Until this year, Dr. Leila Myrick had never seen a case of measles.
She doesn’t remember professors in medical school talking about the virus. When she saw photos of the characteristic red rash on practice board exams, she flipped back through her textbooks to figure out what it was.
“Most practicing doctors, in today’s day and age, are not going to see it in real life,” she said.
But in the past few months, Dr. Myrick, a family medicine doctor in Seminole, Texas, has treated about 20 people with measles. She is likely to see more cases, as a raging outbreak that has infected 481 people in Texas and killed one child continues to spread. In Texas, New Mexico and other parts of the country where cases have emerged, health care workers like Dr. Myrick are confronting the highly contagious virus for the first time. On Friday, the Centers for Disease Control and Prevention reported 607 confirmed cases of measles in the U.S. this year — more than double the number of cases seen in all of 2024.
“The generation of physicians who are currently, for the most part, treating patients haven’t actually seen what a measles case looks like other than from a textbook or a video,” said Dr. Andy Lubell, chief medical officer of True North Pediatrics in Pennsylvania, where a physician diagnosed the practice’s first ever measles case this March.
The United States declared measles eliminated in 2000. Cases still pop up around the country each year, sometimes seeding larger outbreaks. But public health experts worry that this year, measles could become more common in more places. The virus is spreading rapidly in some parts of the country, and vaccination rates nationwide have been falling for years.
“I remember learning about measles, German measles, all these things,” said Dr. Seth Coombs, a doctor at the Lovington Medical Clinic in New Mexico who saw his first measles case this year. “But you just don’t see them. And so like anything, if you don’t use it, you lose it.”
Measles can sometimes be hard to recognize at first, especially if a doctor doesn’t think to look for it. The infection causes a telltale red rash, but it can take days to appear. Before that, someone with measles might have only a fever, cough, a runny nose and red, watery eyes — symptoms that mimic the signs of many other viral infections.
“We see anywhere from 120 to 200 patients in the emergency department each day,” said Dr. Michael Koster, director of the division of pediatric infectious diseases at Hasbro Children’s in Rhode Island. “And probably 70 percent of them are kids coming in with fever.”
In January, Dr. Koster said, the hospital’s emergency room staff treated a baby who was dehydrated and had a fever, and then sent the family home. Days later, the infant returned, still with a high fever. It was only on the second visit that doctors realized the baby had measles.
Even when people do present with a rash, doctors who aren’t familiar with measles cases or don’t have the infection at the top of their minds could confuse it for an allergic reaction to medication, said Dr. Laraine Washer, an infectious disease doctor at Michigan Medicine.
Recognizing measles quickly matters, in large part because doctors want to isolate patients who might be contagious. Measles can linger in the air for two hours after an infected person leaves the room. If someone with the virus shows up in an emergency room unmasked, they can spread the virus widely.
And prompt care is important, too. Doctors confirm a diagnosis with laboratory tests and work to ease symptoms, often using medications to lower a fever and ensuring patients stay hydrated to counteract lost fluids. They also watch closely for complications: About one in every 20 children develops pneumonia, which is the most common cause of measles deaths in young children. Providers also monitor for brain swelling, which can occur in rare cases and lead to hearing and vision loss, intellectual disabilities and permanent neurological damage.
Doctors are now working to quickly get each other back up to speed. At UCLA Health, attending physicians lecture residents and medical students on how to spot signs of an infection that are harder to recognize, like small white dots that can show up inside an infected patient’s cheeks.
Dr. Sanchi Malhotra, a pediatric infectious disease specialist at UCLA Health, said she has been showing colleagues photos of the subtle differences in measles rashes across a variety of skin tones.
These efforts have felt all the more urgent since two people with measles passed through Los Angeles International Airport, said Dr. Ishminder Kaur, a pediatric infectious diseases physician at the UCLA Mattel Children’s Hospital.
“We want to teach everybody possible now,” she said, “before somebody misses a patient and then ends up bringing them to the emergency room full of other immunocompromised patients.”