Immunizations & Vaccines • Jul 23, 2019

The Return of the Measles | What Parents Should Know

Working in the ER, I have fielded a lot of questions about measles from concerned parents over the last few months. The US measles outbreak of 2019 has been the largest since the 1990s! According to the Centers for Disease Control (CDC), as of last week, there have been 839 cases of measles reported from 23 states. Historically in the US, before the introduction of the measles vaccine in 1963, there were about four million cases, with 48,000 hospitalizations and 500 deaths, every year. Measles was also a global killer of children. It’s still common in other areas around the world, including countries in Europe, Asia, the Pacific, and Africa. Vaccination has significantly lowered mortality due to measles, saving approximately 20.4 million lives. And thanks to widespread vaccination, by 1993 we declared the virus “eliminated” in the US.

Today, the bulk of the cases are in New York City. However, there are reports of new cases from as many as 23 states. Public health authorities attribute the New York City outbreak to anti-vaccination sentiments among a small subgroup of Orthodox Jewish residents among whom the virus has spread.

Measles is one of the most infectious diseases! A person infected with measles can cough in a room, and even hours later an unvaccinated person could catch the virus from the droplets in the air the infected person left behind. There is no medicine to treat measles. It spreads easily among unvaccinated persons. Measles can cause some very serious complications. It can even be potentially fatal, especially in the young, the elderly and the immune-compromised.

Below, I have summarized some of the most common questions from parents.

What are the symptoms of measles?

Within seven to 14 days after getting infected with the measles, the earliest symptoms feel like a cold or the flu, with a fever, cough, runny nose and sore throat. Often the eyes get red and runny. Three to five days later, a red or reddish-brown rash forms and spreads down the body from head to foot. About 30 percent of people who get measles develop complications such as pneumonia, ear infections, diarrhea, and encephalitis.

What is the recommended schedule for the measles vaccination?

The Measles-Mumps-Rubella (MMR) vaccine provides immunity to measles. The vaccine’s full series is two doses at least 28 days apart. The recommendation for children is one dose between 12-15 months of age, and the second dose between 4-6 years of age. The recommendation for teens and adults is two doses 28 days apart. People are usually fully protected within two to three weeks of receiving the vaccine.

Do previously vaccinated adults need a booster considering the recent outbreak?

If you were born before 1957 OR born after 1957 but received two doses of the vaccination per schedule OR you have previously had the measles infection, then you are immune to measles according to the CDC. People in any of these categories do not need a booster. However, consult your doctor for any further clarifications.

How do I protect my baby less than one year of age?

Stay away from areas or people who are known or suspected to have the infection. Handwashing and proper hygiene measures help protect the entire family. There is currently no recommendation to vaccinate a child younger than one year of age if traveling to a place in the U.S. with an ongoing outbreak. However, if you are planning to travel internationally, infants under 12 months old can get an early MMR vaccine to help with protection if they will be traveling to an area that has not eliminated the measles and that has an ongoing measles outbreak.

How can vaccine refusal by some people lead to a widespread outbreak of measles?

Growing trends and outlooks about vaccine refusal contribute to waning “herd immunity.” For any vaccine to be effective, a certain percentage of people in a population need immunization. This prevents the disease from spreading through the population very easily. Plus, it protects those who aren’t or can’t be vaccinated, like newborns and people with vaccine allergies. “Measles parties,” where parents bring children to the home of a child who has the infection to expose them on purpose, are very dangerous! They expose the child to a wild virus that can cause serious complications including death. And they can spread the infection to susceptible populations.

Measles is an eradicable disease through universal immunization. There are accurate diagnostic tests, an extremely effective vaccine, and humans are the only hosts. If history is any indication, vaccine refusal trends can cause a serious disease burden for our children. We can mitigate the problem if we act now. We can make sure that we protect as many people as possible against the disease with vaccination.

If you think your child has been exposed to measles, call your pediatrician right away. The risk of developing the disease will depend on several factors including immunization status, chronic illnesses and any chronic medications that your child may be taking.