The US has seen a dramatic rise in measles cases in the past few months, with as many as 90 new cases recently in Texas, and new cases in six other states, including Georgia.
We highly recommend vaccination against Measles with the MMR vaccine, which provides up to 99% protection. The first dose is given at the 12- or 15-month checkup, and a second dose at 4 years of age.
Measles: An Overview
Measles, also known as rubeola, is one of the most contagious infectious diseases, with at least a 90% secondary infection rate in susceptible domestic contacts. Despite being considered primarily a childhood illness, measles can affect people of all ages.
Although the elimination of endemic measles transmission in the US in 2000 was sustained through at least 2011, according to a CDC study, cases continue to be caused by virus brought into the country by travelers from abroad, with spread occurring largely among unvaccinated individuals.
Symptoms
Onset of measles ranges from 7-14 days (average, 10-12 days) after exposure to the virus. The first sign of measles is usually a high fever (often >104° F) that typically lasts 4-7 days. Early symptoms include fatigue, loss of appetite, and the classic triad of conjunctivitis (pink eye), cough, and coryza (nose congestion).
On average, the rash develops about 14 days after exposure and lasts for 5-7 days before fading into coppery-brown hyperpigmented patches, which result in peeling.
Treatment
Treatment of measles is essentially supportive care, as follows:
- Maintenance of good hydration and replacement of fluids that may be lost through diarrhea or vomiting.
- IV rehydration may be necessary if dehydration is severe.
- Vitamin A supplementation may be useful.
Immunization
A vaccine against Measles was first developed in 1963 and resulted in a dramatic decline in the disease providing protection to 95% of recipients. However, from 1989 to 1991, a major resurgence occurred in the US, affecting primarily unvaccinated preschoolers. This measles resurgence resulted in 55,000 cases and 130 deaths and prompted the recommendation that a second dose of measles vaccine be given to preschoolers in a mass vaccination campaign that led to the effective elimination in the United States of endemic transmission of the measles virus.
Today, the MMR (Measles, Mumps, Rubella) vaccine is used to immunize children. A single dose of this vaccine administered to a child older than 12 months induces protective immunity in 95% of recipients. A second dose of vaccine, now recommended for all school-aged children in the United States, induces immunity in 99% of people.
The vaccine is preventive if administered within 3 days of exposure to the measles.
Complications
The prognosis for measles is generally good, with infection only occasionally being fatal. The CDC reports the childhood mortality rate from measles infection in the United States to be 0.1-0.2%. However, many complications and sequelae may develop, and measles is a major cause of childhood blindness in developing countries.
Common infectious complications include otitis media, interstitial pneumonitis, bronchopneumonia, laryngotracheobronchitis (ie, croup), exacerbation of tuberculosis, transient loss of hypersensitivity reaction to tuberculin skin test, encephalomyelitis, diarrhea, sinusitis, stomatitis, subclinical hepatitis, lymphadenitis, and keratitis, which can lead to blindness. In fact, measles remains a common cause of blindness in many developing countries.
Rare complications include hemorrhagic measles, purpura fulminans, hepatitis, disseminated intravascular coagulation (DIC), subacute sclerosing panencephalitis (SSPE), thrombocytopenia, appendicitis, ileocolitis, pericarditis, myocarditis, acute pancreatitis, and hypocalcemia. Transient hepatitis may occur during an acute infection.
Approximately 1 of every 1000 patients develops acute encephalitis, which often results in permanent brain damage and is fatal in about 10% of patients.
Recommendation
If your child is older than 12 months and has not been vaccinated, we recommend you call our office to schedule it. If your child’s well check-ups are up-to-date, the shot can be given in a simple nurse visit. If your child is behind in check-ups, we require a well check-up visit in conjunction with the vaccine.
If your child is unvaccinated and is exposed to a known case of Measles, contact our office as soon as possible for instructions.
Source: emedicine at Medscape.com accessed February 2025
Here is a USA Today article on the outbreak.
Watch an educational video on Measles.