Measles is on the rise globally

Child with measles

Measles cases are rising in some parts of the world. To understand why, you don’t have to look much further than those who don’t have measles vaccinations.

“The recent rise in measles cases abroad is concerning,” says Dartmouth Hitchcock Clinics Manchester pediatrician Jaisal Pragani, MD. “Measles vaccination rates have dropped across the world since the start of the pandemic and we are seeing the effects of that in some countries among the unvaccinated. To me, this uptick in cases underscores the importance of getting your children vaccinated no matter where you are.”

Measles is caused by a virus and is highly contagious. It is spread through coughing and sneezing. Symptoms include a fever, a runny nose, and an itchy rash of red-brown spots. But according to the American Academy of Pediatrics, about 95 of every 100 people will be protected after getting one dose of the MMR vaccine. Two doses of MMR protect 97 to 99 of every 100 people.

“Measles vaccines are very safe and highly effective,” says H. Cody Meissner, MD, Professor of Pediatrics at Geisel School of Medicine at Dartmouth. “Parents need to make sure that their children are getting their vaccinations so cases don’t go up.” 

Measles on the rise

Experts attribute the recent rise in cases abroad largely to the number of unvaccinated people and how easily the disease spreads, measles being among the most contagious infectious diseases in the world.

The World Health Organization (WHO) reported 941 measles cases in the WHO European Region in 2022. In the first 10 months of 2023, the case count had risen to some 30,000, according to this mid-December bulletin. By the end of December, those numbers had exceeded 42,000.

Recently, the United Kingdom has been sounding warning bells, too. It had more than 300 cases from the start of October through to the end of January, and the Health Security Agency says that the virus is at risk of spreading further among the unvaccinated.

Researchers there suggest that a low uptake of the measles vaccine is a key driver, with recent data from the National Health Service (NHS) showing that only about 85% of children in England received two MMR vaccine doses by 5 years old. This rate falls below the vaccination rate of at least 95% needed to achieve ‘herd immunity’, which substantially reduces disease spread as recommended by the WHO.  

Cases in the U.S. 

To date, the United States has been relatively unaffected by what is happening abroad.

Recent ​outbreaks have been isolated among unvaccinated people in some states, with 23 confirmed cases of measles over the two-month period between December 1, 2023 to January 23, 2024. 

“Most of these cases were imported by international travelers coming or returning to the United States and occurred among children and adolescents who had not received a measles-containing vaccine,” points out Meissner.

But the United States also has seen a downtick in vaccination rates, which is concerning to medical experts. 

At the start of the 2023 school year in the United States, the independent research organization KFF pointed to CDC-collected data showing that for the second year in a row, the national MMR vaccination rate among kindergarten U.S. students fell below the Healthy People 2030 target of 95%. Specifically, the share of kindergarteners with all state-required vaccines, including MMR, DTaP (diphtheria, tetanus, and acellular pertussis), and varicella (chickenpox), had declined from approximately 95% in 2019 through 2020, to 93% in 2021 through 2022.

That most recent MMR rate was the lowest reported in almost a decade and left approximately 250,000 school children unvaccinated and unprotected against measles. 

“We have seen drops in vaccination rates in New Hampshire as well,” notes Pragani, pointing to a report by the New Hampshire Department of Health and Human Services suggesting that many children and adults fell behind on receiving recommended routine vaccines during the COVID-19 pandemic.

More specifically, New Hampshire as a whole was below the national MMR vaccination average at 88.7%, according to 2021 to 2022 CDC data put together by KFF. Vermont was slightly above, at 93.4%. Both were below the Healthy People target.  

But observers warn against becoming alarmist, particularly if your children have been vaccinated. 

“All this is not to say that the U.S. will experience what is happening in England or elsewhere where cases may be more concentrated due to population density of unvaccinated people,” says Pragani. “But as a pediatrician, my message has not changed. Get your children vaccinated.”

Agrees Meissner: “Measles is a serious disease that many people have forgotten about because of the availability of extremely safe and effective measles vaccines. Measles could return to the United States if measles vaccines are not accepted. Parents need to remember that children should receive two doses of the measles vaccine starting with the first dose at 12 to 15 months of age and the second dose should be administered at 4 to 6 years of age. Teenagers and adults should be up-to-date on their measles vaccination, too.”

More on measles

According to the American Academy of Pediatrics, the most recognizable measles symptom is a very high fever accompanied by a red or brownish blotchy rash, although this is not the only symptom.

Before the rash appears, children with measles develop cold-like symptoms, including:

  • Cough
  • Runny nose
  • Fever
  • Red, watery eyes

These symptoms tend to get worse during the first one to three days of the illness. For more information about how to protect your children, check out How To Protect Your Children During a Measles Outbreak from the American Academy of Pediatrics.

New Hampshire and Vermont vaccination resources

The NH Immunization Program (NHIP) is a vaccine resource for healthcare providers, schools, childcare providers, families, and the general public. DHHS, through the NHIP's Vaccines for Children (or "VFC") program, provides all the recommended vaccines for every child in the state, regardless of insurance or income. DHHS urges individuals and caregivers to talk with their healthcare provider about which recommended vaccines are right for them.

The Vermont Department of Health provides this information about measles, reminding people that measles is preventable when people get vaccinated. They point out that even though measles was declared eliminated in the United States in the year 2000, outbreaks can happen in communities with low immunization rates.