Experts worried over increases in preventable measles cases: 'We will see more in Tennessee'

Tennessee has four confirmed measles cases, and health care experts know with certainty that means more are on the way. Measles was declared eliminated from the United States in 2020, but it is surging again as parents decline to vaccinate their children.

Cases have been reported in other parts of the state, but not Knox County. "The most recent reported case in Knox County was in 1980," Knox County Health Department spokesperson Kelsey Wilson told Knox News.

Roughly 500 cases were recorded March 27 across 18 states, with two confirmed deaths attributed to measles and another death under investigation, in the latest data available. Cases have surpassed the 285 recorded in 2024.

Measles is extremely contagious among unvaccinated people, Dr. John Adams told Knox News. It causes a high fever and rash, and can lead to complications.

"I've already told my younger partners in our group, you're going to see measles in your career. You're probably going to see mumps in your career. These childhood illnesses were so well controlled that generations of physicians have grown up not even knowing what they look like. They're going to be seeing them again," said Adams, a Covenant Health epidemiologist.

"We will see more in Tennessee."

With measles in Tennessee now, what can Knoxville and neighboring counties expect?

While herd immunity through vaccination is playing a significant role in slowing the spread of measles, the rate of cases is increasing because of the number of unvaccinated people.

The recent politics of vaccines and, in some cases, religious beliefs, lead some parents to skip vaccinations.

"There are people throughout the nation who lack immunity for whatever reason. We have not eradicated measles the way we did, say, smallpox. It's going to be around," Adams said. "We now have (multiple cases) from this current resurgence in Tennessee, and although I am generally very much the optimist, in this case, I must take a little bit more of a cautious position."

The most significant concern is the disease spreading easily among school-age children.

Most Tennessee school districts require childhood vaccinations, including one for measles, mumps and rubella, but the risk of an outbreak in children is more significant now that vaccine hesitancy has increased.

The overall immunity level in Knox County is roughly 95%, which is enough to prevent an epidemic. However, that percentage drops to roughly 90% for schoolchildren and continues to decline as you move into outlying counties, according to Adams.

Lower vaccination rates make rural communities more susceptible.

How do you prevent the spread of measles?

Measles vaccines are the best way to prevent contracting or spreading the disease.

Measles is one of the most contagious viral diseases with a 90% infection rate among nonimmune people, according to Adams. That means 9 out of 10 people will get measles if they aren't vaccinated.

"Get vaccinated if you haven't been. Unfortunately, there's been a major growth industry in vaccine hesitancy and just outright rejection in this country and globally for the last number of years," Adams said.

The measles, mumps and rubella vaccine, or MMR, is the one to ask your doctor or pharmacist about.

"Immunity to measles is typically achieved through two doses of MMR vaccine, which provides a 95% chance of immunity. People born before 1957 are presumed immune due to natural exposure. The MMR vaccine is a sterilizing vaccine, preventing both illness and transmission," Adams said.

Antibodies build up after the first dose of MMR within about two weeks with a 93% chance of immunity, and within 30 days of the first dose, it is advised to get the second, which gives a 95% chance of immunity.

About the MMR vaccine

The MMR vaccine is safe.

"There's all kinds of allegations about concerns for the vaccine, none of which have been validated," Adams said. "The vaccine is incredibly safe and is proven to be highly effective. As far as I'm concerned, that's one where the book has been written, signed, sealed and delivered, we don't need to go there again ... and restudy it."

The vaccine has been around for decades and far surpasses all other prevention methods.

"The safety record for the MMR vaccine is excellent. Hundreds of millions of doses of the MMR vaccine have been given in the United States over the past fifty-plus years. If side effects do occur, they are typically mild (fever, tenderness at the injection site, mild rash)," Wilson said. "Conversely, measles can be a serious disease. Prior to the MMR vaccine introduction, there were approximately 30 million cases of measles and more than 2 million deaths worldwide."

What are the symptoms of measles?

Measles can cause severe illness and even death. The symptoms are:

• A fever between 102 and 103 degrees
• Rash
• White spots in the mouth called koplik spots
• Runny nose
• Scratchy throat
• Dry cough

Those with measles are contagious up to four days before the rash appears, which means that before the fever hits, a person can spread it. People usually remain contagious four or five days after the rash appears.

Symptoms typically appear seven to 14 days after exposure but can go as long as 21 days, so if someone is exposed to measles, the quarantine period lasts 21 days. That means parents must take a significant amount of time off of work to watch their child as they recover or are quarantined.

Complications include encephalitis or measles pneumonia, which can be life-threatening. Measles can, in some cases, cause people to develop a rare disease called subacute sclerosing panencephalitis, a fatal and untreatable neurological degenerative condition that arises up to a year later.

Infants, the elderly and pregnant women are the most at risk for death and severe complications.

How to get an MMR vaccination

Children from 12 months to 15 months old should get the first dose of the MMR vaccine. A second dose is given at 4 to 6 years old, according to the Centers for Disease Control and Prevention.

Adults are advised to stay up-to-date on their vaccinations unless they have presumptive immunity, having been born before 1957. Immunity can decline with age and with other Immunosuppressing diseases.

Usually, only one dose is required for nonimmune adults, but for those attending a post-high school facility like a college or those visiting affected areas like an at-risk school, experts suggest two doses.

Pharmacies offer MMR vaccines, as does the Knox County Health Department. Call the health department at 865-215-5070 (Travel and Immunization Clinic) or 865-215-5950 (West Clinic) for an appointment.

The Knox County Health Department requires a $15 fee that usually is covered by insurance. No one will be denied based on ability to pay.