New Hampshire has remained untouched by the recent measles outbreaks that have struck around the U.S., but doctors are raising concerns over the state’s low vaccination rates for the disease.

Since the start of the year, 113 measles cases have been reported in 17 states as of Friday, according to the Centers for Disease Control and Prevention. The majority of cases are in unvaccinated children, and connected to international travel, while 83 of the 113 are linked to one of seven measles outbreaks nationwide, defined as three or more related cases.

The measles, mumps and rubella (MMR) vaccine is safe and highly effective, according to the CDC. But immunization rates have been declining in recent years, and New Hampshire has fallen below the national average.

“Misinformation and vaccine skepticism are primary drivers,” Dr. Aalok Khole, an infectious disease physician at Cheshire Medical Center in Keene, said in an email. “This was further fueled by the polarized approach that came into being during the COVID vaccine era.”

What is measles?

Measles is an airborne disease with high transmissability that carries potential for serious complications and even death, according to the World Health Organization. Although anyone can be infected with the virus, it most commonly affects children.

Thus far in 2024, 58 percent of U.S. measles cases have resulted in hospitalizations, and the majority of people hospitalized have been children under 5, according to the CDC.

Early symptoms include high fevers, cough, runny nose and watery eyes, also referred to as conjunctivitis, which in severe cases can result in extreme sensitivity to daylight and blindness. Within two to three days of infection, “koplic spots” small white dots, may appear inside the mouth, according to the CDC. After three to five days, a rash will begin on the face and spread over the entire body, and fevers can spike to over 104 degrees.

“Measles is a very nasty virus,” said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University Medical Center in Tennessee.

Dropping vaccine rates

The Granite State’s average rate for kindergartners who have received the measles mumps and rubella (MMR) vaccines was 89.4 percent during the 2022-23 school year, down from 91.5 percent in the 2019-2020 school year. During the same time period, the national MMR vaccination rate dropped from 95.2 percent to 93.1 percent, according to the CDC.

A national vaccination rate of at least 95 percent is recommended to achieve “herd immunity,” when a large portion of the community’s population is immune to a specific disease, according to the U.S. Department of Health and Human Services.

Schaffner attributed low vaccination rates to an “avalanche of misinformation” around the virus, and emphasized the importance of educating people about the effects measles had before the invention of the MMR vaccine.

“Parents today are not very knowledgeable about measles, understandably, because even their mothers didn't experience measles,” Schaffner said. “It's been a couple of generations now.”

He stressed that measles is one of the most transmissible viruses, and spreads “extremely rapidly.”

“Even if you had uncomplicated measles — just simple, straightforward measles — it was a miserable illness,” he said.

Schaffner said measles can result in a number of complications, including infections of the middle ear, which often require antibiotics. The viral disease can also cause pneumonia and encephalitis — inflammation of the brain. Schaffner said both of these can be fatal, and many times were, before the MMR vaccine came about.

Schaffner said measles can also present social challenges.

“If you have a child ill with measles, they can't stay home by themselves. So, somebody's got to stay home to watch that child,” he said.

He added measles is disruptive to academic performance, as children who get measles are typically sick and out of school for multiple weeks, or even longer if more complicated symptoms arise.

When the vaccine came out in the 1960s, Schaffner said people were “ecstatic” that they finally had a weapon to combat the outbreaks. And, after enough doses were given, the outbreaks were eradicated from the entire western hemisphere.

Vaccine reluctance

In New Hampshire specifically, a lot of vaccine hesitation stems from religious beliefs and the fact that religious exemptions for vaccinations in schools are generally easy to declare, according to Dr. Suzanne Schoel, the medical director of pediatrics at Monadnock Community Hospital in Peterborough.

“A lot of people who are not immunized fall into little enclaves where it's a group of people who are always together,” she continued, adding that people living in certain areas tend to have similar beliefs.

Schaffner also emphasized that the “paradox of the success of vaccines” is also a contributing reason.

“Vaccines are really successful,” he said. “And if the disease disappears, the knowledge about the disease also begins to dwindle.”

The idea that before the vaccine “everybody got it, and they got better — it was a little rash, big deal. That's a completely erroneous concept,” Schaffner said. “If there's no respect for the disease, it's difficult to value the vaccine.”

Schaffner added there is a lot of fear around vaccines not being “natural.”

“If you get appendicitis, it's not the natural way to have surgery either,” he said, “but, we do surgery in order to relieve your appendicitis.”

Schoel said when people are hesitant to give their child the vaccine, she always asks about the cause of their skepticism.

“Oftentimes, it’s fear around the ingredients of vaccines, such as mercury,” she explained.

Her response to this worry is, “it’s in such a tiny, tiny amount that basically, if you ate a tuna fish sandwich, you probably have more mercury than in a vaccine.”

Schaffner added the only children who might not have the ability to get the vaccine are those with immune-compromising illnesses, as the vaccine can put them at more risk. He emphasized the importance of having other children vaccinated to protect those who are immuno-compromised.

Children who, in the “bad old days,” would have died, have been able to survive thanks to modern medicine, he explained. But, they are fragile, he said.

“We, and I say this unabashedly, have an obligation to protect them,” he said, “and the way we protect them is to vaccinate our own children, so the virus can't get through our children to find those special children who can't be vaccinated themselves.”

Vaccine availability

Doctors offices are always offering MMR vaccines and patients can make a specific appointment or get caught up at their next scheduled visit. The CDC recommends children receive the first dose of the MMR vaccine between the ages of 12-15 months and the second between ages four and six years old.

Cheshire Medical pediatrics patients can schedule an MMR vaccine appointment by calling 603-354-6666. Family Medicine patients can call 603-354-6760 to schedule an appointment.

Monadnock Community Hospital is also offering MMR vaccines, which can be obtained either at an annual physical or at a scheduled nurse’s visit, according to Rheanon Valcourt, Practice Manager with Monadnock Health Partners.

Schaffner added the two-dose MMR vaccine will keep people protected “for your entire lifetime.”

Khole at Cheshire Medical, emphasized the importance of getting vaccinated before spring, “given that spring season is known to see increased travel.” He added that vaccinating will protect against “lost time and wages related to unnecessary quarantines.”

If not, he emphasized, “we're going to have more and more outbreaks of measles in the United States, and that's turning the clock back 50 years.”