Measles is Back, What Should You Know?

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Measles, a disease that was a rare occurrence in the recent past, has become much more common beginning in 2025. As I have received many questions about measles vaccine and treatment options, I thought it would be a good initial topic to discuss in early 2026.

Measles Cases Continuing to Increase

The incidence of measles in the US and many developed countries has been on the rise. In 2025 the US, the Centers for Disease Control and Prevention have noted 2276 cases in 44 states.1 Most cases (68%) were in children, and the youngest children (<5 years old) have the highest rates of hospitalization (20%).1 In early 2026, these increases continue with 733 cases by February 5, 2026.1

Measles Vaccine is Very Effective

The measles, mumps, and rubella (MMR) vaccine is a very effective live attenuated vaccine.  One dose of MMR is about 90% effective and 2 doses 97%.2,3  Without appropriate immunity (primarily obtained from vaccination), measles is very contagious, causing disease in more than 90% of exposed individuals.3

MMR vaccination is routinely recommended as a 2-dose series (dose 1 at 12-15 months of age, dose 2 at 4-6 years).4-6 Doses as close as 28 days apart are considered valid.  The MMR vaccine is also recommended for susceptible individuals as young as 6 months of age during an outbreak (consult local public health for specifics) or in those planning international travel (doses given prior to 12 months of age do not count towards 2 routine dose recommendation).7,8

How does measles disease present?

Measles has an initial prodrome when symptoms can be similar to a severe cold or flu with fever (often high), cough, runny nose, and conjunctivitis.3,7 The characteristic Koplik spots may be present during the prodrome or may become present a day or two later. The rash, which begins in the head/facial area and spreads downward has been one of the most obvious symptoms of measles, does not present until 2-5 days into the illness. Thus, besides being very contagious, another reason patients transmit it to others is they may not think they have measles while they are most contagious. In healthy individuals, the infectious period is 4 days before and 4 days after the rash appears.3,7

Measles can have complications and infants and young children are at risk for these. The most common complications include diarrhea, ear infections and pneumonia.3 Important, but rare complications include acute encephalitis as well as a late onset (7-10 years later) fatal complication of subacute sclerosing panencephalitis.3

What can I do if susceptible children are exposed?

Vaccines and measles immunoglobulin can be helpful at protecting exposed patients, if the patient is aware and can obtain it in time. The vaccine is the preferred recommendation (84 – 100% effectiveness) in non-immune eligible patients (i.e., ≥ 6 months and without contraindications) who were exposed in the prior 72 hours.7,9 Immune globulin is recommended (76-100% effectiveness) for those who have a risk factor and are unable to receive the vaccine due to age (e.g., < 6 months), timing (e.g., > 72 hours but < 5 days), or contraindication to the vaccine (e.g., immunocompromise, pregnancy).7,9

Are there any treatments for measles?

There are no antivirals that have efficacy against measles.  Data from a 2025 Cochrane review on the use of vitamin A for the treatment of measles, relied on limited studies published in the 1980’s and 1990’s.10 In their review of the studies they found that two doses of vitamin A at 200,000 IU did not result in overall lower risk of mortality; however, it was associated with lower mortality in young children (e.g., < 2 years) and in those who had measles associated pneumonia.10 It also had a slight reduction in measles croup.  The vitamin A was not, however, effective at preventing pneumonia and had only a non-significant impact on the duration of pneumonia.10

Summary

It is important to make sure that all are aware that measles is preventable by a highly effective routine immunization recommended in childhood.  Catch-up vaccination can be given to all those without protection as long as they do not have any contraindications.  When individuals contract measles disease there are no specific treatments, although a 2-dose series of vitamin A may help in some circumstances.

References

  1. Centers for Disease Control and Prevention. Measles Cases and Outbreaks. Accessed February 6, 2026https://www.cdc.gov/measles/data-research/
  2. Paul Gastanaduy, Penina Haber, Paul Rota, Manisha Patel. Chapter 13: Measles. In: Elisha Hall, A. Patricia Wodi, Jennifer Hamborsky, Valerie Morelli, Sarah Schille, eds. The Epidemiology and Prevention of Vaccine-Preventable DiseasesPublic Health Foundation; 2024
  3. James L. Goodson and Thomas D. Filardo. Measles (Rubeola). In: Centers for Disease Control and Prevention (CDC), ed. CDC Yellow Book 2026: Health Information for International Travel.2026th ed. https://www.cdc.gov/yellow-book/hcp/travel-associated-infections-diseases/measles-rubeola.html
  4. American Academy of Family Physicians. Immunization Schedules. Accessed December 12, 2025 https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines/immunization-schedules.html
  5. American Academy of Pediatrics, Committee on Infectious Diseases. Red Book : Report of the Committee on Infectious Diseases 2024 – 2027. AAP Immunization Schedule. Accessed December 12, 2025 https://publications.aap.org/redbook/resources/15585/AAP-Immunization-Schedule
  6. Centers for Disease Control and Prevention. Child and Adolescent Immunization Schedule by Age (Addendum updated August 7, 2025). Accessed September 20, 2025 https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html
  7. Committee on Infectious Diseases, American Academy of Pediatrics. Measles. In: David W Kimberlin, Ritu Banerjee, Elizabeth D Barnett, Ruth Lynfield, Mark H. Sawyer, eds. Red Book: 2024–2027 Report of the Committee on Infectious Diseases (33rd Edition) American Academy of Pediatrics; 2024
  8. Mathis AD, Raines K, Filardo TD, et al. Measles Update – United States, January 1-April 17, 2025. MMWR Morb Mortal Wkly Rep. 2025;74(14):232–238
  9. Montroy J, Yan C, Khan F, et al. Post-exposure prophylaxis for the prevention of measles: A systematic review. Vaccine. 2025;47:126706
  10. Huiming Y, Chaomin W, Meng M. Vitamin A for treating measles in children. Cochrane Database Syst Rev. 2005;2005(4):CD001479