Dr. Greg Cohen has practiced medicine in Chariton since 1994 and is president-elect of the American College of Osteopathic Family Physicians. He was named the Rural Health Champion by the Iowa Rural Health Association in 2014 and was awarded the Living Doc Hollywood Award for National Rural Health day in 2015. He was named a Distinguished Fellow by the American College of Osteopathic Family Physicians as well as Physician of the Year by the Iowa Osteopathic Medical Association in 2019.

I was hoping I would never have to write this, but measles has come back to Iowa. Although the last measles case in Iowa was was recorded in 2019, it has been more than a generation since the last significant outbreak. It has been 25 years since the United States was declared measles free—meaning there was no longer year-round spread.

We are now at a 30-year high in cases and still rising. Since the start of this year’s outbreak in Texas, there have now been more than 1,168 cases in at least 35 states, 137 hospitalizations, and three confirmed deaths. 95 percent of those diagnosed with measles this year have been unvaccinated, and all of the deaths have been unvaccinated. The Iowa Department of Health and Human Services announced on June 11 the third confirmed measles case in our state: an unvaccinated child “who was exposed during international travel.”

WHAT MEASLES LOOKS LIKE AND HOW IT SPREADS

For those who have never seen the illness, measles (also known as rubeola) is a viral infection that is most serious for small children, immunocompromised adults, and pregnant women. It is spread through the air and is one of the most infectious diseases on earth.

People who are unvaccinated and have not had measles have a 90 percent chance of contracting the disease if they are exposed. Even people walking down a hallway four to six hours after someone with measles has been there can still contract measles.

Unlike COVID-19 and influenza, measles symptoms typically appear seven to fourteen days after exposure and include fever up to 105 degrees, dry cough, runny nose, red watery eyes and tiny white spots in the mouth called Koplik spots.

The characteristic rash typically starts three to five days after the appearance of symptoms and begins on the face or neck, then spreads to the rest of the body. People with measles become infectious about four days prior to the appearance of symptoms and remain infectious for four days after.

WHY MEASLES IS SO DANGEROUS

About one in nine measles patients require hospitalization. About one in 20 get pneumonia. One or two per thousand get encephalitis or swelling of the brain with brain damage, and one or two per thousand typically die. Other complications include blindness, inclusion body encephalitis, and subacute sclerosing panencephalitis, fatal complications which can occur years after infection.

So, what can we do for someone who gets measles? We can give supportive care like intravenous fluids or antibiotics if a patient develops a bacterial pneumonia, but there are no specific treatments or medications for measles. Let me repeat that: there are no medications for measles. The primary treatment is prevention.

Vaccination with two doses provides 97 percent protection. Even one dose can provide 90 to 93 percent protection. The vaccine is safe. Despite misinformation spread on the internet, some media and even some government officials, the measles vaccine (which has existed since 1963) has been scrutinized and studied again and again, It has been proven safe and effective. There is no evidence of any association with autism.

HOW WE GOT INTO THIS MESS

How did we allow this easily preventable disease back into our country? We stopped listening to the right people and started listening to the wrong people.

In 1998, Andrew Wakefield, a surgeon in the UK, published an article in the Lancet suggesting an association between measles vaccine, a form of enterocolitis, and autism. A close review of his article and methods revealed that he had intentionally fabricated his data in hopes of selling test kits that would have earned him an estimated $43 million a year. He was discredited and essentially lost his title and license to practice medicine.

Despite Wakefield’s fraudulent and unethical behavior, anti-vaccine groups continue to promote his study and his conclusions. That has led to a dramatic drop in vaccination rates in the U.S.

Current measles vaccination rates in Iowa are about 84 percent. National vaccination rates are about 91 percent. While rural vaccination rates for measles are not definitively known, a 2024 study showed general vaccination rates in rural children are about 9 to 10 percent lower than their metropolitan counterparts. Studies show that it takes about a 95 percent vaccination rate to stop measles from spreading.

HOW TO KNOW IF YOU NEED THE VACCINE

If you have had measles or two doses of the vaccine, you are considered immune. If you were vaccinated between 1963 and 1967 and did not get measles, the vaccine you were given was considered less effective and you should get a booster.

If it is unclear whether you received the vaccine or had the disease, you can either get a blood titer for antibodies against measles or get the vaccine. While titer testing can be helpful for certain groups like health care workers, international travelers, or those in areas with active outbreaks, they do not fully reflect immune status. Getting an MMR (measles, mumps, rubella) vaccine is probably preferable. There is no evidence of harm for those who receive additional doses of the vaccine.

Vaccination of children is generally recommended at 12 to 15 months and again between the ages of 4 and 6 years. But in times of outbreak, children as young as 6 months can receive the MMR vaccine, and children under 4 who have already received their first dose can get their second dose earlier.

Although there is no evidence of that the MMR causes birth defects or other harm to pregnant women and their unborn children, measles vaccine is not recommended during pregnancy. If a pregnant woman is exposed to measles, they can receive intravenous immune globulin to provide temporary protection.

HOW TO PROTECT OUR CHILDREN FROM MEASLES

How can we protect our kids during this outbreak? We need to tell people the truth.

1. Measles is a preventable, serious childhood illness. Prior to the introduction of the vaccine in 1963, measles infected 3 to 4 million Americans annually, causing about 500 deaths and 48,000 hospitalizations. Major outbreaks occurred every two to three years and nearly everyone had measles by the age of 15.

2. The MMR vaccine is safe and effective, and has never been shown to have a relationship with autism.

3. The discredited physician in the UK who suggested the relationship with autism was a fraud and was removed from the British Registry of Physicians.

4. Leaving your children unvaccinated in hope that others who are vaccinated will protect them is a bad plan. It will lead to more outbreaks, hospitalizations, pneumonias, brain damage, and deaths.

5. We need to dramatically increase vaccination rates across the country. We have a responsibility to protect ourselves, our loved ones and each other.

6. The longer we allow misinformation to fester and guide our decisions about vaccinating our children, the more likely we will allow not only measles back into our lives but other preventable diseases like polio, rubella, whooping cough, diptheria, and hemophilus influenza as well.

I have spent a lifetime reading studies and continuing my medical education so I could give my patients and the citizens of Iowa the best care and advice possible. Most of your doctors have too. We barely got though a pandemic over the past five years that damaged our health care system, tore the fabric of our society, killed millions, damaged millions more, and divided us, resulting in more mistrust and lower vaccination rates.

We cannot let this be yet another casualty of the COVID-19 pandemic. If you have medical questions or concerns, ask a doctor! We shouldn’t have to spend the rest of our careers battling the preventable diseases that harmed and killed so many children in the past.