BY MELISSA PATRICK
KENTUCKY HEALTH NEWS
A highly contagious childhood disease that was declared eliminated in the United States in the year 2000 is making a comeback, largely driven by a declining vaccination rate in the country.
“Unfortunately, as the measles vaccination rate has decreased, it’s just one of those things where folks are opting out of vaccination more often, we’re starting to see the increase of measles in the United States,” Dr. Steven Stack, commissioner of the Kentucky Department for Public Health, said at a Feb. 29 press conference.
In Kentucky, about 90% of the state’s kindergarteners are vaccinated for measles, mumps and rubella “and that has to be 95% or higher to stop transmission,” said Stack.
Stack spent the bulk of his time talking about a disease that he said most people in our country, including health-care providers, have never seen. Further, he said, it is a disease that is “virtually, entirely vaccine-preventable.”
“If you are vaccinated, you almost certainly will get no symptoms from measles,” he said. “In fact, the vaccine is so effective, you won’t get sick at all and you don’t transmit the virus.”
Stack said symptoms of measles include a cough, congestion, fever that may go up to 104 degrees, and a full-body rash. The Centers for Disease Control and Prevention also mentions sore, red eyes that may be sensitive to light, watery or swollen eyes, small greyish-white spots in the mouth, and a loss of appetite.
“You feel miserable,” said Stack, adding, “In the unlucky ones, the complications are pneumonia, diarrhea, ear infections, and even sometimes brain swelling that can lead to things like seizures, developmental disabilities and other permanent brain damage.”
Among the unvaccinated population, Stack said more than one in five measles victims are hospitalized and one in 20 get pneumonia, which is the most common cause of death.
“The most common age of death is under 5; those are the individuals hurt the most by this disease if you’re unvaccinated,” he said. “And for the really unlucky, one in one thousand can get a permanent brain injury from the brain swelling that I talked about.”
Because measles is a highly contagious virus that is spread through the air, with an incubation period of 10 to 12 days, it is easy to spread it unknowingly. Stack said a person is contagious for four days before the rash and four days after the rash, which is why it is recommended for anyone who has been exposed to measles or who has it to stay at home for 21 days to avoid spreading the disease.
“Measles is probably the most contagious viral disease on planet Earth at present. The only thing that could maybe compete with it is COVID,” he said. “In this room, all of us in this press conference for a period of 40 to 60 minutes, if one person had measles in this room and we were unvaccinated, nine out of 10 of us would become infected with measles in about 10 to 12 days.”
As of Feb. 29, the CDC reported there had been 41 measles cases reported in 16 states, none in Kentucky.
“This is becoming more common and because people travel a lot and are portable in ways that weren’t possible . . . in the prior century, it spreads too easily and can cause too many problems,” said Stack. “Everybody please go get yourselves and your children vaccinated if you are not already vaccinated.”
Florida, with its many airports and a regular vacation spot for many Kentuckians, is one of the states with a recent outbreak. Of concern to public health officials is a letter issued by the Florida State Health Department that does not urge parents of unvaccinated children at that school to get vaccinated or to quarantine. Instead, it leaves these decisions up to parents.
These recommendations go against well-established public health guidelines that call for unvaccinated people or those with no prior immunity to isolate for 21 days after exposure and for unvaccinated children to get vaccinated within 72 hours of exposure, which allows them to return to school as long as they don’t develop symptoms, Katelyn Jetelina and Dr. Kristen Panthagani, write in their Your Local Epidemiologist newsletter.
Asked about what precautions Kentuckians should take if they are traveling through the Florida airports or spending time in the state, Brice Mitchell, spokesperson for DPH said a person’s level of concern should be determined by whether they are vaccinated or not.
“If you are vaccinated for measles, there are no special precautions necessary. If you are unvaccinated for measles, the Kentucky Department for Public Health urges that you get vaccinated,” he said in an email. “For further information, please review the Centers for Disease Control and Prevention guidance.”
Dr. Sean McTigue, interim chief of infectious disease at Kentucky Children’s Hospital, agreed.
“Anyone who is up to date with this vaccine is protected against measles infection and would not need to take any additional precautions when traveling to Florida or through Florida airports,” McTigue said in an email. “If planning a trip to Florida and one or more travelers are not already up to date with MMR vaccine, then now would be an excellent time to be vaccinated.”
Two doses of measles, mumps and rubella (MMR) vaccine are recommended to children starting at 12 months. Adults can also be vaccinated.
McTigue called this measles outbreak and others a “wake-up call” for those who are not protected and provides an opportunity for parents to protect their children against measles.
“Because the MMR also protects against mumps and rubella, it is also an excellent way to protect against mumps, which can cause testicular infection and sterility in males and against rubella, which can cause severe birth defects if a pregnant woman is infected during her pregnancy,” he said.
Stack also pointed to the protections provided by the vaccine, saying in a news release, “Two doses of MMR vaccine are 97% effective at preventing measles and provides lifelong protection if exposed to the virus. Even if exposed to measles, vaccinated persons may continue routine activities.”
The CDC says that while detectable antibodies generally appear within just a few days after getting the measles vaccination, it takes about two or three weeks to be fully protected. Ideally, the CDC says a person should be fully vaccinated at least two weeks before they travel.
More information can be found in a Los Angeles Cedars-Sinai Hospital blog post, “Measles Makes a Comeback: What Parents Need to Know.” It says measles cases worldwide increased 79% in 2023, according to the World Health Organization. In 2022, the WHO estimated that measles killed more than 130,000—most of them children.
“Measles is a huge concern and directly related to declining measles vaccination rates,” said Dr. Priya Soni, a pediatric infectious disease specialist with Cedars-Sinai Guerin Children’s Hospital. “Vaccine hesitancy, fueled during the pandemic by the anti-vaccine movement, has affected vaccination rates nationwide. In addition, because children were quarantined during the pandemic, many missed out on well-child visits and didn’t catch up on their vaccines. That has meant 61 million fewer doses distributed nationwide between 2020 and 2022.”
Although the first dose of the MMR vaccine is traditionally given to infants 12-15 months of age, and the second around a child’s fifth or sixth birthday, Soni said infants as young as 6 months can receive the first vaccine if they are traveling to areas where the measles infection rate is high.
Kentucky Health News is an independent news service of the Institute for Rural Journalism in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.