A recent measles outbreak traced to Disneyland in Anaheim, California, has struck at least 121 people in North America so far (it’s still spreading). An infected person likely visited the amusement park between December 17 and 20; since then, California has seen its worst outbreak in 15 years, with patients ranging in age from 7 months to 70 years. In just one month, the epidemic spread to 13 other states. But what exactly is measles, and why is everyone so concerned? Here, we address your questions.
1. I’ve heard of measles, but what exactly is it?
First, know that measles is highly contagious. It’s a virus that multiplies in the cells lining the back of the throat and lungs, and causes fever, cough, runny nose, and a characteristic spotty rash all over the body. It can spike fevers to 104 degrees, and lead to other illnesses like pneumonia or encephalitis (brain swelling). Roughly 90 percent of people without measles immunity who are physically close to someone with measles will catch it through the air, via droplets from an affected person’s sneeze or cough, or an infected surface (where the virus can live for up to two hours), according to the Centers for Disease Control and Prevention (CDC).
2. Measles symptoms sound bad, but why exactly is everyone so worried?
Before the vaccine for measles became available in 1963, almost all children fell sick with it before age 15. Although measles was common then, it was also fatal. Hundreds of Americans died yearly from the disease. Today, for every 1,000 people infected with measles, one to two will die from complications (globally, nearly 146,000 children died in 2013). “Measles is one of—if not the most—infectious of infectious diseases,” Tom Frieden, MD, CDC director, told NBC News. “We’ve seen circumstances where one infectious kid has gone into an auditorium, and only a handful of other kids among hundreds of others were not measles immune. Virtually every one of them got measles.”
Young children are especially prone to fatal complications. Infection can lead to deafness, blindness, seizures, and developmental delays. If a woman contracts measles while pregnant, she could miscarry or give birth prematurely. “Measles is not a trivial illness,” Gil Chavez, MD, state epidemiologist for California, told reporters. “Those of us who have cared for measles patients can attest to its potential severity.”
3. So as an adult, I can still get measles?
Absolutely. In fact, more than 62 percent of those affected in the recent California measles outbreak have been adults. Ask your doctor to check your medical records to see if you’ve received the measles vaccination; perhaps your parents chose not to vaccinate or you were allergic to ingredients in the vaccine. Another thing to consider: When doctors started vaccinating in 1963, they suggested only people born after 1957 receive the vaccination because they assumed those born before had already been infected and were therefore immune. But if you were born before 1957 and never got the measles, you’re not in the clear.
The vaccination works most of the time, but it’s still best to stay away from anyone infected—of the 42 California patients infected, five reported being fully vaccinated. “When you have a scenario where hundreds of hundreds of people get exposed, then even if the vaccine is 99 percent good after two doses, you’re going to have a handful of people who are going to get sick,” Orange County Public Health Officer Eric Handler, MD, told the Los Angeles Times.
4. Should I get vaccinated again?
Perhaps. Though the measles vaccine was introduced in 1963, only one dose was given until 1989, when two doses were introduced for better coverage. One dose is 95 percent effective against measles infection; a second dose is 99 percent effective. “Anybody who doesn’t know if they’ve had two doses should get a dose of vaccine,” James Cherry, MD, primary editor of the Textbook of Pediatric Infectious Diseases, told the Los Angeles Times. Blood tests can reveal whether you are immune to measles.
4. How do I know if my children or I have the measles?
Symptoms first appear as a high temperature, runny nose, and sore eyes. A few days later, small white dots with blue centers—lesions called Koplik spots that are specific to measles—form inside the mouth. Three to five days after symptoms start, an itchy rash begins at the hairline before it erupts over the rest of the body. At this point, fever spikes. After a few days, both the rash and the fever typically lessen. Those infected with measles can spread the disease beginning four days before the rash appears until four days after, according to the CDC.
5. Yikes. If I see those measles symptoms, what do I do?
As tempting as it may be, don’t rush straight to the doctor’s office. Call ahead and explain your symptoms. Your doctor may arrange for you to arrive at the office using an alternative entrance so you don’t infect others. After examining you or your child, the doctor might call for a blood test or viral culture.
There is no treatment or cure for measles. The best way to get better is to stay at home, rest, and drink plenty of fluids. A doctor may recommend that an infected child take vitamin A supplements (measles can cause vitamin A deficiencies even in well-nourished children). The vitamins have been shown to reduce mortality and blindness rates. Stay away from other people—meaning no school, day care, work, or any other public places until at least four days after a rash appears. Most patients recover within two weeks.
6. How can I avoid contracting measles?
Since 2000, there have typically been about 60 cases of measles per year in the United States, but in 2013, this number tripled to 175 and soared to 644 in 2014. Many of these outbreaks involved international travelers who visited countries where the virus was more common. The best way to avoid contracting the disease is to get the measles, mumps, and rubella (MMR) vaccine, which protects nearly everyone who is given two doses. It’s typically given to children first when they are about between 12 and 15 months, and again between 4 to 6 years of age. If you’re planning to have a baby, and haven’t received the MMR vaccination or aren’t sure if you have, consider getting it first (it’s not recommended during pregnancy). If there’s a chance you’ve been exposed to the measles virus during pregnancy, you’ll be given a concentration of antibodies that can offer short-term but immediate protection via a human normal immunoglobulin (HNIG) injection.
7. Why are some people against vaccinations?
Some parents may think vaccines introduce unnecessary, potentially harmful chemicals into a child’s body. Others are frightened that the MMR vaccine could cause development disabilities like autism, since a now-discredited study making such claims made headlines in the late 1990s. Though the vaccine may cause some benign side effects like fever, health officials say the benefits greatly outweigh the risks. “The majority of the adults and children that are reported to us for which we have information did not get vaccinated or don’t know whether they have been vaccinated,” Anne Schuchat, MD, an assistant surgeon general and director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters. “This is not a problem with measles vaccine not working. This is a problem of the measles vaccine not being used. Measles can be a very serious disease and people do need to be protected.”
Over five decades, hundreds of millions of children worldwide have safely been vaccinated. Still, some parents refuse to vaccinate, says Eric Ball, MD, a pediatrician in southern Orange County, where some schools report that up to 40 percent of parents have sought a personal beliefs exemption to vaccination requirements. “Sometimes, I feel like we’re practicing in the 1950s,” Dr. Ball told The New York Times. “It’s very frustrating. It’s hard to see a kid suffer for something that’s entirely preventable.” In light of the recent Disneyland measles outbreak, some pediatricians—including Dr. Ball—are no longer taking patients who don’t follow the standard immunization schedule.
8. If my kid has the measles vaccine, why should I care if other children are not vaccinated?
It comes down to a concept called herd immunity, or community immunity: The more vaccinated people there are, the bigger the chance that chains of transmission won’t be sustained. Let’s say an infected person passes the virus to two others. If those two are unvaccinated, they can infect another two unvaccinated people, until there is an exponentially growing outbreak. However, if an infected person passes on the virus to two others, and one is vaccinated, only one other infected person will pass on the disease. If the next two people the virus hits are both vaccinated, it’s stopped in its tracks. Not only does this protect others, but it also protects you or your child if you’re part of the handful of people not immune to measles—even with a vaccination.
What’s more, measles poses a significant risk to those who can’t be vaccinated, such as babies under age 1, who are too young to receive the vaccination, as well as children and adults who are immune-compromised.
9. Are the elderly at risk from measles, too?
Since most people born before 1957 already contracted measles during childhood, they are likely to be immune to the disease. If they never had measles, never got vaccinated, or only received one dose, however, their less-well functioning immune systems can put the elderly at higher risk of measles complications. “It may be well important in the future that we give additional doses to adults,” Dr. Cherry told NBC News. “We have people who are 40 years out from vaccination, and some of these people will get measles because their protection has dropped.” Older adults should talk to their doctors about getting a booster shot if they’re concerned about full protection.