Measles Surge in US and Why This Represents a Bigger Issue

The United States is currently experiencing a surge of measles cases, underscoring 2 critical issues we’re facing: gaps in vaccination and politicization of public health. The Centers for Disease Control and Prevention (CDC) reported that in 2023, the US experienced a total of 58 cases. As of March 7, 2024, the CDC reported the country has 45 reported measles cases. And the City of Chicago is reporting 2 more additional cases of measles, which would make it 47 confirmed cases. Sadly, this trend isn’t unique to the United States, as the United Kingdom has also reported clusters and global measles cases are on the rise.

The CDC has alerted clinicians of the recent spike in cases and to try and increase vaccination rates as most cases were identified in those unvaccinated (children and adolescents). The concern many of us have is that it’s not simply just a few cases springing up, but transmission, which is deeply worrisome for this very contagious viral infection. Ensuring herd immunity requires a 95% vaccination rate in children, but a recent report from the CDC noted a 93% vaccination rate in kindergartners.

To add to this, the Florida Surgeon General, Joseph Ladapo, MD, continued to fuel vaccine skepticism and public health recommendations but telling parents to defy CDC guidance for those unvaccinated children. In a letter sent to parents, he noted that they could ultimately decide if their child should attend school, despite CDC guidance for unvaccinated children in impacted schools to remain home for the duration of the quarantine period (21 days). As measles is highly contagious, exposures can be significantly impacting, which makes rapid identification of those exposed and unvaccinated critical.

Recently, a third-grade student in Broward county, Florida, was just diagnosed with measles despite no international travel, and another six were diagnosed in Manatee Bay elementary school, meaning that transmission is occurring. Halting the spread of this disease requires stringent efforts to protect the unvaccinated (and people who are immunocompromised) and keep those sick at home.

Recently, a measles outbreak occurred in Philadelphia in January that was caused when a seven-month-old infant contracted the disease while traveling abroad, and contrary to the advice of physicians at the Children's Hospital of Philadelphia and vaccine expert and pediatrician Paul Offit, MD, the young child was brought to daycare.

So here we are with a spike in measles cases, decreased vaccination coverage, increased skepticism, and politicization of public health efforts. Following a pandemic, it’s both surprising that we would see resistance to effective interventions, but also not surprising given our experiences during COVID-19.

With measles though, we have far more experience with the impact of vaccine skepticism and how it can create deeply impacting outbreaks. These outbreaks in communities which have low vaccination rates due to skepticism and the spread of mis and /or disinformation, can be impacting surrounding communities, but also those working in public health response. As Daniel Engber noted, Florida is experimenting with measles and trying out a new approach: “No one will be forced to not get sick.”