The Resurgence of Measles in the United States

The measles is a highly contagious viral disease caused by the measles virus, a member of the Paramyxoviridae family. It has been recognized for centuries, with descriptions dating as far back as the 9th century. The disease became more prevalent in the 19th and 20th centuries, contributing to significant morbidity and mortality worldwide. The development of the measles vaccine in the 1960s marked a pivotal point in controlling the infection. Thanks to widespread vaccination efforts, measles was declared eliminated in many countries, including the United States, in the early 2000s. However, due to vaccine hesitancy and reduced vaccination rates, outbreaks have resurfaced in recent years.

Nationwide, state-required vaccination coverage among children attending kindergarten declined from 95% (for the previous 10 years) to 93% over the 2020-2021 and 2021-2022 school years. The decline persisted even after the impacts of the COVID-19 pandemic. With MMR (measles-mumps-rubella) in particular, during the 2023-2024 school year, vaccination status had declined to 92.7%. This, combined with an increase in exemptions over the years, has increased the risk for vaccine-preventable disease outbreaks, such as the measles. Low herd immunity will increase both the likelihood and transmission rate of these types of viruses. 

US Cases in 2025 

The incubation period for measles averages about 10-14 days after exposure. It typically presents with the following clinical manifestations:

1.  Prodromal (early symptoms) Stage:
   • High fever (104°F or higher)
   • Cough
   • Runny nose (coryza)
   • Conjunctivitis (red, inflamed eyes)
   • Koplik spots (small white spots inside the mouth)

2. Rash Stage: 

   A characteristic red, blotchy rash appears 3-5 days after the onset of symptoms, typically starting at the hairline and spreading downward.  The rash usually lasts for several days and fades in the same order it appeared. 

3. Possible Complications:

   Measles can lead to serious complications, particularly in young children and adults. These may include:

   • Diarrhea: An acute complication that can lead to dehydration.
   • Otitis Media: Ear infections that may require treatment.
   • Pneumonia: A serious respiratory complication that is a leading cause of measles-related deaths.
   • Encephalitis: Inflammation of the brain occurs in about 1 in 1,000 cases, resulting in seizures or neurological deficits.
   • Subacute Sclerosing Panencephalitis (SSPE): A rare, progressive neurological disorder occurring 7-10 years after measles infection, leading to severe disability or death.

There is no specific antiviral treatment for measles. Management primarily focuses on:

• Supportive care: Including hydration, nutritional support, and medications to reduce fever and pain (e.g., acetaminophen).
• Vitamin A supplementation: The WHO recommends vitamin A for children infected with measles to reduce the risk of complications, particularly in malnourished individuals.

The Value of Vaccination

Vaccination is the most effective way to prevent measles. The measles, mumps, and rubella (MMR) vaccine is typically administered in two doses: the first between 12-15 months and the second between 4-6 years of age.

Key benefits of vaccination include:

• Herd Immunity: High vaccination coverage protects vulnerable populations who cannot be vaccinated (e.g., newborns, immunocompromised individuals) by reducing overall transmission.
• Elimination of the Disease: Widespread vaccination efforts can lead to elimination of measles in the population, reducing the incidence of outbreaks.
• Cost-Effectiveness: Vaccination is far less costly than managing outbreaks of measles, which can lead to significant healthcare expenditures and broader economic impacts.

In summary, measles is a preventable infectious disease with serious health implications. Robust vaccination programs are essential in curbing outbreaks and ensuring public health safety.

With the typical increase in travel over the spring and summer months, health officials expect that the outbreak may continue to grow, potentially transmitting to more states than we’ve seen thus far; however, it’s hard to tell how many cases that may end up being before the outbreak is controlled and ended.
The most important steps to take as individuals, families, and citizens, is to determine if you and your loved ones have been fully vaccinated (or are up-to-date with the series). Two doses of the MMR vaccine provides 97% immunity. If you are unsure and are unable to obtain your medical records, a simple blood test can be drawn to measure your antibodies and determine if you have immunity or not. 

Unsure of your status? Our team can contact your providers offices to confirm you vaccination status, or arrange for a blood test to confirm your antibody levels. If you are concerned about the safety or efficacy of the measles vaccine, our physicians are available to discuss the science, benefits, and risks of receiving or not receiving the vaccination.