In 1957, just six years before a vaccine was released, Sarah R. and her cousin were infected with measles at the same time. Sarah, who now lives in Oakland, California, eventually recovered without major lasting effects. But her cousin, whom the family affectionately referred to as “Cotton” because of his platinum blond hair, lost both his hearing and eyesight. They were 6 years old.
The two cousins started feeling ill during one of their family’s frequent visits together. Cotton soon went home, and Sarah continued to get sicker: Her fever spiked to more than 105 degrees. She was given a painful immune globulin injection, which contains antibodies and can sometimes reduce the severity of measles infection.
Despite the shot, Sarah became very ill, unable to leave her bed for two weeks. Her grandmother bought her a canary to cheer her up. “That bird saved my life,” she says. Her high fever triggered seizures. She began hallucinating monsters and horrible creatures wandering her room. “I was absolutely terrified for hours at a time,” she says. “I had dreams of them for years — scary, scary dreams.”
Now 73, Sarah recovered without serious physical consequences, save for a heart murmur that’s still present today. Cardiac issues can happen if the inflammation from an infection is severe enough to damage the heart muscle. (Sarah asked to be identified only by her first name to maintain anonymity as a former public figure.)
Cotton was less fortunate. According to Sarah’s family, his health went downhill quickly. He developed meningitis, or inflammation around the brain and spinal cord, and encephalitis, inflammation of the brain tissue itself. This caused him to lose his hearing, a common meningitis complication. It also affected his optic nerve, Sarah says. Barely in first grade, Cotton became both deaf and blind. “He had been a perfectly happy, healthy, bouncy, athletic little boy,” Sarah recalls. “He was terrified of just about everything after that.”
After about two years, Sarah saw Cotton again. “He mostly just touched my face and cried.” Not long after that, Cotton was taken to be cared for in an institution, Sarah says. She never saw him again. “It affected me for life,” she says.
And that’s precisely what measles can do: affect you for life. Long-term side effects aren’t widely reported or discussed, but they’re real and range from mild to debilitating.
From Eradicated to Complicated
Measles is a highly contagious viral disease that spreads through the air. Because of the success of measles vaccines, the disease was declared eradicated in the U.S. in 2000, though it remains widespread in other parts of the world. But it returned in March with an outbreak that began in largely unvaccinated communities in Texas and has since spread to 17 states, according to the World Health Organization. At last count, there were more than 800 cases and at least three deaths, the largest outbreak in all but one of the last 25 years.
Because it’s been a quarter century since the last large outbreak, some people believe that measles is comparable to the flu or other common infections. Nothing could be further from the truth, health experts say.
Most Americans who remember living with measles are in their 60s or older. They remember what the world looked like before the vaccine. The CDC estimates that measles infected as many as 3 million to 4 million people in the U.S. each year. Many escaped without major consequences, but many others did not. Every year, about 500 people died, tens of thousands were hospitalized, and about 1,000 developed encephalitis.
“The complication rates are pretty high, when you think about it,” says Jeffrey Kahn, MD, PhD, chief of the Division of Pediatric Infectious Disease at the University of Texas Southwestern Medical Center in Dallas. The death rate is about 1 to 3 in 1,000. About 1 in 5 people end up hospitalized, mostly children under 5 years old. In 2024, more than half of children under 5 with measles were hospitalized.
Measles also wipes out your immune system, including your adaptive natural immunity from other diseases, essentially unvaccinating you against pathogens you’ve already encountered, Khan adds. It opens you up to other diseases, including the flu; respiratory syncytial virus, or RSV; and severe pneumonia, any of which can be fatal. It also makes you vulnerable to dangerous bacterial infections, such as bacterial meningitis, the form most likely to cause hearing loss.
Attacking Eyes and Ears
LaDonna Qualtieri, who lives in Oakland, had hearing loss after getting measles as a newborn in 1961. After her infection, doctors discovered she was severely hard of hearing in her left ear as a result of nerve damage. “As a child I always felt like I wasn’t quite getting something,” Qualtieri says. “I was exhausted, I think, from trying to hear everything.”
Qualtieri also had vision trouble, which she suspects was related to her infection because she has no family history of poor eyesight. Indeed, measles is a leading cause of childhood blindness in less developed countries without good vaccine access. “In the car, I would always see these big, blurry, red and green objects. I thought they were Christmas decorations,” Qualtieri recalls. “It wasn’t until I got my first pair of glasses, and we were driving home from the optometrist, that I could see they were traffic lights.”
Qualtieri’s hearing loss also affected her career. Born with a love and a talent for mechanics, she applied to her dream job as an apprentice operating engineer in 1985. “I always wanted to be in a union so badly,” she says. But they sent her a letter of rejection on the basis of her hearing loss. She was crushed. “I remember getting that letter and just crying.” She spent 25 years making a living largely in low-paying, heavy labor jobs.
Attacking the Brain
Encephalitis can also have significant mental and emotional consequences. In March 1960, 6-year-old Emmi Herman of New York watched her older sister, Marcie, get measles from a classmate. Marcie, then 9 years old, became sick quickly and was rushed to the hospital. She had developed encephalitis. She fell into a coma for more than five weeks, Herman says, and had irreversible brain damage.
Around Passover in April, Marcie finally came home. “She survived, but she was a different Marcie,” Herman recalls. Her movements and social cues had become strange. Her laugh had become exaggerated. She often had abrupt mood changes. She’d been a great dancer, but now she struggled with balance. A gifted pianist, she now made frequent mistakes. She became easily frustrated and got sick often. She’d been popular, but now she struggled to make friends. “She was ostracized,” Herman says, emotion entering her voice. “She ate her lunch in the bathroom.” As she got older, she would get herself into unsafe situations because of poor judgment.
Marcie grew up and eventually married, becoming Marcie Cline. She divorced shortly thereafter, but retained her married name, Cline. Over time, Cline developed severe mental illness. She began hoarding, living in a “garbage-strewn apartment,” and eventually received a diagnosis of schizophrenia. But Herman believes the diagnosis was not complete because Cline refused most mental health care, becoming agitated at the mention of psychological illness. They tried family therapy, but Cline stormed out of every session. “She claimed she was not disabled,” Herman says. “There was nothing wrong with her, and we were all crazy.”
After speaking with psychologists, Herman came to suspect that Marcie had developed anosognosia, a condition linked to brain damage that causes people to be unaware of their condition. This lack of self-awareness made it almost impossible to get Cline adequate care. She allowed most medical care, “but when it came to her mental health, that’s where we lost her,” Herman says.
Herman was eventually able to get Cline into short-term secure psychiatric care at Cornell Weill Medicine and later into an assisted living facility in Yonkers, New York, where she could finally make strides towards feeling more stable. “There was a big difference in the help she got later on,” Herman says. “But of course, it didn’t really” make up for the years before.
In August 2020, just after her 70th birthday, Cline died of a major stroke following a bout with COVID-19.
Rare but Real Consequences
It’s rare for measles to affect the brain, but that complication is not as rare as one might think. “Encephalitis usually occurs in about 0.1% to 1% of measles cases,” or 1 to 10 in 1,000 cases, Kahn says. That’s roughly the same odds as having identical twins (about 4 in 1,000 births) or getting your car stolen in the U.S. (about 3 in 1,000).
One serious form of encephalitis, called subacute sclerosing panencephalitis, happens when a natural measles infection reactivates in the brain, typically several years later. It affects between 1 and 28 people per 100,000 measles cases. But in unvaccinated infants younger than 15 months, that ratio is much higher: as many as 1 in 600, according to a study by the American Academy of Pediatrics. It is almost always fatal. The risk of SSPE after vaccination with the weakened measles virus is almost nonexistent.
When the measles vaccine was introduced in 1963, it sent measles infections crashing down to about 22,000 cases in 1968. As more people got vaccinated, that number kept shrinking. “We hit a low in this country in 2004” of 37 cases, Kahn says. “Give me an example of a greater accomplishment in medicine than that.” The vaccine was so effective that many doctors today don’t even recognize the disease when they see it, Kahn says.
Out of hundreds of millions of vaccinations worldwide, there have been no known deaths in healthy people caused by the measles, mumps, and rubella vaccine, commonly called the MMR vaccine. There have been exceedingly rare serious allergic reactions reported, about 1 in 1 million doses. The vaccine can make you sick if you’re severely immunocompromised. But overall, decades of experience with the vaccine have proven it to be quite safe.
Herman, Qualtieri, and Sarah are now staunch advocates for measles vaccination, having lived with the dire consequences that can come from this preventable disease.
“We felt so alone in 1960,” Herman says. “But now when I write Marcie’s story, I get responses from readers who had [measles], or have a relative who had it, and so many of the issues are so similar to what my family went through. Those kinds of things stay with you for your whole life.”
