Dr. Miriam Bettencourt Speaks on Measles Resurgence and the Dermatologist’s Role
Key Takeaways
- Measles remains highly contagious and clinically significant despite prior elimination
- Declining vaccination rates are driving recent outbreaks in the United States
- Dermatologists play a critical role in early recognition, reporting, and patient education
As the ominous music from the “Mission Impossible” movies played over the speakers, a dramatic voice spoke: “Good morning, doctors. Sixty years of safe and effective vaccine has resulted in the eradication of measles. Recently, however, a distrust of science has produced an alarming increase in new measles cases. Your mission, should you choose to accept it, is to learn to identify this potentially deadly disease and to prevent a new epidemic. The Secretary of HHS will disavow any knowledge of your actions. This tape will self-destruct in 5 seconds. Good luck, doctors.”
With that, Miriam Bettencourt, MD, took the stage at the 67th Noah Worcester Dermatological Society Annual Meeting to deliver a compelling presentation titled “Mission Impossible: The Spotted Reckoning,” addressing the resurgence of measles and its implications for dermatology practice.
Framing measles as both a clinical and public health challenge, Dr. Bettencourt emphasized the dermatologist’s evolving role in early recognition, patient education, and prevention in the context of declining vaccination rates and increasing global transmission.
WHY MEASLES STILL MATTERS
Dr. Bettencourt began with an overview of the severity and transmissibility of measles, describing it as “the most contagious disease of humankind,” with one infected individual capable of transmitting the virus to 15 to 18 others. Transmission occurs via respiratory droplets, with viral particles remaining airborne for up to 2 hours—posing significant risks in clinical settings.
Clinically, measles follows a recognizable progression: high fever, followed by the “three Cs” (cough, coryza, and conjunctivitis), and then Koplik spots and a characteristic morbilliform eruption that begins at the hairline and spreads cephalocaudally. Dr. Bettencourt noted that the rash typically spares the palms and soles but may involve them in atypical presentations.
Given the disease’s rarity in recent decades in the United States, Dr. Bettencourt stressed the importance of maintaining diagnostic vigilance.
“In this day and age,” she said, “if you see a patient with a rash, fever, and fatigue, you should consider measles.”
COMPLICATIONS AND AT-RISK POPULATIONS
Although often perceived as a childhood illness, measles carries substantial morbidity and mortality across age groups, Dr. Bettencourt said. She highlighted complications including pneumonia, otitis media, diarrhea, and encephalitis, noting that even in developed countries, approximately 1 in 1,000 patients may develop encephalitis.
She also discussed subacute sclerosing panencephalitis, a rare but fatal delayed complication occurring years after infection. Vulnerable populations include children under 5, adults over 20, pregnant patients, and immunocompromised individuals, including those receiving biologic therapies.
DIAGNOSTIC CONSIDERATIONS AND DIFFERENTIAL DIAGNOSIS IN MEASLES
Accurate diagnosis is critical, particularly given overlapping presentations with other exanthems. Dr. Bettencourt reviewed key differentials including rubella, parvovirus B19 infection, and roseola, noting distinguishing features such as absence of high fever or differences in rash morphology and distribution.
Polymerase chain reaction testing of throat swab or urine remains the preferred diagnostic modality for confirming measles infection.
EPIDEMIOLOGY: FROM ELIMINATION TO RESURGENCE
Dr. Bettencourt traced the epidemiologic trajectory of measles, emphasizing the dramatic decline following vaccine introduction in 1963 and the declaration of elimination in the United States in 2000.
However, recent years have brought a reversal. In 2019, outbreaks were linked to geographic clustering of unvaccinated populations. More recently, 2025 data indicate more than 2,200 confirmed cases across 45 states, representing the highest levels since elimination.
Dr. Bettencourt noted that “95% of reported measles cases are unvaccinated or those with unknown vaccination status.”
Declining vaccination rates—the United States’ is currently approximately 92%—fall short of the 95% threshold for herd immunity, she noted. Factors contributing to resurgence include vaccine hesitancy, international travel, and policy shifts affecting immunization requirements.
VACCINATION EFFICACY, GAPS, AND MISCONCEPTIONS
Dr. Bettencourt reviewed current vaccination guidelines, noting that the measles-mumps-rubella (MMR) vaccine is 93% effective after one dose and 97% effective after two doses.
She highlighted specific considerations, including the need for boosters in individuals vaccinated with earlier formulations and the importance of verifying immunity among healthcare professionals.
Addressing misinformation, Dr. Bettencourt reiterated that claims linking vaccines to autism are unsupported, referencing multiple large, well-controlled studies disproving such associations.
She also emphasized that alternative approaches, such as vitamin A supplementation, are not substitutes for vaccination.
PUBLIC HEALTH CHALLENGES AND FUTURE RISK
The presentation contextualized measles resurgence within broader public health challenges, including reduced vaccination uptake and disruptions in global health collaboration. Dr. Bettencourt warned that the United States is at risk of losing its measles elimination status without sustained control efforts.
Modeling studies suggest that even a 10% decline in vaccination rates could result in millions of measles cases over time.
THE DERMATOLOGIST’S ROLE IN PREVENTION
A key takeaway from the session was the expanding role of dermatologists in infectious disease recognition and prevention. Dr. Bettencourt encouraged clinicians to remain vigilant, report suspected cases, and engage in patient education regarding vaccination.
She also noted potential medicolegal implications, including “loss of opportunity to diagnose, treat, and prevent future complications,” reinforcing the importance of timely recognition and action.
Dr. Bettencourt emphasized that dermatologists are uniquely positioned to identify early cutaneous manifestations and to contribute to public health efforts.
“Dermatologists should be proponents of prevention and education of our patients,” she said.