Dr. Gina French, a pediatrician at Kapi‘olani Medical Center for Women &Children, has been spending more time these days explaining the importance of vaccines to patients and clearing up misinformation being spread online.
She said she is able to allay fears for some families, but not for others. Still, it’s a necessary conversation to have, especially as certain areas of the U.S. are experiencing growing outbreaks of highly contagious measles.
In her 40-year career, French, a developmental-behavioral pediatrician, has never personally diagnosed measles in a child but has treated youngsters suffering from complications from the disease and seen how debilitating and heartbreaking it can be.
“Measles is potentially quite a dangerous disease,” she said. “Prior to us having this vaccine, about 500 children a year were dying in the U.S. from measles and about 1,000 were getting brain swelling or encephalitis from it.”
The same conversations are being had at doctors’ offices across the U.S. after a measles outbreak in Texas has since grown beyond 250 cases, with one death reported in a school-aged child — the first in a decade. A second death was reported earlier this month in an adult in New Mexico, where measles cases also are growing. Both were unvaccinated.
As of Friday, the U.S. Centers for Disease Control and Prevention reported 301 confirmed measles cases nationwide, surpassing the 285 reported for all of 2024.
The CDC has issued a health advisory, warning that more cases are expected as the outbreak continues to expand rapidly. The agency also urged vigilance among clinicians, public health officials and travelers, particularly with spring and summer travel season coming up. The measles-mumps-rubella vaccine, CDC said, remains the most important tool for preventing measles.
Hawaii a gateway
Measles cases this year have so far been reported in at least 15 states, including Texas, New Mexico, Oklahoma, Alaska, California, and Florida — but not in Hawaii. With the volume and ease of modern air travel and increasing measles activity internationally and on the continental U.S., Hawaii — as a gateway to both sides of the Pacific — is more likely to see measles reaching its shores at some point, according to the state Department of Health.
“Infected individuals can spread the virus up to four days before and four days after symptoms, further increasing the risk of potential spread,” DOH said in a statement. “Measles is also one of the most contagious viruses.”
According to the department, 9 out of 10 people of all ages exposed to an infected person will become infected if they do not have immunity. Exposure includes entering a room up to two hours after an infected person has been there.
“Due to these factors and the upcoming Spring Break, it is critical to ensure that our community is appropriately protected against this highly contagious disease,” DOH said. “Measles vaccination is highly protective against infection, prevents further spread, and remains our best defense against measles.”
Hawaii’s last detection of measles two years ago was travel- related. In April 2023, DOH reported one case of measles in an unvaccinated Oahu resident returning from international travel. Several weeks later, DOH reported a second case in an Oahu resident who was exposed to the first case.
Prior to that, the last measles outbreak in Hawaii occurred in 2014, with 15 cases reported.
A measles outbreak in Hawaii is of concern, particularly with the state’s limited hospital capacity. DOH said an outbreak on a neighbor island, for instance, could heavily strain its health care system as there are no pediatric ICU beds available and seriously ill children would need to be medically transported to Oahu.
Vaccinations dropping
Hawaii’s vaccination rate against measles has dropped below the 95% threshold needed for so-called herd immunity to prevent an outbreak.
The measles vaccine is usually given together with those for mumps and rubella. The MMR vaccine has been available in the U.S. since 1971.
The first dose of MMR is recommended for children between 12 and 15 months, followed by a second dose between ages 4 and 6. The CDC says two doses of the MMR vaccine provide 97% protection.
Among kindergartners in Hawaii, the MMR vaccination rate in the 2023-2024 school year was at 89.8%. DOH said rates fell some time between the 2021-2022 and 2022-2023 school years, consistent with falling rates nationally.
In 2000 the U.S. declared measles eliminated, with no measles spreading within the country for more than a year, which was considered a historic public health achievement.
That is now unraveling due to vaccine skepticism and misinformation, particularly in the wake of the COVID-19 pandemic, according to KFF, a health policy research nonprofit formerly known as the Kaiser Family Foundation.
KFF noted it has become an increasingly bipartisan issue, with polls showing that a quarter of Republican parents agree that the risks of the MMR vaccine outweigh the benefits.
U.S. vaccination rates, including for the MMR vaccine, have declined since 2010 while exemptions from childhood vaccinations have increased.
In Hawaii, there has been a 25% jump in students who are not up to date on required school immunizations, with a growing number claiming religious or medical exemptions. In the state, 5.3% of kindergarteners were exempted from one or more vaccines.
A House bill in the state Legislature this year proposing to end religious exemptions for childhood immunizations was shelved following hours of testimony opposing the measure. Opposition came from groups such as the Hawaiian Islands Republican Women, Hawaii Christian Coalition and Libertarian Party of Hawaii who framed the issue as a violation of religious and medical freedom and parental rights.
Many parents said only they should decide whether their kids are vaccinated, while others insisted the vaccines were unsafe or inadequately tested. Some testified that without religious exemptions, they would be forced to homeschool their kids, and some railed against COVID-19 vaccines, which are not part of the list of required school immunizations.
French said among the misconceptions often brought up is that the MMR vaccine causes autism, based on a now-discredited study out of England years ago that put the idea out there.
As a doctor who treats autism, she said numerous scientific studies have shown no connection between MMR vaccines and autism.
“It’s been around a long time and we’ve been giving this vaccine safely,” she said. “And more than that, we’ve saved the lives of so many children around the world. We don’t want to lose that.”
When asked about vitamin A, which has been touted as a treatment, French said that while it is part of treatment for serious cases, particularly in children who may be vitamin A-deficient, it does not prevent measles. Additionally, vitamin A can potentially become toxic if too much of it is taken, so she is concerned about parents administering it to their kids to prevent measles.
French said her conversations with parents often start with, “Tell me what you’re worried about and why.”
“It’s just vital that everybody go out and get their kids immunized to measles and get their kids immunized to all these vaccine-preventable diseases,” French said.
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Facts about measles
>> Measles is a serious viral respiratory illness and one of the most contagious of all infectious diseases.
>> Measles is airborne and can live in the air for two hours after an infectious person leaves the area. Measles also can be spread from an infected person to others through direct contact, coughing and sneezing.
>> Measles can be spread to others from four days before to four days after symptoms appear.
>> Symptoms include a high fever, cough, red and watery eyes followed by a rash that starts on the face and upper neck that spreads to the arms and legs three to five days later.
>> About 1 out of 5 unvaccinated people in the U.S. who get measles are hospitalized due to complications such as pneumonia. Encephalitis (brain swelling) and other serious neurological complications as well as death also can occur.
>> Measles also can lead to complications during pregnancy.
Sources: Centers for Disease Control and Prevention, state Department of Health
