In a recent measles outbreak that has sickened hundreds, two people have died—including an unvaccinated school-age child with no underlying condition in Texas. The majority of measles cases are among children in Gaines County, Texas, but the outbreak has spread to at least eight other counties in Texas and a dozen states. Keep track of the numbers from Texas Health & Human Services Commission here.
The deaths mark the first measles-related deaths in the United States since 2015 and have renewed conversation around a disease that was declared eradicated in the U.S. in 2000. So, what do parents need to know about measles? What does measles look like, how does it spread—and most importantly—how can you prevent it? Here, Dr. Carla Garcia Carreno, an infectious disease specialist at Children’s Health in Dallas, explains.
DFWChild: How contagious is measles, compared to other viruses like the flu or COVID-19?
Carla Garcia Carreno, MD: Measles is a highly contagious infectious disease. If a person with measles is in a room with unvaccinated individuals, 9 of 10 of those exposed will become ill with measles. For comparison, a person with COVID-19 would infect 1 to 3 exposed individuals at the beginning of the pandemic. A person with influenza would infect 1 to 2 exposed individuals.
Measles is transmitted via airborne spread; the small respiratory particles will travel beyond 6 feet and will linger in the air for around two hours, even after the person leaves the room. Given this, if a person that is unimmunized walks into a room an hour after the infected person left, that susceptible individual can still be infected with the virus, despite not having direct contact with the person with measles.
It is important to recognize that the infected person will be contagious starting four days before the onset of the rash, until four days after the onset of the rash. This means that the infected person can spread the virus before the diagnosis of measles is made.
What are the symptoms of measles?
Measles symptoms usually present 7–14 days after exposure but can present up to 21 days after contact with someone with measles. It starts as a non-specific upper respiratory infection or influenza-like illness, with fever, cough, congestion and conjunctivitis (eye redness).
This is followed by the appearance of classic mouth lesions called Koplik spots, right before a generalized red and raised rash appears. The rash starts at the hairline and spreads down to trunk and extremities, affecting the entire body. The rash usually appears on day 3 to 5 of illness.
What are the potential complications?
Measles can have several complications, especially in young children, children with a weakened immune system and pregnant women. These complications include ear infection (around 9% of cases) which may lead to hearing loss, lung infection or pneumonia (around 5% of cases). About 1 in 1000 cases will have encephalitis (brain swelling).
A rare but fatal complication of measles (4–11 of 100,000 cases) will occur 7–10 years after the acute infection and is known as Subacute Sclerosing Panencephalitis (SSPE). It is another type of brain inflammation.
Another complication seen after acute infection is the weakening of the immune system’s cellular response, causing a defective immune response against certain infections. Measles has a mortality of 1–3 per 1,000 pediatric cases.
“There are no antiviral medications against the measles virus. Only supportive treatment is available, like drinking plenty of fluids and treating the fever.”
What is the recommended age for the measles vaccine?
The measles vaccine is a live-attenuated virus vaccine that is combined with mumps and rubella vaccines. The Measles-Mumps-Rubella vaccine (MMR) is recommended in a two-dose schedule. The first dose is given to babies 12 to 15 months of age. The second dose is provided at 4 to 6 years old.
After the first dose, 93% will develop antibodies against measles, and after the second dose, 97% of the population will be protected. In certain circumstances, an earlier dose (starting at 6 months of age) might be considered (before international travel or in cases of a local outbreak).
However, this dose would not count towards the immunization schedule, and these babies need to receive two additional doses after their first birthday.
The protection is lifelong after vaccination. It usually takes about two weeks to elicit an immune response, but even a few days after the dose, the vaccinated person can have some protection.
How long does it take to become effective?
Vaccination is one of the measures implemented by health authorities within 72 hours of measles exposure for unvaccinated individuals, to prevent severe disease.
If children weren’t vaccinated according to the recommended schedule, can they get the vaccine now and is it still as effective as if they were younger?
Yes, the vaccine can be given at any time after 12 months of age. Two doses are recommended, at least 28 days apart. The vaccine will still provide the same protection.
Given that this vaccine is a live-attenuated virus vaccine, people with some immunocompromising conditions and pregnant women cannot receive the vaccine. Families need to discuss with their primary care providers about each personal history and contraindications for vaccination, as well as strategies to protect those surrounding the vulnerable people in the family, by vaccinating the household.
“If your child is unvaccinated against measles and was exposed to a case, monitoring for signs and isolation is required for 21 days.”
Might adults who were vaccinated as children need a measles booster?
Once a person has received two doses of the vaccine will have protection for life and there is no need for booster doses. However, one possible consideration are the adults that received the initial formulation of the vaccine between 1963 and 1967, which was slightly less effective. These individuals should discuss with their primary care provider to assess if they would need an additional dose. Adults who are unsure of their immune status can talk to their doctor about getting a blood test.
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What’s most important for parents to keep in mind amid the recent measles outbreak?
There are no antiviral medications against the measles virus. Only supportive treatment is available, like drinking plenty of fluids and treating the fever. Given this, prevention of measles through the vaccine is the most effective way to keep our kids safe. The available vaccine is a safe and effective tool for prevention. Make sure your children are up to date on all their doses.
If your child is unvaccinated against measles and was exposed to a case, monitoring for signs and isolation is required for 21 days. In these circumstances, a vaccine dose can be provided within 72 hours of exposure, and a special measles antibody (immunoglobulin) can be given from day 3–6 of exposure. Children with immunocompromising conditions that were exposed qualify for the immunoglobulin. Of note, isolation needs to extend to a period of 28 days if the immunoglobulin was provided.
Recognizing signs and symptoms of measles for prompt diagnosis is of uttermost importance. You need to call your doctor ahead of time to coordinate testing, to prevent exposure to other patients, given how contagious this virus is.
If your child is sick with measles, monitor for the complications discussed above. If your child presents with difficulty breathing, lethargy, seizures or signs of dehydration (including decreased number of wet diapers or urination, thick saliva, no tears), seek medical care as soon as possible, and remember to notify in advance.
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