1. What’s going on? Why is there a focus on measles? Wasn’t it was declared “eliminated”?
Measles was declared “eliminated” (free of sustained person-to person transmission for more than 12 months) in 2000. High population immunity was achieved by high 2-dose MMR (measles/mumps/rubella) vaccine coverage. Unfortunately, measles is still common in many parts of the world, including areas in Europe, Asia, and Africa. That is why cases sporadically arise in the US, potentially infecting unvaccinated children and adults.
Most recently, Centers for Disease Control and Prevention is investigating a multi-state outbreak of measles, which started in California in December 2014. People in the initial confirmed cases reported visiting Disneyland in Orange County. Since then, 51 confirmed measles cases have been reported to CDC, three of which are from Utah. In all, 86 percent of cases are unvaccinated or had unknown vaccination status. Eight of the 51 were hospitalized. All were genotype B3, a strain of measles linked to an outbreak in the Philippines earlier in 2014.
2. Who is at risk of getting measles?
People with measles are infectious from four days before the rash, to four days after the rash. It is a highly contagious virus. Infectious droplets and airborne particles stay on air and surfaces up to two hours after contact. Thankfully, vaccination prevents infection in 99 percent of persons given two vaccinations separated by at least four weeks. People who are unvaccinated are at highest risk of infection.
3. What does measles look like? What are the symptoms?
Prior to widespread immunity, CDC estimates there may have been three to four million cases per year. Of these 48,000 people per year were hospitalized. About 1000 per year were debilitated with neurologic complications. Now, most young healthcare providers have never seen a measles case.
Initially a person develops a fever, frequently as high as 105 degrees (F). Next, they begin feeling unwell, developing a cough, inflamed eyes (pinkeye). Irregular white, pink or bluish spots will develop on the roof of the mouth or inside the cheeks and lips. This is followed by a skin rash where elevated red bumps cover otherwise smooth areas of the body. The rash may not appear in people who have weakened immune systems due to another condition or medical treatment.
Common complications are ear infection, pneumonia, inflamed windpipe and lungs, and diarrhea. Mild inflammation of the brain is less common, affecting only one in 1000 cases. This condition is neurologically devastating, resulting in brain damage that is permanent. Dawson Disease, also known as SSPE (Subacute sclerosing panencephalitis), is a rare complication where behavioral and cognitive deterioration happens seven to 10 years after measles infection. Death can occur in one to three of every 1000 cases. Death rates are higher in children under 5 years of age, children who have immune systems weakened by another disease or treatment and children who are malnourished.
4. If I have been vaccinated, do I need to get tested to prove I am immune?
If you have your vaccination records, check the dates. The current guidelines recommend two doses of MMR or Measles/Mumps/Rubella vaccine separated by at least four weeks, with the first dose on or after the first birthday. More than 99 percent of those who meet these criteria develop measles immunity. If you have no record of receiving the vaccine or don’t know if you’re immune, ask a medical professional to review your records.
5. What should I do if I think a family member has measles?
Use prevention measures immediately. Have the person who is ill wear a surgical mask and take them to the doctor. They should avoid all waiting areas and be placed directly in an exam room. You and anyone else assisting them should also wear a surgical mask to keep you from ingesting the air-born virus.