Hawaiʻi Department of Health
on March 6, 2024

The Hawaiʻi State Department of Health (DOH) is advising travelers and residents to be on alert for measles, as international and continental U.S. outbreaks continue to increase, currently affecting 16 U.S. states as of February 29, 2024. DOH sent an advisory to physicians on January 26, 2024, reminding healthcare providers to be vigilant.

“Hawai‘i has not experienced any recent outbreaks or spread of measles within the state, but infection can be just a plane ride away,” said State Epidemiologist Dr. Sarah Kemble. “Current outbreaks in the U.S. and abroad are a serious concern because of our popularity as an international and domestic travel destination and our frequent traveler resident population. Both groups have the potential to introduce and spread measles.”

The best way to prevent measles is to get vaccinated with the measles-mumps-rubella (MMR) vaccine. DOH encourages everyone to check their records and contact their healthcare provider if they need to be immunized. Before international travel or travel to areas experiencing a measles outbreak, infants ages six through 11 months should receive one dose of MMR vaccine. Children ages 12 months and older, as well as teenagers and adults without evidence of immunity, should receive two doses of MMR vaccine separated by at least 28 days.

MMR coverage rates have dropped among children globally, nationally, and locally here in Hawai‘i since pre-pandemic years. Based on recent data from the Centers for Disease Control and Prevention (CDC), Hawai‘i’s 2022-2023 kindergarten coverage rate is estimated to be 86.4%, which is nearly 10% lower than the 95% coverage level recommended for community protection. Hawai‘i had the largest increase in non-medical kindergarten vaccine exemptions nationally from 2021-2022 to 2022-2023. Staying up to date on routine vaccinations is an effective way of protecting our families and the larger community from measles outbreaks.

“The decline in routine childhood vaccination rates is concerning for a potential measles outbreak in Hawai‘i,” said Dr. Kenneth Fink, Director of Health. “Whereas unvaccinated and immunocompromised individuals can be protected by community immunity, weʻre now below that threshold for measles putting this group at risk. Vaccination helps protect the person vaccinated and the community. I encourage parents who are hesitant about vaccination to discuss their concerns with their child’s healthcare provider.”

Measles was declared eliminated in the United States in 2000, but remains a very contagious disease that is caused by a virus and can be serious. It spreads through the air when an infected person coughs or sneezes. Measles starts with fever, followed by cough, runny nose, and redness in the white parts of the eyes. Then a rash of tiny, red spots breaks out. It starts at the head and spreads to the rest of the body.

Measles can cause serious health complications, especially in children less than a year old, pregnant individuals, and persons who have a weakened immune system. According to the CDC, one out of every 20 children with measles gets pneumonia, and one out of 1,000 develops encephalitis (swelling of the brain). Nearly one to three out of 1,000 children who become infected with measles, will die from respiratory and neurologic complications.