Measles: How to Protect Yourself and Your Children

What to know:

• Measles is not “just a rash.”  Measles is a highly contagious disease that causes high fever, rash, cough and red eyes and can lead to complications like brain inflammation and pneumonia and death.
• Getting the measles vaccine is the best way to prevent getting and spreading measles.
• Two doses of the MMR vaccine are recommended by health care providers as the best way to protect against measles and is 97% effective.
• Children 12 years and under may get two doses of MMRV vaccine instead.
• MMR and MMRV vaccines usually protect people for life against measles; boosters are not necessary once you’ve been fully vaccinated.
• These vaccines are safe and effective. There is no link between the MMR or MMRV vaccine and autism.
• Vitamin A does not prevent measles. Vitamin A supplements, and cod liver oil containing vitamin A, do not prevent measles. High doses of these substances are unsafe and can damage the liver. Do not take without the supervision of a health care provider.

Measles is a serious illness

Before measles vaccines were available, there were an estimated 3 million to 4 million cases of measles in the U.S. each year, nearly 50,000 hospitalizations, and around 500 deaths (mostly in children).

Survivors of measles may have life-long complications such as permanent hearing loss or brain damage, and measles can cause “immune amnesia,” which causes the body to “forget” how to protect itself against other infections and can last months or years.

Lastly, there is a late fatal complication that occurs 7 to 10 years after a seemingly successful recovery from measles, called Subacute Sclerosing Panencephalitis.  While rare, this affects mostly children who were infected before 2 years of age, and causes slowly progressive neurologic disease that is 100% fatal.

Vaccination is the best way to protect yourself against measles

The best way to protect yourself against measles is to get the measles, mumps and rubella (MMR) vaccine. Children ages 12 years and under may get the measles, mumps, rubella and varicella (MMRV) vaccine instead, which protects against chickenpox too.

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Most people who are vaccinated with MMR or MMRV will be protected for life

Vaccines and high rates of vaccination have made these diseases much less common in the United States – achieving “elimination” status in the year 2000.  This means that while cases of measles can still occur, there is not ongoing person-to-person transmission for at least one year.

You may receive both the MMR and MMRV vaccines at the same time as other vaccines. Your health care provider can give you more information.

How to know if you’re immune

Evidence of immunity includes:

• Receipt of two doses of MMR or MMRV vaccine.
• A blood test showing immunity to measles (positive IgG antibodies).
• Birth before 1957.
• Past measles illness confirmed by a laboratory test (a verbal “history of measles” doesn’t count – you should get a blood test to confirm).

MMR

The MMR vaccine protects you against measles, mumps and rubella.  Immunity to measles and rubella is lifelong, but mumps immunity can wane over time.

Older children, adolescents and adults (born 1957 or later) need one or two doses of MMR vaccine if they don’t have evidence of immunity. Doses should be separated at least 28 days apart.

• One dose is sufficient for most adults who were not vaccinated as children.
• Two doses should be given to international travelers (see below), people who work in a health care-related field, and students in college, university, technical or vocational school.

Anyone traveling internationally should be fully vaccinated before traveling. Infants ages 6 to 11 months old should get one dose of the MMR vaccine before travel. Then they should get two more doses after their first birthday. (The first one doesn’t “count” as their routine 12- to 15-month vaccine.) Older children who have only gotten one MMR dose can get their second dose early, as long as it has been at least 28 days after their first dose. Early doses may also be recommended if there is a local measles outbreak.

MMRV

The MMRV vaccine protects against measles, mumps, rubella and varicella (chickenpox). Immunity to measles, rubella and varicella is lifelong, but mumps immunity can wane over time.

Why getting vaccinated is important

Almost everyone who has not had the MMR vaccine will get sick if they are exposed to measles. It is probably the most contagious illness known in humans.

Measles makes kids (and adults) sick – they are usually miserable.  The vaccine keeps your child from missing school or childcare, and you from missing work to care for your sick child. And again, while most children will recover from measles without any complications, there is a small but very real risk of hospitalization, complications and death. Vaccination also limits the size, duration and spread of outbreaks and protects those who cannot themselves be vaccinated, like infants under 6 months, pregnant women and those with weakened immune systems.

The vaccine is safe and effective

MMR vaccine is very safe and is effective at preventing measles, mumps and rubella. Vaccines, like any medicine, can have side effects. These are usually mild and go away on their own.

There is no link between the MMR vaccine and autism. The initial study in the 1990s that claimed to show a link between the MMR and autism has since been shown to be fraudulent and was retracted; the primary author lost his medical license. Over the following decades, multiple studies with hundreds of thousands of children have investigated this issue. None has found any link between autism and the MMR vaccine.

It is safe for breastfeeding women to receive MMR vaccination. Breastfeeding does not interfere with the response to MMR vaccine and the baby will not be affected by the vaccine through breast milk.

Rarely, vaccinated people may still get measles if they are exposed to it, especially when there is a lot of measles circulating in the community.  This is because while MMR is highly effective, no vaccine is 100% effective. Measles in vaccinated people tends to cause milder illness and they are less likely to spread measles to others.

Vitamin A, and other supplements with high levels of vitamin A like cod liver oil, do NOT prevent measles and can be toxic to the liver.  Parents should not give these substances to their children without recommendation from a physician.

What are the risks from MMR vaccine?

Everything we do in life has risks, so every day we are making risk-based decisions, often without having to think about it. For example, is there risk if I drive with my infant to the store? Yes, I could get in an accident. Can I reduce that risk? Yes, by driving carefully and by using seat belts and a car seat. But does that eliminate all risk? No.

With many vaccines, people tend to over-estimate the risk from the vaccine and under-estimate the risk from the illness or illnesses the vaccine prevents.

Most people don’t have any side effects from the MMR vaccine. The side effects that do occur are usually mild and may include:

• Soreness, redness or swelling where the vaccine was given.
• Fever (5% to 15% of people).
• Mild rash (5% of people).
• Temporary pain and stiffness in the joints (seen in about 1 in 4 adult women receiving the vaccine, but is related to the rubella component).

Compared with measles infection people are much, much less likely to have any serious complications from the measles vaccine. Check out this graphic:

Reasons to delay MMR and MMRV, or not be vaccinated

Some people should not get the MMR/MMRV vaccine, or should wait. You should not get these vaccines if you:

• Have had a severe allergic reaction (such as anaphylaxis) after a previous dose of MMR or MMRV vaccine, or to any of its components.
• Are or may be pregnant. Wait to get the MMR vaccine until after you are no longer pregnant. Avoid getting pregnant for at least one month after getting the MMR vaccine.
• Have a weakened immune system due to disease or medical treatments.

In addition, you should discuss vaccination further with your health care provider if you have any of the situations below. These do not mean that you can’t be vaccinated, however, but you may need to wait.

• Have ever had a severe, life-threatening allergy.
• Have a close relative with a history of a hereditary or congenital immune system problem.
• Have ever had a condition that makes them bruise or bleed easily.
• Have recently had a blood transfusion or received other blood products.
• Have tuberculosis.
• Have gotten any other vaccines in the past four weeks.
• Are feeling moderately or severely ill. People with a minor illness, like a cold, can be vaccinated.

Also, for the MMRV vaccine you should discuss with their provider if you:

• Have a history of seizures, or have a parent, brother, or sister with a history of seizures.
• Are taking or plan to take salicylates (such as aspirin).

Treating measles

There is no specific treatment for measles, but supportive care is important. The most common complication, reason for hospitalization and cause of death in children with measles is pneumonia, so seeking care should not be delayed.  Vitamin A, cod liver oil, budesonide (a steroid) and other remedies do NOT treat measles. These can also be toxic at high doses and should not be given unless under the care of health provider.

After an exposure to measles

While it is always better to be protected from measles ahead of time, if you don’t have immunity become exposed to measles, talk with your health care provider about getting the MMR vaccine right away.

• Getting the MMR vaccine within 72 hours of being exposed to measles may prevent you from getting measles at all, or you may have a milder illness.
• Exposed people at very high risk who cannot get the vaccine (such as pregnant women, infants under the age of 6 months and people with weakened immune systems) may get a different medicine called immunoglobulin (IG) within six days of being exposed to measles. This also can either prevent the disease or lead to milder illness.
• People who cannot get the MMR vaccine within 72 hours should still be vaccinated, to prevent future exposures.

While a few studies have found a benefit from vitamin A in malnourished children, there is very limited data in developed nations that this helps.  However, a health care provider may give one to two doses of vitamin A to hospitalized children with measles. Parents should NEVER give high doses of vitamin A, cod liver oil, or other home remedies to treat measles, as these can be toxic to the child’s liver.

Where to get vaccinated

Your health care provider’s office is usually the best place to receive recommended vaccines. Vaccines also may be available at pharmacies, workplaces, community health clinics, health departments, schools, or religious centers.

Most health insurance plans cover the cost of vaccines, including MMR and MMRV. However, you may first want to check with your insurance provider for cost information and for a list of in-network vaccine providers. Your children may be able to get no-cost vaccines through the Vaccines for Children Program. This program helps families of eligible children who may not be able to afford or have access to vaccines.