Measles is in the news once again, and once again, the high impact of nutrition on measles isn’t usually mentioned. Though we are accustomed to media click-baiting with scary headlines, here’s some good news: There is indeed a high impact from nutrition on measles, and vice versa too. This means you can leverage nutrition to protect and support your family before and during measles exposures.

Historically, measles was regarded as a routine infection that pediatricians expected children to get, and recover fully from, by about age 5 or 6. Kids who didn’t get it were a bigger concern, since it was a tougher course for teens or adults.  By the time I was born in 1960, this was still true, as measles shots were not yet available. There was no hysteria, and you can see why in the CDC’s historical data below.

Deaths from measles in the US fell dramatically, to fewer than 2 per 100,000, by 1945 (see page 85 here), nearly twenty years before a vaccine existed. The graphs below show this timeline. On the far right, the last arrow shows introduction of measles vaccine, many years after deaths and illness from measles had flattened, thanks to improved nutrition and sanitation. The second graph illustrates same, but for measles only. For both, here is the CDC source:

A measles vaccine became available in 1963, followed by the measles-mumps-rubella (MMR) trivalent vaccine since 1971. In 1989, the CDC placed a second MMR dose on the pediatric schedule. Currently, nationwide compliance with MMR shots is 93%.This is at or above the level that public health experts want for herd immunity: Historically, convention dictated that a herd with roughly two thirds immunity can protect its population as a whole (see page 279 here). However, even in the 1980s, when MMR vaccine had been in use for years, this same classic epidemiology text warns that rubella immunization programs may not confer herd immunity, noting that “outbreaks have occurred even in populations in which 85-90% have been immune owing to natural infection or vaccination.” In his 1912 text Diseases of Children (Rachford) states that “it is rare indeed to find instances where [naturally] acquired immunity does not protect throughout life. This protection is more marked in measles than in any other acute infections.” (page 333 here) Clearly, naturally acquired immunity is more robust compared to vaccination for measles. Natural immunity also appears protective against some cancers later in life.

The problem isn’t quite that more people should be vaccinated, but that MMR vaccines can fail. We began seeing this in the early 1980’s, with outbreaks spreading through fully immunized populations. In this case, the CDC takeaway was this: “This outbreak demonstrates that transmission of measles can occur within a school population with a documented immunization level of 100%”. Despite this investigation being published by the CDC itself, media and academics alike assert that this only happens because of people who don’t vaccinate. Even Science Magazine made this gaff with a piece titled: “Measles Outbreak Traced To Vaccinated Person For First Time “. The reality is that periodic outbreaks can occur in vaccinated kids, and vaccinated kids can spread measles, as has been documented. Meanwhile, the periodicity of measles outbreaks that the US now sees is not too unlike what occurred before measles vaccines existed: Rachford writes that “extensive epidemics recur every two three years due to the fact that in the time large numbers of children have grown to the susceptible age [3-7 years old] since the last epidemic.”

Another problem is that US children are overfed and undernourished, or, just undernourished, as I so often found in my pediatric nutrition practice of 25 years. Food may be plentiful in the US but we have a multitude of nutrition problems in our pediatric population. For example, iron is just one of the critical nutrients that drive outcomes for an infection like measles; see below for details on other nutrients that can also make or break a measles infection outcome. As for iron status in US children, 2023 study found that nearly 40% of US female teens met criteria for iron deficiency; another study (see Table 2 here) notes that 30% of toddlers (age 12-24 months) are iron deficient in the US. Iron deficiency has a profound impact not only on a child’s immune defenses, but on learning, behavior, development and more – but, our health care system is not terribly effective at preventing this. Iron deficiency impairs vaccine efficacy – giving a dramatic yet unengaged demonstration of nutrition’s importance to immune function.

Whether your child is exposed to measles from wild type infection or from MMR shots, both make vigorous demands on the immune system, and both require the immune system to respond. Your child’s nutrition status before, during, and after these exposures determines the severity of illness or tolerance for the shot, and whether or not there are complications. In my pediatric nutrition practice of nearly 25 years, I have encountered a single unvaccinated child who got measles. This child was in the Philippines and was about two years old. The child had a mild course and recovered fully. On the other hand, I have encountered many hundreds of children whose parents reported poor tolerance of MMR doses, across several countries including the US and UK. In these cases, lasting debility ensued, for GI features, developmental features, or both.

My siblings and I grew up in the era when many pediatricians worried if you didn’t get measles, not the other way around. Measles, chickenpox, and mumps infections were regarded as beneficial childhood milestones that developed a vigorous, healthy immune system. Measles infection was so benign for healthy children that our lexicon created the word “measly” from it – meaning, insignificant, or “contemptibly small“. How times have changed! Pediatricians today who are under the age of 50 may never have seen a healthy child with measles in the flesh, or know how to guide you through it.

The impact of nutrition on measles means that well nourished children are more likely to have an uncomplicated course of this infection. They will in that case likely be uncomfortable and sick for a week or two, with cough, fever, malaise, and rash, then recover fully. Nutrition on measles works the other way too: Underweight, depleted children will be at higher risk for a longer or more complicated course, or even for serious secondary infections, like pneumonia or encephalitis. But these are extremely rare in children who are healthy and in strong nutrition status, before exposure.

While sick with measles, your child probably won’t feel like eating, will have a fever, and may have a cough and diarrhea. Measles exposure (natural or injected) triggers changes in gut tissue and immune function, causing children to lose protein in stool during this illness, when the immune system most needs it. Replenish your child daily with good food during this infection. If they feel too nauseous to eat, feed organic beef broth or bone broths that are not low sodium – your child needs electrolytes here. Stir a half teaspoon of ghee or grass fed butter (a vitamin A source) into the broth. Give electrolyte drinks and any protein rich foods they will accept. Lactose intolerance is a documented effect for some children exposed to measles, so if dairy foods that your child usually loves suddenly feel awful during this illness, switch to non-dairy protein sources like egg, meats, chicken, homemade broths, collagen, non-dairy milks like Kate Farms or Kiki Milk, or any tolerated legumes/beans/peas. Elemental amino acid formulas and supplements are available too.

Here are key nutrition-measles points to keep in mind:

1 – Growth Pattern Counts – Your child’s weight relative to his height (body mass index, or BMI) should be in a healthy range. BMI should be above 10th percentile. Underweight children, especially those with a body mass index or weight-to-height ratio below the fifth percentile, are at higher risk for infection in general and for more complications from infections. Though we often hear about childhood obesity in the US, most children in my practice are struggling with gaining weight and growing – and these are kids who get sick more often, stay sick longer, and have more complications. Don’t fear feeding your kids ample portions of all macros, including carbohydrates, and traditional fats.

2 – Check on Iron  – Iron status should be robust. A good way to assess this is to check a child’s ferritin level. It should be at least 30, though reference ranges drop to 10. A functional level is 50-60. Signs of weak iron status – besides frequent infections  – include pallor, veins visible through skin, shiners at eyes, penchant for chewing ice or other non-food items (sticks, rocks, sand, pens, paperclips, fabric), fatigue, intermittent hyperactivity, depression or mood swings, or poor restless sleep. Counterintuitively, girls may have heavier menses when iron deficient. Iron is the single most commonly deficient nutrient world wide, including in US children. To learn more about when kids need iron and how to properly test it, click here.

3 – Vitamin A Is Key Against Measles –  Vitamin A should be strong in your child’s diet every day. Vitamin A in particular is specifically protective against measles virus and will be depleted by the demands made on the immune system if your child is exposed. Vitamin A deficiency dramatically increases mortality from measles. Cod liver oil, whole milk or butter that is from grass fed cows or is fortified, pastured eggs, brightly colored orange or yellow vegetables and fruits are all important food sources to help immune function. Use a supplement if necessary, to maintain good intake. Though vitamin A deficiency is rare in the US according to CDC surveillance data, serum retinol (vitamin A) is not routinely screened in children at pediatric visits. Pediatric lab ranges are wide. Even if screened, a child’s serum retinol may land inside a normal range; if this is near bottom of range, it will be rapidly depleted to deficient during course of a measles infection, endangering the child needlessly.

During infection, high dose vitamin A protocols have been used for decades to reduce complications and shorten course of illness. Ask your doctor to guide you if you would like to use high dose vitamin A. This therapy is often overlooked, and though vitamin A has a long and strong record of efficacy during measles, more recent studies downplay its effectiveness. Typically these studies use shorter course or lower dose than the recommendations below. Also problematic is that pediatricians are not trained to recognize vitamin A deficiency nor do they routinely test for vitamin A status, leaving children more vulnerable.

Vitamin A for treatment of measles is administered once daily for two days, at the following doses (source):

4 – Zinc Is An Immune WorkHorse – zinc status should be strong. Eat zinc rich foods daily – raw cashews, nut butters, pumpkin or sunflower seeds, pork, lamb, beef, mushrooms, or legumes and beans are good sources. You can also use a supplement to 15-30 mg daily for children in most cases. Picky eaters may especially need help with a supplement to maintain healthy levels – chewables and liquids are available in my FullScript platform here.

5 – Protein Status Protein status refers to good tissue function and tissue reserves of protein in the body. Give your child strong protein status with good food, so the immune system has the building blocks needed to make globulins and other immune molecules to mount a defense. Your child should be eating at least 35-60 grams protein daily depending on age, from varied sources (that is, not just milk, cheese, and yogurt – see my blog on dairy addiction if that is your kid).

The impact of nutrition on measles and lessening the impact of this infection is legendary in public health circles, and has filled volumes for decades – from vitamin A status as a predictor of measles deaths, to how fish oils modulate certain immune proteins in our bodies. Your child can have marginal status for any of these nutrition factors without your pediatrician’s notice – a scenario I routinely find in my pediatric nutrition practice. If you’d like a nutrition assessment for your child with recommendations tailored to their needs, contact me here.