Loading ...

The measles outbreak in West Texas that has killed one child to date and spread to neighboring New Mexico has pediatricians and other physicians across the country rethinking patient protocols as cases emerge elsewhere.

States where additional cases have been reported as of March 5 include Alaska, California, Georgia, Kentucky, New Jersey, New York City, and Rhode Island. Outbreaks have become more common in recent years, largely due to the dropping immunization rates globally.

The current national vaccination rate is 92.7%, down slightly from 93.1% in 2022-2023, according to the Centers for Disease Control and Prevention (CDC). The target rate for all vaccines is 95%, which the CDC says is the threshold necessary for herd immunity.

The most recent tally of cases nationally is 164, with the CDC reporting that 153 (93%) are outbreak-associated cases. And it’s only March. That’s compared with 198 (69%) of 285 outbreak-associated cases reported in 2024. The CDC defines “outbreak” as three or more cases.

The CDC also reports that 95% of those infected in the current outbreak are either of unknown vaccination status or unvaccinated. Nearly half of the currently measles-infected persons nationally are children.

Outbreak Fears in Some States

In Alaska, the measles, mumps, and rubella (MMR) vaccination rates are at 84.3% — a more than 10% drop from where they were a decade ago, according to the CDC.

This concerns John Cullen, MD, a family medicine doctor in Valdez, Alaska. “Our vaccine rates in Alaska are pretty horrible,” he told Medscape Medical News. He said he believes vaccine rates are at least 5 percentage points lower than federal reports.

“We’re just set up for a measles outbreak. I’ve been telling everyone it’s just a matter of time. We need at least 90% to have immunity, and we’re nowhere near there.” Cullen is a past president of the American Academy of Family Physicians (AAFP).

“I’m really worried about it. I wonder if we should start bringing kids in earlier for their immunizations,” Cullen said. “There’s a reason why this particular schedule was settled, but it doesn’t mean that under emergencies that we can’t change the schedule a little bit. It’s not something I would be doing on my own, though, but maybe with the CDC or the chief medical officer of Alaska.”

Pediatricians in Kentucky are also wary, according to Kristina Bryant, MD, a professor of pediatrics in the Division of Pediatric Infectious Disease at the University of Louisville School of Medicine, Louisville, Kentucky. Now that an adult case of measles has been confirmed by Kentucky public health officials, Bryant said, “There is a lot of worry among pediatricians that we could see cases in children next. Anecdotally, I think there is a lot of worry among parents too, especially with the recent death of a child in Texas who was infected with measles.”

During the 2023-2024 school year, an estimated 90% of Kentucky kindergarteners were fully vaccinated against measles, according to federal data. Bryant said that rates of immunization could be even lower in some communities.

“Pediatricians in Kentucky know that this puts us at risk for outbreaks of measles,” Bryant told Medscape Medical News.

‘Firing’ Patients

In Kentucky, Bryant said signs are that many parents are proactive. “Pediatric offices report a spike in phone calls from parents wanting to make appointments for vaccination or confirm that their child is up to date with MMR vaccines,” she said.

“I’ve had a few patients already asking me about their vaccination status — mostly adults,” Alexander Hernandez, MD, an internist with CHI Saint Joseph Medical Group in Lexington, Kentucky, told Medscape Medical News.

Hernandez said he is pondering asking noncompliant families to find care elsewhere, which he said might be difficult for them to do. “It’s a gray area. I want these kids to get cared for, but I also have to think about my other patients,” he said. Hernandez’s practice is focused on pediatrics.

Cullen said, “That’s sort of the question I ask myself. We do full spectrum family medicine, which means that I have a fair number of pregnant people in my clinic, and so I do worry about that. But we are the only real clinic for about 120 miles.”

Instead of firing patients, he cajoles them. “I tell them I’m very flattered that they think I can handle their child with measles or some other infectious disease, when I can’t,” he said. “I mean that’s just not something that we have any treatments for.”

Cullen also shares his own experiences, which he said largely has proven effective at easing patient fears. “I’m the last generation of docs that really saw a lot of meningitis because the Hib [Haemophilus influenzae type B] vaccine came out while I was in residency,” Cullen said. “I always tell people I’m really good at doing spinal taps because I did so many when I was in medical school. But then there was the vaccine and that was that. It was just the most amazing thing I’ve ever seen. So, I’m just trying to communicate how amazing vaccines are.”

Despite the dramatic effect of vaccines, a growing distrust of science and fears of potential adverse outcomes have contributed to decreasing immunization rates nationally, according to Susan H. Wooton, MD, a professor of medicine and a pediatric infectious disease specialist at McGovern Medical School at the Texas Medical Center in Houston, Texas.

“I think after COVID, people are more wary [and] they are less trustful of science,” said Wooton. “We’ve always had an antivaccine movement for as long as we’ve had vaccines. But with social media, the capacity to spread vaccine disinformation is exponential,” Wooton said. “For whatever reason, the people who won’t vaccinate feel the risks outweigh the benefits.”

COVID Era ‘Parking Lot’ Clinics and Telehealth

Should measles continue to spread in Kentucky, Hernandez said he has been considering how best to protect his patients.

“We may have to start seeing patients in a telehealth visit to avoid any contamination,” he said. “That is not optimal because we also can’t do an exam to see what’s causing the fever or do a lung exam,” Hernandez said.

In the meantime, Hernandez asks patients to call ahead if they suspect measles, so that his call center can identify who might need a telehealth appointment. And he also asks all patients, symptomatic or otherwise, to wear a mask in the waiting room.

“We actually have had a long-standing policy for rashes to keep those patients out in the parking lot,” Cullen said. “We have a parking lot that’s really close to the clinic. We just go out and take a look at the child outside. We fine-tuned that when we were dealing with COVID and so we actually have a whole protocol set up as far as taking care of people outside, which in Alaska can be a little bit daunting.”

Develop Suspicion

Wooton thinks that since most clinicians in the United States have never seen a case of measles, “There’s going to be a very steep learning curve as to how this presents.”

Jay W. Lee, MD, MPH, family physician, Director of Primary Care at CareMore Health in Long Beach, California, and a board member for the AAFP, told Medscape Medical News said that he is reviewing protocols that his office had in place for COVID in the event that a patient arrives with respiratory symptoms, fever, and a rash. “But, quite frankly, in my 23 years of doing this, I actually have not seen a single case because vaccines were so effective that in 2000 we declared it resolved as a public health matter.”

Cullen said that there is a risk of misdiagnosing measles since the thinking was that it had been eradicated. “I think that’s true for all infectious diseases. It’s true for Haemophilus influenzae B. I think that’s true for meningococcal disease. I mean, these are all ones that should be gone. We have the technology. It’s just very frustrating to see them coming back.”