Why we need to take measles seriously again

Measles, that ghost from a distant past, is making an unwelcome return, in many countries around the world, including in developed nations. And it’s impossible to ignore. We could soon be staring at a ‘Measles Map’ indicating regions where the protection of herd immunity has now fallen apart.

How we got here

For many years, the MMR vaccine (measles, mumps, rubella) has kept a sentinel watch on these dangerous viruses, offering protection not just with a 95% effectiveness for the vaccinated but also through “herd immunity” for those unable to be vaccinated. That wall of immunity has now begun to slowly break down. In the post-COVID years, many regions across countries saw reduced access to routine childhood vaccinations such as MMR, even critically low levels, due to increased strain on over-extended public health facilities overwhelmed by the COVID-19 outbreak. Additionally, due to lockdowns, a large number of parents couldn’t access hospitals for timely vaccinations for their children.

India also reported over 32,000 suspected and confirmed measles cases in late 2022, with Maharashtra, Kerala, Jharkhand, and Gujarat being the hardest hit. Mumbai became the epicentre with its numerous clusters in high-density areas. Overall, the pandemic and its after-effects caused approximately 3 million children in the country to miss their routine measles vaccine doses.

Spartanburg’s shadow

To grasp the sobering truth of what the Measles Map of 2026 entails, one needs look no further than Spartanburg County in South Carolina, United States. What began with a small number of sporadic cases quickly mushroomed into a full-blown outbreak, with more than 550 reported cases as of January 2026. Schools were closed, hospitals prepared for overflowing paediatric wards, and people were caught unawares of the alarming rate of virus transmission.

The situation in Spartanburg County is not unique: measles has reared its head in other countries too, including 14,000 reported cases in Indonesia, as well as in Yemen and Pakistan. A worrying aspect is the fact that in 2025, Canada lost its measles elimination status and the USA and Mexico face the same reality in 2026, undoing decades of public health progress.

India needs to brace for this.

Understanding measles

Measles is far more than just a rash and a fever. Its true danger lies in what scientists are calling “immunological amnesia”, which often gets lost in public discourse. When the measles virus infects a child, it doesn’t just cause acute illness; it systematically targets and destroys the very cells that form the backbone of the immune system’s memory. These are the cells that remember how to fight off other diseases—influenza, pneumonia, even chickenpox.

Measles affects the immune system in such a way that sometimes, even years after recovery, a child is left with a compromised immune system, essentially reverting to an infant-like state of vulnerability. This means children who survive measles in 2026 will likely face a significantly higher risk of succumbing to other common infections for the next two or three years, creating a “secondary health crisis” that public health systems may be ill-equipped to handle.

Recognising measles

Measles doesn’t start with a visible rash; rather, it begins as a cold, which is often mistaken for the common flu. This cold could also be accompanied by cough, runny nose, and conjunctivitis (red, watery, and light-sensitive eyes). After two or three days of these symptoms starting, tiny white spots may appear inside the mouth along with a fever. About 3–5 days from the onset of the first symptoms, a rash will appear, usually starting at the hairline or behind the ears, and it then spreads downward to the neck, trunk, and finally the hands and feet.

For most people, two doses of the MMR vaccine provide permanent, lifelong immunity. You do not need booster shots as an adult, if you have completed the two-dose series.

International travel precautions

With major outbreaks expected in 2026 across Europe, Southeast Asia, and parts of the U.S., here are some things to take care of before planning international journeys:

• Ensure you have documentation of two doses of the MMR vaccine. If you are unsure, you can either get a “catch-up” dose (it is safe even if you’ve had one before) or take a blood test to check for antibodies.

• If traveling with an infant (six–11 months old), they should receive an early dose of the vaccine before leaving.

• Get vaccinated at least two weeks before departure to allow the body to build immunity.

• Measles has a long incubation period. Monitor your health for 21 days after returning from an affected country.

• If you develop a fever and rash while travelling, wear a mask immediatelyand alert airline staff. Measles is airborne and can stay in the air for up to two hours after an infected person has left a room or plane.

• People who are pregnant or have severely weakened immune systems should consult a doctor before travel, as they cannot receive the live MMR vaccine and are at high risk for complications if exposed.

More shots, less protection?

There is an interesting shift in policy regarding vaccinations. An advisory board recently generated controversy in recommending an adjustment to the usage of the four-in-one MMRV vaccine (measles, mumps, rubella, and varicella/chickenpox). There have been concerns about a small increase in the risk of febrile seizures in a few children. Recommendations are to have the MMR and Varicella vaccines separately.

On the surface, this might seem like a cautious, patient-centric approach. But in the real world of childhood immunisations where parental compliance is paramount, it’s a dangerous gamble. More shots could mean lower compliance as parents, already juggling busy schedules, are significantly less likely to return for two or three separate appointments in place of one convenient combination shot.

The Measles Map of 2026 is an important reminder of broader community responsibility. The struggle against this invisible enemy is not just to protect ourselves; it is also to preserve the vulnerable immunological memory of our children, the wellness of our communities, and to reclaim our health.

(Dr. Anil Kumar Sapare is head of paediatrics at Narayana Health City, Bengaluru. anilkumar.sapare.dr01@narayanahealth.org)