by George Lewinnek ·
Friday, April 10, 2026
The recent outbreaks of measles are the largest in this country since 2000, when the disease was declared eliminated in the United States, according to a January 2026 article by Dr. Robert H. Shmerling in HarvardHealthOnline+, a Harvard Medical School site for lay people.
The outbreaks involved 2,671 cases in 44 states over 12 months. The largest outbreak was in West Texas, where 99 cases required hospital care. Two school children who had never been vaccinated died.
The answer is “no,” but with qualifications for those who have not been vaccinated. The reasons for the “no” are based on the history of measles before vaccinations became available, and the history of controversies that have developed over vaccination.
In the days before vaccinations, almost every child would have had the disease. Usually it was mild, but not always. The disease began with a cough, nasal congestion, and inflamed eyes. Fever, sometimes as high as 104 to 105 degrees, might develop, with occasional seizures from the high fevers. Then a rash of slightly raised red patches began on the face or around the ears. Patches expanded. They spread to the trunk and the extremities. Within days after the rash started, recovery began. The entire illness lasted seven to 10 days.
Electron microscopes revealed the virus that causes measles. Virus particles attack the lining cells along the airways, from the nose to the lungs. The virus also attacks the immune system cells in the airways. Further spread beyond the airways occurs; signs of the virus have been found elsewhere, including the skin and the brain.
Serious complications were—and still are—rare. The Centers for Disease Control and Prevention (CDC) reported that in a severe outbreak in 1958 deaths occurred in about one of every 2,000 cases. Death, when it occurs, is most often from pneumonia.
Statisticians note that gamblers can ignore risks below 5%, such as the roulette table risks of the ball stopping on a 00. The risk of death from a case of measles is an infinitesimal fraction of 5%.
An even rarer fatal complication than death from pneumonia is delayed inflammation of the brain. The technical name is “subacute sclerosing panencephalitis.” Symptoms begin—surprisingly—around 10 years after the initial illness. It is invariably fatal. Studies after death show portions of the measles virus in the brain tissue. Fortunately, this brain inflammation occurs only about once in every 5,000 cases.
More moderate complications include permanent problems with vision and hearing. Also, after the attack by the measles virus, the immune system is less effective for two or three years.
Measles is very infectious. Before vaccines were available, the average person who developed measles infected 12 to 18 others, and measles occurred in outbreaks or epidemics in comminities that could last two to three months. Every child who was not already immune became infected. Then the outbreak ended, not to recur for two to five years, by which time there was a new group of vulnerable children.
Even today physicians lack a cure for measles. Antivirals do not work on this RNA virus. Vitamin A has a moderating effect, mainly in limiting eye complications. However, home treatment with Vitamin A has led to liver damage, for an excess of this vitamin is toxic.
In some reports, 5% to 10% of all measles cases are hospitalized. Most hospitalizations are for pneumonia.
In the U.S. today, there is opposition to vaccination. Some, like the Amish and the Mennonites, have a community tradition of opposing modern practices. Others, including Robert F. Kennedy Jr., Secretary of Health and Human Services, have argued that vaccines are linked to autism (a significant developmental problem that can occur in children), or that a case of measles protects against cancer. Neither claim meets the standards of medical authorities. Kennedy now recommends vaccination against measles, not as a mandate, but as an individual choice.
For an individual, choosing vaccination has the benefit of avoiding death from pneumonia or brain inflammation, as well as any eye, ear, and immune complications of measles.
For a community, there may be a wish to avoid the disruptions to households and to schools by outbreaks. There is also a concern about costs. One dose of measles vaccine is $1 or less, according to the World Health Organization. The hospital costs of caring for even the occasional case of pneumonia are much higher.
According to the federal Communicable Disease Center, 95% or more of a community must be vaccinated to avoid outbreaks. In some states, including Massachusetts and New York, school authorities will not allow a student to attend school unless the student has received the MMR (measles-mumps-rubella) or MMRV (measles-mumps-rubella-varicella) vaccines. In Massachusetts, the vaccination rate is now 97%. New Hampshire, however, has only an 89% vaccination rate.
Sandi Richard, community health nurse with the Nashoba Associated Boards of Health, reports there have been no recent cases of measles in our area. She had no local information to supplement the statewide vaccination rate of 97%—there are no surveys of local doctors’ offices to determine the percentages of children who receive vaccinations.
To return to the question with which we started, should Harvard residents worry?
For those who have been vaccinated, the answer is, no. The protection provided by vaccination is very good. Those who have not been vaccinated but were born before 1957 can assume they are immune from childhood exposure. They too need not worry.
For those who have not been vaccinated, the answer is still that there is little to be concerned about, as long as they remain in Massachusetts or travel to states with high vaccination rates. The community vaccination rate protects them from outbreaks. They are slightly more exposed than the vaccinated are, but their risks are low enough that they could be ignored.
However, if the unvaccinated travel to areas with vaccination rates below 95%, the risks go up. Then it is time to worry. They may encounter an outbreak. Then they are likely to get infected. If their circle of family and friends back home is also unvaccinated, then everyone in the circle should worry as well. Then one thinks again about those two deaths in West Texas.
A history of the measles vaccine
Measles vaccines were developed just after polio vaccines. The same techniques were used for both. The first measles vaccine became available in 1963. This first vaccine had more side effects than later ones—side effects like a mild illness with low-grade fever.
Over time, measles vaccines were combined with others. The combination MMR inoculated against measles, mumps, and German measles (rubella). The combination MMRV added chicken pox (varicella). Newborns are protected against measles for about a year by factors passed to them from their mothers. Because of this, the initial MMR or MMRV vaccine is given late in the first year, in the United States often around 9 months. Protection is more reliable if a booster dose is given, often at about 18 months of age. The protection with two shots, which is about 97%, lasts a lifetime. There is no need for later measles booster shots.
The human measles vaccine came under attack in 1998 in an article in a respected British medical journal, The Lancet. The author asserted a link between MMR vaccine and autism, but without robust scientific evidence. Later, better studies showed no link with autism. The Lancet retracted the paper. British authorities investigated. In 2010, they barred the author from any further practice of medicine.
—GL