Reports about measles exposures and outbreaks continue to make headlines in 2019. In addition to the public health issue, legal challenges have drawn attention to the balance between personal rights and public safety.
Measles, a virus declared “eliminated” from the United States in 2000, actually saw 349 confirmed cases in 26 states and Washington, D.C. in 2018. That’s the second highest number of cases confirmed by the Centers for Disease Control and Prevention (CDC) since 2000 (2014 saw 667 confirmed cases). Across Europe, 365 cases were reported in 2018, with 35 deaths. There are ongoing outbreaks in France, Greece, Italy and Romania.
While all this certainly sounds scary, luckily, if you and your loved ones have already been vaccinated against measles, you’re pretty much in the clear. According to the CDC, “the best protection against measles is measles-mumps-rubella (MMR) vaccine.” If you’re an adult born in the US after 1957, it’s likely that you’ve received the necessary doses to achieve immunity against measles.
So, how did we get here? And should you be concerned?
But Wasn’t Measles Eliminated from the US?
“Elimination” doesn’t actually mean a complete lack of cases. The CDC defines “elimination” as “the absence of endemic measles virus transmission in a defined geographic area, such as a region or country, for 12 months or longer in the presence of a well-performing surveillance system.”
Basically, we have achieved an end to constant, year-round spread of the virus and have a strong system in place for reporting and tracking cases. But that’s in the U.S. There are many areas of the world where measles is still a common disease. Travelers sometimes bring the measles virus back with them.
How Measles Outbreaks Occur in the US
While there have been cases each year in the U.S. since 2000, generally, we’ve had less than 200 per year. These measles cases occur as a result of a non-immune person catching measles outside of the U.S. and then spreading it to other non-immune people while here. Outbreaks then occur in communities with groups of unvaccinated people.
“Measles has one of the highest attack rates of any infectious disease that we know of,” says Sarah Boggs, MD, a UVA pediatrician who is board-certified in infectious diseases. “If you are unvaccinated and you are in a room with someone with measles, you are going to get it. It is very, very contagious.”
Measles can spread to others through the air when an infected person coughs. It lingers in the air for some time afterward. It is so infectious that, according to the CDC, “if one person has it, 90 percent of the people close to that person who are not immune will also become infected.”
Like so many diseases, it’s not clear what you have right away. “You start with a cough and runny nose and goopy eyes, but so can 100 other cold viruses … It happens before you get the rash. That’s the most infectious time, and you can be infectious for about 3 weeks,” comments Boggs. The classic measles rash follows the cold-like symptoms a few days later, spreading from the head to the whole body.
But Measles Isn’t a Big Deal … Right?
“People think of measles as ‘oh, you get a rash, and then you get better,’ but if you get measles, even in the U.S., there is a high risk of death,” states Boggs. Although most people do survive measles, there can be serious long-term effects for survivors, especially in children under five years old. Ear infections that cause permanent hearing loss can occur. There is a form of brain swelling, called subacute sclerosing panencephalitis, that can develop seven to ten years after infection with measles.
And, a 2012 study found that measles may alter your immune system so that it “forgets” how to fight diseases to which you had immunity before infection with measles. Interestingly, the introduction of the measles vaccine saw an increase in childhood immunity to many other diseases in the U.S. population as well. It seems that reducing the number of measles infections also reduced the possibility of immune systems forgetting how to combat other diseases.
What About Herd Immunity?
“Herd immunity” is a kind of indirect protection against infection. When a large population becomes immune to a disease, the lack of circulating infection provides some protection for individuals in that population who are not immune or can’t receive the vaccine. With measles, however, it’s different. “Because measles is so contagious,” states Boggs, “even a single infected person can start a virus spreading through a community where there are unimmunized individuals. So, herd immunity is less protective.”
Want to Know More About the Current Measles Outbreaks?
Review the CDC’s extensive information about the 2018/2019 measles outbreaks, including which states have been affected.
So, the best way to protect yourself and your loved ones is to make sure that your vaccinations are up-to-date. And if you’re an adult who has not been vaccinated, it’s still possible to get the vaccine and protect yourself. The CDC states that adults who aren’t immune to measles should receive at least one dose of the MMR vaccine. UVA has gone a step further and recommended that adults should make sure to receive a second dose if they are a healthcare worker, a college student or an international traveler.
“One measles vaccine, and you’ve got 95 percent protection. For children, a second dose of the vaccine is important to both boost the amount of protection you receive and to ensure that the protection is long-lasting,” agrees Boggs. All you need to do is have a conversation with your healthcare provider to get started.
What About the Risks of Harm from Vaccines?
“Any time you talk about a vaccine, you have to talk about the risks. The biggest risks, for any vaccine, are going to be a little bit of low-grade fever, a little soreness at the injection site. Maybe for infants, a little fussiness for a day or two. And those are really the biggest risks,” says Boggs.
“There is a very, very small risk of an allergic reaction that may occur in 1 in 100,000 people, but they’re incredibly rare.”
And Boggs reminds us that the study claiming that there was a link between vaccines and autism was debunked long ago. “I always encourage parents of patients to bring me resources that they have read that they are concerned about so we can review it together.”
If you’re vaccinated and your loved ones have been vaccinated, there is very little to worry about. The CDC does recommend that if you are exposed to someone with measles, you should check in with your healthcare provider immediately to confirm your immunity or decide on next steps. (Rarely, vaccinations don’t result in full immunity.)
Unsure if You’re Vaccinated?
Get evaluated by a UVA primary care provider: Schedule an appointment.
If you’re unsure about your vaccination status, look for your childhood immunization records or check in with your providers. They may recommend another dose of the vaccine or can test you for immunity. Receiving another dose of the vaccine if you’re already immune is not harmful. If you can’t get the vaccine (the CDC has a list of reasons that may prevent you from receiving it), have a conversation with your healthcare provider on the best methods of protecting yourself.
If you believe you have been infected with measles, contact your healthcare provider immediately for evaluation.
We originally published this in January 2019 and updated it in May 2019.