Measles
- mfulk78
- Jul 8
- 5 min read
As I have told many of my patients, I would write immediately when NC sees its first Measles case.
Well, North Carolina has its first measles case: The North Carolina Department of Health and Human Services has confirmed a case of measles in a child who was visiting Forsyth and Guilford counties. The child became ill while traveling to NC from another country where measles outbreaks have recently been reported. To protect the individual and their family’s privacy, no additional information about this individual will be released. This is the first confirmed case of measles in the state in 2025. NCDHHS is recommending all unvaccinated individuals ages one year and older receive measles vaccination to protect themselves and those around them. (NCDHHS)
So, it is finally in NC. If you are still on the fence of whether to vaccinate, the issue is now truly pressing.
From the CDC:
U.S. Hospitalizations in 2025
12% of cases hospitalized (148 of 1227)
Percent of Age Group Hospitalized
Under 5 years: 20% (72 of 355 cases) 50% of the total hospitalized. Highest risk bucket.
5-19 years: 8% (35 of 455)
20+ years: 10% (40 of 404)
Age unknown: 8% (1 of 13)
Deaths 3
U.S. Cases in 2025
Total cases
1227
Age
Under 5 years: 355 (29%)
5-19 years: 455 (37%)
20+ years: 404 (33%)
Age unknown: 13 (1%)Vaccination Status
Unvaccinated or Unknown: 95%
One MMR dose: 2%
Two MMR doses: 3%
In case you missed it a few weeks ago.
What is measles - a refresher?
Measles is a serious, highly contagious and potentially deadly viral infection. It is caused by an RNA paramyxovirus. It is spread by contact with droplets from an infected person's nose, mouth or throat. Sneezing and coughing can aerosolize the droplets and increase the range of infectious spread. Symptoms usually develop 8 to 10 days following exposure to an infected individual. A sick individual is contagious for 4 days before and 4 days after symptom onset. The reproductive rate is very high at 12+ meaning that 1 person will infect 12 and those 12 will get 12 more sick (144) and then 144 X 12 = 1728 X 12 = 20,736 and you are off to the exponential races.
For comparison - some infectious outbreaks of the past and their estimated median r0 numbers are:
· Measles – 12-18
· Chickenpox – 10-12
· Polio – 10-12
· HIV/AIDS – 2-5
· SARS – 0.19-1.08
· MERS – 0.3-0.8
· Common Cold – 2-3
· Ebola – 1.56-1.9
· Seasonal Influenza – 0.9-2.1
· 1918 Influenza Pandemic – 1.4-2.8
· 2009 Influenza Pandemic – 1.4.1.6
· COVID19 – 0.4-5.7 (Shabir 2021)
Measles presents with high fever, rash, cough, myalgias, sore throat and red eyes. Children often look very sick. The rash begins 14 days after exposure and is characterized by red bumps that start on the head and move down the body. The illness can be mild or severe. Some children go on to get encephalitis, a brain inflammatory disorder that can be deadly. This occurs in 1 in 1000 cases of measles. Other complications include: pneumonia, ear infections and sinusitis.
Another rare but serious complication of measles is a disorder called sub-acute sclerosing pan-encephalitis. This is a brain disorder that occurs years after you have recovered from the virus. More below. The immune system over reacts to the virus and slowly causes sclerosis of the brain tissue leading to death. This occurs in 1 per 10,000 infected individuals. The measles death rate is 2 per 1000 cases in the current environment according to the Red Book. These deaths are clustered in the under five year olds and those with immune compromised states.
Measles is very dangerous for pregnant women. It can cause premature birth and miscarriage.
Since I have never seen this disease, I am again avidly reviewing the pictures and clinical history. It was all but eradicated from the US in the 1990's. My partner, Dr. Koontz, has seen it many times during his years of training in Texas in the 1960's. I listen to his stories and he confirms that this is a scary player when it is active and endemic. I encourage those with unvaccinated children to seriously reconsider their position on the vaccine or at least know what the illness looks like. Go to google images and look at the rash and Koplik spots which are pathognomonic for the illness.
If you think that you or your child may have measles, it is imperative that you inform your medical provider or the location that you are going to prior to showing up so that appropriate precautions can be taken to isolate the infected person as to limit the viral spread. Walking into the waiting room dramatically increases viral spread as it is spread through coughing and can live on any surface for 2 hours. Others can then touch a surface containing viral particles and become infected. This is how contagion begins.
Measles is not treatable but you can take Vitamin A as prescribed by your physician to help with the illness or potentially prevent it (a 50% beneficial effect - not even close to vaccination). Vitamin A deficiency is a known risk factor for a bad outcome when infected with measles. The reason for this effect is due to Vitamin A's important role in activating nuclear retinoic acid receptors in epithelial cells, mucous and on innate and/or adaptive immune cells. These necessary responses to vitamin A are hampered in a deficiency/insufficiency state leading to immune weakness and thus measles morbidity risk. Again, the old adage that an ounce of prevention is worth a pound of cure rings true here. Keep adequate vitamin A stores by eating red peppers, carrots, salmon, liver and many other sources.
For a concise and deeper look at immune vitamin A we see: from the Linus Pauling website: "Vitamin A was initially coined “the anti-infective vitamin” because of its importance in the normal functioning of the immune system. The skin and mucosal cells, lining the airways, digestive tract, and urinary tract function as a barrier and form the body's first line of defense against infection. Retinoic acid (RA) is produced by antigen-presenting cells (APCs), including macrophages and dendritic cells, found in these mucosal interfaces and associated lymph nodes. RA appears to act on dendritic cells themselves to regulate their differentiation, migration, and antigen-presenting capacity. In addition, the production of RA by APCs is required for the differentiation of naïve CD4 T-lymphocytes into induced regulatory T- lymphocytes (Tregs). Critical to the maintenance of mucosal integrity, the differentiation of Tregs is driven by all-trans-RA through RARα-mediated regulation of gene expression. Also, during inflammation, all-trans-RA/RARα signaling pathway promotes the conversion of naïve CD4 T-lymphocytes into effector T-lymphocytes − type 1 helper T-cells (Th1) − (rather than into Tregs) and induces the production of proinflammatory cytokines by effector T-lymphocytes in response to infection. There is also substantial evidence to suggest that RA may help prevent the development of autoimmunity." (Linus Pauling Oregon State Web )
If you have a known exposure, seek medical help for possible vaccination or immune globulin therapy. (especially if you are high risk: Pregnant women, infants and people with weakened immune systems).
Dr. M
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