What you need to know about Measles

As of December 5, 2019, there have been at least 1,276 measles cases confirmed in 31 statesThis is the greatest number of cases reported in the U.S. since 1992 and declared eliminated in 2000. 124 of the people who got measles this year were hospitalized, and 61 reported having complications, including pneumonia and encephalitis.

What can I do to help spread the word about the importance of vaccination?

What is the MMR vaccination schedule? Health experts recommend:

  • The first dose of MMR vaccine is recommended at 12 months of age.
  • The second dose of MMR vaccine is recommended at 4 years of age.
  • For those who travel abroad, CDC recommends that all U.S. residents older than 6 months be protected from measles and receive MMR vaccine, prior to departure.
    • Infants 6 through 11 months old should receive 1 dose of MMR vaccine before departure.
    • Children 12 months of age or older should have documentation of 2 doses of MMR vaccine (separated by at least 28 days). Please note that this is a recommendation for those who travel abroad.
  • Teenagers and adults without evidence of measles immunity should have documentation of 2 appropriately spaced doses of MMR vaccine.

CDC guidance for healthcare providers as of May 3, 2019 :

  • Providers do not need to actively screen adult patients for measles immunity.  This is because of high population immunity and low risk of disease among adults in non-outbreak areas in the U.S.
  • Providers should make sure patients have measles protection before international travel.  U.S. residents traveling internationally are at high risk for acquiring measles abroad.  They can also transmit measles to susceptible persons, such as infants, when they return home.
  • If a patient is traveling internationally and measles immunity is unknown, providers should vaccinate, unless there are contraindications.  Serologic testing for measles immunity is not recommended.
  • During outbreaks, providers should consult with local health departments for the most up-to-date recommendations for their community.  This may include additional doses of MMR for your patients.

Where can I go to get immunized?
This list has recommendations for locations throughout Nevada. You can also visit the HealthMap Vaccine Finder and search by zip code.

How effective is the MMR vaccine against measles?
According to Greg Wallace, MD, lead of the measles, mumps, rubella and polio team at the CDC, two doses are 97 percent effective against infection. "That means that 3 of 100 will potentially contract measles if exposed," he said. "If you have a group of 1,000 people concentrated in a small space—like oh, say, hypothetically, an amusement park—about 90 percent of them will be vaccinated (hopefully). Measles is crazy contagious, so of the 100 people who aren’t vaccinated, about 90 will get infected. Then, of the 900 people who are vaccinated, 3 percent—27 people—get infected because they don’t have full immunity."

How long does it take the measles vaccine to start working?
The shot usually provides protection in 10 days to two weeks.

Can vaccinated people still get measles?
Yes. The bottom line is that U.S. schools are seeing a rising number of personal belief vaccine exemptions being filed (However, Nevada does not have this type of exemption.) Additionally, unvaccinated people often cluster together. When you combine the two, you get a virus that has more potential to spread. According to the article “Five Things To Know About The Disneyland Measles Outbreak” by Forbes contributor Tara Haelle: “No vaccine can protect 100% of those who receive it…vaccines can fail. The antibodies your body creates can wane, or your body may not have sufficiently responded to the vaccine in the first place. But those who are unvaccinated are at a greater risk by far. An unvaccinated person is 35 times more likely to catch measles than a vaccinated person.”

I've heard there are ongoing measles outbreaks in Europe. What is the risk to the U.S.?
More than 82,000 European children and adults became infected with measles in 2018, according to the World Health Organization (WHO) and over 70 deaths have been reported in 47 countries including France, Georgia, Greece, Italy, the Russian Federation, Serbia, Ukraine, and the United Kingdom. Those who travel to countries experiencing outbreaks may end up infecting those in the U.S. who are unvaccinated. Checking your vaccination records is recommended by the CDC before international travel. 

Do children attending child care need to be immunized against the measles?
Yes, per NRS 432A.230-235, children attending child care in Nevada must be up-to-date on their measles immunizations unless excused because of religious belief or medical condition. Children must receive their MMR (measles, mumps, rubella) vaccine at 12 months and 4 years in order to attend child care.

Do children attending (public/private/charter) school need to be immunized against the measles?
Yes, per NRS 392.435 and NRS 394.192, students attending public, private, or charter school in Nevada must be up-to-date on their MMR (measles, mumps, rubella) vaccine in order to enroll in school. unless excused because of religious belief or medical condition.

Do students attending university need to be immunized against the measles?
Yes, per NAC 441A.755, students attending any university within the Nevada System of High Education or any private post-secondary educational institution must have two doses of the MMR (measles, mumps, rubella) vaccine in order to enroll in school unless excused because of religious belief or medical condition.

How is measles transmitted?
Measles is transmitted via air. “Measles is extremely contagious,” said Dr. Anne Schuchat, CDC and United States Public Health Service. “It is so contagious that if one person has it, 90% of the people close to the person who aren't immune will also be infected. You can catch it just by being in the same room as a person with measles; even if that person left the room because the virus can hang around for a couple of hours.”

My friend told me that the MMR vaccine causes "shedding". Is this true?
MMR is a live vaccine and based on research, the measles and mumps attenuated viruses do not cause shedding. A much greater concern than live vaccine shedding of a weakened strain would be that the unvaccinated child might get a natural infection with measles or chicken pox and pass that on to a person with an immune system problem. Read more here. 

Why does this matter, since measles is just a rash?
Measles is not just a rash. According to the Immunization Action Coalition: Measles can lead to serious complications and death, even with modern medical care. The 1989–1991 measles outbreak in the U.S. resulted in more than 55,000 cases and more than 100 deaths. In the United States, from 1987 to 2000, the most commonly reported complications associated with measles infection were pneumonia (6%), otitis media (7%), and diarrhea (8%). For every 1,000 reported measles cases in the United States, approximately one case of encephalitis and two to three deaths resulted. The risk for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents. SSPE is a progressive neurological disorder characterized by inflammation of the brain (encephalitis). The disease may develop due to reactivation of the measles virus and usually develops 2 to 10 years after the original viral attack.

How do I find out if my family is current on vaccinations?
Visit the Nevada Web IZ Public Access Portal  or call the Nevada Web IZ help desk at 1-877-689-3249. The Public Access Portal allows parents and legal guardians to print official immunization records for their child(ren) (aged 0 through 17 years). It also allows adult individuals (aged 18 years and over) to print official immunization records for themselves. This is an official record and can be used as proof of immunization for school entry, summer camp, employment, etc. Additionally, contacting your health care professional can also provide you with answers to your questions about your vaccination record.

What is community immunity (aka herd immunity), and why does it matter? 
According to vaccines.gov: 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.

Do adults need an MMR booster shot?
According to Dr. Robert Schooley, head of the Division of Infectious Diseases at UC San Diego:  Some might. Anyone born before 1957 likely has immunity because the virus was in wide circulation until the first vaccine was introduced in 1963. However, a second dose was not added to the childhood vaccination schedule until 1989. So adults born after 1957 but before 1985 may have received only one MMR shot and may benefit from a second dose. Also, the CDC recommends two MMR doses for anyone who received an inactivated or “killed” measles vaccine, or one of unknown origin, from 1963 to 1967. That’s because more recent versions of the vaccine are more effective. If you are unsure about your vaccination status, you can check with your healthcare provider.

Are there any situations where more than 2 doses of MMR are recommended?
There are two circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing age who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. MMR should not be administered to a pregnant woman.
In 2018, ACIP published guidance for MMR vaccination of persons at increased risk for acquiring mumps during an outbreak. Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine (MMR or MMRV) to improve protection against mumps disease and related complications. 

I have a toddler. The CDC recommends a first dose for babies at 12 months and a second between the ages of 4-5; should I get the second dose early?
The second dose of MMR can be given as early as 4 weeks (28 days) after the first dose and be counted as a valid dose if both doses were given after the child's first birthday. We recommend you discuss this option with your healthcare provider.

Does the MMR Vaccine cause Autism?
There is no scientific evidence that MMR vaccine causes autism. The question about a possible link between MMR vaccine and autism has been extensively reviewed by independent groups of experts in the U.S. including the National Academy of Sciences’ Institute of Medicine. These reviews have concluded that the available epidemiologic evidence does not support a causal link between MMR vaccine and autism. Additionally, the largest study to date of the MMR vaccine was recently published and found no link to autism. 

Who should not be vaccinated? According to the CDC:

  • Anyone who has ever had a life-threatening allergic reaction to the antibiotic neomycin, or any other component of MMR vaccine, should not get the vaccine. Tell your doctor if you have any severe allergies.
  • Anyone who had a life-threatening allergic reaction to a previous dose of MMR or MMRV vaccine should not get another dose.
  • Some people who are sick at the time the shot is scheduled may be advised to wait until they recover before getting MMR vaccine.
  • Pregnant women should not get MMR vaccine. Pregnant women who need the vaccine should wait until after giving birth. Women should avoid getting pregnant for 4 weeks after vaccination with MMR vaccine.
  • Tell your doctor if the person getting the vaccine:
    • Has HIV/AIDS, or another disease that affects the immune system
    • Is being treated with drugs that affect the immune system, such as steroids
    • Has any kind of cancer
    • Is being treated for cancer with radiation or drugs
    • Has ever had a low platelet count (a blood disorder)
    • Has gotten another vaccine within the past 4 weeks
    • Has recently had a transfusion or received other blood products
  • Any of these might be a reason to not get the vaccine, or delay vaccination until later.

How do I know if my child has measles, or just a common cold virus?
Many viruses this time of year look similar to start with. Measles onset typically includes fever, cough, runny nose, pink eye and white spots inside cheeks. Measles can have severe complications, so it is important if you continue to be concerned that you check with your doctor. The rash associated with measles appears 2-4 days after onset of symptoms and begins on face and head and moves down and across the body.

Are vaccinated people still able to be "carriers" of measles even though they can't get it? (I’m concerned about a pregnant friend being exposed.) 
The measles virus can spread in a person four days before the onset of the telltale rash. So people with the virus start being contagious before they’d ever know they had measles, and this could happen if the vaccinated person falls into the group who could still contract the disease, which is less than 3%. Your friend who is pregnant should make sure she talks with her doctor about any concerns around exposure.

What are my options in protecting my children from unvaccinated children? 
We recommend discussing vaccination status with family and friends if you are concerned. If your children are fully vaccinated, chances of contracting measles is reduced; however the more children immunized in a community helps protect everyone. The majority of cases from recent outbreaks are in unvaccinated individuals.

If my child is 4 and is up to date; what are her chances of getting measles? 
The vaccine is about 97% effective if she's had two doses, which would be considered up to date.

Can anything kill the measles virus in the air or on surfaces — disinfectant sprays, wipes, etc.? 
Infected droplets of mucus can remain active and can be passed on by touching (they are contagious) for around two hours. This means that the virus can live outside the body — for example, on surfaces and door handles. The CDC recommends to disinfect frequently touched surfaces, such as toys, doorknobs, tables, counters.

I understand that the first vaccine is recommended for children at 12 months and the second between 4-6 years. But I also have heard that it's safe anytime between 12 months and 4 years as long as it's more than 28 days after the first shot. Therefore, should I get my 2-year-old her second vax now, given the current potential for outbreak? 
The minimum recommended interval is at least 4 weeks between doses, we recommend you discuss this option with your healthcare provider.

Is it possible to get the measles shot only….not combined with the Mumps and Rubella for children who have medical conditions that put them at risk? 
it is not possible as single antigen vaccines are no longer produced for use in the United States.

If you have no idea about the second dose and you are an adult and your family doctor retired years ago and no medical records are still around should we get another dose? If our kids have had them all, should they get another or are they ok? 
If you don't know your vaccination status as an adult, it is recommended to have two doses for full protection. Children who have had two doses have completed the recommendation.

My child is in a daycare facility; do I have a legal right to find out if the other children in her room are current on their MMR vaccinations? 
Nevada requires certain vaccinations for enrollment in licensed childcare centers, and you can ask the child care center for their vaccination rates, or you can search on vfcnevada.org to see if they've reported their immunization rates.

Do vaccines still contain mercury? That seems to be a common complaint heard from anti-vaxxers. 
Since 2001, with the exception of some influenza (flu) vaccines, thimerosal (mercury-containing preservative) is not used as a preservative in routinely recommended childhood vaccines.

Do you recommend vaccinating infants slightly under a year old? 
In certain circumstances, like before international travel or during a declared outbreak by the local health department, MMR is recommended for infants age 6 through 11 months. Nevada experts recommend vaccinating children age 12 months and older at the earliest indication (12 months, instead of 12 through 15 months). Do not count any dose of MMR vaccine as part of the 2-dose series if it is administered before a child's first birthday. Instead, repeat the dose when the child is age 12 months.

Should I be concerned, even though my child has had only one dose of the MMR vaccine?
One dose of measles vaccine is about 93% effective at preventing measles if exposed to the virus. Two doses are about 97% effective.The CDC recommends a dose at 12 months and a second dose at 4 years of age for full protection. You should follow up with your healthcare provider to confirm your child's vaccination status. 

*always talk to your healthcare provider if you have questions about vaccinations. These questions and answers are summarized from healthcare experts and organizations such as the CDC, Immunization Action Coalition, and more. Email us if you have a question not listed here.