Measles

A highly contagious viral disease that was declared eliminated in the U.S. in 2000 but continues to cause outbreaks due to declining vaccination rates.

Overview

Measles (rubeola) is a highly contagious viral infection caused by the measles virus, a paramyxovirus. It is one of the most infectious known diseases, with an R0 (basic reproduction number) of 12-18, meaning that one infected person can transmit the virus to 12-18 others in a completely susceptible population (CDC, 2024).

Before the introduction of the measles vaccine in 1963, an estimated 3-4 million people contracted measles annually in the United States, resulting in 400-500 deaths. The vaccine led to a 99% reduction in measles cases in the U.S. The disease was declared eliminated in 2000, meaning there was no continuous transmission for more than 12 months (CDC, 2024).

However, measles remains endemic in other parts of the world, and importations continue to occur. Recent years have seen resurgence in communities with low vaccination rates, including notable outbreaks in 2019 and 2024-2025.

Symptoms and Complications

Typical Symptoms

  • High fever (often exceeding 104°F/40°C)
  • Cough, runny nose, and red/watery eyes
  • Characteristic rash (begins at hairline, spreads downward)
  • Koplik spots (white spots inside cheeks)
  • Illness typically lasts 7-14 days

Serious Complications

  • Ear infections (7-9% of cases)
  • Diarrhea (8% of cases)
  • Pneumonia (1-6% of cases) - leading cause of death
  • Encephalitis (1 in 1,000 cases)
  • Subacute sclerosing panencephalitis (SSPE) - rare, fatal

Epidemiology and Outbreaks

Globally, measles remains a leading cause of vaccine-preventable death. The WHO estimates that in 2022, there were 136,000 measles deaths worldwide, mostly among children under 5 years old (WHO, 2024).

U.S. Outbreak Data

In 2019, the U.S. experienced 1,282 individual measles cases across 31 states - the largest number since 1992. This was largely driven by outbreaks in under-vaccinated communities. In 2024, new outbreaks have been reported in multiple states (CDC, 2024).

Most measles cases in the U.S. occur among unvaccinated individuals who traveled to areas with ongoing transmission and brought the virus back to their communities. The virus spreads quickly in settings with low vaccination rates, such as schools and daycare centers.

Vaccine Information

MMR Vaccine

  • Type: Live attenuated virus
  • Dose: Two doses
  • First dose: 12-15 months
  • Second dose: 4-6 years
  • Efficacy: 97% after two doses
  • Duration: Long-lasting (lifelong in most)

CDC Recommendations

  • All children should receive two doses of MMR vaccine
  • Adults born 1957 or later should have at least one dose
  • Healthcare workers need two doses
  • International travelers should be fully vaccinated
  • Infants 6-11 months can receive dose before travel

Sources & Citations

Related Pages