What Worries Medical Experts About The Measles Outbreak In Texas

One hundred forty-six people in West Texas are currently infected with measles, a highly contagious illness that is avoidable when enough people get the measles vaccine. People are also infected in other states, including New Mexico, Pennsylvania, New Jersey and California.

Vaccination rates in the United States are dropping, which means fewer and fewer people are getting life-saving vaccines and the spread of vaccine-preventable diseases, like measles, are on the rise.

“Before the measles vaccine was introduced, which was in the early 1960s, 2 1/2 million people died of measles every year in the world … and because we’ve had a vaccine for so many decades, that number has gone way down. In 2023 … there were just over 100,000 people who died from measles across the globe, but most of those people were people who either lived in a space where they didn’t have access to vaccines, or they were other people who were not vaccinated,” said Dr. Elizabeth Meade, a pediatrician in Seattle and spokesperson for the American Academy of Pediatrics.

Measles is most dangerous for children, and particularly children under 5 years old, Meade added. In Texas, an unvaccinated school-aged child died of measles last week.

At first, Robert F. Kennedy Jr. ― now the secretary of the U.S. Department of Health and Human Services ― seemed to downplay the measles outbreak, experts say, but has since changed his tune.

On Sunday, RFK Jr. wrote a Fox News op-ed in which he stated the risks of measles, particularly for unvaccinated people, and the importance of vaccination for individual protection and community protection. This op-ed was a complete flip from his anti-vaccine past. Previously, he has claimed that vaccines cause autism (which has not been proven), and his nonprofit, the Children Health Defense, is said to have played a big role in stirring up measles vaccine hesitancy in Samoa, which resulted in a deadly outbreak.

“RFK has spent his career trying to weaponize the real anxiety some parents feel about giving their children vaccines to spread disinformation campaigns, so this is a welcome shift in his public health messaging,” said Dr. Anita Patel, a pediatric critical care doctor in Washington, D.C.

Experts are encouraged by this messaging and hope it can help quell MMR vaccine hesitancy.

“I was pleasantly surprised. I, frankly, wouldn’t have expected to see that, but I’m glad he did,” said Dr. Jennifer Nuzzo, a professor of epidemiology and the director of the Pandemic Center at Brown University School of Public Health in Rhode Island.

Notably, in his op-ed, RFK Jr. wrote, “The decision to vaccinate is a personal one.”

“I know some people have criticized that [his op-ed] doesn’t directly say, ‘Go out and get vaccinated,’ but I think it was more than I could have hoped for, really. It’s quite clear it affirms that MMR vaccines are critical for protecting not only ourselves, but our broader community, and I’d like to see more of that,” said Nuzzo.

For some people, the decision to get vaccinated has to do with protecting the vulnerable people in their community, and, for others, it’s to protect themselves, said Nuzzo. But either way, if RFK Jr.’s statement leads to more vaccinations, it’s a win.

This statement is a huge shift from RFK Jr.’s messaging as recently as last week at a Cabinet meeting, when he seemed to downplay the severity and called the measles outbreak “normal,” said both Meade and Patel.

At the time, “He either didn’t know or was purposely manipulating the situation … and to have the leader of our health care system not either know what is the reality or who is actively lying about it is concerning ― and not just concerning, it’s terrifying,” said Patel.

This new messaging, while promising, didn’t come fast enough, Patel said.

“For most of us in the health care and public health space, this complete 180 in his messaging feels like a weak attempt to rescue a situation that has already spiraled out of control,” added Patel.

“The time for this messaging was when the outbreak began. The time for this messaging was on the day we lost a child to this vaccine-preventable disease rather than weak arguments that this current measles outbreak is normal. The time for this messaging was before the Children’s Health Defense tried to push ‘natural immunity to measles’ as superior to vaccine-induced immunity,” Patel said.

Vaccine hesitancy, increasing measles spread and questionable decisions from the current administration concern medical professionals. Below, they share their thoughts on the current measles outbreak in Texas.

Measles is what experts call a “herald infection,” because “typically, when we see an outbreak of measles, that heralds the fact that vaccine rates have dropped enough that we’re starting to see these,” Meade said.

“And then we may start to see other things, like polio, like mumps, other things that we haven’t seen in this country for quite some time,” added Meade.

Nuzzo noted that a school in Texas reported a rubella case, which is pertinent because the measles vaccine, which is known as the measles, mumps and rubella (MMR) vaccine also prevents rubella infections.

The reason that measles shows up first is because it’s highly contagious, said Meade. It’s more contagious than both COVID and the flu. “It’s one of the most contagious illnesses that we see,” she said.

“Just to put things in perspective for people, if someone has measles and they cough or sneeze in a room, and then they leave the room, and you walk into the room two hours later, you can become infected with measles,” explained Meade.

“Pediatricians across the country have a very deep understanding of infectious diseases and how something like measles can actually really herald a bigger problem,” said Meade.

“We have a lot of people in the hospital, and I have to say that is also deeply concerning, one because measles is very tough for hospitals because of the isolation that’s required [since] it’s such a contagious disease, [and] there’s so many vulnerable people in hospitals,” said Nuzzo.

According to data from the Texas Health and Human Services department, 20 of 146 people are currently hospitalized.

RFK Jr. suggested in last week’s cabinet meeting that people are in the hospital for quarantine and isolation, which isn’t true, Nuzzo noted. They’re in the hospital because they’re sick.

“So, just to say that, yes, we have had a death, but we also have a lot of people in the hospital, and that means that they are ill enough to be in the hospital,” Nuzzo said.

“We declared measles eliminated, which is you drive down the incidence to near zero, but not necessarily zero, like 25 years ago,” said Nuzzo.

Since then, the U.S. has been able to maintain its measles elimination status, but there was a large measles outbreak in New York in 2019 where the U.S. just “barely missed losing our measles elimination status, so we’ve retained it.” Nuzzo said.

“But when we have outbreaks that spiral out of control that could imperil our measles elimination status … I think [it] has consequences,” Nuzzo noted. “It has huge psychological consequences in terms of what kind of country we are and how committed to public health we are. That would put us on par with some of the more resource-constrained settings in the world.”

“So, I think it is something that we have to take quite seriously in terms of our stature,” she said.

With measles cases cropping up throughout the country, it’s natural to be worried. But “if you’re a fully vaccinated individual [and] you are not immunocompromised, you should have no reason to be scared,” said Patel.

If you aren’t sure if you’ve had your measles vaccine, you can talk to your doctor about getting your titers drawn, which is a blood test that shows the level of antibodies in your body.

If you haven’t been vaccinated or haven’t had both doses of the shot, Meade said your best bet is to get the MMR vaccine.

The first MMR dose is generally given to babies at 12 months, but if you are worried about your child’s exposure, talk to your doctor about getting them the vaccine early.

“We do this for kids who have to travel out of the country to places that have endemic measles, and we’re certainly doing it for children who are living near the epicenters of the current outbreaks that we’re seeing,” Meade said. Generally, this is done for babies who are at least 6 months old.

“For parents of children who are over 12 months and have already had one dose but haven’t yet gotten that second dose, which is typically given between age 4 and 6, you absolutely can get that second dose early,” Meade noted.

As long as it’s been at least 28 days since the first dose, you’re eligible for the second shot.

“And I think that’s important for parents to know. I’m planning to get all of my children their second dose early now, because we are seeing [measles] in Seattle, and that’s the absolute best way that I have to protect them,” Meade said.