Questions and answers — Measles

I thought measles was a mild illness, why the alarm now?

Measles is a severe disease, causing high fever and a flu-like illness with inflamed eyes, cough, congestion and a characteristic rash that is more severe than the usual rash that accompanies other viral infections. The infection can be complicated by ear infections, pneumonia and croup. However, the most dreaded complication is inflammation of the brain called encephalitis, which occurs in about one out of every 1,000 cases, and frequently results in severe brain damage and death.

For several years, Measles was considered eliminated from the United States, as a result of a very effective and safe vaccine. However, like all vaccines, the measles vaccine is not 100% protective. Therefore, a second dose is used to increase the rate of protection. Even then, there will still be a small number of vaccine recipients (1% – 5%) who don’t have a protective response, and will remain susceptible.

The reason it is back in the news is because of the virus being reintroduced into the country by an international traveler, who is contagious, but not yet sick. Contagiousness happens about four days before the onset of the rash, and the patient remains contagious for about four days after the onset of the rash.

In the case of the California outbreak, the virus was introduced into the Disney Amusement Park, a typically crowded environment, where the virus could easily seek out susceptible victims, who are either vaccine failures or non-recipients, and the rest is history.

How is measles spread?

The Measles virus is considered the most contagious infectious agent known to man. It can easily spread in the air on suspended droplets that are coughed or sneezed by a contagious person. Then, all it takes is for a susceptible person to come in contact with these invisible, infectious droplets.

Is the measles vaccine safe?

Yes. The Measles vaccine is one of the safest and effective vaccines available. It has been in wide use since the early 1960’s, with a very good reputation. It is made with a weakened live measles virus that cannot produce Measles disease, but produces excellent protection to the 95% – 99% of those who respond. Like all vaccines, there can be a minor fever and or mild rash, but the vast majority of recipients have no significant side effects, only minor discomfort at the shot site.

What are the symptoms of the measles?

As noted above, it begins with a high fever and flu-like symptoms of cough, congestion inflammation of the eyes, and the rash, which begins on the face and rapidly spreads down to the rest of the body.

We have a trip to Disneyland planned. Should we cancel? What about other travel?

Don’t cancel your trip, but do make sure your measles vaccine is up to date. You can usually find out by calling your primary provider’s office. This applies to any travel, especially going to other countries. The United States and Canada remain the only countries without endemic measles circulating, but localized outbreaks, like that in southern California are still possible for the reasons noted above.

When do children need to get the measles vaccine?

It is recommended to receive the first dose at 12 months of age, and the second dose between 4 – 6 years of age. However, in the event of a need due to travel or being in an outbreak situation, the second dose can be given any time after 28 days from the first dose.

How long does the measles vaccine provide protection?

Currently, the two-dose series is all that is recommended. However, as time goes by, a booster could be recommended as the vaccinated population ages. But, at this time, there is no such recommendation.

I’m not sure if I’ve received measles vaccine. Do I need a booster?

I would recommend that you see your primary provider, who should be able to review your vaccine record. If it turns out that you cannot confirm receiving the Measles vaccine, it is clear that taking more Measles vaccine than you need does not cause harm, so then it is advisable to take it if there is a chance that you missed taking it before. If it turns out that your child missed both doses, then taking the two-shot series is recommended. If an adult born after 1957 has not been immunized, they should see their provider to take a single dose. The Measles vaccine always comes as a combination with Mumps and Rubella as well (the MMR), which are also infections that can cause many problems, and should be avoided if possible.

Written by: James Brien, DO, a pediatric infectious disease specialist.