March 8, 2025
One Vax Two Lives | Latest Vaccine in Pregnancy News
Public Health News
Measles Cases Rise Across the U.S.
As of March 6, 2025, 222 measles cases were reported by 12 jurisdictions in the states of Alaska, California, Florida, Georgia, Kentucky, New Jersey, New Mexico, New York City, Pennsylvania, Rhode Island, Texas, and Washington. Most of these cases have occurred in unvaccinated children in Texas and New Mexico. There are now two deaths associated with these outbreaks; one was in an unvaccinated school-age child living in Texas and in the second, the measles virus was detected in a deceased individual. Among the 222 cases, 94% occurred in unvaccinated (or vaccine-status unknown) individuals. An additional 4% were in insufficiently vaccinated individuals who have received only one MMR vaccine. In comparison, there were 285 measles cases in the U.S. in a 12-month period in 2024.
Measles can cause serious, life-threatening illness; 25% of affected individuals this year have required hospitalization for treatment of severe disease. Prior to the introduction of the MMR vaccine in 1963, measles caused an estimated 48,000 hospitalizations and 400-500 deaths annually in the US. These outbreaks offer a powerful reminder of the importance of MMR vaccination for public health.
Sources:
https://www.dshs.texas.gov/news-alerts/measles-outbreak-feb-28-2025
Is Measles Harmful in Pregnancy?
The short answer is ABSOLUTELY.
As a disease, measles is not simply a rash and a fever. Measles is one of the most contagious viruses we know and can be deadly. In fact, the World Health Organization estimated that 110,000 people died of measles in 2017.
Babies and pregnant women are extremely susceptible to measles and its most severe complications. The most concerning for pregnant women are severe breathing problems and brain damage. A pregnant woman can also lose a pregnancy to miscarriage or stillbirth due to measles. The infection can also cause preterm birth, which can lead to serious lifelong health problems for the baby.
Congenital Measles
Congenital measles refers to a measles infection that occurs in a developing fetus when a pregnant woman contracts the disease. Like many other viruses, the measles virus can cross the placenta and infect the developing fetus. It is particularly common in the first trimester and is likely to occur when a pregnant woman has no immunity to measles, meaning she has not been vaccinated with MMR (two vaccines) or received only one MMR vaccine.
Congenital measles is not specifically reported or tracked in the U.S., but we should track these cases as they represent a devastating outcome of undervaccination. A measles infection of the placenta or fetus may lead to a miscarriage, preterm birth, or low birth weight. The infant may have a higher risk of dying after birth. The infant may have an active measles infection at the time of birth, which can lead to breathing difficulties or developmental problems.
A Message to Pregnant Women in a Time of Measles Outbreaks
Adapted from an Op-Ed in Seattle Times (author: Kristina Adams Waldorf, MD), published March 13, 2019 after a large outbreak in Clark County (Washington State)
Source: https://www.seattletimes.com/author/kristina-adams-waldorf/
“As an obstetrician (Dr. Adams Waldorf) who has spent her career protecting pregnant women and fetuses from complications in pregnancy, I understand parents’ desire to do what is best for their children. The anxiety around the safety of vaccines is based on a now debunked “scientific” article. Some of the clearest evidence supporting the safety of the measles, mumps and rubella vaccine came from a Danish study of more than 650,000 children with more than 5 million person-years of follow-up. Autism risk was not increased in the vaccinated children. There were no study subgroups, such as children with autism risk factors, in which the vaccine was linked to autism risk. I cannot be more clear: The risks of vaccines are nowhere near the risks of the diseases they prevent. Measles is no exception.
Ironically, although we are confident the vaccine is safe, a measles infection in pregnancy may lead to autism in the child. We published a manuscript in JAMA Psychiatry describing an increased risk of autism and depression in children exposed to a severe infection in pregnancy in Swedish women who were hospitalized between 1973 and 2014. This time span included nearly 2 million pregnancies with up to 41 years of follow-up, which provided striking evidence that a severe infection, like measles, can result in inflammation that can disturb fetal brain development and increase the risk for mental health disorders.
Even if you’ve had the measles, mumps and rubella vaccine, up to 3 percent of individuals may not be completely protected. In pregnant women who received the vaccine 35-40 years ago, their immunity from the vaccine may not be enough to provide protection. Unfortunately, we can’t give the measles vaccine during pregnancy, which leaves women with uncertainty as to whether they are immune.
For pregnant women living near an active measles outbreak or planning travel there, talk to your doctor or medical provider about measles. In my opinion, the only safe approach for pregnant women and infants is to avoid traveling to places with active measles outbreaks.
To people who willingly choose not to vaccinate, it is my duty to remind you of the risk you introduce into your homes, schools, and communities. I urge you to re-examine the information that has led to this choice. Please trust in the decades of research proving the safety and effectiveness of the measles vaccine. A measles infection could cost our patients their pregnancy or even their life.”
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Thank you for this cogent, clear piece.
One other thing that is important to remember about congenital measles, in addition to the very real and increased risks of prematurity, stillbirth, and other consequences such as congenital pneumonia, is the much higher rate of SSPE for the infant. Some studies say up to 16x higher! Additionally, the interval to developing SSPE is shorter for infants with congenital measles; in typical cases people may get it decades later; in the case reports of congenital measles that I've read, that interval can be shorter, to the tune of a few years. Devastating!
SSPE: subacute sclerosing pan-encephalitis, which is an irreversible, progressive - though in some cases with periods of plateau- illness that is universally fatal. Neurological deficits followed by seizures, hypertonicity, cognitive regression, death.
I wrote about my experience taking care of a baby with congenital measles here, if that is helpful. https://substack.com/home/post/p-158402630 (links in the piece to medical literature)