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On March 26, 2024, the New York State Department of Health issued an emergency advisory following the confirmation of a measles case in Nassau County. The case involved a young, unvaccinated child who had not traveled internationally. Officials emphasized the need for immediate action from healthcare professionals due to the highly contagious nature of the virus.
In the first three months of 2024 there have been 97 cases of measles reported across 18 states, surpassing the total of 58 cases reported in the U.S. for all of 2023. Approximately 75% of these cases occurred in individuals who were not fully vaccinated.
Before the introduction of the measles vaccine in 1963 — a precursor to the measles-mumps-rubella (MMR) shot — the United States reported 4 million annual infections with 48,000 hospitalizations and 500 deaths. A robust nationwide vaccination program in the early 1990s resulted in a 97% immunization rate, which drastically reduced the number of infections. By 2000, the World Health Organization (WHO) declared measles eliminated in the U.S.
Credit: CDC.gov
However, outbreaks are on the rise again and the U.S. is at risk of losing its elimination status. The WHO attributes the rise in cases to an inadequate vaccination rate that, combined with introduction of the virus from unvaccinated travelers, allows the virus to spread easily across under-immunized communities.
Measles is one of the most contagious viruses in the world: six times more contagious than COVID-19. The virus has been wiped out in the U.S. for a generation, leaving many unaware of measles’ course and consequence, which can cause complications beyond a fever and a rash. One in 1,000 victims develop brain swelling (encephalitis) resulting in permanent impairment, including chronic seizures, deafness and intellectual disability. Retinal damage can lead to blindness. Half of adult measles victims develop secondary bacterial pneumonia. Three in 1,000 die.
Uncomplicated measles is a long-lasting, miserable disease. Symptoms will appear 10 days after exposure and include high fever (up to 105 degrees Fahrenheit), cough, runny nose, red and watery eyes, and the infamous rash: raised red spots that start on the face then spread to the torso and extremities. An infected individual is contagious for one week and sick for three.
People born before 1957 — 98% of whom had the measles — have lifelong immunity and don’t need the vaccine.
For the rest of the American population, vaccination rates are below the Center for Disease Control’s (CDC) goal of 95% for herd immunity, where a vast majority is resistant to disease spread. New York state has an immunization rate of 79.4%, ranked seventh nationally. Dutchess County residents are 80.6% vaccinated, Columbia County 81.9%; Rockland County has the fewest immunized at 54.4%. First place Rhode Island fell far short of the target at 87.1%.
Misinformation, particularly regarding the debunked link between the MMR vaccine and autism, contributes to low vaccination rates.
Credit: CDC.gov
Childhood immunizations are mandatory for school attendance in the U.S., with medical exemptions available. Because MMR is a live “attenuated” vaccine — designed to create immunity without causing full-blown disease — those with a weakened immune system (from diseases like cancer) or who take immunosuppressive medications (such as daily steroids) can’t have the shots.
New York is one of only five states that doesn’t allow nonmedical exemptions, such as religious beliefs. The law was changed in 2019 after a large measles outbreak: 1,274 cases, nearly all from an under-immunized close-knit Orthodox Jewish community in New York City. Viral spread was successfully contained with urgent MMR vaccinations.
There’s no treatment for measles, but prevention is simple. Two doses of MMR — usually given to children at age one and five years — provides lifelong immunity. If you are born between 1957 and 1971, you may need to be re-immunized; early vaccines were less reliable.
Side effects of MMR are no different from other standard vaccines — low-grade fever, fatigue, soreness at the injection site. For those medically restricted from receiving MMR, an immunoglobulin shot to boost antibodies can minimize the severity of a measles infection.
If you think you or someone you know has measles, call your doctor or clinic immediately. Diagnosis involves a throat or nostril swab similar to a COVID-19 test. You can also contact your local health department. In Dutchess County residents can call the Department of Behavioral and Community Health at 845-486-3404.
Dr. Mary Jenkins, a contributor to the Herald and member of its board of directors, retired after nearly 40 years as a family practice physician in New York state.