Measles is one of the world’s oldest and most contagious diseases. It incubates for 10–12 days with a rash (flat red spots that may have raised bumps, starting at the hairline around the face and moving down the body) developing 7–21 days after exposure. Symptoms include fever (as high as 104 degrees), cough, and pink eye. Koplik spots, or tiny white flecks on the palate, are one way to tell measles from other rashes.

Common secondary infections include pneumonia and eye and ear infections that can cause long-term loss of hearing and vision. Encephalitis can occur, causing permanent brain damage, and a rare but 100% fatal condition called subacute sclerosing panencephalitis can appear up to a decade after recovery.

Prior to development of the MMR compound vaccine in 1963, measles claimed the lives of about 500 people a year in the U.S., mostly children under the age of five. A two-shot regimen of the vaccine confers 97% resistance to measles. All Health Insurance Marketplace plans and most other private insurance plans must cover the MMR vaccine, usually without charging a copay or coinsurance. To maintain herd immunity, 95% of the population must be vaccinated.

Though CDC declared that measles had been eliminated from the U.S. in 2000, vaccine rates have been declining, especially since the COVID-19 pandemic. Overall progress in global measles vaccinations has stalled, with first-dose coverage yet to spring back to pre-pandemic levels.

Vaccine skepticism and outright hostility towards vaccinations are on the rise. One oft-cited reason is a now-debunked fraudulent article and publicity campaign by Dr. Andrew Wakefield, who claimed that heavy metals in vaccines caused autism and Crohn’s disease. Religious beliefs also play a part, with some believers stating that impurities in the vaccines defile the body, and others worrying that vaccines interfere with the divine plan regarding death and disease. Some sociologists have pinpointed Christian nationalism as a reliable predictor of vaccine refusal.

Measles has been endemic in Europe, Africa, and Asia for hundreds and possibly thousands of years. Some scholars believe it jumped from cattle to humans around the 6th century BCE. During European colonial expansion, the measles devastated previously unexposed populations all over the world.

Measles can be diagnosed testing urine, blood, or samples from the nose and throat. Diagnosis can also be done by clinical symptoms. A blood test is needed to confirm the disease, which must be reported to the local health department, in addition to the infectious disease departments of hospitals and healthcare facilities.

There is no treatment for measles other than supportive care, which includes rest and hydration to manage the symptoms. Vitamin A does not cure measles, though it may support underlying health in patients who have been hospitalized. A post-exposure vaccination can be administered, even to infants, within 72 hours of exposure. Immune serum globulin may be administered to pregnant women, infants, or people with weakened immune systems up to six days after exposure.

Rigorous isolation, sanitation, and airborne precautions must be followed for patients who have been admitted to a hospital. Everyone who comes in contact with the patient must be able to demonstrate evidence of immunity and wear a respirator that is at least as protective as a fit-tested, NIOSH-certified disposable N95 filtering facepiece respirator. Measles can linger in the air for up to two hours after a measles patient has been present, so rooms and ambulances should only be cleaned at least two hours after they have been occupied by someone with measles.

Pregnant women who catch measles are risk of complications, including pneumonia, miscarriage, neonatal death, and delivering a child with birth defects. If an unvaccinated pregnant woman is exposed to measles, she should be offered Human Normal Immunoglobulin within six days of exposure and the MMR vaccine after delivery. The administration of the MMR vaccine to pregnant women is not associated with adverse outcomes either to the woman or the fetus.

With the federal government slashing the healthcare workforce and funding for international vaccine campaigns, healthcare providers and public health experts are more important than ever. Healthcare providers must be prepared to have frank conversations with parents, listen to their concerns, and explain where vaccine disinformation comes from and who benefits from it.

Now more than ever, healthcare providers are called upon to be educators as well as public health experts.