Measles: What You Need to Know
Measles has been in the national news almost daily with increasing case counts, several “outbreaks” (defined by the CDC as three or more related cases), and the confirmed death of a school-age child in Texas.
Columbia pediatrician Ashley B. Stephens, MD, is a vaccine expert who has been educating her patient’s families about measles and providing vaccines.
Dr. Stephens explains the risks posed by measles and the best way to protect you and your family from the disease.
What is measles? What are its signs and symptoms?
Measles is a very contagious disease caused by a virus.
Measles often causes symptoms such as high fever, cough, runny nose, red eyes (conjunctivitis), white spots inside the mouth, and a rash that spreads from head to toe. It can also cause ear infections, diarrhea, pneumonia, and encephalitis (inflammation and swelling of the brain).
Do adults and children react differently?
Both adults and children can get sick with measles, but children under the age of five are more likely to have complications that could lead to hospitalization and even death. The most dangerous complications include pneumonia, encephalitis, and severe dehydration.
Pregnant women, people with weakened immune systems, and adults over age 20 are also at higher risk of complications from measles. It’s important to note, too, that measles during pregnancy can cause preterm birth or low birth weight.
I want our readers to understand that measles can be serious. This may surprise some, but around 20% of unvaccinated people who get measles need to be hospitalized.
How does measles spread?
Measles is extremely contagious. It is what we call an “airborne” disease, which means it is spread through small droplets when someone who has measles coughs, sneezes, or even talks.
If, for example, a person with measles coughs in a room, people can get sick with measles for up to two hours after that person leaves the room. Furthermore, nine out of ten people in that room who don’t have immunity will get sick with measles.
Is there a cure or an effective treatment for measles?
There is no cure for measles. Treatments can include managing fever with acetaminophen or ibuprofen or providing fluids if someone is dehydrated. Many people who get sick with measles will recover within a week or two.
As I said earlier, children under the age of five are at risk of getting very sick with measles. If a child becomes very sick and is hospitalized, their treatment will likely include taking vitamin A. But I want to be clear here. First, vitamin A does NOT prevent measles. And second, vitamin A is toxic at high doses. It should NOT be given to a child at home without the supervision of a doctor.
Let’s say I’m a parent with a young child. How should I protect my child?
The best protection from measles is prevention through vaccination. The Measles, Mumps, Rubella (MMR) vaccine is very safe and very effective. One dose of MMR vaccine is 93% effective at preventing measles, and two doses are 97% effective. Our current understanding is that the protection is lifelong.
In the U.S., under normal conditions (meaning no measles outbreak), we typically give the first dose of MMR vaccine to children at age 12-15 months, and then we give a booster dose at age four to six years. If your child is under age one, the best thing to do is reduce their possible exposure.
In certain situations, such as families planning overseas travel, we would give a child the first dose of MMR vaccine early, starting at age six months. For children older than a year, we would make sure they are protected with two doses prior to travel.
If a child lives in an area with an active measles outbreak, the local health department may advise pediatricians to give infants ages 6-11 months a first dose of MMR vaccine and older children a second dose earlier than four to six years. Parents should talk with their child’s pediatrician about local recommendations.
What if my child has been around someone who tested positive for the measles virus?
If your child has been exposed to someone with suspected or confirmed measles virus, call your child's doctor right away. The first thing to check is your child's immunization status. If they already received two doses of the MMR vaccine, they likely have good protection against getting sick, but it is still important to speak with your child's doctor and watch for symptoms.
If your child is under six months and therefore not immunized, they have up to six days to get an injection of antibody (IMIG), which could help protect them from infection.
For children over six months of age, who have not yet received the MMR vaccine or have not yet received their second dose, they have up to 72 hours to get an MMR shot, which could help protect them from infection. Talk to your doctor to determine if these measures make sense for you and your family.
How should I protect myself?
Check your vaccination status, and if you're unsure, ask your doctor. In the meantime, here are a few guidelines:
People born before 1957 generally don’t have to worry about measles. They very likely acquired immunity from being exposed to the measles virus, which circulated widely before the development of the MMR vaccine.
Adults born after 1957 should check their vaccine records to see if they received the MMR vaccine. If they got the live-attenuated MMR vaccine, they’re protected. If they don’t have the records or don’t know their status, they should talk to their doctor about getting titers drawn (a blood test to check for immunity) or getting a single dose. For most adults, a single dose during one’s lifetime is sufficient.
There are some adults (less than 5%) who may have received inactivated (killed) measles vaccine from 1963 through 1967 during childhood. For these people and those adults who don’t know their vaccine status, the CDC recommends a single dose of MMR vaccine.
If you live in an area with an active measles outbreak, your local health department may advise doctors to give an additional MMR dose (on top of your initial vaccination). Talk with your doctor about local recommendations and what they mean for you.
If you suspect you’ve been exposed to measles and are uncertain about your vaccine status, getting an MMR shot within 72 hours of exposure may provide some protection. Talk with your doctor to determine if this measure makes sense for you.
If I’m a concerned parent and want more information about vaccines, whom should I talk to? Can you suggest one or two online resources?
Talk with your child’s pediatrician. We counsel our patients about vaccines and give vaccines every single day. We have encountered many of the questions parents have, and we can help parents make an informed choice based on correct information. We also recognize that there is a lot of misinformation about the MMR vaccine on social media and other forums. We are here to help you sort facts from fiction. Please bring us your questions and concerns.
Ashley B. Stephens, MD, is an assistant professor of pediatrics at the Columbia University Vagelos College of Physicians and Surgeons.