Story by Maya Hagan
As a child, Dr. Christoph Diasio’s colleague got the measles.
It was before 1963, so the vaccine wasn’t available. As he told Diasio decades later, he spent 10 days in his bedroom so he wouldn’t spread the disease to the rest of his family. Even dim light was so painful to be around, he recalled, he spent the entire 10 days with the lights off and his head under the pillow.
“This is the most contagious disease in the history of human beings on the planet Earth,” said Diasio, who has been a pediatrician for 24 years and is a member and former president of the North Carolina Pediatric Society. “It is way more infectious than flu, way more infectious than COVID, more infectious than smallpox. I mean, this is a big deal.”
Although North Carolina has not been affected by the virus thus far, medical professionals warn that clusters of unvaccinated individuals could leave the state vulnerable. As the measles virus reemerges in parts of the country, doctors are urging parents to get their children vaccinated to help prevent the spread.
Dr. David Wohl, who is a professor of medicine in the Division of Infectious Diseases at the University of North Carolina at Chapel Hill, said one of the main symptoms of measles is a rash that is unlike chickenpox because of the itching and burning components of the measles. Other symptoms of measles can include sensitivity to light, high fever, muscle pain and possible blindness. Wohl said what ultimately kills both adults and children is the pneumonia that can accompany measles because of how the virus can get into the lungs and cause inflammation.
According to Wohl, part of what also makes measles dangerous is its effects on the immune system because of how the virus impacts the way the body responds to other diseases.
“Measles does a weird thing to our immune systems. It wipes out some of the immunity we have to other diseases,” Wohl said.
Measles was declared eliminated in the United States in 2000. But, according to the World Health Organization, 2,318 measles cases, three of which were fatal, have been confirmed in the Americas and the Caribbean from January 1 to April 18 of this year. The organization said the majority of these cases have occurred among people ages 1-29.
The Centers for Disease Control and Prevention recommends that people get two doses of the measles-mumps-rubella (MMR) vaccine; the first between 12-15 months of age and the second between 4-6 years of age.
CDC data also show that during the 2023-24 school year, the immunization rate among U.S. kindergarteners decreased to less than 93% putting the nation beneath the organization’s target of at least 95% for the fourth consecutive year. In North Carolina, 93.8% of kindergartners had the vaccine in the same school year.
Texas has seen the most measles outbreaks this year with 663 reported cases as of April 29, said a release form the Texas Department of Health Services. According to Diasio, part of what has prevented North Carolina from seeing a similar pattern is that there are fewer large groups of unvaccinated people in one area. One of the groups Diasio listed that may cluster and be vaccine hesitant are religious communities such as the Mennonite community in Texas, where the outbreak started, according to the John Hopkins School of Public Health.
“It’s gotta be over 90% of people in a community vaccinated to get it back to that situation where even if a traveler comes back, has measles, that they wouldn’t be able to spread it,” Wohl said. “There wouldn’t be enough kindling to light a fire. So we have an outbreak right now, 100% due to under vaccination.”
The vaccine rate in the Mennonite community in Gaines County, Texas, was about 80% when the outbreak began. According to Carolina Demography, a unit within the Carolina Population Center, 48% of North Carolina’s population adheres to some religion.
However, religious communities such as the North Carolina Council of Churches have worked with the North Carolina Department of Health and Human Services (NCDHHS) to get the MMR vaccine to faith-based communities in the state.
Rev. Jennifer Copeland, the executive director of the North Carolina Council of Churches, said the communities the council usually works with believe in science. With that, Copeland said she supports the MMR vaccine and that trusted messengers are crucial in increasing vaccine rates in religious communities. She said people may need to see that others who are part of the same religion got their children vaccinated and that it was not harmful.
“We have to respect the fear and the mistrust as legitimate in the lives of people. You can’t just roll in and say, ‘look, I’m smarter than you are, I know more about science than you do, listen to me…’You’ve got to find out why people are afraid,” Copeland said.
According to the National Library of Medicine, part of the fear surrounding the MMR vaccine within religious networks often stems from the use of aborted fetus tissue in the rubella part of the vaccine.
“There’s no fetal material. These vaccines weren’t developed inside of a fetus, but it’s the technology that was used to help test the viruses in their development. But there’s nothing going on in any of these vaccines now that has to do with fetal tissue,” Wohl said.
The technology that Wohl is referring to is the testing used to develop the MMR vaccine. According to the Children’s Hospital of Philadelphia, the rubella component of the shot is grown in an aborted fetal cell line because these cells are less likely to introduce other viruses given that they were formed in a sterile environment in the womb.
However, after the rubella portion of the shot is grown, it is separated from the fetal fibroblasts that it was developed in and the cells are removed, meaning the vaccine does not contain fetal cells, according to an article from the Children’s Hospital of Philadelphia. The cells used to grow rubella were first obtained from two abortions in the early 1960s and are the same cells used today. No other fetal cells have been used.
Concerns about the MMR vaccine have spread outside of faith communities in recent years, said holistic pediatrician Dr. Ana-Marie Temple. Within her practice in Charlotte, North Carolina, Temple has seen an increase in vaccine hesitancy since the COVID-19 pandemic.
“Parents started doubting the information on the traditional vaccines that have been around for a long time,” she said.
For some patients at Temple’s clinic, much of the hesitancy comes from vaccine mandates during the pandemic. She said many parents she talks with are not entirely anti-vaccine; they are looking for healthcare providers to have a conversation with them and give them guidance.
“I always tell families, we have parents who come in and they wanna hang onto our every word about the best kind of baby bottle or the right order or which solid foods to start for first for a child who’s transitioning from breast milk or formula to solid foods,” Diasio said. “And we’ve got little little pieces of data around those things but then the vaccines, and especially measles vaccines, stand on a mountain of data.”
As a holistic medicine doctor, Temple agrees that the best way to prevent the measles is by getting the vaccine. However, she also said that for parents who chose not to get their child vaccinated, one natural prevention option she recommends is cod liver oil which is a natural form of Vitamin A.
Wohl, who has done work in the Sub-Saharan country of Liberia since 2014, said a study done in Sub-Saharan Africa showed that children who were Vitamin A-deficient had worse cases of measles than those who had sufficient levels. He emphasized that this does not mean that Vitamin A prevents measles. He said it is uncertain if the Vitamin A deficiency was the factor that caused the children in Sub-Saharan Africa to get sicker or if it was a symptom of malnutrition. Wohl also does not recommend cod liver oil as it can contain different levels of Vitamin A and if the level is too high, the oil can be harmful.
“We [give patients Vitamin A] just in case they are deficient because we don’t wanna wait for a test to come back, and two days later it says, ‘oh, you’re Vitamin A deficient and you missed two doses.’ So that’s why it’s done. I’m not sure it’s gonna help that much,” Wohl said.
Diasio said he doesn’t know if North Carolina will see an outbreak, but the best case would be if it reaches an area with a high vaccine rate. As of 2023, according to a graph from the North Carolina Division of Public Health, Cherokee County in western North Carolina has the lowest vaccination rate in the state of 83.7%.
For those questioning if they should get their child vaccinated or have decided not to, both Diasio and Wohl point to the importance of MMR immunization not only for the child but for the whole community.
UNC Hospitals employee Tess, who asked to be referred to by first name only to protect her children’s privacy, said she did not hesitate to get her 3-year-old and her 6-month-old vaccinated against MMR.
“Our pediatrician offered [the vaccine] to us at 6 months due to the nationwide outbreak. It is typically offered at 6 months to those that travel and/or may be at higher risk if there is an outbreak,” Tess said.
Tess’ doctor said her son’s immunity would not be in danger if the MMR vaccine was administered before 12 months, which she said helped ease her concerns. Temple said it is open conversations like these that parents are often looking for.
“The first question I usually ask parents is, ‘Tell me, what is your worry about contracting the disease naturally versus having the vaccine? Give me the pros and cons of having the illness in your eyes and the pros and cons of having the vaccine in your eyes?’” Temple said. “And then based on that, we kinda discuss what the disease is, because most people have never seen it, so they don’t actually understand what it is.”
While doctors can assist families in making their vaccination decisions, North Carolina schools can help with accessibility. According to Alecia Smith, the communications and public relations manager for Durham Public Schools, at the beginning of each school year the school district reserves days for children to come in to get their required vaccines in their immunization clinic. Smith said vaccines are offered all year but Durham Public School holds specific days in hopes that it will be easier for kids to get their immunizations, including MMR.
DPS students who are uninsured or underinsured, Smith said, may be able to receive required vaccinations at low or no cost through the Vaccines for Children Program.
Outside of public education, one of the steps North Carolina takes to prevent the spread of measles is requiring that private providers report measles cases to their local health department within 24 hours, according to NCDHHS. In addition, according to North Carolina’s Infectious Disease Response Plan, the protocols in place in the event of an outbreak of a disease such as measles involves contact tracing, quarantine measures and vaccination campaigns.
As measles continues to spread in the U.S., healthcare professionals such as Wohl are uncertain if there will be an outbreak in North Carolina. For now, he and Diasio recommend that parents get their children vaccinated and say it is the best way to prevent their children, themselves and others from contracting the virus.
“Let me do as good a job for your child as I wanna do for my own child. Let us protect your child the same way that we protect our own children. And I tell parents all the time, ‘my kids get vaccine out of the same fridge that your kids do,’” Diasio said.
