Measles cases reach 600: Experts warn of contagion risk and vaccine importance

by Matt Sheehan
OSF Healthcare

PEORIA - As measles cases continue to climb across the United States, the long-term implications can’t be ignored.

The respiratory viral infection, although thought eliminated in the U.S. in 2000, has reemerged, especially among unvaccinated individuals. As of early April 2025, the Centers for Disease Control and Prevention (CDC) has reported more than 600 confirmed cases of measles.

Measles is extremely contagious

"The key to measles is how highly infectious it is. Each person that has measles will infect between 12 and 18 people in an unvaccinated situation," says Doug Kasper, MD, an infectious disease specialist with OSF HealthCare. "The key for controlling measles is widespread vaccine use."

Doug Kasper, M.D.
OSF Infectious Disease Specialist

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For reference, each influenza patient, on average, will infect one to two others.

The measles vaccine is normally offered once a child has reached one year of age. It's a two-shot series, which came on the market in 1963. Dr. Kasper says this gives medical experts decades of data that show a correlation between people receiving the vaccine, and close to zero circulation of the virus in the United States.

The states with measles outbreaks are in unvaccinated people, and no breakthrough cases (in those who have received the vaccine) have been reported, Dr. Kasper adds.

The long-term risks for unvaccinated measles patients

"There is emerging information that vaccination not only protects an individual from not becoming ill or having less severity of illness with a viral exposure, whether that's measles, chicken pox, influenza or COVID-19, but that there are long-term risks from viral infections that we do not appreciate in the moment," Dr. Kasper says. "Some of these have been associated with memory loss or dementia as somebody ages. Some of these are associated with organ disease like hepatitis or kidney disease."

Subacute Sclerosing Panencephalitis (SSPE)

SSPE is a rare, deadly degenerative disease of the central nervous system that can happen seven to 10 years after a measles infection. Young children, pregnant women and immunocompromised people are the most at-risk for SSPE. One to three out of every 1,000 children who become infected with measles will die from respiratory and neurologic complications, the CDC says.

SSPE symptoms happen over four stages.

• Stage 1: Personality changes, mood swings or depression. There may also be fever and headaches, this stage can last up to six months
• Stage 2: Muscle spasms and uncontrolled movement problems. Loss of vision, dementia and seizures can occur
• Stage 3: Twisting movements and rigidity. Sometimes death
• Stage 4: Serious brain damage, including areas of the brain that control breathing, heart rate and blood pressure, leading to coma and death

Immune amnesia

Another long-term impact of measles is known as immune amnesia. The American Society for Microbiology (ASM) calls immune amnesia “one of the most unique and most dangerous features of measles pathogenesis.” The extremely rare condition causes people’s immune systems to “forget” how to fight off infections and makes the person more susceptible. The ASM determined it normally takes two to three years after a measles infection for protective immunity to return.

A measles outbreak was declared in Northeast Illinois in early 2024 and declared “over” by the Illinois Department of Public Health (IDPH) in June. The expectation of statewide health experts is that measles will return to Illinois in the coming months. This is mainly due to heavy travel through Chicago airports and summer festivals. County health departments have now been tasked with keeping an eye on their measles vaccine rates and identifying areas where vaccine rates are low.

Peoria County's measles vaccine rate is quite high, around 95%. But outlying communities in central Illinois have lower vaccine rates, normally more rural counties. Health experts at Michigan Medicine call the Great Lake State “ripe for a measles outbreak,” as only 66% of toddlers receive the recommended childhood immunizations.

Measles symptoms

"Measles typically presents with a high fever, typically much higher than what we'd see with seasonal colds or influenza. Fevers can be 104 or 105 degrees Fahrenheit," Dr. Kasper says. "That's followed by a runny nose and a characteristic rash. This typically develops on the head and then spreads down the rest of the body."

“We don’t want to go back”

"Measles at its peak, in the 1950s before the vaccine, led to a significant number of hospitalizations in young children. Around 50,000 hospitalizations were estimated per year and about 500 deaths," Dr. Kasper says. "We don't want to go back to that scenario in any capacity, where we have a large number of unvaccinated people. The outcomes could be too severe."

Immunocompromised people like those who have received an organ transplant, cancer patients or those on long-term therapies that could impact their immune system, are at high risk for measles.

Why vaccines are so important right now

Summer travel along with large crowds at places like airports and theme parks, will likely bring more measles cases to the United States.

"This time, as good as any time, is to make sure somebody is updated on their vaccinations. If somebody isn't sure if they were vaccinated as a child, they should talk to their primary care provider about testing or receiving the vaccine. If someone is immunocompromised and they might be at a higher risk for measles through travel in areas that have exposure, they should talk to their primary care provider about the vaccine," Dr. Kasper says. "If someone has young children or is at an age where vaccine is recommended, we wholly recommend for them to discuss with their provider to remain up to date on their vaccine series."

Vaccine hesitancy continues to be a topic of discussion, one that Dr. Kasper recommends patients openly discuss with their medical provider.

Natural immunity is not a viable option with measles. The highly infectious nature of the virus, along with the severity of symptoms and potential for long-term complications, make it an illness people need to try and avoid entirely.

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Sing your way to better health

Some research has shown that singing can boost immunity. Other research has found singing can help stave off moderate dementia. OSF doctor Alina Paul suggests it is possible to sing your way to better health.

Bernd Everding/Pixabay

by Tim Ditman
OSF Healthcare

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CHAMPAIGN - Alina Paul, MD, has been singing for as long as she can remember. She added guitar while in boarding school in India.

Alina Paul, MD

Fast forward to 2023, and the family medicine physician at OSF HealthCare finds herself singing for patients who request it to brighten their day.

“It has changed the way I treat patients,” Dr. Paul says with conviction. “Singing and playing guitar is medicine. It’s medicine for the soul.”

Hearing those tunes is not just a temporary respite for the person in for a checkup. Dr. Paul says research has shown singing can have long-term health benefits.

The benefits

· Pain levels, physical and mental, can decrease. For people suffering from anxiety and depression, singing can increase the level of endorphins, the “feel-good hormone,” as Dr. Paul puts it. This brings them out of a dreary mood.

· Some research has shown that singing can boost immunity by increasing the level of the antibody immunoglobulin A. This antibody helps fight respiratory and other infections, Dr. Paul says.

· It helps your lungs perform better.

“We’re using our lungs to sing. We take deep breaths. Certain movements of the chest wall help with lung function,” says Dr. Paul.

· Other research has found singing can help stave off moderate dementia, Dr. Paul says.

“That’s amazing,” she says.

“We see a lot of patients with dementia. When you incorporate singing or even sing to them, their memory seems to improve. They’re happier,” Dr. Paul adds.

· Dr. Paul says singing can increase oxytocin, the so-called “love hormone.” This can help with social bonding and a sense of belonging.

· Singing can also improve public speaking skills, especially if you sing in front of others. Simply put, the more you use your voice, the more comfortable you are with it.

Keep your well-being in mind

Dr. Paul says there are some obvious, but important health matters to keep in mind if you pick up singing.

· If singing causes your lungs or throat to hurt, take a break. If minor symptoms persist, go to an urgent care. For things like difficulty breathing, chest pain or loss of consciousness, call 9-1-1.

· If you are sick, don’t sing – or do much else – around others. When we say words, our mouth spews microparticles that can carry diseases. And when you’re sick, you should be resting and recovering.

· Be kind to your neighbors, like in an apartment building. Don’t sing loudly at all hours.

How do I start?

Don’t feel like you have to run out and join a choir, Dr. Paul says. And don’t worry if your vocal skills aren’t Grammy worthy.

“Don’t take it as an exercise. Don’t do it because you have to. Do it because you want to do it,” Dr. Paul advises.

Try singing while in the car or shower. Do karaoke with friends. You don’t even need music. Try belting out your favorite song acapella while cleaning the house. Dr. Paul says closing your eyes can help focus the activity.

“Anybody can sing. Make a point to sing. It’s like meditation. It’s very beneficial,” Dr. Paul says.

The risk of heart infection higher after Covid when compared to incidence post-vaccination

Courtesy The American Heart Association

Study finds the risk of myocarditis was substantially higher in the four weeks after COVID-19 infection than after a first dose of a COVID-19 vaccine.

DALLAS -- In a detailed analysis of nearly 43 million people, the risk of myocarditis in unvaccinated individuals after COVID-19 infection was at least 11 times higher compared to people who developed myocarditis after receiving a COVID-19 vaccine or booster dose, according to new research published today in the American Heart Association’s flagship, peer-reviewed journal Circulation. This analysis included data from England’s National Immunization database for people ages 13 and older who received at least one dose of a COVID-19 vaccine between December 1, 2020 and December 15, 2021 in England.

Several previous studies and reports from public health agencies around the world including the U.S. Centers for Disease Control and Prevention have highlighted a possible connection and potentially increased risk of myocarditis after receiving an mRNA COVID-19 vaccine, generating considerable scientific, policy and public interest.

Typically thought to be trigged by a viral infection, myocarditis is the inflammation of the heart muscle, the myocardium. This condition is uncommon and may temporarily or permanently weaken the heart muscle and the heart’s electrical system, which keeps the heart beating normally. An episode of myocarditis may resolve on its own or with treatment, and may result in lasting damage to the heart. In the general population not during a global pandemic, it is estimated that approximately 10 to 20 people per 100,000 are diagnosed with myocarditis each year, according to the American Heart Association’s 2021 scientific statement on myocarditis.

“We found that across this large dataset, the entire COVID-19-vaccinated population of England during an important 12-month period of the pandemic when the COVID-19 vaccines first became available, the risk of myocarditis following COVID-19 vaccination was quite small compared to the risk of myocarditis after COVID-19 infection,” says first author of the study Martina Patone, Ph.D., a statistician at the Nuffield Department of Primary Health Care Sciences at the University of Oxford in Oxford, England. “This analysis provides important information that may help guide public health vaccine campaigns, particularly since COVID-19 vaccination has expanded in many parts of the world to include children as young as 6 months old.”

In this study, Patone and colleagues evaluated England’s National Immunization database of COVID-19 vaccinations for all people ages 13 or older who had received at least one dose of the ChAdOx1 (a two-dose adenovirus-vector COVID-19 vaccine developed by the University of Oxford and AstraZeneca, most similar to the one-dose Johnson & Johnson/Janssen COVID-19 vaccine available in the U.S.), the Pfizer-BioNTech or the Moderna COVID-19 vaccine (the same mRNA vaccines available in the U.S.) between December 1, 2020 and December 15, 2021. This dataset totaled nearly 43 million people, which included more than 21 million who had received a booster dose of any of the COVID-19 vaccines (meaning they had received a total of 3 doses of a COVID-19 vaccine). The database detailed the type of COVID-19 vaccines received, dates received and dose sequencing, along with individual demographic information including age and sex for each individual. Nearly 6 million people tested positive for COVID-19 infection either before or after COVID-19 vaccination during the study period.

England’s National Immunization database records were then cross-referenced and matched to the national offices with data on COVID-19 infection, hospital admission and death certificates for the same time period, December 1, 2020 through December 15, 2021. Individuals were classified based on age and sex to reveal which groups had the highest risk of myocarditis after a COVID-19 vaccine or after COVID-19 infection and hospitalization. The authors used the self-controlled case series (SCCS) method, which was developed to estimate the relative incidence of an acute event in a pre-defined post-vaccination risk period (1-28 days), compared to other times (pre-vaccination or long after vaccination). Being a within-person comparison, the analyses were controlled to adjust for any fixed characteristics, including sex, race or ethnicity, or chronic health conditions.

In the overall dataset of nearly 43 million people, the analyses found:

Fewer than 3,000 (n=2,861), or 0.007%, people were hospitalized or died with myocarditis during the one-year study period. 617 of these cases of myocarditis occurred during days 1-28 after receiving a COVID-19 vaccination, of which 514 were hospitalized.

People who were infected with COVID-19 before receiving any doses of the COVID-19 vaccines were 11 times more at risk for developing myocarditis during days 1-28 after a COVID-19 positive test.

The risk of COVID-19 infection-related myocarditis risk was cut in half among people infected after vaccination (received at least one dose of a COVID-19 vaccine).

The risk of myocarditis increased after a first dose of the ChAdOx1 COVID-19 vaccine (an adenovirus-vector vaccine most similar to the Johnson & Johnson/Janssen COVID-19 vaccine available in the U.S.) and after a first, second and booster dose of any of the mRNA COVID-19 vaccines. However, the risk of vaccine-associated myocarditis was lower compared to the risk of COVID-19 infection-associated myocarditis, except for after a second dose of the Moderna vaccine.

Myocarditis risk was found to be higher during days 1-28 after a second dose of the Moderna COVID-19 vaccine for people of all genders and ages, and the risk also persisted after a booster dose of the Moderna vaccine. However, people receiving a booster dose of Moderna were, on average, younger in comparison to those who received a booster dose of the ChAdOx1 or Pfizer-BioNTech vaccine, therefore, results may not be generalizable to all adults.

Risk of COVID-19 vaccine-associated myocarditis among women:

Of the nearly 21 million women, 7.2 million (34%) were younger than age 40, and a slightly increased risk of myocarditis was found among this younger age group after receiving a second dose of the Moderna COVID-19 vaccine: 7 estimated extra cases of myocarditis for every one million women vaccinated.

Among women older than age 40, a slight increased risk of myocarditis was associated with receiving a first or third dose of the Pfizer-BioNTech COVID-19 vaccine, respectively 3 and 2 estimated additional cases of myocarditis for every one million women vaccinated.

Risk of COVID-19 infection-associated myocarditis among women:

Among women younger than age 40, the risk of infection-associated myocarditis was higher compared to the risk of vaccine-associated myocarditis: 8 extra cases associated with having COVID-19 infection before vaccination.

Among women older than age 40, the risk of infection-associated myocarditis was higher compared to the risk of vaccine-associated myocarditis: 51 extra cases associated with having COVID-19 infection before vaccination.

Risk of COVID-19 vaccine-associated myocarditis among men:

Among the 18 million men in the dataset, all of whom received at least one COVID-19 vaccine, more than 6 million men (34%) were younger than age 40.

An increased risk of vaccine-associated myocarditis was found in men ages 40 and younger after a first dose of either of the mRNA COVID-19 vaccines (4 and 14 estimated extra cases for every one million men vaccinated with respectively Pfizer or Moderna vaccine), or a second dose of any of the three COVID-19 vaccines available in England during the study period: 14, 11 and 97 estimated additional cases of myocarditis for every one million men vaccinated, respectively for the ChAdOx1, the Pfizer-BioNTech or the Moderna vaccine.

The increased risk of developing myocarditis among males younger than age 40 was also higher after receiving two doses of the Moderna vaccine when compared to the risk of myocarditis after COVID-19 infection. The researchers noted, however, the average age of people who received the Moderna vaccine was 32 years, compared to the majority of those who received the other vaccines were older than age 40.

In men ages 40 and older, a slightly increased risk of myocarditis was found after a booster dose of either of the two mRNA vaccines (Pfizer-BioNTech or Moderna): 3 estimated extra cases of myocarditis for every one million men vaccinated with either mRNA vaccine.

Risk of COVID-19 infection-associated myocarditis among men:

Among men younger than age 40, the risk of infection-associated myocarditis was higher compared to the risk of vaccine-associated myocarditis: 16 extra cases associated with having infection before vaccination, with the only exception of a second dose of Moderna vaccine.

Among men older than age 40, the risk of infection-associated myocarditis was higher compared to the risk of vaccine-associated myocarditis: 85 extra cases associated with having infection before vaccination.

“It is important for the public to understand that myocarditis is rare, and the risk of developing myocarditis after a COVID-19 vaccine is also rare. This risk should be balanced against the benefits of the COVID-19 vaccines in preventing severe COVID-19 infection. It is also crucial to understand who is at a higher risk for myocarditis and which vaccine type is associated with increased myocarditis risk, ” said Professor Nicholas Mills, Ph.D., the Butler British Heart Foundation Chair of Cardiology at the University of Edinburgh and a co-author of the paper. “These findings are valuable to help inform recommendations on the type of COVID-19 vaccines available for younger people and may also help shape public health policy and strategy for COVID-19 vaccine boosters. The SARS-CoV-2 virus continues to shift, and more contagious variants arise; our hope is that this data may enable a more well-informed discussion on the risk of vaccine-associated myocarditis when considered in contrast to the net benefits of COVID-19 vaccination,” said another co-author Julia Hippisley-Cox, F.R.C.P., professor of clinical epidemiology and general practice at the University of Oxford.

Authors noted there are two unanswered questions that likely require further investigation. The first is about myocarditis risk among children ages 13-17 because there were too few cases of myocarditis to quantify the risk specific to this age group. Secondly, researchers were not able to directly compare the death rate after COVID-19 infection vs. death after COVID-19 vaccination since the database only included people who had received at least one COVID-19 vaccine. More expansive data and a different analysis are still needed to address these questions and numerous other COVID-19 topics.

The study has two notable limitations. The number of cases of myocarditis among individuals who received a booster dose of the ChAdOx1 or Moderna vaccines was too small to calculate the risk of myocarditis. Additionally, researchers cannot exclude the possibility of over- or under-estimated risk due to misclassification of any health information in the database, though the U.K.’s National Health Service is known to provide timely and accurate data.