Pediatricians across the country are stepping up efforts to encourage vaccination amid a measles outbreak that led to the death of a child in Texas and infected hundreds, a majority of whom are unvaccinated children.
With cases reported in at least 12 states, providers also are responding to attempts to downplay the seriousness of the disease and are combating misinformation about its origins and treatment options.
Alexandra J. Cvijanovich, M.D., M.Ed., FAAP, a general pediatrician in Albuquerque, N.M., said the outbreak has changed the way many families view vaccination.
Thirty-three cases had been reported in the state as of March 11, and an unvaccinated resident tested positive for measles after dying.
Some families have asked to receive measles-mumps-rubella (MMR) vaccines early for their children, while others have canceled appointments out of fear of exposing their children to measles in a clinical setting, she said. Still other parents have refused vaccination, including families who previously vaccinated their children.
“I remind parents they can’t rely on herd immunity,” Dr. Cvijanovich said. “The herd immunity is going away, so if you want to protect your child, you need to be proactive. I think for my fellow pediatricians, remember that every time you see a child is an opportunity to vaccinate.”
Cases rising
The largest outbreak has occurred in west Texas, particularly Gaines County, which had a nearly 18% vaccine exemption rate among kindergartners for the 2023-’24 school year, according to the Texas Department of State Health Services (DSHS). As of March 11, more than 220 measles cases had been reported in the region, including a school-age child who died in late February. The child was not vaccinated and had no known underlying conditions, according to a DSHS release. It was the first measles-attributed death in the U.S. in a decade.
“The death of a child is always tragic, but it is particularly devastating when a child dies from a preventable injury and illness,” said Valerie B. Smith, M.D., M.P.H., FAAP, president of the Texas Pediatric Society (AAP Texas Chapter). “We grieve for the family and those who cared for this child. We know that MMR vaccination is safe, effective and can help stop the spread of measles and save lives. Pediatricians in Texas will continue to advocate for vaccination and provide access to the MMR vaccine as the most important way to keep children healthy and safe from measles.”
The AAP and the Centers for Disease Control and Prevention (CDC) recommend children receive the MMR vaccine at age 12-15 months and again at 4-6 years. Two doses are 97% effective against measles.
“The reason many parents in the U.S. have not had to worry about measles in decades is because of widespread immunization with this safe and effective vaccine,” said AAP President Susan J. Kressly, M.D., FAAP. “However, when immunization rates drop in a community, the disease can spread, putting our most vulnerable — especially young children — at risk.”
During a press briefing Feb. 26, Lara W. Johnson, M.D., FAAP, chief medical officer at Covenant Children’s Hospital in Lubbock, Texas, said about 20 patients have been hospitalized with measles. Many received supplemental oxygen to help them breathe.
While respiratory issues are a key concern among those hospitalized, Dr. Johnson said neurological issues can occur with the measles virus and may show up years after initial infection.
Opportunities to discuss vaccines
Dr. Cvijanovich recalls treating a teenager in the early 2000s who became infected with measles as an infant after being exposed to an unvaccinated child. The patient later developed long-term effects of the initial measles infection.
“I happened to be there the night he was admitted to get a spinal tap to see if he indeed had the measles virus in his spinal fluid,” Dr. Cvijanovich said. “And I was there the night about a year-and-a-half later when he died of aspiration pneumonia, and he was at that point neurologically devastated. It was horrible watching this perfectly delightful 13-year-old slowly, slowly die. The choices another child’s parents made took away this child from their family.”
Dr. Cvijanovich shares the story with her families to promote vaccination. While many are moved by her experiences, some still refuse immunizations. Still, she encourages her peers to use any and all opportunities with families to discuss vaccination to protect the larger community.
“I do think personal stories are powerful. I think the positive is people are talking about vaccines, and it gives me an opportunity to remind parents about resources,” Dr. Cvijanovich said. “I guess the positive is we are talking about not just measles, but other vaccine-preventable diseases. If a child is in for pink eye, talk about vaccines. Teenagers are notoriously difficult to get in the office, so if they come in for a sprained knee and they’re due for vaccines, bring up vaccines.”
Combating misinformation
In addition to working to vaccinate and treat children, pediatricians also are debunking claims that certain treatments, including vitamin A, can prevent measles.
Many U.S. experts concur with administering vitamin A to all children in the United States with measles, regardless of hospitalization status, according to the AAP Red Book. While there is no specific antiviral treatment for measles, the World Health Organization recommends two doses of vitamin A be administered by a health care professional 24 hours apart for children and adults with measles.
This information may have led some to believe vitamin A can prevent measles. Larger, prolonged doses of vitamin A can cause nausea and vomiting, headache and fatigue, joint and bone pain, blurry vision and skin and hair problems. This also can lead to dangerously high pressures inside the skull that push on the brain, liver damage, confusion, coma and other problems.
“Vitamin A is recommended for children diagnosed with measles to help prevent complications, particularly in children who are hospitalized,” said Sean T. O’Leary, M.D., M.P.H., FAAP, chair of the AAP Committee on Infectious Diseases. “It should not be used to try to prevent measles, and high doses of vitamin A are potentially very harmful. The only effective way to prevent measles is the MMR vaccine.”
Clinicians also are debunking claims that the outbreak of measles was caused by the MMR vaccine itself. According to the CDC and DSHS, genotype testing has linked the outbreak to a genotype of measles virus called D8 that is circulating in Europe.
