Measles Cases in Several States: What’s Going On?

Several recent measles outbreaks have public health officials concerned — and are drawing attention to rising childhood vaccine exemptions and renewing calls for increased measles awareness.

Philadelphia’s health department confirmed nine cases of the illness as of Tuesday, which spread at local health facilities and a daycare. At least three of the infections were in unvaccinated children, according to ABC News.

As of January 12, two counties in Washington state noted “3 lab-confirmed and 3 [epidemiologically]-linked measles cases have been identified among unvaccinated adults.” Delaware identified 20-30 people who were exposed to measles at the Nemours Children’s Hospital a few days earlier.

Camden County, New Jersey confirmed a measles case on January 13, and around the same time, Virginia health officials flagged a case in someone who may have exposed people at Dulles International Airport and Ronald Reagan Washington National Airport.

In Missouri, too, the public health department posted an alert about a confirmed measles case.

Is It Normal to See This Many Measles Cases?

Katelyn Jetelina, MPH, PhD, epidemiologist and author of the “Your Local Epidemiologist” newsletter, calls the recent measles outbreaks a potential symptom of “collective amnesia” in a recent newsletter, writing, “As generations age, the memory of mid-20th-century diseases like measles fade. … Some don’t know why this disease is bad or if this vaccine is safe. This is understandable.”

Walter Orenstein, MD, DSc, from Emory University School of Medicine, echoed this sentiment in a call with MedPage Today. “Measles itself is not a trivial illness — in a sense, vaccines can be victims of their own success,” he said.

Though measles cases crop up every year, U.S. cases have ticked up in recent decades, according to CDC data cited by Jetelina. Worldwide cases have increased, too, according to provisional data from the World Health Organization. “Measles is coming back, and with that there’s more chance of importation into the United States,” Orenstein added.

Why Are We Seeing More Measles Cases?

Experts told MedPage Today that this year’s cases may partially stem from fallout from COVID-19. Routine vaccination went down during the worst of the pandemic, and international travel is up since then.

Vaccine hesitancy, another leftover from the pandemic era, is also playing a role, Jetelina and others noted. In the 2022-2023 school year, nonmedical vaccine exemptions for kindergarteners increased in 41 states, according to the CDC. Health misinformation persists, and experts cited concerns about eroding trust in established health systems.

“The ones that are getting measles are those that are simply not vaccinated, for whatever reason, whether it’s mistrust of the public healthcare system, [or] maybe they’re having eroding confidence in their healthcare providers,” Steven Schweon, RN, MPH, MSN, a member of the Emerging Infectious Diseases task force for the Association for Professionals in Infection Control and Epidemiology, told MedPage Today. “They may believe misinformation that’s out there, as opposed to credible information.”

What Are the Risks of Measles Infection?

Though most recover from measles, children are particularly susceptible to it. The disease can become serious, with complications including hearing loss, pneumonia, encephalitis, and even death.

Schweon said to look out for the “Three C’s” of measles: “Conjunctivitis, coryza — running eyes, runny nose — and a cough.”

“The very early symptoms of measles can mimic the flu,” Schweon added. “But after several days with measles, they develop that typical rash, which is key for the diagnosis of measles.”

Measles is also highly infectious. “Measles, in essence, is really the most contagious of the vaccine-preventable diseases,” Orenstein said, such that someone with measles could infect 12-18 other people in a totally susceptible population, on average.

Schweon agreed, saying that measles is “much more infectious to people than COVID or the flu, for instance,” and added, “There’s long-term nervous system consequences of getting measles disease, and death.”

Measles can actually alter immune memory, wiping out preexisting antibodies in the body and making it harder to fight future pathogens, experts told MedPage Today.

“It’s easier to prevent an infection than it is to treat one,” Schweon said.

What Can Healthcare Providers Do About Measles?

According to Schweon, healthcare providers should ask if patients have been vaccinated, and vaccinate without hesitation, if possible.

“Healthcare providers should be asking [patients] about their vaccine history, if they are up to speed with their vaccines,” Schweon said, “and if their patients aren’t sure, depending on the vaccine and why, it’s a great opportunity to vaccinate them right there in the office.”

Public health departments in a number of the states with confirmed cases are offering measles vaccines, including the Black Doctors COVID19 Consortium, which held a vaccination event with free measles vaccines and testing on Monday at the Dr. Ala Stanford Center for Health Equity in Philadelphia.

When it comes to vaccine hesitancy, Orenstein said the priority should be to build trust and overcome concerns about vaccination.

“It’s important to try and explain that getting the measles vaccine is your protection — and protects them from diseases — that will prevent hospitalizations, pneumonia, ear infections and even encephalitis or brain damage,” he said. “So we need to get that message across, and we need to find the right messengers.”

Schweon cited a measles outbreak in 1990-1991 — where 486 were infected and six children died — in a largely unvaccinated religious community. “I think about those pediatric deaths from 1991,” Schweon said. “And the children did not have a voice in that decision not to vaccinate them — that clearly was a parent’s preference.”

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