Measles, Measles Everywhere

Increasing measles cases, why we shouldn't blame parents and a quick measles Q&A.

UNICEF and WHO released a report stating that in 2024 Europe recorded its highest number of measles cases in 25 years. They recorded 127,352 cases, with 74,428 of the cases resulting in hospitalization. But this isn’t an issue unique to Europe.

In 2024 the USA reported 285 cases total for the whole year and no deaths. This year we are already at about 250 cases in Texas and New Mexico (which have been confirmed to be linked to each other), as well as more cases popping up in other states around the country. The USA has also had its first two deaths from measles in a decade. One was an unvaccinated child, and one was an unvaccinated adult. The father of the child recently spoke to a reporter for The Atlantic. The whole article is well worth reading.

These increases in cases are driven by declining vaccination rates and illustrate a concerning trend regarding the resurgence of vaccine-preventable diseases. Because of this situation I’ve gotten tons and tons of measles questions so this is going to be a quick Q & A post answering some of your most common questions.

For those wanting more here are some great resources:

Katelyn Jetelina

discussed measles case counts in her newsletter this week. You can read it here.

Those Nerdy Girls

posted a measles update last week with some good information regarding symptoms, vaccine eligibility and more, read it here.

Jessica Malaty Rivera, MS

did a FAQ on measles so I tried to stick to ones that she did not address, though I did think it was important to reiterate some points for those who may not read both (repetition is key friends). Often those spreading rumors and lies ‘flood the zone’, and we need to be better at flooding the zone with true information too!

First though, I want to address something I have brought up a few times on my Instagram, but it is important enough to address here.

Why most parents are not the enemy and what to think about instead

After the news broke about the child in Texas dying of measles, I immediately started to see posts about the parents that made me cringe (I talked about it here). I do understand that it is WILD out here right now and emotions and stress are high. However, those of us on the ground having conversations with vaccine hesitant parents know that the issue is not as easy to fix as many people want it to be. Blaming and shaming is not going to help. This ignores many of the biggest issues related to the people spreading well-designed lies for profit (examples here, here, here, here, here, and here). They’re the ones to blame.

Information alone is not enough to change minds, it can be one aspect sure, but it is not enough. This is true for many reasons that I won’t touch on in this post. I want to focus on one specific aspect related to the privilege inherent in people stating that information alone should be enough. This statement ignores things like:

1. Not everyone has access to information. This could be due to issues such as no internet, low literacy, English as a second language, not knowing how to find it, algorithms or other barriers.

2. Not everyone can parse out “good” information from “bad” information. This is increasingly hard to do when anti-vaccine lies are so prevalent and are also being spread by the heads of our government. This is one great resource if you want to learn more about how to start doing this and teaching your kids.

What does help is building relationships, sharing stories, having empathetic conversations, starting from a place of common ground and building information in from there.

Most parents want to do the best for their kids. Most want to keep themselves and their children safe. I have touched on this concept before here. This is one common ground many of us can start from to enter into these difficult conversations. However, they can be hard and take a lot of time. They’re worth it though. Shaming, blaming and a lack of empathy will not help. These actions will only build echo chambers and make the world less safe for all of us.

So, if our desire is to make the world safer for our children, those immunocompromised and more, then we need to be willing to engage in hard conversations with empathy. We didn’t get into the situation we are in overnight, and we cannot get out of it overnight.

Also, to be clear here. The burden is not always shared. I understand that those at high risk are most vulnerable at this moment. Not everyone can or should engage in this work. But we all can understand that information alone is not enough, and do what we can to not make the problem worse.

Question Grab Bag

1. What does it mean that MMR is a live vaccine?

The MMR vaccine is a live attenuated vaccine, which means the viruses have been weakened so they do not cause the same disease as the full virus (known as the wild-type virus).

2. Can you get and spread measles from the vaccine?

Some people who get the MMR vaccine may develop a measles-like rash, but this is not the same as measles and will resolve. Very rare cases of actual measles have been reported post-vaccine. This is a reason why someone who is severely immunocompromised is not recommended to get live vaccines like MMR. If you’re not immune compromised this is not a risk, and those immune compromised should be discussing MMR vaccination carefully with their provider.

Importantly, though, a systematic review has not found any evidence of the vaccine strain of measles spreading to other people. We CAN tell the difference by looking at the RNA of the virus (its genetic material) as the vaccine version can be distinguished from the wild-type version. This is why we know the outbreak happening right now is not due to the MMR vaccine but the wild virus.

3. Why are babies under 1 not typically vaccinated for measles?

I recently covered this question in a collaborative post for Those Nerdy Girls. You can watch the video on Instagram or Facebook. But in short, a pregnant person transfers antibodies through the placenta to the developing fetus if they have been vaccinated for measles or had been infected. These antibodies last for a period of time after birth.

Because the MMR vaccine is a live attenuated vaccine, if a child is vaccinated early, the maternal antibodies can bind and block the vaccine virus before the infant can make an effective immune response. This would leave them inadequately protected. Usually, by the time a child is one the maternal antibodies are no longer an issue.

4. When should a child get an MMR vaccine early?

Normally children in the USA receive the first dose around one year of age, and the second dose between four and six. Right now, the recommendation is to vaccinate an infant between 6 and 12 months of age only if they’re in an area with an active outbreak or are traveling to one. But you should always discuss this with your healthcare provider.

This type of recommendation is working to balance multiple factors. You are balancing waiting for maternal antibodies to wane to give the most protection, with wanting to ensure the infant is protected from measles. If you’re not near an outbreak, waiting makes sense. However, when the risk of measles is high because you’re traveling or in an outbreak area, the balance shifts.

Note: If a child receives a dose of MMR prior to the age of one it is considered a “zero dose” and they would still need to get two additional doses (for a total of three). This goes back to the maternal antibodies I mentioned in the prior question.

An early second dose is also possible if in an outbreak zone or traveling. One dose of MMR is effective at providing protection for the majority of people. But there are some who do not respond to that first dose, but will respond to the second.

Jessica Malaty Rivera, MS

and Dr. Lauren Hughes (@Bloomdpc on Instagram) made this handy flowchart on this topic (screenshot below).

5. What’s the deal with vitamin A?

Vitamin A is not a substitute for vaccination. It cannot prevent measles. Data suggests it can reduce infection complications in children who are deficient in vitamin A, but this is rare in the USA. There are some suggestions that a measles infection may deplete vitamin A and lead to worse outcomes. This is one reason why WHO, AAP, and NFID all state children with measles, particularly severe cases, can be given two doses of vitamin A by their medical provider.

However, the data on how much this helps when a child is not already deficient is unclear, so the risk and benefits must be discussed with a medical professional.

But again, vitamin A does not prevent measles, nor is it a substitute for vaccination. Vitamin A can also cause health impacts if taken inappropriately, so this is why advice from a medical professional is key here and should not be done at home.

For more details on this very nuanced topic (with references) read this post on Vitamin A here by

Kevin C. Klatt, PhD, RD

.

6. Should I get my titers for measles checked?

This is generally not recommended if you know you have received two doses of MMR. This is because immune memory is more than just antibodies (which is what a titer measures). However, if you’re unclear about your vaccination status, unsure if you have received two doses, or concerned for another reason, you can discuss with your provider. There is no harm in getting a dose of MMR in these situations.

This article from Yale Medicine also covers considerations related to this topic!

7. Does measles have any health benefits?

Heck no and I already covered this as part of a collaboration here.

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What can you do?

Life is overwhelming right now which is why I am trying to include this section more often to remind you of the things you can do.

1. Make sure you and your family are up to date on their vaccines. Mine are!

2. Call your representatives and let them know what issues you care about — including science ones. Use 5 calls or this website to find your representatives.

3. Share you stories about vaccines and science. Bring up the fact your child had their MMR vaccine and how it went. Share about how science impacts and benefits your life. We need to normalize science and its many uses and benefits in life.

4. Take breaks. There is a lot going on right now. Take breaks from the scrolling and constant bad news and find joy where you can. For me this means spending time with family, running and reading a good book. I am currently reading The Vanishing Bookstore by Helen Pheer (I was able to get an advanced listener copy from NetGalley).

Photo by Kristine Wook on Unsplash