Measles increase: Discussing vaccination with vaccine-hesitant parents

Contemporary PEDS JournalMay 2024
Volume 40
Issue 04

In a time when vaccine hesitancy is contributing to a rise in measles cases, an understanding of why parents are hesitant is key to help change their narrative.

Measles increase: Discussing vaccination with vaccine-hesitant parents | Image Credit: © Feng Yu - © Feng Yu -

Measles increase: Discussing vaccination with vaccine-hesitant parents | Image Credit: © Feng Yu - © Feng Yu -

The United States has seen a significant increase in reported measles cases over the past few months. As of May 3, 2024, there have been 131 confirmed cases of measles reported to the CDC—more than double the number of cases observed during the entirety of 2023 (58).1*

The disease typically begins with symptoms that include high fever, cough, runny nose, and red or watery eyes at 7 to 14 days after infection. These symptoms can be followed up by tiny white spots inside the mouth, also known as Koplik spots, 2 or 3 days after onset of symptoms. After 3 to 5 days, the measles rash breaks out with flat, red spots appearing on the face that spread down to the neck, trunk, arms, legs, and feet.2

Measles infection can lead to severe complications, especially for children younger than 5 years. Pneumonia is the most common cause of death from measles infection in young children, with as many as 1 in 20 children with measles developing pneumonia as a result. According to the CDC, almost 1 to 3 of every 1000 children with measles will die from respiratory and neurologic complications.3

In a March health advisory alert to health care professionals, the CDC recommended that “health care providers should ensure children are current on routine immunizations, including measles, mumps, and rubella (MMR).”4 Part of the increased number of cases is the result of unvaccinated or undervaccinated individuals, which could be because of vaccine hesitancy. Of the 131 cases reported as of May 3, 57 are among children younger than 5 years.* Overall, 81% of cases are among individuals who are either unvaccinated or have a status that is unknown. Of the total number of reported cases, just 5% have 2 MMR doses recorded, CDC data show.1*

For situations where parents are hesitant to have their child vaccinated, conversations of consequences, benefits, and outcomes are crucial to have. Equally important is listening to why parents are hesitant to have their children vaccinated.

“It’s very unfortunate. We have a very effective and safe way of preventing individuals from getting measles, and in those countries where MMR vaccine is available, those individuals who choose not to receive it are driving a lot of what we’re seeing, and that’s very unfortunate,” Tina Tan, MD, FAAP, FIDSA, FPIDS, said. Tan is editor in chief of Contemporary Pediatrics, professor of pediatrics at Feinberg School of Medicine at Northwestern University in Chicago, Illinois, and pediatric infectious diseases attending physician at Ann & Robert H. Lurie Children’s Hospital of Chicago. She added, “I think people need to take extra time to speak with those families who are somewhat vaccine hesitant and explain to them the importance of protecting their child against a disease that does have complications and spreads very rapidly.”

These conversations can play an important role in dispelling misinformation or false associations of MMR. Findings from a 2023 study published in Vaccines revealed several social drivers that induce vaccine hesitancy, including education, economy, primary care, and government or policy factors. Education and income had the potential to help facilitate or hinder vaccine adherence, depending on how the determinant was experienced. The authors concluded, “Fear of autism was the most cited reason for MMR hesitancy.”5

“You need to find out the reason why [parents are] hesitant to get the vaccine and then start to talk to them based upon that reason, to tell them that the vaccine is safe and effective, it has never been associated with autism or all these other things that people say that it’s associated with, and that it is a way of protecting your child and others against getting the disease. It’s very important to listen to them and find out the reason why they’re hesitant,” Tan said.

Furthermore, Tan emphasized the importance of discussing the complications that can occur from a measles infection, especially for children who may not be able to receive the vaccine. This population is dependent on community vaccination to prevent disease spread, and parents should be aware this population exists, according to Tan.

“[Explain that] there are individuals who, for one reason or another, are unable to be vaccinated,” Tan said. “Either they’re too young, or they have an immunocompromising condition that doesn’t allow them to be vaccinated. We also need to protect those individuals from getting the disease because they’re at higher risk for complications.”

“At a time [when] we have an increased number of cases in the United States, it’s incumbent on patients to get the vaccines, for physicians [and] health care professionals to recommend these vaccines, and for the parents to ensure they protect their children,” Mirza Rahman, MD, MPH, FAAFP, FACPM, said.4 Rahman is president of the American College of Preventive Medicine in Washington, DC, and adjunct associate professor of epidemiology at Columbia University Mailman School of Public Health in New York, New York.

Vaccination coverage among US children in kindergarten has decreased from 95.2% during the 2019-2020 school year to 93.1% in the 2022-2023 school year. The result is approximately 250,000 kindergartners susceptible to measles each of the past 3 years, the CDC stated.6

Conversation on full, not partial, vaccination is equally important when addressing vaccine-hesitant parents, as 2 MMR doses are 97% effective compared with 93% with 1 dose.6 “There’s a [seemingly] small difference [in efficacy], but it is the difference between all the folks getting it or not and then being fully protected,” Rahman added.4

“People cannot forget that measles is still there, and as you can see, as our vaccination rates have dropped, we are seeing more cases, especially [because] people are bringing it back from other countries where there are very large measles outbreaks that are occurring,” Tan said. “It’s important to vaccinate those individuals who either are unvaccinated or not up to date on their vaccine because that is the only tool that we have to control the spread and transmission of measles.”

*Numbers as of May 3, 2024.

Click here for more from the May issue of Contemporary Pediatrics.


  1. Measles cases and outbreaks. CDC. Updated April 5, 2024. Accessed April 11, 2024.
  2. Signs and symptoms. CDC. Updated November 5, 2020. Accessed April 11, 2024.
  3. Complications of measles. CDC. Updated November 5, 2020. Accessed April 11, 2024.
  4. Fitch J. CDC issues health advisory amid increasing US, global measles cases. Contemporary Pediatrics. March 21, 2024. Accessed April 11, 2024.
  5. Novilla MLB, Goates MC, Redelfs AH, et al. Why parents say no to having their children vaccinated against measles: a systematic review of the social determinants of parental perceptions on MMR vaccine hesitancy. Vaccines (Basel). 2023;11(5):926. doi:10.3390/vaccines11050926
  6. Increase in global and domestic measles cases and outbreaks: ensure children in the United States and those traveling internationally 6 months and older are current on MMR vaccination. CDC. March 18, 2024. Accessed April 11, 2024.

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