State health officials advise residents to be up-to-date on vaccinations amid measles outbreak on the mainland

While cases of measles have not been reported in Hawai‘i, state health officials issued a medical advisory to health care providers due to the rapidly expanding outbreak of the virus in Texas and New Mexico.

The advisory, issued on March 11 by the Hawai‘i Department of Health, emphasizes identifying and reporting cases and ensuring that all patients without other evidence of immunity — especially those planning international travel — are up to date with measles, mumps, and rubella (MMR) vaccination.

Gov. Josh Green, who is also a doctor, said the best protection against the virus is vaccination.

“Two doses of the MMR vaccine are 97% effective in preventing infection and stopping the spread,” the governor said. “Measles was once eliminated in the U.S., but low vaccination rates are bringing it back. We can’t let that happen here in Hawaiʻi.”

Many other illnesses can mimic measles, and currently, no cases of measles acquired in Hawai‘i have been reported.

Measles is an acute viral respiratory illness. Symptoms usually begin 7-14 days after exposure. The first sign is typically a high fever, often accompanied by a cough, red, watery eyes and a runny nose. A red rash usually appears a few days later, starting on the face and upper neck and spreading to the arms and legs.

Despite the success of vaccines in preventing diseases, the highly contagious viral illness is returning after being declared eliminated in the United States in 2000, the Hawai‘i Department of Health stated in a press release Monday.

In 2023, four outbreaks and 59 cases of measles were reported on the mainland. The numbers rose to 16 outbreaks and 285 cases in 2024. As of March 13, the Centers for Disease Control and Prevention reported there are already 301 confirmed cases across 15 states so far this year.

Measles cases are also increasing globally with the World Health Organization reporting 10.3 million cases worldwide in 2023.

“It spreads fast, causes severe complications, and puts our keiki, kūpuna, pregnant women, and those with weakened immune systems at risk,” Green said of the measles. “Prevention is the best cure, and a measles outbreak is preventable.”

The state health department stated risk of a travel-related measles case in Hawai‘i continues to increase, and the risk of an outbreak in Hawai‘i from exposure to a travel-related measles case has increased due to the high contagiousness of measles and the low vaccination rate against measles.

Individuals infected with measles can spread the virus up to four days before and four days after the presence of symptoms.

Measles is one of the most contagious viruses currently known, the health department stated. If a person is infected with measles, an expected nine out of 10 people nearby who do not have immunity also will become infected. The measles virus can remain airborne and infectious for up to two hours after an infected person leaves an enclosed area.

The more infectious a virus is, the higher the percentage of the population that needs to be vaccinated to prevent an outbreak.

“For measles, a population vaccination rate of at least 95% is needed to protect the community from an outbreak,” the health department release stated. “The state’s measles, mumps, and rubella (MMR) vaccination rate for kindergartners was 90% for the 2023-2024 school year, below the national average of 93%.”

Vaccination rates in Hawaiʻi are even lower in some pockets.

Multiple schools on Maui, Kauaʻi, and Hawaiʻi Island report vaccination rates below 75%, which could lead to greater vulnerability. State health officials say this is below the 82% vaccination rate in Gaines County, which is the epicenter for the Texas-New Mexico outbreak.

“An outbreak on a neighbor island would heavily strain its healthcare system, and no neighbor island hospital has a pediatric intensive care unit,” the release stated.

In the United States, about 1 in 5 unvaccinated people who contract measles are hospitalized due to complications, such as pneumonia. Other complications include ear infections that can lead to hearing loss and rarely encephalitis (brain swelling) and even death.

Newborns who are too young to get vaccinated are at increased risk, and a measles infection during pregnancy is associated with an increased risk of miscarriage, stillbirth, and low birth weight.

If you suspect you may have measles, it is important to call ahead to your health care provider so they can begin the process of determining whether measles is present and advise you on steps to prevent its spread in the clinic before your arrival.

DOH urges all residents, particularly parents, to ensure their children are up to date on immunizations. High vaccination rates not only protect vaccinated individuals but also safeguard the broader community.

For more information on measles and vaccination, visit the Hawai‘i Department of Health website.