The measles outbreak traced to an amusement park in California has continued to grow, and currently there are 85 cases now confirmed in seven states. In an effort to ensure the health and safety of all of our patients, and to minimize the spread of potentially serious infectious diseases such as measles, we encourage you to contact your doctor’s office first, prior to coming to the doctor’s office or Urgent Care with symptoms that may be consistent with measles. That way we will be able to set a plan in motion which would allow you or your child to be evaluated expeditiously while minimizing the potential to infect others.
As a result, of the current measles outbreak we thought it might be helpful to provide some information about the disease, how it spreads and what we can all do to prevent measles from spreading in the future.
Q: What is Measles?
A: Measles (Rubeola) is a highly contagious and potentially life threatening respiratory disease caused by a virus. In most people, the disease produces fever (temperature > 101 F [38.3 C]), runny nose, cough, red eyes, sore throat and is followed by a generalized rash that spreads all over the body.
Q: What are the typical symptoms and time course of measles?
A: The symptoms of measles generally appear about seven to fourteen days after a person is infected.
Measles typically begins with:
- high fever
- runny nose (coryza)
- red, watery eyes (conjunctivitis)
Two or three days after symptoms begin, tiny white spots (Koplik spots) may appear inside the mouth.
Three to five days after symptoms begin, a rash breaks out. It usually begins as flat red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small raised bumps may also appear on top of the flat red spots.The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person’s fever may rise to more than 104° Fahrenheit. After a few days, the fever subsides and the rash fades.
Q: What are the complications of measles?
A: Measles can be serious in all age groups. However, children younger than 5 years of age and adults older than 20 years of age are more likely to suffer from measles complications. Common complications include ear infections and diarrhea. Ear infections occur in about one out of every 10 children with measles and can result in permanent hearing loss.
Some people may suffer from severe complications, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain), which would require hospitalization.
As many as one out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children.
About one child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or mentally retarded.
For every 1,000 children who get measles, one or two will die from it.
Measles may cause pregnant woman to give birth prematurely, or have a low-birth-weight baby.
Q: How is measles spread from one person to another?
A: Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. Infected people can spread measles to others from four days before to four days after the rash appears. It can spread to others through coughing and sneezing. Also, measles virus can live for up to two hours on a surface or in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected. Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.
Q: What is the best way to prevent getting or spreading measles?
A: Measles can be prevented with the MMR (measles, mumps, and rubella) vaccine. In the United States, widespread use of measles vaccine had led to a greater than 99% reduction in measles cases compared with the pre-vaccine era. Measles is still common in other countries.The virus is highly contagious and as we have seen, can spread rapidly in areas where people are not vaccinated. Worldwide, an estimated 20 million people get measles and 122,000 people die from the disease each year—that equals about 330 deaths every day or about 14 deaths every hour from measles.
Q: What is the regular schedule to get the measles vaccine?
A: There are two shots. The first shot is recommended between 12 to 15 months of age, and the second between ages 4 and 6.California law requires two doses of measles shots for new kindergartners, but exemptions can be made for medical reasons or if a parent says that vaccines conflict with their personal beliefs. Infants as young as 6 months old can get the vaccine in an outbreak situation or before international travel.
Q: Is the measles vaccine safe?
A: Vaccine safety experts, including experts at CDC and the American Academy of Pediatrics (AAP), agree that MMR vaccine is not responsible for recent increases in the number of children with autism. In 2004, a report by the Institute of Medicine (IOM) concluded that there is no link between autism and MMR vaccine. The most common adverse events following the MMR vaccine are pain where the vaccine is given, fever, a mild rash, and swollen glands in the cheeks or neck.
Q: How common was measles in the United States before the vaccine?
A: Before the measles vaccination program started in 1963, about 3 to 4 million people got measles each year in the United States. Of those people, 400 to 500 died, 48,000 were hospitalized, and 4,000 developed encephalitis (brain swelling) from measles.
As a result of the vaccination program, measles had been nearly eradicated in the US. However, in the past few years the number of cases in the US has been rising, and the statistics for 2014 indicate that the number of measles cases were at the highest level in nearly 20 years, with California reporting the greatest number of cases.
Q: What is community (herd) immunity?
A: Immunization can greatly reduce the spread of deadly diseases and will not only protect the person receiving the immunization but will also protect other members of the community.
When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines—such as infants, pregnant women, or immunocompromised individuals—get some protection because the spread of contagious disease is contained. This is known as "community immunity."
Unfortunately there are pockets of communities where the immunization rate for measles, as well as other highly infectious diseases, has dropped and as a result, there is potential for highly contagious viruses, like the measles virus, to spread amongst those who are unvaccinated.
Q: Do I need a shot if I had the measles long ago?
A: No. For people who had measles a long time ago, there's good evidence to indicate that they are protected for life.
Q: What if I can't remember whether I had the measles?
A: You can get a blood test that will show if you are immune to measles. Or you can get the measles vaccine, known as MMR for measles, mumps and rubella.
Q: What if I got only one shot of the vaccine?
A: If you got only one shot of the vaccine, you should receive the second.
Q: Why is it important to get two shots?
A: There's a 5% chance of vaccine failure in people who receive only one shot. The chance of failure falls to less than 1% for those who get two.
Q: If I can't remember, is it OK to get a third shot?
A: Yes, it's safe.
Q: Why do some people still get measles even though they received two shots?
A: In some people, the vaccine doesn't produce enough antibodies to fight off the measles virus. One reason is "waning immunity." In the 1960s and '70s, the systems of immunized people had to regularly fight off the measles virus. Practice makes perfect. But now, immune systems are out of practice and some people who got the shots in the 1960s, '70s and '80s may be more susceptible today.
Q: What is illness like if you have already been fully vaccinated?
A: In most people, it can be a weaker form of illness than in unvaccinated people.
Q: What should I do if my child has not been vaccinated and is the appropriate age for vaccination?
A: Please make an appointment with your doctor/pediatrician to get the vaccine.