The Rise of Measles is Entirely Preventable
By Brenna L. Hughes, MD, MSc, and Naima T. Joseph, MD
In late February 2025, the first confirmed measles-related death in the United States in a decade was reported when an unvaccinated school-aged child in West Texas died. A second measles-related death of a child in Texas is under investigation. Before this recent outbreak, measles cases in the US were low and mostly connected to international travel. As of April 3, a total of 607 measles cases were reported to the CDC from 22 states. The highest number of these cases are in Texas (505 cases) and New Mexico (56 cases), with the vast majority of these cases occurring in unvaccinated people or those whose vaccination status is unknown. And the numbers continue to rise.
Measles, an entirely preventable disease through vaccination, is a highly contagious illness that spreads easily through respiratory droplets. The risk for infection is increasing in some parts of the US due to pockets of unvaccinated populations, vaccine misinformation, and imported cases due to travel.
There are currently two safe and highly effective measles, mumps, and rubella (MMR) vaccines available to protect against measles. The MMR vaccine is given in two doses, the first at 12-15 months of age and the second at 4-6 years old. Older children and adults with no prior history of vaccination or little to no immunity against measles based on lab tests may need 1 or 2 doses of the MMR vaccine.
Measles and Pregnancy: A Dangerous Mix
Pregnant people are considered susceptible to measles, so it is important to get the MMR vaccine prior to becoming pregnant if not already vaccinated.
During pregnancy, maternal and fetal complications from measles infection can be very serious and even deadly. Pregnant people with measles have an increased risk of pneumonia, hospitalization, and the need for breathing support. Contracting measles during pregnancy can lead to severe complications, including an increased risk of miscarriage, stillbirth, low birth weight, preterm delivery, and respiratory distress in the newborn. The measles virus can pass from the pregnant person to the fetus, which can lead to increased maternal and fetal mortality, and devastating neurological complications for the fetus.
As obstetrician-gynecologists and maternal-fetal medicine subspecialists, we recommend waiting at least four weeks after receiving the MMR vaccine before trying for pregnancy because it is not recommended during pregnancy. The MMR vaccine is a live but weakened form of the virus. Although live vaccines provide strong, lifelong immunity, they are considered contraindicated in pregnancy due to the theoretical risk of a measles infection to the fetus. However, it is worth noting that inadvertent vaccination during pregnancy has not been associated with harmful outcomes.
Vaccination Is a Family and Community Affair
Immunization planning for the whole family is strongly recommended because vaccination is the safest and most effective way to prevent measles.
With more than three-quarters of measles cases in the United States occurring in infants and school-aged children, there is a pressing need to vaccinate early to prevent serious illness and death, especially as immunization exemptions and vaccine hesitancy continue to rise. Vaccine hesitancy, fueled by the spread of health misinformation and disinformation, has contributed to declining vaccination rates, especially among school-aged children. In 2024, immunization exemptions—including those for school-required vaccines like MMR—increased by 3.3% among children in kindergarten1. The international travel of unvaccinated individuals is further contributing to measles outbreaks of measles in several states.
Vitamin A Treatment: Not So Fast
The usefulness of vitamin A as a treatment in managing people with measles needs to be better understood. Vitamin A is a fat-soluble vitamin that we get through our diet from fruits, vegetables, and animal-based food products. Sufficient dietary intake of Vitamin A supports a healthy and functioning immune system. However, its purported benefits as a treatment for adults with measles have not been well established.
Although vitamin A supplementation in children with measles, especially in cases of malnutrition and undernutrition, can reduce harmful health outcomes associated with active infection2, it neither prevents nor cures measles.
Vitamin A supplements should not be used during pregnancy for treatment of measles because of their harmful effects at high doses (above 10,000 units/day) on fetal development.
Vaccines Save Lives
As the measles outbreak continues to grow, there is a critical need for accurate information and access to life-saving vaccines.
Vaccination remains the best way to protect against measles infection, and obstetric patients with no history of prior immunization should receive the MMR vaccine pre-pregnancy or postpartum. Many health systems, hospitals, public health organizations and community-based organizations across the nation have developed tools (such as infographics, assessment flow charts, educational fliers, and infection control protocols), to help clinicians assess and treat patients for measles, but prevention of infection through vaccination is the single most important public health message that we can communicate to our patients and communities.
Brenna L. Hughes, MD, MSc, is Chair, and Naima T. Joseph, MD, is Vice Chair, of the SMFM Committee on Infectious Diseases and Emerging Threats. Dr. Hughes, an MFM subspecialist, is Maternal-Fetal Medicine Division Chief, and Professor of Obstetrics and Gynecology in the Reproductive Infectious Disease and Immunology Research Program at Duke University. Dr. Joseph is an MFM subspecialist in the Department of Obstetrics and Gynecology at Boston Medical Center and an Assistant Professor at Boston University School of Medicine.
References:
1 Seither R, Yusuf OB, Dramann D, et al. Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2023–24 School Year. MMWR Morb Mortal Wkly Rep 2024;73:925–932. DOI: http://dx.doi.org/10.15585/mmwr.mm7341a3
2 Imdad, A., Mayo-Wilson, E., Haykal, M. R., Regan, A., Sidhu, J., Smith, A., & Bhutta, Z. A. (2022). Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age. The Cochrane database of systematic reviews, 3(3), CD008524. https://doi.org/10.1002/14651858.CD008524.pub4