Is your family protected from measles?

Measles outbreaks occur periodically in communities throughout the country, underscoring three things for parents (and everyone) to keep top-of-mind about this highly contagious virus:

• Measles spreads quickly
• Complications can be serious
• Vaccination is important (the majority of people who get the disease during outbreaks are unvaccinated)

Most people are fortunate to not have seen measles at its worst and don't remember how ill family members and friends got from this infection prior to the introduction of the vaccine in 1963. Before the vaccine was commonplace, millions contracted measles every year and several hundred died from it. Despite the effectiveness and safety of the vaccine and recommendations from respected health organizations, not all children are vaccinated.

In the U.S., the documented measles immunization rate is about 92%. This is below the 95% threshold needed to prevent large-scale spread. and to protect children too young to get immunized or those rare individuals who are truly allergic to, and cannot receive, the MMR vaccine. 

We're taking a look at everything about measles: the symptoms, how it spreads, and most importantly, what to do to protect your family.

Measles symptoms before the rash

When most people think about measles, they picture a rash. However, measles typically starts with a high fever (103-105 F), cough, red watery eyes, runny nose, and low energy. The rash usually appears about 14 days following initial exposure, starting on the head and face as many small dots, then spreading down to the torso and limbs. As it does, the rash becomes wider and blends into a patchy red uncomfortable swollen rash before gradually fading.

Unfortunately, by the time the rash appears, the infected person has already been spreading the virus for four days and will continue to be contagious for four additional days. When particles of the measles virus enter the air through a cough or sneeze, they can remain for two hours. It is so infectious that nine out of 10 susceptible people will contract the virus when exposed to the infected air, even if the infected person is no longer physically present. 

Measles complications can be serious

Thirty percent of people infected with measles will have serious complications, including: 

• Pneumonia
• Diarrhea
• Bronchitis
• Severe ear infection
• Blindness
• Encephalitis (swelling and damage of the brain)

When should a child get the measles vaccine?

While there is supportive treatment for measles, no cure exists. The good news is that measles is preventable with the MMR (measles, mumps and rubella) vaccination. 

Children should get two doses of the MMR vaccine, the first at 1 year of age; the second at 4 years. The first vaccination provides a child with 93-94% immunity to measles. The second shot increases that immunity to 97-98%. 

Teens and young adults attending college, as well as people planning international travel, should be sure they have received two doses of the vaccine.

Are there exceptions to the immunization schedule?

If there is a measles outbreak in your community or your infant will be traveling outside the U.S. between 6 and 11 months of age, they can safely get a dose of the MMR vaccine to offer protection from measles infection. This does not count for the infant’s first MMR, and the child should still get two doses at the ages recommended above.

Do adults need a measles vaccine or booster?

In some cases, adults may need to consider measles vaccination. Here are some guidelines.

Adults born prior to 1957 likely have immunity from exposure to the measles disease prior to the development of the vaccine. However, if you are not sure, it is a good idea to get a blood test called a measles titer to measure your amount of immunity. If the titer shows minimal immunity, it is recommended you get two doses of the MMR vaccine, separated by at least 1 month.

Adults born between 1957 and 1962 likely received only one MMR shot. Also, your records may not specifically indicate if you received the inactivated or active attenuated (recommended) virus. Because of this, the safest action is to get the titer.

Adults who received MMR vaccine between 1963 and 1967 received an inactivated form of measles in the vaccine. That vaccine has since been found to be ineffective at conferring immunity. As a result, these individuals are considered to have no measles immunity and should get two doses of MMR, separated by at least 1 month.

Adults born between 1968 and 1989 may have received only 1 dose of MMR—the vaccine recommendations until the mid-1990’s. If you only had one MMR, you should get another dose to ensure full immunity. 

What happens if someone is exposed to the measles?

If a child or adult received two doses of the MMR vaccine, they will very likely not contract measles if exposed to someone who has the virus. A baby or other person without measles immunity has a 90% chance of contracting measles after even a short exposure. 

There are options to prevent or at least decrease the severity of the disease after exposure including:

• Getting the MMR vaccine within 72 hours of the exposure (if more than 6 months old).
• Getting immunoglobulin within six days of the exposure (can be given to babies younger than six months). Immunoglobulin is an injected serum of trained white blood cells that know how to recognize and fight measles. 

If you or your child is exposed to, or is showing signs of the measles, contact your doctor’s office for advice. Avoid going to a waiting area in an office, clinic or hospital to limit the spread of this highly contagious disease. Call ahead so that the physician's office or hospital can make arrangements to evaluate you or your child.

For the latest information on measles outbreaks, visit the CDC website.