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What is the History of Measles in America and Other Countries?
Measles was first described in the 9th century by Persian physician-philosopher Zakariya Razi. His accurate description of measles was recognized by the World Health Organization (WHO) in 1970 as the first written account of the illness.
In 1757, Scottish physician Francis Home concluded that measles was an infection of the respiratory tract and could be found in the blood of affected individuals. Home attempted to develop a measles vaccine, however, his vaccine experiments were not successful as the measles virus had not yet been isolated. In 1954, Dr. Thomas C Peebles and Dr. John F. Enders successfully isolated the measles virus during an outbreak among students in Boston, Massachusetts. Measles vaccination development began shortly after their discovery.
In the U.S., measles became a reportable disease in 1912. In 1920, there were 469,924 recorded cases and 7,575 deaths associated with measles. Increases in measles cases generally occurred in late winter and spring, every two to three years.
Prior to measles vaccine licensing in 1963, the Centers for Disease Control (CDC) admitted that measles cases were significantly underreported “because virtually all children acquired measles, the number of measles cases probably approached 3.5 million per year (.i.e., an entire birth cohort).” Other experts reported that up to 5 million measles occurred yearly in the United States.
In 1960, three years before the first measles vaccine was approved for use in the U.S., there were approximately 442,000 reported measles cases and 380 related deaths , among the 3.5 to 5 million Americans who likely were infected with measles. In 1969, measles deaths were estimated at 1 in 10,000 cases.
The CDC attributes the drop in reported measles cases and deaths in the U.S. to use of the measles vaccine beginning in the mid-1960’s; However, published measles morbidity and mortality data give evidence that death rates for measles had dropped significantly in the U.S. before the measles vaccine was introduced in 1963.
In 1967, public health officials announced that measles could be eradicated from the U.S. within a few months, with the introduction and use of measles vaccines. However, mass vaccination of children beginning at approximately one year of age and the push for all children entering school to receive a dose of measles vaccine, did not result in eradication and outbreaks of measles continued to occur in highly vaccinated populations. By the end of 1968, 22,231 measles cases had been reported to the CDC.
In the 1970s, attempts were made to use MMR, Merck’s newly licensed live virus vaccine which combined the attenuated measles vaccine with live mumps and rubella vaccine, to eradicate measles by employing surveillance and containment strategies that worked to eradicate smallpox. This was attempted despite knowledge that the highly contagious measles vaccine was very different than the less contagious smallpox virus. The eradication campaign was a complete failure and measles cases and outbreaks continued.
In 1979, public health officials launched an effort to eliminate measles in the United States through vaccination, with a goal of elimination by October 1, 1982. In 1982, there were a record low 1,697 reported cases of measles in the United States and while public health officials conceded that the goal of elimination had not been met, they publicly stated that it was “right around the corner”.
From 1985 to 1988, there were between 55 and 110 measles outbreaks every year in the U.S., primarily in highly vaccinated school-aged populations. Measles swept through a middle school in Texas, where 99 percent of the students were vaccinated, and in a Massachusetts high school with a 98 percent vaccination rate.
A resurgence of measles in the United States occurred between 1989 and 1991, when reported measles cases increased 6- to 9-fold over the previously studied period between 1985 and 1988. This resurgence was associated with unusually high morbidity and mortality. While the CDC stated that they didn’t know why there were increases in measles and insisted that “measles vaccines appear to be as effective today as in the past,” they also admitted that the “analysis of contemporary strains of measles virus suggest that circulating viruses may have changed somewhat from past strains.”
There were more than 45,000 measles cases reported in the U.S. between 1989 and 1990, and over 100 deaths. Many cases occurred among vaccinated school children; however a large number of cases also occurred in babies less than 15 months old, in unvaccinated toddlers, as well as in college students.
As a result of the significant increase in the number of reported measles cases, the CDC’s Advisory Committee on Immunization Practices (ACIP) changed its measles recommendation, and all children were advised to receive an additional dose of measles vaccine prior to school entry.
Reported measles cases dropped by the early 1990’s and in an eight-year period between 1993 and 2001, there were 1804 cases and 120 outbreaks reported. In 2000, when only 86 measles cases were reported, the CDC declared measles to be eliminated in the United States.
From 2000 to 2007, the U.S. recorded an average of 63 cases of measles a year. Measles cases increased slightly in 2008 to 140 reported cases, but decreased again in both 2009 and 2010. In 2011, 220 cases were reported and frequently associated with travelers returning from European and Southeast Asian countries.
In 2014, there were 667 reported measles cases, and many cases were linked to the Philippines, which was experiencing a significant measles outbreak. 383 cases were associated with an outbreak involving an Amish community in Ohio.
In January 2015, a multi-state outbreak linked to a California amusement park resulted in 147 confirmed cases of measles. No known outbreak source was confirmed, however, the CDC believes that an international traveler was likely responsible for the outbreak. The particular measles strain responsible for the California outbreak was reported by the CDC to be identical to a strain found in the Philippines.
The 2015 measles outbreak prompted a media firestorm, with newspapers and health officials blaming the parents of unvaccinated children for outbreaks, calling them ignorant, anti-science, and worse. Many state legislators responded quickly by introducing vaccine legislation aimed at eliminating or severely restricting religious and conscientious/philosophical vaccine exemptions. Vaccine choice advocates were highly successful in defeating most bills, however, California lost its personal belief exemption and Vermont lost its philosophical exemption but retained its religious exemption.
In 2017, a published study revealed that in 2015, of the 194 measles virus specimens collected and analyzed, 73 were determined to be vaccine-strain. While referred to by the CDC as a vaccine reaction, a rash and fever occurring 10-14 days following vaccination is indistinguishable from wild type measles and requires confirmation by genotyping (specific testing that can determine whether the virus is wild-type or vaccine strain). Measles genotyping is important and multiple studies on vaccine-strain measles have reported on the need for rapid genotyping to quickly differentiate between wild and vaccine-strain measles, especially during an outbreak.
In 2017, a 75 case outbreak occurred in Minnesota and affected mainly Somalian Americans living in Minneapolis. A total of 122 cases of measles were reported in 2017.
349 measles cases and 17 separate outbreaks were reported to the CDC between January 1 and December 29, 2018 and cases were reported in 26 states and the District of Columbia.
In January 2019, the World Health Organization (WHO) announced “vaccine hesitancy” to be one of the top ten global health threats. By late January, as a result of the rising number of reported measles cases in the U.S., the government and media launched an unprecedented response.
In Rockland County, New York instead of quarantining people infected with measles, government officials threatened parents of healthy unvaccinated children with fines and imprisonment if their children appeared in public spaces – the first time ever in American history. Unvaccinated children and adults living, working or visiting in neighborhoods with certain zip codes in Brooklyn were threatened with steep fines if found in contact with someone with measles.
Several state legislatures, including Arizona, New York, Connecticut, New Jersey, Minnesota, Iowa, Alabama, Missouri, Maine, Massachusetts, Oregon, Pennsylvania, Washington, and Wisconsin, introduced bills to eliminate religious and conscientious/philosophical vaccine exemptions for school entry. In California, a bill was introduced and amended to severely restrict its medical exemption.
Washington State passed a bill which eliminated the philosophical exemption for MMR vaccine, and Maine’s legislature removed its religious and philosophical exemption for all vaccines. On June 13, 2019, the New York State legislature repealed its religious exemption to vaccination in one day, without permitting any public hearings.
From January 1, 2019 to July 3, 2019, 1,109 cases of measles in 28 states have been reported. The CDC reports cases and outbreaks to be associated with travelers from countries such as the Ukraine, Israel, and the Philippines, where large outbreaks are occurring.
Measles is a common infection seen in many developing countries, especially in Asia and Africa. The World Health Organization (WHO) reports that 110,000 measles related deaths occurred globally in 2017 and most deaths involved children under the age of 5. Complications occur more frequently in young children who are malnourished and insufficient in vitamin A. Children with immunosuppressive diseases, such as HIV, are also more likely to suffer from complications.
Measles has re-emerged globally and as of mid-April of 2019, WHO reported 112,000 cases impacting 170 countries, which WHO officials said reflected about 10 percent of all cases.
IMPORTANT NOTE: NVIC encourages you to become fully informed about Measles and the Measles vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
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9 Wood DJ, Brunell PA. Measles Control in the United States: Problems of the Past and Challenges for the Future. Clin Microbiol Rev 1995; 8(2): 260-267.
10 CDC Reported incidence of notifiable diseases in the United States 1962. MMWR Sep. 16, 1963; 11(53): 1-29
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13 Wood DJ, Brunell PA. Measles Control in the United States: Problems of the Past and Challenges for the Future. Clin Microbiol Rev 1995; 8(2): 260-267.
14 CDC SUPPLEMENT – Collected Recommendations of the Public Health Service Advisory Committee on Immunization Practices MMWR Oct. 25, 1969; 18(43) : 1-31
15 CDC Measles, Mumps, and Rubella—Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. May 22, 1997; 47(RR-8); 1-57.
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21 CDC Reported incidence of notifiable diseases in the United States, 1968 MMWR 17(53): 1-60
22 Orenstein WA. The Role of Measles Elimination in Development of a National Immunization Program. Pediatr Infect Dis J 2006; 25(12): 1093-1101.
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32 Wood DL, Brunell PA. Measles control in the United States: problems of the past and challenges for the future. Clin Microbiol Rev 1995; 8(2): 260-267.
33 CDC Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR Dec 29, 1989; 38(S-9);1-18
34 Yip FY, Papania MJ, Redd SB. Measles Outbreak Epidemiology in the United States, 1993-2001. J Infect Dis. May 1, 2004; 189 Suppl 1:S54-60.
38 CDC Summary of Notifiable Diseases --- United States, 2009. MMWR. May 13, 2011; 58(53);1-100
39 CDC Summary of Notifiable Diseases — United States, 2010. MMWR. Jun. 1, 2012; 59(53);1-111
40 CDC Summary of Notifiable Diseases — United States, 2011. MMWR. July 5, 2013; 60(53);1-117
41 CDC Summary of Notifiable Infectious Diseases and Conditions — United States, 2014 MMWR. Oct. 14, 2016; 63(54);1-152
44 NVIC Measles in Disneyland: Third MMR Shot and Vaccine Exemption Ban? Jan 28, 2015
46 Roy F, Mendoza L, Hiebert J et al. Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR. J Clin Microbiol. 2017 Mar;55(3):735-743.
47 CDC Measles (Rubeola) Genetic Analysis of Measles Viruses Jun. 5, 2018
48 Tramuto F, Dones P, D Angelo C et al. Post-vaccine measles in a child with concomitant influenza, Sicily, Italy, March 2015. Euro Surveill. 2015 May 21;20(20). pii: 21134.
49 Murti M, Krajden M, Petric M et al. Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013. Euro Surveill. 2013 Dec 5;18(49). pii: 20649.
50 Kaic B, Gjenero-Margan I, Aleraj B, et al. Spotlight on measles 2010: excretion of vaccine strain measles virus in urine and pharyngeal secretions of a child with vaccine associated febrile rash illness, Croatia, March 2010. Euro Surveill. 2010 Sep 2;15(35). pii: 19652.
51 Morfin F, Beguin A, Lina B, et al. Detection of measles vaccine in the throat of a vaccinated child. Vaccine. 2002 Feb 22; 20(11-12):1541-3.
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53 Roy F, Mendoza L, Hiebert J et al. Rapid Identification of Measles Virus Vaccine Genotype by Real-Time PCR. J Clin Microbiol. 2017 Mar;55(3):735-743.
58 Weisman N. Washington Hopes Locking Unvaccinated Kids Out of School Will Prevent Next Measles Outbreak. Popular Science Jan. 29, 2019.
59 Tampone K. Rockland County’s Ban on Unvaccinated Minors from Public Carries Fine, Jail. Post Standard Mar. 27, 2019.
60 Dunne A. Some Lawmakers Support Vaccine Bill Amid Rockland’s Ongoing Measles Outbreak. WAMC Radio (NPR-NY) Mar. 28, 2019.
61 Fisher BL. New York Judge Halts Action by Rockland County Exec Banning Unvaccinated Kids From Public Spaces. The Vaccine Reaction Apr. 10, 2019.
62 Ricks D. DeBlasio declares measles health emergency for parts of New York City. Newsday Apr. 9, 2019.
64 Thompson M Arizona vaccine exemptions: New House Bills could change parental rights, options ABC15 Arizona Feb. 19, 2019
65 National Vaccine Information Center New York Bill Removing Religious Vaccine Exemption Turned Into Law on One Day with No Public Hearings The Vaccine Reaction June 14, 2019
66 Altimari, D Lawmakers hear testimony on proposal to end religious exemption to vaccination Hartford Courant May 13, 2019
67 Symons, M NJ close to ending ‘religious’ exemptions for vaccines New Jersey 101.5 Apr. 18, 2019
68 Murphy E Hundreds Rally To Oppose Bill Limiting Vaccine Exemptions WCCO 4 CBS Minnesota Feb. 25. 2019
69 Lynch JQ Iowa lawmakers propose competing changes to vaccination exemptions Quad-City Times Feb. 18, 2019
70 Gore L Religious exemption to vaccines would be eliminated under new Alabama bill Al.com May 9, 2019
71 Baiter, K Missouri faces vaccination hesitancy amid measles case AP News Apr. 5, 2019
73 Lannan K Mass. Sees 2nd Measles Case This Year. Now There's A Bill To Remove Religious Exemption For Vaccines 90.9 wbur Jun. 3, 2019
74 VanderHart D Tougher Vaccine Laws Pass Oregon House, Head To Senate OPB.org May 7, 2019
75 Snyder M Pennsylvania bill would end religious, philosophical exemptions from vaccines ABC News 27 Mar. 29, 2019
76 Sun LH, Millares Young K, Washington measles outbreak draws crowd to hearing on vaccine law The Washington Post Feb. 8, 2019
78 Associated Press California Bill to Tighten Vaccine Exemptions Amended to Sharpen Focus on Bad Doctors KTLA5 June 18, 2019
79 Wamsley L Washington State Senate Passes Bill Removing Exemption For Measles Vaccine NPR.com Apr. 18, 2019
81 National Vaccine Information Center New York Bill Removing Religious Vaccine Exemption Turned Into Law on One Day with No Public Hearings The Vaccine Reaction June 14, 2019
86 NPR. U.S. Measles Outbreaks Are Driven By A Global Surge in the Virus. Apr. 30, 2019.