Pediatric Annals

Editorial Free

Measles Anyone?

Joseph R. Hageman, MD

I guess my mother thought I was all right, so we proceeded with my 3-year-old birthday celebration anyway. That day, all my friends got measles from me. It is likely that many of you who are reading this have never experienced what it is like to have the measles. My mom told me I got really sick. This was in 1954, 4 years before the first measles vaccine was tested. The combination MMR (measles, mumps, rubella) vaccine, which was an attenuated virus vaccine, debuted in 1961.1

How is measles being spread in the United States, as it was declared eliminated in 20002? The majority of people who get measles are unvaccinated.2

Presently, measles outbreaks have occurred in different parts of the country. The following states have reported to the Centers for Diesease Control and Prevention:2 Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Virginia, and Washington. These outbreaks are resulting from a combination of international travel and parents who are opting not to vaccinate their children against measles with the MMR vaccine.2 Parents of children who are not vaccinated are relying on “herd immunity,” but studies suggest that it takes more than 94% of children to be vaccinated to protect unvaccinated children in the community.3

Why are parents opting to not vaccinate their children? I discussed this with my daughter who has two toddler-aged daughters and a 4-month-old daughter. The toddlers have both been vaccinated against measles, and all three have received the appropriate vaccines according to their pediatric schedules. According to my daughter, some of her friends who live in Illinois are concerned that MMR vaccines result in children developing autism, which is still a common concern,4 despite multiple, well-designed studies that have shown no causal relationship between the MMR vaccine and autism.5,6

Vaccine refusal by parents is based on a variety of medical reasons in addition to the concern about autism. These include apprehension about vaccine safety due to exposure to multiple antigens and adjuvants, including thimerosal and aluminum, and the concern about sudden infant death syndrome and attention-deficit/hyperactivity disorder (ADHD).5 A recently established website from the Children's Hospital of Philadelphia5 highlights key references6–11 that provide evidence of no toxicity or any links between developmental problems such as autism and ADHD in children and vaccines. These resources are useful in discussions with families regarding the importance of immunization against measles and other vaccine-preventable illnesses.


  1. The history of vaccines. Accessed June 13, 2019.
  2. Centers for Disease Control and Prevention. Measles cases and outbreaks. Accessed June 13, 2019.
  3. Wallinga J, Heijne JC, Kretzschmar M. A measles epidemic threshold in a highly vaccinated population. PLoS Med. 2005;2(11):e316. doi:10.1371/journal.pmed.0020316 [CrossRef]
  4. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retracted in: Lancet. 2010;375(9713):445. doi:10.1016/S0140-6736(10)60175-4.]. Lancet. 1998;351(9103):637–641. doi:. doi:10.1016/S0140-6736(97)11096-0 [CrossRef]
  5. Children's Hospital of Philadelphia. Vaccine safety references. Accessed June 13, 2019.
  6. Jain A, Marshall J, Buikema A, Bancroft T, Kelly JP, Newschaffer CJ. Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. JAMA. 2015;313(15):1534–1540. doi:. doi:10.1001/jama.2015.3077 [CrossRef]
  7. Glanz JM, Newcomer SR, Daley MF, et al. Association between estimated cumulative vaccine antigen exposure through the first 23 months of life and non-vaccine-targeted infections from 24 through 47 months of age. JAMA. 2018;319(9):906–913. doi:. doi:10.1001/jama.2018.0708 [CrossRef]
  8. Christensen DL, Baio J, Van Naarden Braun K, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. MMWR Surveill Summ. 2016;65(3):1–23. doi:. doi:10.15585/mmwr.ss6503a1 [CrossRef]
  9. Karwowski MP, Stamoulis C, Wenren LM, et al. Blood and hair aluminum levels, vaccine history, and early infant development: a cross-sectional study. Acad Pediatr. 2018;18:161–165. doi:. doi:10.1016/j.acap.2017.09.003 [CrossRef]
  10. Yang YT, Shaw J. Sudden infant death syndrome, attention-deficit/hyperactivity disorder and vaccines: longitudinal population analyses. Vaccine. 2018;36:595–598. doi:. doi:10.1016/j.vaccine.2017.12.065 [CrossRef]
  11. Plotkin SA. How to prepare for expert testimony on the safety of vaccination. Pediatrics. 2019;143(4):e20183578. doi:. doi:10.1542/peds.2018-3578 [CrossRef]

Joseph R. Hageman, MD

Pediatric Annals Editor-in-Chief Joseph R. Hageman, MD, is the Director of Quality Improvement, Section of Neonatology, Comer Children's Hospital; a Senior Clinician Educator, The University of Chicago Pritzker School of Medicine; and an Emeritus Attending Pediatrician, NorthShore University HealthSystem.

Address correspondence to Joseph R. Hageman, MD, via email:


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