The tragic death of a child in Texas prompted us at the Independent Medical Alliance to prepare a series of short  videos to inform our viewers about measles.

Measles circulates cyclically and there are a few cases every year in the US.  In the 25 years ending at the beginning of February 2025, there were 4,499 cases in the US or about 180 cases per year. The last spike in cases happened in 2019, with over 1200 cases that year.  There was a lot of press blaming orthodox Jews in New York as you may recall.

Measles is usually a self-limited illness with rare side effects if it affects a child who lives in a developed country.  Measles is much more serious for children who live in developing countries without access to proper sanitation and clean water, especially if they live in crowded conditions.

Some reports of death rates include deaths in developing countries and should not be extrapolated to the US or other developed nations.  Risks of many viral illnesses vary depending on the underlying health of the patient and the circumstances in which they live.  Vaccine decisions should take those factors into account.

High dose vitamin A (50,000 to 400,000 units a day for 2 days only) is remarkably effective in treating measles.  While vitamin A supplementation is effective in reducing total mortality and complications from measles infections, it is likely to be more effective in populations suffering from nutritional deficiencies. To start with.  Vitamin C is also an  excellent antiviral and treats oxidative stress from the illness itself.  Adequate Vitamin D levels are also protective.

Sometimes people hear of a measles outbreak and think they should run out and urgently get their child an MMR booster.  However, both the monovalent measles vaccine and the triple measles mumps and rubella vaccine have been shown to decrease Vit A levels 9-14 days after vaccination, to a significant degree (p value =.005).  So, it may not be prudent to do a booster which is likely to decrease vitamin A levels if the child does get measles.

Adequate Vitamin A levels are a factor that is associated with the child doing well with a measles infection. Malnutrition, especially vitamin A deficiency, is a primary cause of more than 100,000 measles deaths annually in underdeveloped nations. In the U.S. and other developed countries, 92% of hospitalized measles cases are low in vitamin A.

The incubation period for measles is 11-12 days until the prodromal symptoms of nasal congestion, cough and red eyes begin. The rash comes a few days later and measles illness usually lasts 7-10 days.  The patient is contagious from 4 days before to 4 days after the rash per CDC guidance.

Measles can be treated with high dose Vitamin A for 2 days as discussed but also with immune globulin (for immunocompromised patients or those on chemotherapy) and ribavirin, and anti viral.

Common complications from measles included diarrhea and ear infections.  Very uncommon complications include pneumonia and encephalitis.  Death in developed countries is extremely rare.  My thanks to Physicians for Informed Consent for the data I am about to present.

Some risks to the measles:

• 0.03–0.035% of measles cases result in seizure.10
• 1 in 20K = 0.005% of measles cases result in measles encephalitis.4
• 0.00125% of cases result in permanent disability from measles encephalitis.4
• 0.7% of cases are hospitalized.11
• 0.0006–0.0022% of cases result in subacute sclerosing panencephalitis (SSPE).12
• 0.001% of measles cases with normal levels of vitamin A result in permanent disability or death.13
• Make graphic from data below
• 3 to 3.5 in 10,000 or 0.03–0.035% of measles cases result in seizure.10
• 1 in 20,000 or 0.005% of measles cases result in measles encephalitis.4
• 1 in 80,000 or 0.00125% of cases result in permanent disability from measles encephalitis.4
• 7 in 1,000 or 0.7% of cases are hospitalized.11
• 6 to 22 in 1,000,000 or 0.0006–0.0022% of cases result in subacute sclerosing panencephalitis (SSPE).12
• 1 in 93,000 or 0.001% of measles cases with normal levels of vitamin A result in permanent disability or death.13

Most people are not aware that deaths from measles declined dramatically PRIOR to MMR vaccine development or use.  Measles vaccine was introduced in 1963.  Deaths from measles has been quite scarce since 1950.  Many vaccine preventable diseases declined due to better sanitation including indoor toilets and clean water sources.   Between 1900 and 1963, the mortality rate of measles dropped from 13.3 per 100,000 to 0.2 per 100,000 in the population, due to advancements in living conditions, nutrition, and health care — a 98% decline.

In the next video we will examine some aspects of the controversy about MMR  vaccines.

References:

Eduardo Villamor, Wafaie W. Fawzi, Vitamin A Supplementation: Implications for Morbidity and Mortality in Children, The Journal of Infectious Diseases, Volume 182, Issue Supplement_1, September 2000, Pages S122–S133, https://doi.org/10.1086/315921

YalÇIn, S. SongÜL, Kadriye YurdakÖK, İMran ÖZalp, and Turgay CoŞKun. “The effect of live measles vaccines on serum vitamin A levels in healthy children.” Pediatrics International 40, no. 4 (1998): 345-349.

Centers for Disease Control. Current trends measles — United States, 1990, June 1991. MMWR. 1991 Jun;40(22):369-72. https://www.cdc.gov/mmwr/preview/mmwrhtml/00001999.htm; in 1990, there were 13,310 reported cases of measles under age 5 (48.1% of 27,672) of which 49 were fatal, resulting in case fatality rate of 0.37%.

World Health Organization. Measles vaccines: WHO position paper. Wkly Epidemiol Rec. 2009 Aug 28;84(35):350. https://apps.who.int/iris/bitstream/handle/10665/241404/WER8435.PDF?sequence=1; the measles case-fatality rate for young children in underdeveloped nations, where vitamin A deficiency is prevalent, is about 5–10% of reported cases, 14 to 27 times higher than in developed countries.7

Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington, D.C.: Public Health Foundation; 2015. Appendix E3. https://physiciansforinformedconsent.org/cdc-pink-book-13th-edition-and-appendix-e-2015-combo.

Grove RD; Hetzel AM; U.S. Department of Health, Education, and Welfare. Vital statistic rates in the United States 1940-1960. Washington, D.C.: U.S. Government Printing Office;1968. 559-603. https://www.cdc.gov/nchs/data/vsus/vsrates1940_60.pdf

Magno H, Golomb B. Measuring the benefits of mass vaccination programs in the United States. Vaccines. 2020 Sep 29;8(4):3-5. https://pubmed.ncbi.nlm.nih.gov/33003480/.

Langmuir AD, Henderson DA, Serfling RE, Sherman IL. The importance of measles as a health problem. Am J Public Health Nations Health. 1962 Feb;52(2)Suppl:1-4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522578/; between 1959 and 1962, annually there were 400 measles deaths5 out of 4 million cases2, about 1 in 10,000 cases

Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington, D.C.: Public Health Foundation; 2015. 210. https://physiciansforinformedconsent.org/cdc-pink-book-13th-edition-2015/; measles surveillance in the 1980s and 1990s showed that there are 3 to 3.5 times more measles seizures than measles deaths (3 to 3.5 per 10,000 cases).

Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Hamborsky J, Kroger A, Wolfe S, editors. Washington, D.C.: Public Health Foundation; 2015. 210. https://physiciansforinformedconsent.org/cdc-pink-book-13th-edition-2015/; measles surveillance in the 1980s and 1990s showed that there are half as many cases of measles encephalitis as there are measles deaths, 1 in 20,000 cases (50% of 1 in 10,000 cases of death). Of these cases, 25% (1 in 80,000 cases) result in residual neurological injury.

Centers for Disease Control. Current trends measles — United States, 1990, June 1991. MMWR. 1991 Jun;40(22):369-72. https://www.cdc.gov/mmwr/preview/mmwrhtml/00001999.htm; measles surveillance in 1990 showed that there are about 70 times more measles hospitalizations than measles deaths (7 per 1,000 cases).3

Merck. Whitehouse Station (NJ): Merck and Co., Inc. M-M-R II (measles, mumps, and rubella virus vaccine live); revised 2015 Oct. https://physiciansforinformedconsent.org/merck-mmr-measles-mumps-rubella-ii-package-insert.

Butler JC, Havens PL, Sowell AL, Huff DL, Peterson DE, Day SE, Chusid MJ, Bennin RA, Circo R, Davis JP. Measles severity and serum retinol (vitamin A) concentration among children in the United States. Pediatrics. 1993 Jun;91(6):1177-81. https://pubmed.ncbi.nlm.nih.gov/8502524/; about 5% of children have low levels of vitamin A, therefore of the 4 million annual measles cases before the vaccine,2 3.8 million (95%) have normal levels of vitamin A. Before the vaccine, 41 annual measles cases with normal levels of vitamin A resulted in permanent disability or death,9 therefore, the risk of permanent disability or death for measles cases with normal levels of vitamin A is 41 in 3.8 million (1 in 93,000).

Perry RT, Halsey NA. The clinical significance of measles: a review. J Infect Dis. 2004 May 1;189 Suppl 1:S4-16. https://academic.oup.com/jid/article/189/Supplement_1/S4/823958.

California Department of Public Health. Sacramento (CA): California Health and Human Services Agency. Measles investigation quicksheet: August 2023; [cited 2023 Dec 26]. https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immunization/Measles-Quicksheet.pdf.

Roy Moulik N, Kumar A, Jain A, Jain P. Measles outbreak in a pediatric oncology unit and the role of ribavirin in prevention of complications and containment of the outbreak. Pediatr Blood Cancer. 2013 Oct;60(10):E122-4. https://pubmed.ncbi.nlm.nih.gov/23629813/.