So There's a Measles Outbreak Near You. How Worried Should You Be?
An infectious disease expert weighs in on the symptoms and complications of measles and the MMR vaccine's safety and effectiveness.
Measles is in the news a lot lately, from potential airport exposures to ongoing localized outbreaks across the country.
The Centers for Disease Control and Prevention reported 17 outbreaks and 372 cases of measles in 2018. There are already 268 cases linked to six outbreaks reported in 2019.
While a few hundred cases may not sound like a huge deal in the grand scheme of things, doctors say that, because the measles virus is so contagious, every single diagnosis is cause for concern. An uptick in cases in recent years has health experts paying attention, as well.
To learn more about measles, and how worried we really should be about the measles outbreaks in recent headlines, Health spoke with Rachael Lee, MD, assistant professor in the Division of Infectious Diseases at the University of Alabama at Birmingham. Here’s what she wants everyone to know.
What is measles, and why is it "back"?
Measles, also known as rubeola, is a highly contagious virus that spreads through coughing and sneezing, says Dr. Lee. The virus can also live for up to two hours in the air or on surfaces where an infected person has been, and other people can become infected if they breathe in that air or touch those surfaces and then touch their eyes, nose, or mouth.
Before the measles, mumps, and rubella (MMR) vaccine was introduced in 1963, about 3 to 4 million people in the United States got measles every year—and about 500 people a year died.
The disease was declared eliminated in the United States in 2000, but people do still bring measles here from other countries. Once that happens, the virus can spread, especially among communities of unvaccinated people.
Are recent outbreaks really that bad?
In just the first seven months of 2018, there were nearly as many measles cases reported to the CDC as there were in the entire previous year. (That would be 118 people from 15 states in 2017.) In 2016 and 2015, respectively, 86 and 188 measles cases were reported. Many of those 2015 cases were traced back to Disneyland in California, where health experts believe an infected tourist visited and spread the measles virus after picking it up abroad.
But 2014 was the worst year for measles in recent history, with 667 cases from 27 states reported to the CDC. About half of these cases stemmed from an outbreak among unvaccinated Amish communities in Ohio, while many other cases were brought into the United States from the Philippines.
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Measles symptoms: The three Cs, then the rash
When most people think about measles, they think about the trademark head-to-toe rash. But that’s not the first symptom of the virus, nor is it the most serious one. “At first, patients just appear to have a typical virus,” says Dr. Lee. “It’s characterized by high fever, a general feeling of sickness, and what we call the three Cs: cough, coryza—which means runny eyes and runny nose—and conjunctivitis, or red eyes.”
Then comes the red, itchy rash, about 14 days after exposure. “It spreads from head to chest, and then down to the toes,” says Dr. Lee. Ear infections also occur in about 10% of children, and some also experience diarrhea.
A small percentage of people who get measles develop complications that can cause long-term disabilities or can even be fatal. These include pneumonia, hearing loss, tracheal infections, and a very rare brain disease called subacute sclerosing panencephalitis, which causes intellectual deterioration seven to 10 years after measles exposure.
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Treatment for measles
Because measles is viral, there's no cure and no medicine that will make it go away. In most cases, the illness simply has to run its course, and most people feel better within two to three weeks.
There are some things that may help relieve the discomfort of measles or help people from feeling even worse, however. Doctors may recommend acetaminophen or other over-the-counter drugs to relieve fever and muscle aches, along with lots of rest and plenty of water or other fluids.
If someone with measles tests positive for low levels of vitamin A—which can make cases more severe—they may be prescribed a supplement. And if they develop a bacterial infection like pneumonia, they will need antibiotics.
You can be contagious without knowing it
“Patients are considered contagious from four days before the rash appears to four days after the rash appears,” says Dr. Lee. “That’s one reason we’re so concerned about the spread of the virus, because patients are contagious prior to actually having the classic rash we’re used to seeing.”
According to the CDC, measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected. Babies are among the most vulnerable, since they can’t be vaccinated against the disease until they’re a year old.
Pregnant women are also at risk, since their immune systems are weakened, and so is anyone else—adults and children alike—who has not been vaccinated or who did not have measles as a child. That can include people with cancer and other chronic illnesses, whose immune systems are too weak to receive the vaccine.
Vaccination protects you and your loved ones
The CDC recommends two doses of the MMR vaccine—one between 12 and 15 months and the second one between ages 4 and 6. (Or, children can instead get the MMRV vaccine, which also protects against varicella, or chickenpox.) People who receive these vaccinations are considered protected for life and have a lower chance of spreading the illness to others.
The MMR vaccine, when given in two doses according to this immunization schedule, is 97% effective against measles. That means that about three out of every 100 vaccinated people exposed to measles will still get sick. (In other words, yes, you can get measles if you were vaccinated as a child—but it's rare.) It’s also 88% effective against mumps, another highly contagious disease that’s been making a comeback in recent years.
The vaccine is also very good at preventing serious complications caused by these diseases; even if a person gets measles after receiving a vaccination, it’s more likely to be a mild case and less likely to spread to others.
“A lot of people unfortunately have incorrect information about the measles vaccine, because past research articles have implicated it as a cause of autism,” says Dr. Lee. “Those articles have been completely disproven, and pediatricians are 100% behind getting the MMR vaccine and other vaccines.”
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Should you worry?
The majority of people who’ve gotten sick from measles in recent years have been unvaccinated—so the first thing you can do to protect yourself is make sure your immunizations are up-to-date, says Dr. Lee. People traveling overseas, especially those with children younger than 1, should also talk to their doctors about how they can protect themselves.
And while most people certainly shouldn’t panic about measles, it does help to be aware of the threat it can pose—especially if you know there is an outbreak in your area, or in a location you're planning to visit. (So far this year, measles outbreaks have been reported in New York, Washington, Texas, Illinois, and California.)
All the time, but especially during an outbreak, it’s important to know if you and your children are up-to-date on your measles vaccines—and to talk to your doctor about what to do if you're not. If an unvaccinated person gets the vaccine within 72 hours of being exposed to measles, he or she may receive some protection or may develop a milder case. Doctors can also give a medicine called immunoglobulin (IG) to unvaccinated people, which may also provide some protection.
This post was originally published on August 15, 2018 and updated for accuracy.