,000 cases will progress to encephalitis, which can lead to seizures, and lasting deafness and intellectual deficits. Rarely, if Measles was contracted in a patient under 2 years of age, a delayed consequence called Subacute Sclerosing Panencephalitis (SSPE) can develop up to a decade later, and manifests as a progressive degenerative neurologic disease that results in death. Complications from Measles infections are more common in children under 5 years of age, adults over 20 years of age, pregnant women, and those with compromised immune systems.

Measles is an extremely contagious germ. It is spread through respiratory droplets (coughing, sneezing, talking), and the virus can live in the air for up to two hours. Patients with Measles can be contagious up to four days prior to the development of rash (the first symptom), so they may not realize yet that they are ill. Measles is so transmissible that anyone exposed to an infected individual has a 90% chance of contracting Measles.

These data change with vaccination– The MMR vaccine is powerfully protective. Statistics demonstrate the two-shot series is 97% effective in preventing a serious Measles infection. Experts recommend getting both doses prior to Kindergarten, but the vaccine is often dosed at 12 and 18 months of age, to effectively protect this young, vulnerable population.

But how do we protect those who can’t get the MMR vaccine? Herd immunity explains the concept of a critical majority of people getting vaccinated to protect those who cannot, or whose immune systems will not respond. Because Measles is wildly contagious, the threshold for protective herd immunity for this germ is 95%. That means 95% of the population needs to be vaccinated against Measles in order to defend those without the benefit of immunization. This includes children under 12 months of age, for whom this vaccine cannot yet be administered and for whom the risks of serious consequences of a Measles infection are staggering. The underlying messaging has to be: If you can get vaccinated with MMR, you must— for your own safety and that of the most vulnerable in your community.

Measles infections are on the rise in the US. Ohio reported zero Measles cases from 2019 to 2021, but an outbreak in 2022 brought 90 cases to our state. In 2022, Ohio’s compliance rate with Measles vaccination was only 88%. That’s good, but not good enough to protect the most susceptible and defenseless in our herd. It’s vitally important to immunize every child against Measles, a hugely contagious but preventable contributor to serious lower respiratory disease, permanent neurologic damage, and death in children.