Since mid-December 2014, California has been experiencing an outbreak of measles. On Monday, February 2, 2015, the Washoe County Health District announced that it is investigating two possible measles cases in the Reno/Sparks area. While there have not been any confirmed cases of measles in northern Nevada, concerned parents have contacted our office regarding measles. Below are answers to some commonly asked questions.
UPDATE 2/21/2015: The Washoe County Health District has announced that all laboratory results for people reported for measles testing up to this date are negative. There have been no confirmed cases of measles in Washoe County.
UPDATE 2/9/2015: The Washoe County Health District has announced that the test results for both the adult and elementary school student they were monitoring for measles are negative. They are awaiting test results in four additional cases they are monitoring. There have been no confirmed cases of measles in the Reno/Sparks area.
- What is measles?
- How is measles transmitted?
- How can I protect my child from measles and how effective is the measles vaccine?
- When should my child receive the measles vaccine? Should my child be vaccinated early?
- Who should not get the measles vaccine or should wait to get it?
- How serious is measles?
- Hasn’t measles been eliminated in the United States? Why do we still need to vaccinate here?
- What should I do if my child has measles symptoms?
- Additional Measles Information
Measles is an infectious viral respiratory disease. Symptoms usually begin 7 to 21 days after infection. Measles typically starts with a fever, followed by a bad cough, runny nose, conjunctivitis (pink eye), and a rash. The rash usually starts on the face, along the hairline, and upper neck, and spreads down the back and chest, and then extends to the arms, hands, legs, and feet. After about 5 days, the rash fades in the same order in which it appeared.
Measles is a highly contagious airborne virus transmitted from person to person. The virus resides in the mucus in the nose and throat of those who are infected. It can be spread by infected people sneezing or coughing. Measles can survive for up to 2 hours in the air or on objects and surfaces. Those who are infected are usually contagious from about 4 days before to 4 days after they develop a rash. It has been estimated that 90% of those who have not been vaccinated or have not previously contracted the disease (and thus developed immunity), will be infected if exposed to the measles virus.
While measles is highly contagious, it is also highly preventable. The best protection is to make sure your child is up-to-date on his or her measles vaccinations. The Measles, Mumps, Rubella (MMR) and Measles, Mumps, Rubella & Varicella (MMRV) vaccines protect against measles infection. They are attenuated (weakened) live virus vaccines. These vaccines result in lifelong immunity. Generally, it takes approximately two weeks after a person receives a vaccine to develop immunity.
The measles vaccine is safe and highly effective. 95-98% of people will develop immunity to measles after one dose of vaccine. 99% of people who receive two doses will develop immunity. We encourage our patients to contact us or the Washoe County Health District’s Immunization Program if their children have not received the measles vaccinations recommended for their age and make arrangements to receive their MMR or MMRV shots.
If you are unable to afford immunizations, please contact us and speak to one of our medical assistants to determine if you are eligible for the Vaccines for Children (VFC) program. Both we and the Washoe County Health District participate in the VFC program. One of our medical assistants can help you confirm if you are eligible for VFC, but typically the following children are eligible:
- Children enrolled in Medicaid (proof of enrollment is required)
- Children enrolled in Nevada Check Up (proof of enrollment is required)
- Children who are American Indian or Native Alaskan
- Some children who have insurance which does not cover immunizations
- Some children who do not have insurance
No child needs to go unvaccinated due to financial hardship. We will assist you in getting your child vaccinated.
If you are unwilling to vaccinate, or unable to vaccinate your child due to medical reasons, we urge you to be cautious if a measles outbreak occurs in your area. Following the most recent outbreak in California, the California Department of Public Health “is urging caution to individuals who are not vaccinated, especially infants under 12 months. Any place where large numbers of people congregate and there are a number of international visitors, like airports, shopping malls and tourist attractions, you may be more likely to find measles, which should be considered if you are not vaccinated.”
The Centers for Disease Control and the American Academy of Pediatrics recommend that children receive two doses of measles vaccine. The first dose is recommended at 12-15 months of age. The second dose is recommended at either 4-6 years of age or 11-12 years of age. In Nevada, the second dose is usually given at 4 years of age. There needs to be a minimum of 28 days between the first and second doses of MMR. Or a minimum of 3 months between the first and second doses of MMRV. These recommendations have not changed based on the recent outbreak of measles in California and other states. Currently, it has not been recommended to vaccinate all children before 12 months of age or to accelerate vaccinations because of the current outbreak.
If your child has fallen behind on his or her shots, there is no upper age limit on when you can receive a MMR shot, it can be given to older children and adults. The second dose of MMRV can be given to children up to age 12 as long as it is at least 3 months after the first dose.
The first dose of measles vaccine is not given until 12 months of age because most infants in the United States receive passive protection from antibodies from their mother. If these maternal antibodies are present when the vaccine is administered, they can destroy the vaccine virus causing the vaccine to be ineffective. By 12 months of age, almost all infants have lost this passive protection.
However, infants are sometimes infected by measles and other vaccine preventable diseases, particularly when traveling abroad. Thus, the CDC recommends that certain vaccines be accelerated for some infants traveling out of the country. For example, currently, it is recommended that infants under 12 months of age traveling to the Philippines or Vietnam receive one dose of MMR before they travel. However, this dose will not count for their routine series because it may not be effective. Thus, these infants should be revaccinated on or after their first birthday with two doses separated by at least 28 days.
- Anyone who has ever had a life-threatening allergic reaction to the antibiotic neomycin, or any other component of the vaccine should not get it.
- Anyone who has had a life-threatening allergic reaction to the first dose of vaccine should not get another dose.
- Those who are moderately to severely ill may be advised to wait until they recover to receive the vaccine.
- Pregnant women should not get the vaccine.
- Anyone with a compromised immune system, such as a disease affecting the immune system, being treated with drugs affecting the immune system, or a blood disorder (a low platelet count), may be advised not to get the vaccine or delay getting it.
- Those with cancer, or being treated for cancer with radiation or drugs, may be advised not to get the vaccine or delay getting it.
- Those who have recently had a transfusion or received other blood products may be advised to delay getting the vaccine.
- A vaccine, like any medicine, is capable of causing serious side effects, such as severe allergic reactions. The risk of measles vaccine causing serious harm is extremely small, and getting the vaccine is much safer than getting measles or the other diseases the vaccine protects against. All of our physicians had their own children vaccinated. Nonetheless, we encourage our patients to raise any questions or concerns they may have related to vaccines, such as a history of severe allergic reactions, history of seizures, family history of immune system problems, and to discuss the risks of vaccines with their physician.
- your child has a fever and rash,
- he or she has traveled internationally or been in contact with someone who has traveled internationally (including transit through an international airport or visit to an international tourist attraction in the United States) within the last three weeks,
- visited a state or community where measles is occurring in the United State within the last three weeks,
- or been in contact with a confirmed source of measles.
- If your child received his or her immunizations from another healthcare provider, your doctor will also want to know your child’s immunization history.
Most people will recover from a measles infection in about 10-14 days. However, measles sometimes causes serious complications which may require hospitalization, and in rare cases cause permanent disabilities or death. Complications occur in about 30% of measles cases, and arise most often in patients under 5 and over 20 years of age. Six to 20 percent of people with measles will get diarrhea, an ear infection and/or pneumonia. About one out of 1,000 will develop encephalitis (inflammation of the brain). Approximately one out of 1,000 will die, usually from pneumonia or encephalitis.
Measles indigenous to the U.S. was eliminated around 2000. However, measles is one of the most contagious diseases and it still affects millions of people in other countries. Travelers bring measles to the U.S. every year, and sometimes it then spreads among people living here. Given its highly contagious nature, the vast majority of a population must be vaccinated if we are to avoid recurring or sustained outbreaks until we, hopefully, eliminate this disease everywhere in the world.
Today, measles is rare in the U.S. because a significant portion of our population has been vaccinated. Before measles vaccines were licensed in 1963, approximately 90% of Americans would get the measles by age 15. Each year, about 48,000 were hospitalized, 7,000 had seizures, 1,000 suffered permanent brain damage or deafness, and 450 to 500 would die. Following widespread vaccination, measles infections declined by 98%. However, between 1989-1991, there was a resurgence of measles in the U.S. There were 55,622 reported cases, resulting in 123 deaths (2.2 per 1,000 cases). The geographic areas and groups of people hardest hit by this resurgence had low vaccine coverage, and “[n]inety percent of fatal cases occurred among persons with no history of vaccination.” The CDC concluded that “[t]he most important cause of the measles resurgence of 1989-1991 was low vaccination coverage.”1
By 2000, measles indigenous to the U.S. was eliminated and, by 2002, it was eliminated throughout the continent. In most years since then, there have been fewer than 100 measles cases reported in the U.S. However, measles is still common in many countries outside of the Americas. The World Health Organization estimates that more than 20 million people are infected by measles each year and that, in 2013, there were 145,700 measles deaths globally (approximately 400 per day). Measles remains one of the leading threats to the health of children under 5 years of age in countries which lack widespread vaccination.
Measles from abroad has caused outbreaks in the U.S. since 2000. Noticeable increases occurred in 2008, 2011, 2013, and 2014. In 2008, 140 measles cases were reported, the most annual cases in over a decade. 91% of cases were in those who were unvaccinated or of unknown vaccination status. The CDC found that “[t]he increase in the number of cases of measles in 2008 was not a result of a greater number of imported measles cases. It was the result of more measles transmission after the virus was imported. The importation-associated cases occurred largely among school-aged children who were eligible for vaccination but whose parents chose not to have them vaccinated. Many of these children were home-schooled and not subject to school entry vaccination requirements.”2
In 2011 and 2013, there were 222 and 175 reported cases respectively. In 2014, there were 23 measles outbreaks resulting in 644 reported cases. Lack of vaccination by those living in the U.S. was found to have played a significant role in several of these outbreaks as well. From January 1 to February 6, 2015, there have been 121 reported cases. From 2000 to 2014, there were 14 reported measles cases in Nevada.
We are fortunate that measles cases are limited because outbreaks do not originate here. They have been small enough that we are able to stop it from continuously spreading when it does enter our community and, when one of us does catch it, the risks we face are lower than in many other countries. Nonetheless, even here, measles is a potentially serious disease. Particularly if you are under 5 years or over 20 years old, and most of all for young infants and others who cannot be vaccinated. These members of our community are at the greatest risk for serious complications if they get measles.
The lower our vaccination rate drops, the lower our immunity will be as a community. The community, or herd, immunity provided by a vaccine protects us all, but especially the most vulnerable members of our community. During the major measles outbreaks in 1989-1991, and in outbreaks since, we have seen that the unvaccinated are at greater risk of catching measles. Unlike in prior outbreaks, where school age children accounted for the largest portion of cases, in 1989-1991, children younger than 5 years old accounted for 45% of the cases and 49% of measles deaths. Also unlike prior outbreaks, the incidence rate for infants was more than twice as high as any other age group. However, as discussed above, vaccines are not usually given to young infants because they are not effective until his or her maternal antibodies have declined. Additionally, the immunosuppressed and others who cannot be vaccinated for medical reasons will be at greater risk for contracting measles and having complications. Vaccines protect individuals who receive them and add to the protection of the community in which they live, which to varying degrees is now an international community for many in this country.
We ask that our patients contact our office and let us know of your concern before you come in. Your doctor will contact you to determine whether and how you should come in for an office visit. In particular, your doctor will want to know whether:
If you believe it is necessary to take your child to an urgent care or emergency room for suspected measles symptoms or complications, if possible, it is recommended that you contact the facility before you arrive to inform them of the situation.
Measles is highly contagious and those who are too young to be vaccinated, who are immunosuppressed (and therefore cannot be vaccinated), and those who have not been vaccinated for other reasons will be at high risk of infection if exposed to measles. If possible, please give advance notice if you suspect measles before bringing your child to our office. If you suspect your child has measles keep him or her home from school, daycare, and other public locations, and contact your child’s doctor.
- Centers for Disease Control and Prevention (CDC) – Measles – Q&A about Disease & Vaccine
- National Center for Immunization and Respiratory Diseases (NCIRD) Measles Website
- CDC’s Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book) (12 ed. May 2012) – Chapter 12 Measles
- Washoe County Health District’s Homepage
- California Department of Public Health – Measles
- American Academy of Pediatrics Measles Outbreak Update
- Measles, Mumps, & Rubella Vaccine Information Statement
- Measles, Mumps, Rubella, & Varicella Vaccine Information Statement
- World Health Organization: Health Topics: Measles
- Our Office’s Immunization Schedule and Policy
1 Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, eds. 12th ed., second printing. Washington DC: Public Heath Foundation, 2012. p. 179.
2 Id. pp. 180-181.