Measles Makes a Comeback: A Texas Doctor’s Front-Line Experience in a Preventable Epidemic
In the heart of West Texas, Dr. Leila Myrick, a family medicine and obstetrics physician, is battling a disease she only encountered in textbooks during her medical school days: measles. The recent outbreak, centered in Gaines County, has transformed her from a rural doctor into an unexpected expert on a once-eradicated illness, highlighting the consequences of declining vaccination rates across the nation.
The crisis began in late January when a young girl, unvaccinated and suffering from an underlying respiratory condition, arrived at Dr. Myrick’s emergency room displaying the telltale rash of measles. This case marked the beginning of the largest measles outbreak the United States has seen in six years, with nearly 160 people infected, 22 hospitalized, and tragically, one school-aged child with no underlying conditions succumbing to the disease – the first measles death in a decade.
Dr. Myrick, a 38-year-old physician practicing in the small town of Seminole, found herself revisiting her medical texts to refresh her knowledge of measles, a disease that was once thought to be on the verge of eradication in the U.S. Now, she has treated nearly a dozen cases, and the number continues to rise.
"Now we’re literally seeing when you don’t vaccinate, this is what happens," Dr. Myrick stated, underscoring the stark reality of the situation.
The resurgence of measles underscores the dangerous trend of decreasing vaccination rates in the U.S. Schools, which traditionally require vaccinations for attendance, have seen a drop in immunization rates below the 95% herd immunity threshold recommended by the Centers for Disease Control and Prevention (CDC). This decline has been attributed to growing distrust and misinformation surrounding public health and vaccinations, leading to increases in medical or religious exemptions.
"Measles is the tip of the iceberg," warned Dr. Daniel Kuritzkes, chief of the infectious diseases division at Brigham and Women’s Hospital and a professor at Harvard Medical School. "There are other vaccine-preventable illnesses that we could see recurring, which could also have catastrophic consequences."
Gaines County, the epicenter of the outbreak, exemplifies the issue. Last school year, just over 80% of kindergartners were vaccinated against measles. In the Loop Independent School District, with approximately 150 students, less than half were vaccinated. As of Tuesday, over 100 of Texas’s 159 cases were located in Gaines County, primarily affecting school-aged children. Alarmingly, all but five cases involved individuals who were either unvaccinated or had unknown vaccination status.
Dr. Myrick’s journey to Seminole began five years ago when she traded the bustling environment of Atlanta, with its renowned research institutions like the CDC headquarters, for the close-knit community of a rural town. After studying at Emory School of Medicine and earning a doctorate in neuroscience, she sought to practice family medicine and obstetrics in a setting where she could build relationships with her patients. Seminole, with a population of 7,231 and a diverse mix of white, Mexican, and Mennonite families, offered that opportunity.
Her daily life in Seminole is a world away from the urban sprawl of Atlanta. A three-minute commute with a single traffic light brings her to work, and encounters at the local grocery store often turn into impromptu medical consultations. It’s a community where people look out for each other, fostering a sense of belonging and shared responsibility.
However, before the outbreak, Dr. Myrick encountered prevalent concerns about vaccines, particularly within Gaines County’s Mennonite community, where the measles first emerged in late January. Parents expressed the belief that measles was a disease of the past, rendering vaccination unnecessary. Others downplayed the severity of the illness or falsely claimed that vaccines caused harm, despite decades of scientific evidence demonstrating their safety and effectiveness. As their family doctor, Dr. Myrick consistently recommended vaccination, emphasizing its safety and efficacy.
Such misinformation has contributed to the resurgence of measles. Health experts point to the damaging impact of statements made by individuals like Robert F. Kennedy Jr., who has long advocated against the measles vaccine and contradicted guidance from established health agencies. During the current outbreak, Kennedy has downplayed the severity of measles and disseminated incorrect information about the disease, according to Dr. Richard Besser, former acting director of the CDC and current president and CEO of the Robert Wood Johnson Foundation.
Dr. Besser stressed the importance of pediatricians and family doctors familiarizing themselves with diseases previously relegated to history. They must be able to recognize measles, polio, and various types of meningitis, as well as understand the appropriate isolation protocols.
Measles is a serious disease, with approximately one-fifth of unvaccinated individuals requiring hospitalization. Children who contract measles can develop pneumonia, the most common cause of death from the disease, or brain inflammation, which can lead to hearing loss or developmental delays. The mortality rate among infected children is estimated at 1 to 3 in 1,000.
The most effective defense against measles remains vaccination. The full two-dose series, administered beginning around one year of age, provides 97% protection against measles, while a single dose offers 93% protection.
Measles is highly contagious, spreading through contact with droplets released through coughing, sneezing, or talking. The virus can remain infectious in a room or on surfaces for up to two hours after a sick person has left. One contagious individual can infect as many as 18 others who are not immunized.
The initial diagnosis can be challenging as the symptoms of measles, such as fever, cough, or rash, can be attributed to various other conditions. However, given the high contagiousness of the disease, early identification, isolation, testing, and confirmation are essential to halting its spread. Compounding the challenge, symptoms typically develop a week or two after exposure, and individuals can transmit the virus even before exhibiting symptoms.
Dr. Myrick witnessed this firsthand when the young girl with the underlying respiratory condition arrived in her emergency room. Following the diagnosis of measles by an emergency physician, Dr. Myrick consulted her medical texts to guide her treatment. She vividly recalls the blotchy, red spots covering the girl’s body from head to toe. The child was immediately placed in isolation, and hospital staff donned full gowns and masks. Over the course of the child’s stay, the rash evolved into smaller red dots. Initially, Dr. Myrick believed this would be an isolated case.
"We took every precaution we could to try to contain it and keep it isolated to just that one patient," she said. "And it didn’t work. It didn’t work at all."
The outbreak initially centered within the region’s Mennonite community, which had historically low vaccination rates, resulting in entire families becoming infected. Subsequently, Dr. Myrick and her staff have treated cases among Latino infants too young to be vaccinated, facing serious illness. Pregnant women, who are at increased risk of miscarriage or premature birth from infection, are also vulnerable.
Dr. Myrick anticipates further spread within the community. Many families call describing measles symptoms but are reluctant to seek testing or treatment unless the infection worsens.
Outside of Gaines County, the outbreak has extended to eight other counties, with exposures reported hundreds of miles away, including areas in and around San Antonio. Officials in New Mexico suspect that their outbreak, involving nine confirmed cases, is linked to the Texas outbreak across state lines.
Beyond Texas and New Mexico, neighboring states exhibit vaccination rates below the herd immunity threshold required to prevent outbreaks. While Texas and New Mexico have two-dose vaccination rates among kindergartners at 94.3% and 95%, respectively, surrounding states, including Arizona, Colorado, Kansas, and Oklahoma, reported immunization rates below 90%, according to CDC data from the previous school year.
"A hope and a prayer doesn’t just make it go away," warned Dr. Kisha Davis, a board member of the American Academy of Family Physicians and a health officer in Maryland. Her health department, in Montgomery County, encountered a single measles case a year ago in an unvaccinated individual. Thanks to high immunization rates, an outbreak was averted. "We need to continue to be vigilant," she emphasized.
In Seminole, a wooden sign reading "MEASLES TESTING" now stands across from the local health department. In addition to expanded testing, officials have increased the availability of vaccinations. More people are seeking vaccinations, including some who had previously opposed them, according to Dr. Myrick, who has recently assumed the role of chief medical officer for the town’s hospital. However, vaccine hesitancy remains a challenge.
Dr. Myrick’s own children are aware of the outbreak and concerned about contracting measles. Classmates have been infected, and her children express fear of developing a rash. Dr. Myrick reassures them that they are protected due to their vaccinations. They do not need to be afraid.
