The World Health Organization once declared measles eradicated in the United States, but lately the disease has made a resurgence. The latest outbreak is in West Texas and New Mexico — so far, there are over 300 reported cases and two deaths, though experts fear many other cases haven’t been reported. What’s going on? Should we be worried in New Hampshire? On this episode of “The State We’re In,” Melanie Plenda discusses talks with Dr. Gabriela Andujar Vazquez, hospital epidemiologist at Dartmouth Health’s Dartmouth-Hitchcock Medical Center.
By Rosemary Ford and Caitlin Agnew
This article has been edited for length and clarity.
Melanie Plenda:
Doctor, why are we seeing a resurgence in measles cases?
Dr. Gabriela Andujar Vazquez:
Even before the COVID-19 pandemic, we had started seeing, nationally, a decrease in our vaccination rates, and mainly childhood vaccinations. During the pandemic, that worsened and the rates nationally started decreasing below the 95% threshold where we like to see vaccination rates to be in order to create herd immunity so the community is protected. What we're seeing with measles — which is among one of the vaccine-preventable diseases — is that it mainly is being driven by those declining rates of vaccination.
Melanie Plenda:
What does measles look like? What are the symptoms, and when should you seek medical help?
Dr. Gabriela Andujar Vazquez:
Measles starts with a high, high fever. The struggle is that this particular virus mimics, or is similar to, other childhood illnesses — a fever and rash. Parents experience that a lot. But, it will start with a very high fever, usually up to 105 Fahrenheit, and then four to five days after, you can break into a rash. Usually it starts in the face, and then it spreads through the whole body. People get a cough, runny nose and the eyes become a little bit red.
Call your pediatrician when they're having that high fever because there are severe complications. There are health implications, especially for children, when they get measles.
Melanie Plenda:
Why is what’s happening in Texas and New Mexico concerning?
Dr. Gabriela Andujar Vazquez:
The outbreak is not controlled yet. We have pockets right in the United States where the rates of vaccination may be lower than the national levels. In West Texas, the particular community where the outbreak started, vaccination rates for children were in the low 80s. The outbreak that's happening in New Mexico is a consequence of the West Texas outbreak. There was a pocket of a community there that was also vulnerable, because their vaccination rates were low.
Melanie Plenda:
What’s the likelihood of this outbreak or others spreading?
Dr. Gabriela Andujar Vazquez:
We know that within New Hampshire and Vermont, there are areas where vaccination rates overall are lower than what we want them to be to protect the community. Every state, I think, has been struggling with this. I think in New Hampshire, we are likely to see cases in the future. Hopefully, those come in a cluster, and we can contain them quickly and it doesn’t spread, but we are definitely vulnerable for identifying or getting outbreaks here as well.
Melanie Plenda:
What would happen if the measles spread to New Hampshire? Is the state prepared?
Dr. Gabriela Andujar Vazquez:
In 2024, there was a measles case identified in the summer, and that was actually pretty well contained, with the collaboration between Dartmouth Health and the Department Health and Human Services in New Hampshire. I think every state, including New Hampshire, is prepared to contain an outbreak.
I would say that once we identify those cases, the key thing for the community to know is if you're sick and you think you may have measles is to wear a mask. That helps contain the spread. It produces source control, so we don't infect others while we're sick, and figuring out if we actually have measles.
Vaccination is the other key — making sure that we're up to date on that too, and if we don’t know to ask questions to your doctors. “Am I really protected? Should I be getting another dose of a vaccine?” So I think those conversations need to happen amongst us to protect our community and those most vulnerable — people that will not be able to get vaccinated.
Melanie Plenda:
Tell us about New Hampshire’s vaccination rates for measles. Is it high enough?
Dr. Gabriela Andujar Vazquez:
Unfortunately, it’s not. Based on data from the 2023-24 school year . across all vaccines that are recommended for children going into kindergarten we're around 89% — so we're 5% below of what we would ideally want. That's across the state of New Hampshire. There's probably areas where that may vary, where maybe some vaccination rates are higher and some are lower, and that may vary also based on vaccine.
Melanie Plenda:
How safe is the vaccine? Should any certain area of the population be more concerned or be taking more steps for safety?
Dr. Gabriela Andujar Vazquez:
The vaccine was introduced in 1963 — the vaccine that we actually give now was revamped in 1972. Individuals who were born before 1957 were in a state where they were either probably had measles and are thought to be immune because of natural illness because there were multiple measles outbreaks constantly. Usually, if you're born before that date, you should be good — you should be protected.
When you're born between 1963 and 1967, there was a measles vaccine, but that vaccine was later found to not be as effective as the one that we give now.because it was a killed virus vaccine, not like the live attenuated vaccine of today, which is a little bit more effective in producing immunity. So individuals born between 1963 and 1967 are recommended to get at least one dose of the current vaccine.
After that, if you’ve got your two doses of your childhood vaccination of MMR, you should be protected. There are obviously different conversations that can happen based on your individual risk — medical conditions or things that change over time, and I would encourage those patients to talk to their doctor about. But overall, we can confidently say that if you got your two doses, you're protected for life.
Melanie Plenda:
Does the vaccination prevent you from getting the virus?
Dr. Gabriela Andujar Vazquez:
Yes, absolutely. One dose is 93% effective, and a second dose is 97%. What that means is that your individual risk of contracting measles is reduced by 97% if you get exposed to measles.
Melanie Plenda:
What about the cost of the measles vaccine?
Dr. Gabriela Andujar Vazquez:
In the United States, each state has a vaccination program. In New Hampshire, we have a vaccination program basically called New Hampshire Vaccine Group. What that group does is purchase, basically, vaccines that are recommended for children, and they provide the vaccine to all children at no cost, regardless of whether they have insurance or not, whether they are able to pay or not. So for children, it is completely free, right off the bat, in basically all of the states in the United States. For adults, it is covered, but usually through insurance.
Melanie Plenda:
Are there other outbreaks or causes of concern that you are watching right now?
Dr. Gabriela Andujar Vazquez:
Right now, measles has been taking up a lot of the past couple of weeks, because it's been ongoing, and we're worried that it's still probably a lot of work to be done. There's also been a lot of talk around avian flu and the concerns around how much or how little that may affect human transmission. So far, a lot of the cases across the country have been related to occupation — individuals who work with poultry or cattle and get exposed to a sick animal.
But we have had avian influenza in our flocks for many years. It's not like it's new, but I think we're seeing that it's mutating in a way that it's affecting maybe more of the animals than it used to.
Another thing that comes and goes every five years is norovirus — a virus that causes gastrointestinal problems, like vomiting and diarrhea. It actually starts around spring to pick up, and it seems like it's going to be something that we need to watch for.
Melanie Plenda:
What’s your advice for those who are concerned about this or other outbreaks?
Dr. Gabriela Andujar Vazquez:
It’s basically just asking questions – keeping ourselves informed and having good resources for reliable information. We want to make sure that people are well informed, but with evidence and not necessarily things that may not have not been proven and alarm people unnecessarily. Having conversations personally with your healthcare provider should be a trusted source, then just talking about concerns and sort of fielding those questions to the appropriate experts.
Melanie Plenda:
Dr. Gabriela Andujar Vazquez, hospital epidemiologist at Dartmouth Health’s Dartmouth Hitchcock Medical Center, thank you for joining us today.
“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members.
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