Once Nearly Eradicated, Measles Is Back

With the highest number of reported outbreaks in nearly 20 years, 2019 is a record year for measles. The resurgence is due to misinformation about vaccines, the decline in vaccinated children, and foreign travel. Unvaccinated U.S. residents get the measles while they are abroad, then bring the disease into the United States and spread it to others. New York City was the epicenter of the recent outbreak where the virus was found to be spreading among unvaccinated children.

Measles is a disease of humans. There are no known animal or insect carriers.

“Some people may think that if most people are vaccinated, then the risk of measles is low,” says infectious disease expert Tara Vijayan, MD, UCLA Medical Center. “But that’s entirely contingent on a fully vaccinated population. If even 5-10 percent of our otherwise healthy population are unvaccinated, all it takes is one traveler with measles introducing measles to that 10 percent, plus those unvaccinated due to their lowered immune system, add a handful who might get it even when vaccinated, and the result is our largest measles outbreak to date.”

In May of this year, a study published in the journal Lancet Infectious Diseases placed L.A. County near the top of those most likely to have someone catch the measles from travelers who visited countries with outbreaks. The researchers noted that people who live in counties located near major international airports are at greatest risk.

Who Is Vulnerable

This highly contagious respiratory disease is caused by a virus that lives in the nose and throat. According to the Centers for Disease Control and Prevention (CDC), 90 percent of unvaccinated people who have not had measles will get the disease, if they are exposed to the virus. Depending on when you born and the type of vaccine you received, you may or may not be immune.

“If you were born prior to 1957, you were likely exposed to measles and have an adequate immune response,” says Dr. Vijayan. “If you were born between 1957 and 1968, it really depends on whether you were vaccinated with the live or inactivated measles vaccine. If you received the live vaccine, then you are likely fine. If you received the inactive vaccine or do not know, then it is prudent to get vaccinated with at least one dose as long as your immune system is not suppressed, such as with chemotherapy, medications for rheumatologic conditions, or by certain types of cancers, or HIV.”

The CDC recommends that health-care workers, adults traveling overseas, college students, and anyone living near a community experiencing an outbreak get an MMR booster shot if they are unsure of their immunity. Another option is to get an inexpensive blood test (titer test), which can show if you have enough measles antibodies to be protected against the disease.

Symptoms and Complications

The virus can live up to two hours in a room where an infected person has coughed or sneezed—even before he or she has experienced symptoms. Infected people can spread the disease four days before through four days after the rash has appeared. Incubation period from exposure to symptoms is about 10 to 12 days. The rash can last up to 21 days. Fever can spike as high as 103°F –105°F and be accompanied by coughing, sneezing, red watery eyes, and runny nose.

Some people suffer severe complications from the measles. The CDC reports that one in four people will be hospitalized, and as many as one out of every 20 children with measles gets pneumonia. Dr. Vijayan recommends that family members talk about the importance of vaccinations with the parents of unvaccinated children, as the benefits greatly outweigh the risks.

“The risk of infection in young children is not trivial,” she says. “Nine percent of confirmed cases have been hospitalized, and 3 percent have had pneumonia. In children under the age of 2 there is also a significant risk of a type of encephalitis (inflammation of the brain) called subacute sclerosing panencephalitis (SSPE) that occurs years after the initial infection. This can be devastating.”

It can take up to eight years before symptoms commence. Males are three times more likely to get SSPE, for which there is no cure. According to the National Institutes of Health, the occurrence of SSPE declined by at least 90 percent in countries that have practiced widespread immunization with vaccines.

Vaccines Protect You

The best way to protect against the disease is to get the measles-mumps-rubella shot (MMR). These three vaccines were combined in 1971. Rubella is also known as the German measles. The mumps is a contagious viral disease that attacks the salivary glands. Like the measles, mumps and rubella were common in childhood, but became rare due to the bundled vaccination program.

In the years following licensure of the vaccine, the incidence of measles decreased by more than 95 percent. Today, some parents refuse to vaccinate children on religious or other non-medical grounds, including the belief that vaccines cause disorders such as autism and chronic conditions. These claims have long been discredited by numerous studies.

“As a mother of two young children, I fully empathize with parents who want to do everything they can to protect them. But there is no causal link between the MMR vaccine and autism,” says Dr. Vijayan. “We have amazing pediatricians who are able to diagnose children with those conditions and able to suggest programs to aid in their development. I suspect that at least one of the biggest contributing factors to our seeing a surge in autism cases is because we are so much more aware of it.”

Recommended Vaccines

While you may or may not need the MMR vaccine, there are important vaccines that older adults should not ignore. See the box below for the CDC recommendations. Consult with your primary care physician to make sure you get the right vaccines for you and in the proper time intervals. If you’re traveling abroad, be sure to check the CDC travel notices page for vaccines you may need. Countries with large measles outbreaks include some parts of Europe, Israel, Brazil, and the Philippines. Travel notices can be found at cdc.gov/travel/notices. Keep a record of all your vaccines and note any adverse reactions.

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