NH doctors: Concerns for measles rise as vaccine rates drop

Measles, a disease almost eliminated, is once again on the rise as the rate of children receiving the vaccine has declined in recent years.

New Hampshire state epidemiologist Dr. Benjamin Chan said according to the World Health Organization, there has been a “30-fold increase of measles infections in the European regions.”

“The more that circulates translates to an increased risk here from travelers,” Chan said. “That is just what we are seeing now, with smaller outbreaks happening already across the country.”

USA TODAY reported measles cases in the United States have already surpassed 2023’s total, according to the Centers for Disease Control and Prevention.

The CDC on March 21 reported there have been 64 measles cases in the United States in 2024, in 16 states plus New York City. There were none in New Hampshire to date, but Chan said he is very concerned the state could begin to see cases. There were 58 cases in the United States in 2023.

On March 18, the CDC issued a health advisory, warning people, especially children and travelers, about the rise in cases, recommending immunization.

Chan said the measles vaccine is given in two doses, one in children 1215 months old, and the second between 4-6 years old.

“If a family is going to be traveling, we can give an extra early dose, to a child down to six months of age,” he said.

Why is measles vaccination important for everyone?

Chan said there are people who truly cannot be vaccinated, mostly for medical reasons, and because some religions bar it.

“So, having the rest of the population, those who can get it offers herd immunity to those who cannot, in addition to protecting themselves,” said Chan. “We rely on a lot of that immunity to help prevent outbreaks. We are seeing a general slow decline in the percentage of vaccinated kids every year and that is concerning. According to yearly data, there are 4% of kids entering kindergarten now who are not vaccinated. That number used to be less than half of 1% and that came from medical exemptions.”

Pediatrician speaks up on dangers of anti-vaccine misinformation

Pediatrician Dr. Walter Hoerman of Salmon Falls Family Healthcare in Somersworth is alerting the community and asking parents to listen.

“I know parents think that most of their children’s classmates are immunized,” Hoerman said. “Most are unaware that you just have to check the religious exemption box, no questions asked, and the child is not required to receive the vaccine prior to entering school.”

Hoerman said the religious exemption used to require notarization in New Hampshire, but that changed in 2022. Chan agreed.

“There are two types of exemptions from the MMR (measles, mumps and rubella) vaccine,” said Chan. “There is a medical exemption and religious one. A few years ago, the legislature removed the requirement for a notary. So now, parents need only fill out the form.”

Hoerman said the United States was declared eliminated from community transmission of measles in 2000. He said the country is now at risk for losing that designation.

“It is scariest for babies who can’t be protected until 1 year old,” said Hoerman. “We need to be at 95% immunization to keep it from spreading. We are not. Prior to the introduction of measles vaccination in 1963, there were (more than) 100 million measles cases, resulting in 6 million deaths worldwide, with 4 million cases and 450 deaths in the U.S. annually.”

Hoerman said his understanding is people opposed to vaccines are telling parents they need only check the religious exemption box.

“Parents who do vaccinate their children are thinking that the classmates sitting around their child are also vaccinated, and that might not be true,” Hoerman said. “This is so ridiculously contagious, why are we messing with it?”

A common false claim about the measles vaccine is that it is linked to autism.

“That has been totally debunked,” Chan said. “There is absolutely no relationship between the MMR vaccine and autism. Every vaccine has a potential for side effects, but they are the usual, injection site pain or redness, fever, all self-resolving things.”

How dangerous is measles?

Many people think measles causes you to get a rash, be itchy and then get better. Chan said it is much more than that and can be extremely dangerous.

“Measles starts with typical early symptoms,” Chan said. “Those can be a high fever, cough, runny nose and conjunctivitis. Several days later, the patient will develop a febrile rash and get sicker. One in five unvaccinated children will require hospitalization.”

Chan said one in 20 kids infected with measles get a more severe lung infection like pneumonia. He said one in 1,000 will get a brain infection like encephalitis (a swelling of the brain), which can be fatal.

“And it is entirely preventable,” said Chan. “I would tell parents to talk about their concerns with a trusted health care provider, to get the real facts. I am concerned with the direction this is going, and I think the better the education out there, the better the chances we have of heading off more serious outbreaks.”

How measles spreads

Measles is highly contagious, spread through the air. Chan said the last case in New Hampshire originating with a state resident was in 2011, however there have been isolated cases of New Hampshire children catching it from travelers.

“Measles is one of the most infectious diseases we deal with in the public realm,” Chan said. “And yet, we have a vaccine that is one of the most effective and reliable - if it is used.”

Chan said measles is spread when an infected person, breathes, talks or coughs.

“It can remain infectious in the air for two hours after the infected person leaves,” he said.