Out of sight, out of mind – until it’s too late. This phenomenon is a sad fact of human psyche. Measles was eliminated in the United States in 2000. Then, complacency and skepticism set in – call it out-of-sightness. In these first two months of 2025, 164 measles cases and the death of at least one child have struck unvaccinated people, mostly living in western Texas. But much of the United States remains at risk. At least 95% of a population must be vaccinated to protect against this disease, but in some U.S. regions the vaccination rate is as low as 80%, inviting infection.
Measles is highly contagious. An unvaccinated person sharing a room for just five minutes with someone suffering from measles has a 90% chance of becoming ill. Measles is not a trivial disease. In the U.S., about 1 in 5 unvaccinated persons will require hospitalization for complications that include pneumonia, blindness, and encephalitis.
Very few clinicians in North America have any experience with measles. Neither did I until my two-year deployment to southern Africa. My impoverished host nation was at war and few children were vaccinated. How contradictory that clinicians in the United States, with its wealth and resources, must now become prepared to diagnose and treat this disease.
Could you recognize a patient with measles? The illness typically begins with a nonspecific fever, cough, runny nose, red eyes, and sore throat. This is sometimes called the “Three C’s”: Cough, runny nose (Coryza), Conjunctivitis. Koplik’s spots follow, tiny white spots that appear on the soft palate 2–3 days after symptoms begin. Finally, a red blotchy rash appears 3–5 days after the first symptoms. Medical care for measles is essentially supportive and management of complications, with no specific antiviral treatment.
Measles prevention update: The measles-mumps-rubella (MMR) vaccine is the best way to prevent measles. Two doses are recommended for children, typically at 12-15 months and 4-6 years of age. Just one dose is about 93% effective. Two doses are about 97% effective at preventing measles. Any adult with a questionable history of vaccination should receive MMR vaccine. What are the risks of measles vaccine itself? Common side effects include fever, mild rash, and swelling of glands in the cheeks or neck. MMR vaccine has been linked with a very small risk of febrile seizures, about 4 for every 10,000 children immunized, and no long-term effects. Objective, independent research affirms that MMR vaccine is not linked with risk of autism.
A very important and understated fact is also that vaccination against measles, and other highly contagious diseases, not only protects the individual. It also protects everyone with whom that person comes in contact. In this sense, the biblical mandate to Love one another as you love yourself can also mean to protect our neighbors from this disease by we ourselves becoming vaccinated.
Let us not give up on the human psyche. The worse outcome from out-of-sightness is allow its progress toward actions of out-of-mindness that put children at risk. Rather, may we humanitarian health leaders keep insight and hope in sight.