What's Old Is New Again: Measles

Measles is resurging in the United States, fueled by decreasing vaccination rates and rising vaccine hesitancy. Clinicians are confronted with a highly infectious vaccine-preventable disease that is unfamiliar to them because, as a result of routine childhood vaccination with measles, mumps, and rubella vaccine, measles was declared nonendemic in the United States in 2000 and many pediatricians have never seen a case. In this article, we provide an update on measles presentation, clinical course, and outcomes by reviewing the literature and sharing the expertise of senior pediatric infectious disease physicians with experience in caring for children infected with measles. Measles typically presents with a recognizable clinical picture, allowing providers to appropriately triage cases, make the diagnosis, and implement infection control practices to mitigate transmission. Measles is associated with complications, including frequent pulmonary infections and central nervous system involvement, which may result in morbidity and mortality. Because treatment options for measles are limited, prevention through vaccination and contact tracing are the mainstays in controlling measles outbreaks. Given the high infectivity of this virus, health care providers are an essential first line of defense for communities. Providers can protect children through advocacy for vaccination including effective communication techniques to educate parents and caregivers about measles infection and the benefits of vaccination. They can also maintain a high clinical index of suspicion so that appropriate infection prevention strategies are rapidly implemented when appropriate.