During the twelve months of 2023, there were 58 measles cases in the United States. That was a lot. During the first three months of 2024, there have already been 64 cases of measles recorded here. That’s dangerous. Here’s why you or your family may be at risk, and what you need to know to stay safe. 

What’s So Bad About Measles? 

Now that we have lived through the deadly COVID pandemic, it may be difficult to get excited about 64 cases of measles. After all, on a percentage basis measles seems far less deadly than COVID. That’s because in developed nations with high vaccination rates the measles death rate is .1-.3%. In areas that have not yet eradicated the measles through widespread vaccination, the childhood death rate from the measles is as high as 15%! Measles also causes serious complications other than death. The most common are blindness, pneumonia, and encephalitis, which is inflammation of the active tissues of the brain.  

Percentages aside, measles is far more contagious than the pandemic-launching COVID virus. One person with measles can infect 12-18 people, and 90% of the people close to someone infected can also become infected if they are not protected by vaccination. The virus can stay in the air up to two hours after an infected person has left an indoor space. That means that an unvaccinated person can get measles simply from being in a room where a person with measles passed through. Add to that, the fact that a person can spread the measles long before he or she develops any symptoms, and certainly before those symptoms can be recognized as the measles. 

What Are the Symptoms of the Measles? 

One of the insidious things about the measles is that long incubation period. The first symptoms occur one to two weeks after a person is exposed and infected. At that point, the measles looks a lot like a very bad cold or the flu, beginning with: 

• high fever (may spike to more than 104°), 

• cough, 

• runny nose 

• red, watery eyes 

Tiny white spots (called Koplik spots) may appear inside the mouth two to three days after symptoms begin. The famous measles rash doesn’t appear for three to five days after symptoms begin. It has a very specific evolution. 
 

1. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. 
2. Small, raised bumps may also appear on top of the flat red spots. 
3. The spots may then become joined together as they spread from the head to the rest of the body. 
4. When the rash appears, a person’s fever may spike to more than 104° Fahrenheit. This is also when complications may occur. 

So Why Are Measles Making a Comeback? 

To be clear, technically, the measles are not “back.”  The disease is still considered eradicated, but with the number of cases increasing, the odds are not in our favor.  

Here is a quick history:  

In the decade before 1963 when the vaccine program began, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also each year, among reported cases, an estimated 400 to 500 people died, 48,000 were hospitalized, and 1,000 suffered encephalitis (swelling of the brain) from measles.  

In 1963, the first measles vaccine was licensed in the US after scientists were able to isolate the measles virus in the blood of an afflicted 13-year-old boy. In 1968, an improved vaccine replaced the original. This vaccine, called the Edmonston-Enders strain (Edmonton was the 13-year-old boy and Enders was the scientist who isolated the virus) has been the only measles vaccine used in the United States since 1968.  

In 1978, CDC set a goal to eliminate measles from the United States by 1982. Although this goal was not met, thanks to widespread use of the vaccine, the rate of infection dropped by 80%. However, a 1989 measles outbreaks among vaccinated school-aged children prompted public health authorities to recommend a second dose of MMR vaccine for all children.  

The second dose did the trick, and measles was declared eliminated from the United States in 2000. A disease is considered eliminated if there has not been continuous disease transmission for greater than 12 months. 

Today the measles vaccine is usually combined with formulas for mumps and rubella (MMR), or mumps, rubella, and varicella, known to us as chicken pox (MMRV). The two doses are typically given to children between the ages of one and four.  

Four things have conspired to boost the measles infection rate. 

• An increasing number of refugees from under-vaccinated countries are coming to the US and bringing the disease with them. 

• There has been a spread of vaccine hesitancy thanks to a completely fraudulent study published in 1998 linking vaccines to autism. Even though the fraud was revealed, and a retraction made, the damage was done. 

• Vaccine hesitancy was exacerbated and became a political issue once the COVID vaccine became mandated across the country.  

• The rate of vaccination of children in the MMR age range dropped at least 5% during 2020 and 2021 because parents were keeping their children at home during height of the pandemic.  

Who is Most Vulnerable to the Increase in Measles Cases? 

The full answer to this question may not be what you would expect. Certainly, young children who have not yet been vaccinated are at highest risk for contracting the disease and at highest risk of a dangerous outcome.  

It turns out that some Baby Boomers and Gen-Xers may also be at higher risk of contracting the measles virus. Here’s why: The CDC estimates that prior to 1958-ish, most children were exposed to, and contracted, the highly contagious measles virus. This number declined when the vaccine began being used, before the national measles vaccine program was adopted in 1963. Some young children during that period were not exposed to the measles and missed getting the vaccine. So, there are some Medicare-aged people walking around without any measles immunity. 

Adults born between 1962 and 1989, most likely only received a single dose of the vaccine, giving them limited immunity to the measles. These two groups of adults are vulnerable to being infected here in the US and even more vulnerable if they travel to   under-vaccinated countries where the measles rates are high. Given the rising numbers of measles cases here and the contagious nature of the disease, this is not an insignificant threat. 

What Should You Do with All this Information? 

• Call your healthcare provider immediately if you think you or your child have been exposed to measles. 

• Check your children’s vaccination records to make sure they have received both doses of MMR or MMRV. 

• Check your immunity. A blood test at your doctor’s office can determine whether or not you have antibodies to the measles virus and are immune, based on vaccination or exposure. Results can take a few days, but you’ll know your status. 

• Get another MMR. If you are in the vulnerable age range and think you may have only received one dose of the vaccine, you could just ask your medical provider for another dose.