Measles Disease and the Current State of Infections in the United States and Worldwide

Measles is a highly contagious and serious infection caused by a virus.  Although anyone can get measles, it is most common in children and can cause severe disease, complications, and death. It spreads from person to person easily through close contact with or when an infected individual coughs, sneezes, or breathes, including through airborne transmission. Symptoms usually start after an incubation period of 8-12 days following exposure to the virus.  Children can be contagious and spread the virus up to 4 days before showing any symptoms.  

Symptoms include rash, high fevers, cough, runny nose, and red or watery eyes. 

• The fever may spike higher than 104 degrees.  
• The measles rash typically starts 2-5 days after other symptoms start.  The rash is usually flat red spots starting on the face, neck or behind the ears, and then spreading down over the entire body.    
• The spots often start small and become larger patches as they spread.  
• The rash may sometimes be raised but is usually not itchy or painful.  
• Some children may also develop ear infections and diarrhea.  

Why does Measles Matter? 

• In addition to being highly contagious, measles symptoms and complications are often severe, especially in children under 5 years of age, and can sometimes lead to death.  
• Severe complications of measles include pneumonia and encephalitis (an inflammatory infection of the brain).  
• One out of every 3 children diagnosed with measles under 5 years old requires hospitalization in the US.   
• In the United States 1-3 out of every 1000 children who develop measles dies, and a similar number develop long term brain damage.  

Cases and Outbreaks: – Measles is always just an airplane ride away, and sometimes closer.  

• Since routine measles vaccination started in the United States, cases of measles have decreased dramatically.  However, it remains common in many other countries and cases, including small outbreaks, continue to occur in the US every year.  
• Measle cases and outbreaks in the US typically occur from a combination of travelers contracting and bringing the virus from outside the country as well as spread within pockets of unvaccinated individuals within the community.  
• At the time this article was written (Jan 2024), there are cases being reported in several US states including Delaware, New Jersey, Pennsylvania, and Washington.  
• Cases are also being reported throughout the United Kingdom and the World Health Organization (WHO) is reporting higher than typical numbers worldwide.
• According to the WHO there were an estimated 128,000 worldwide deaths from measles in 2021 (the most recent year data is available) and these were mostly in children under 5 years of age.

It is estimated that nearly 40 million children around the world missed a measles vaccine dose during the COVID19 pandemic, including 25 million children missing their 1st dose.  This is likely the primary cause of the current worldwide increase in measles cases. 

Measles Vaccination:  

• The good news is that measles remains preventable through vaccination.  
• In the US, measles immunization is started between 12-15 months with the first MMR (Measles, Mumps, Rubella) vaccine.  
• A second dose is given after 4 years of age.   
• Measles vaccine can be given as early as 6 months of age if an infant is at high risk of exposure (such as traveling to an area or country with high measles activity.) 

The MMR vaccine given as part of the routine childhood immunization schedule remains highly effective and safe at both ages.  

Measles immunization is the primary prevention against infection in children.  It is especially important to keep high vaccine rates in the community to prevent outbreaks that may affect children who are not yet old enough to be immunized (under 12 months old).  

Resources – 

Measles – healthychildren.org 

Protecting Your Baby From Measles Outbreaks – FAQ – healthychildren.org 

WHO Measles Facts Sheets