Measles Awareness

Understanding Measles

Measles is not just a childhood disease; it is a highly contagious viral infection that can result in serious health complications, such as pneumonia, encephalitis, and even death. Measles is caused by a virus that spreads through respiratory droplets when an infected person coughs, sneezes, or talks. This virus can remain active on surfaces for up to two hours, making it extremely contagious. Measles is contagious 4-5 days prior to symptoms developing as well as 4-5 days afterward. This means an infected person can spread measles without even knowing they have it. Measles typically infects 90% of the unvaccinated exposed to it.

https://www.cdc.gov/measles/media/pdfs/2024/08/Measles-Clinical-Diagnosis-FS-508_updated-7.24.24.pdf

Symptoms of measles include high fever (which may spike higher than 104 degrees F), cough, runny nose, red and watery eyes, and rash. The rash typically develops 3-5 days after symptoms start. It begins as large flat spots and small raised bumps, first appearing on the face and behind the ears. It then progresses to include the chest, back, arms, and legs. Koplik spots, which are tiny white spots inside the mouth, can appear 2 to 3 days after symptoms begin.

Complications of measles include hospitalization, pneumonia, hearing loss, brain swelling (encephalitis), and even death. Measles can also cause subacute sclerosing panencephalitis to develop 7-10 years after recovery, especially in children younger than 2 years old when they had measles. Early symptoms of this condition may include behavioral changes, forgetfulness, poor school performance, and myoclonic jerks. Later symptoms can include seizures, blindness, and coma.

Children under five years old, especially infants, are at the highest risk of complications, including death. Pregnant women are also at very high risk. If a pregnant woman contracts measles, she faces a high risk of dying, having her baby die, or giving birth to a child with defects. Immunocompromised individuals and the unvaccinated are also vulnerable to severe complications from measles.

The Vaccine: MMR

The Measles, Mumps, and Rubella (MMR) vaccine is the leading method for preventing measles, mumps, and rubella. It is administered in two doses: the first dose is typically given between 12 to 15 months of age, and the second between 4 to 6 years old. These two doses provide about 97% protection against measles, while one dose is about 93% effective.

This vaccination not only protects individuals but also contributes to herd immunity. Herd immunity occurs when a significant percentage of the population is immunized, making it harder for the virus to circulate. This protects even those who cannot be vaccinated, including the most vulnerable, such as children under one year old. According to the World Health Organization (WHO) and the CDC, a community needs about 95% vaccine coverage to prevent outbreaks. When vaccination rates dip below this threshold—as has happened in several countries recently, including the United States—measles regains a foothold.

When the MMR vaccine first became available, there were slightly above 500,000 confirmed cases of measles in the US yearly. Among those cases, approximately 400-500 died; 48,000 were hospitalized, and 1,000 developed encephalitis. After the introduction of the vaccine, rates of measles dropped dramatically. Between 1965 and 1968, the number of cases of measles dropped by more than 95%.

Importance of Vaccination

Vaccination should be seen as a shared responsibility. When a large portion of the community is vaccinated, the chances of outbreaks decrease significantly, protecting both individual and public health.

1. Protecting the Vulnerable

Certain individuals cannot receive vaccines for medical reasons, such as those with compromised immune systems or serious allergies. When the majority of the population is vaccinated, it acts as a barrier, protecting these at-risk individuals from measles outbreaks.

2. Reducing Healthcare Costs

Preventing measles through vaccination has significant financial benefits. Treating an individual for measles can cost thousands of dollars, including hospitalization and medical care. For instance, the average hospital cost per child admitted due to measles is around $10,000-20,000+ for moderate to severe cases and $50,000+ if intensive care is needed. This does not include the costs of parents missing work, school shutdowns, and the public health response necessary to curb an outbreak. A mild case of measles that doesn't require hospitalization can cost between $200-$1,000+. The total cost for the MMR vaccine series is around $200, but most patients can receive it for free with their insurance or through the Vaccine for Children Program.

3. Preventing Complications

Vaccination can drastically lower the chances of severe complications related to measles, such as pneumonia and encephalitis. According to the WHO, around one in five unvaccinated individuals diagnosed with measles will need hospitalization due to complications. Vaccination can cut down on these risks, resulting in healthier communities.

Global Impacts

While measles was eliminated in many countries, recent statistics indicate a troubling comeback in cases, especially in regions with lower vaccination rates.

The WHO reported a staggering 556% rise in measles cases across Europe in 2019 compared to the previous year. This sharp increase highlights the urgent need for robust vaccination programs worldwide. Countries must collaborate to ensure that vaccines are available, particularly in underserved areas where vaccine misinformation is rampant.

Current Impact in the United States

This year, there have already been over 1,000 confirmed cases of measles in the US. While the majority of the current cases are in Texas, there are outbreaks in Ohio, Indiana, Tennessee, Michigan, Pennsylvania, Montana, Kansas, Oklahoma, and New Mexico as well. Kentucky has had one confirmed case this year. A staggering 96% of these confirmed cases of measles are unvaccinated. 68% of the cases are individuals aged 19 or younger. Furthermore, 30% of these cases are under 5 years old, and 23% have required hospitalization. Tragically, there have already been 3 deaths.

Addressing Vaccine Hesitancy

In 2000, measles was considered eradicated from the US, meaning that there were no measles spreading in the US, and the only new cases were those contracted abroad. However, since 2008, there has been a dangerous trend emerging. Cases of measles in the US have started to rise again, primarily due to the decline in vaccination rates.

Vaccine hesitancy poses one of the biggest hurdles to achieving high vaccination rates. Misconceptions and misinformation can create doubt and fear among parents and communities.

One of the biggest misconceptions about the MMR vaccine is that it causes autism. This belief stems from a 1998 research article by Andrew Wakefield, which claimed that the MMR vaccine may predispose children to autism. However, this study was retracted due to multiple issues. For instance, Wakefield's study only looked at 12 subjects—a small observational study must have at least 100-200+ subjects to be valid. These subjects were also specifically chosen instead of randomly selected. His results were based on anecdotal reports from parents, not actual scientific data. When he first planned his research study, he aimed to investigate whether the MMR vaccine caused inflammatory bowel disease but instead suggested that it caused intestinal inflammation, which could lead to autism. The biggest problem with his research was that he failed to disclose that he was being paid by lawyers preparing a lawsuit against vaccine makers and that he conducted invasive procedures on children without proper ethical approval and consent.

Since Wakefield's study, multiple large-scale studies worldwide have shown no link between the MMR vaccine and autism. These studies include 1,000-10,000+ subjects per study, with some involving over a million children.

Another source of misinformation is anti-vaccine groups that correlate the number of autism diagnoses with the number of vaccines given. For instance, the cases of autism diagnosed in children aged 8 in 2000 were about 1 in every 150 children; whereas in 2022, that had risen to about 1 in every 31 children aged 8. However, while autism was first described in the early 1900s, it was not widely recognized until the 1950s-60s. At that time, the prevailing medical thinking among psychologists attributed autism to cold, unaffectionate mothers, known as the "refrigerator mother" theory. It wasn't until the 1980s that autism was added to the DSM (Diagnostic and Statistical Manual of Mental Disorders), and a set criteria for diagnosis was agreed upon. Since then, awareness of autism as an explanation for social communication deficits and restricted, repetitive behaviors has expanded, leading to more common diagnoses.

It is during this timeframe of autism awareness and diagnosis that the MMR vaccine became readily available. Thus, it is easy for someone to misuse the statistics of autism and MMR to try to correlate the two into a causal relationship. A similar example is the correlation between ice cream sales and drowning rates. Both ice cream sales and drowning rates increase during the summer, so someone could look at those statistics and conclude that eating ice cream causes drowning. However, we know that ice cream doesn't cause drownings; the increase in both is due to a confounding factor: the weather/season/temperature. In other words, during the summer, warmer weather leads people to eat more ice cream and swim more, increasing the risk of drowning.

Complications from the MMR Vaccine

Serious side effects from the MMR vaccine are extremely rare. Mild side effects like fever or a sore arm may occur, but these are temporary and far less serious than the diseases the vaccine prevents.

Final Thoughts

Facts about measles:

• 1 out of 5 people who get measles will be hospitalized.

• 1 out of every 20 children with measles will get pneumonia, the most common cause of death from measles in young children.

• 1 out of every 1,000 people with measles will develop brain swelling, which may lead to seizures, brain damage, and death.

• 1 to 3 out of every 1,000 people with measles will die.

• About 90% of people exposed to measles who are not vaccinated will develop the disease.

• The MMR vaccine is safe and does not cause autism.

• Children should receive two doses of the vaccine, with the first dose at 12-15 months and the second dose at 4-6 years old. Adults born after 1956 who haven't had measles or the vaccine should get at least one dose. If you are unsure, bloodwork can determine whether you have immunity. If traveling to areas where measles outbreaks are common, you may need to be vaccinated prior to traveling.

  
  

Vaccination serves as a critical tool in preventing measles outbreaks and ensuring public health. By recognizing the importance of the MMR vaccine, we can effectively protect ourselves, our families, and our communities through herd immunity. As we confront challenges from misinformation and vaccine hesitancy, staying informed and advocating for vaccination is crucial.

So, in other words, get your vaccine if you are unvaccinated and medically able to!

Map of measles cases in the US in 2025. https://www.cdc.gov/measles/data-research/index.html