Measles Cases are on the Rise. What to Know if It Makes Its Way to Arkansas

If you were alive in the ‘80s, you probably remember the measles epidemic. Decades later, many of us have forgotten just how sick someone with measles can get. With recent reports in Alaska, Georgia, New York, Rhode Island, and Texas, it’s important to revisit signs and symptoms and refute the disinformation and misinformation campaigns that are causing a decline in vaccination rates and affecting public health.

Arkansas Vaccination Rates are Lower than the National Average

One reason for concern in Arkansas is our low vaccination rates. Dr. Heather Young, associate professor of pediatric infectious diseases at the University of Arkansas for Medical Sciences, spoke about Arkansas’s low vaccination rates in a recent episode of AFMC TV.

While no measles cases have been detected in Arkansas yet, a single case could spread and make a lot of people very sick. The recommended vaccine coverage rate for herd immunity is around 95%. “Only about 23 of our 74 counties have a vaccine coverage rate of 95% or more,” Dr Young says. That leaves over 40% of Arkansas counties at risk for a measles outbreak should a case pop up in our state.

In 2023, 125,000 kindergarteners received an exemption from required vaccines, a record number in the U.S. The U.S. Department of Health and Human Services recommends that 95% of kindergarteners receive both doses of the measles, mumps, and rubella (MMR) vaccine to help prevent outbreaks of measles. For the fourth year in a row, the U.S. has fallen short of this recommendation.

Vaccines are important for public health. Yet, vaccine rates nationwide, particularly in Arkansas, have been steadily declining. The vaccination coverage rate for Arkansas children around age 2 is only about 82.4%, well below the national rate of 90.6%. For 3-year-old Arkansas children, the rate is 86.9%, below the national rate of 93.3%.

Groups of unvaccinated individuals tend to cluster—they go to the same church, visit the same community centers, or even live in the same neighborhood. In these pockets, the vaccine rates are much lower.

Before the MMR vaccine was introduced in 1963, measles claimed around 2.6 million lives worldwide. In 2023, the World Health Organization (WHO) estimated 107,500 measles deaths, mainly in countries with low vaccination rates.

Public Awareness is also Low Statewide

Low vaccination rates demonstrate low public awareness and a need for more widespread education on measles and vaccination. “There is also a large hurdle of disinformation to overcome when it comes to the measles vaccine,” Dr. Young adds.

Because it is so highly contagious, it is critical that we educate patients on symptoms and prevention. Healthcare professionals use the mathematical term R0₀, also called the R-naught or reproductive number, to indicate how infectious a disease is. The number identifies the average number of people who will contract a contagious disease from someone who has already contracted that disease (assuming those who could contract the disease are completely vulnerable or unvaccinated).

The flu, a common illness we encounter every year, has a reproductive number of 1.3, meaning that if someone with the flu walks into a room, one healthy person in that same room is likely to contract the flu from the sick individual. Even some more contagious diseases, like the COVID-19 Delta variant or chickenpox, only have reproductive numbers of 5 to 8 and 8 to 12, respectively. Measles has a reproductive number of 12 to 18, meaning that 12 to 18 unvaccinated people could contract measles from a person who is sick. This makes measles one of the most contagious viruses we know of today.

The MMR Vaccine is the Most Effective Way to Prevent Measles

The MMR vaccine is 93% effective against measles after one dose and 97% effective after two doses. Unvaccinated or under-vaccinated individuals are at greatest risk for contracting measles and experiencing severe complications.

Children typically receive their first dose of the MMR vaccine at around 1 year old. Pediatricians usually wait until a child is 4 years old to give the second dose, but a child can receive their second dose as early as 4 weeks after the first dose.

Symptoms and Complications

According to the WHO, measles weakens the immune system and causes rash, red eyes (conjunctivitis), cough, and a runny nose. Severe cases can result in blindness, pneumonia, or neurodegenerative conditions like encephalitis (swelling of the brain). In some cases, the illness can cause death.

Measles particles will linger in the air for up to two hours. If a patient with measles coughs or sneezes in a closed-off exam room, anyone who enters the room within that two-hour period is likely to be exposed to measles.

It may take one to two weeks for symptoms to show if someone has contracted measles. Two to three days after symptoms begin, tiny white spots, called Koplik spots, may appear on the inside of the mouth. Three to five days after symptoms begin, a measles rash may develop, starting at the hairline and coalescing down the face and trunk as time goes on.

“Kids will be miserable when they have measles, so if you have a child with a rash who is playful and running around the room, that’s probably not measles. Kids with measles will not want to be messed with and will feel absolutely miserable,” Dr. Young explains. “They will also develop a decreased appetite as well as cervical and general lymphadenopathy.”

Because measles symptoms are similar to those of other illnesses, it is not uncommon for primary care doctors to miss the diagnosis in the first few days. Koplik spots and a rash are the telltale signs for a doctor that someone has contracted measles.

“Something else that’s not talked about enough, in my opinion, is that studies have shown that individuals who have had measles develop what we call an immune system amnesia, meaning that their bodies are not able to respond well to other infections, increasing their mortality compared to others who have not contracted the disease,” Dr. Young adds. This “immune system amnesia” can last for months to years after a measles infection.

When to Seek Medical Help

Since measles is so contagious, it is good practice for pediatricians and healthcare professionals to encourage patients to call before they come to the clinic if they suspect their child has measles. This will allow the pediatrician’s office or other health center to devise a plan for examining and diagnosing that child without infecting other patients.

Once a measles diagnosis is confirmed, act quickly. The health department has an outbreak response team doctors can call to report the diagnosis. A workup typically involves a nasopharyngeal or oropharyngeal swab, urine PCR, or IGM serum test to quickly confirm the diagnosis.

An IgG test may also be helpful, but it only really shows whether somebody has immunity to the virus. It does not confirm a diagnosis.

Treatment can be Complicated

Because no antiviral therapy has yet been developed to help prevent or stop measles, supportive care is typically the most common treatment recommendation. Some children develop vitamin A deficiency, so vitamin A supplements may help balance out that deficit, but supportive care is the most common treatment method.

“Supportive care includes keeping children hydrated, keeping them supported with oxygen if they develop pneumonia, and watching for secondary bacterial infections,” Dr. Young says.

Reemphasize the Importance of the MMR Vaccine

The MMR vaccine is safe and necessary for measles prevention. With measles outbreaks occurring in neighboring states, it is important to stay educated and up-to-speed on the symptoms, complications, and prevention strategies. Encouraging parents to ensure their children have received both doses of the MMR vaccine is the quickest and safest way to protect them.