Category: Vaccine Preventable Diseases

How Do You Know If You Have Measles Immunity?

With all of the measles cases, you might be wondering if you have immunity to measles?

Are you worried that you might get measles?

Should you get a booster dose of MMR?

How Do You Know If You Have Measles Immunity?

Fortunately, most of us can feel confident that we do have measles immunity and that we won’t get caught up in any of the ongoing outbreaks.

Why?

If you have had two doses of MMR, then you can be confident that you have measles immunity.

Because we are vaccinated and protected!

If you haven’t had two doses of MMR (or any measles containing vaccine since 1967), then understand that two doses is your best protection against measles.

Is There a Blood Test for Measles Immunity?

What about titer tests?

While there is a blood or titer test for measles immunity, it isn’t routinely used.

The one situation in which a measles titer test might be useful though, is for those born before 1957 to confirm that they really had measles.

For others considering a titer test in place of vaccination, it is typically better to just get another dose of MMR, but only if you haven’t already had two doses.

Why Was My Measles Titer Negative?

A positive measles titer does mean that you are immune, but what about a negative measles titer?

“For HCP who have 2 documented doses of MMR vaccine or other acceptable evidence of immunity to measles, serologic testing for immunity is not recommended. In the event that a HCP who has 2 documented doses of MMR vaccine is tested serologically and determined to have negative or equivocal measles titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of measles immunity. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing.”
Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

If you have had two doses of MMR and have a negative measles titer, you don’t need another dose of MMR. You are likely immune, even with that negative titer.

“Most vaccinated persons who appear to lose antibody show an anamnestic immune response upon revaccination, indicating that they are probably still immune.”
Epidemiology and Prevention of Vaccine-Preventable Diseases

And since you would need a second dose if you had a negative titer after having just one shot, you might as well just get the second dose instead of checking your titer.

Do You Need a Measles Booster?

Have you had two doses of MMR?

If so, then you don’t need another dose.

The second dose isn’t technically a booster anyway. It is just for those who might not have responded to their first dose.

And two doses of MMR are about 97% effective at preventing measles.

That’s why most of the people in measles outbreaks are unvaccianted.

Neither primary nor secondary (waning immunity) vaccine failure are common with the measles vaccine.

What’s the biggest issue with the MMR? Folks who are still too scared to get their kids vaccinated and protected!

Mapping the 2019 Measles Outbreaks

Cases of measles continue to rise, as we pass 1,000 cases in the United States.

2019 Measles Outbreaks

With a record high number of cases, there are measles cases and outbreaks in 29 states, including:

Arizona	1	Massachusetts	2
California	49	Michigan	44
Colorado	1	Mississippi	1
Connecticut	3	Missouri	1
Florida	2	Nevada	1
Georgia	3	New Hampshire	1
Hawaii	2	New Jersey	13
Idaho	1	New York	702
Illinois	7	Oklahoma	4
Indiana	1	Oregon	11
Iowa	2	Pennsylvania	6
Kentucky	2	Tennessee	3
Maine	1	Texas	14
Maryland	4	Virginia	1
		Washington	80

What’s the first thing you notice about this measles outbreaks?

Where Are the Measles Outbreaks

They aren’t spread out evenly through the United States.

In fact, the largest outbreaks are clustered in just a few states, including California, Michigan, New York (Rockland County and Brooklyn), and Washington (Pacific Northwest Outbreak and the Puget Sound Outbreak).

Mapping the 2019 Measles Outbreaks

What does that look like when you map it?

It looks a little strange…

A tilegram mapping the 2019 measles outbreaks in the United States.

And that’s because, amazingly, about 70% of cases this year are in just one state – New York!

But that doesn’t mean that you don’t have to be concerned if you don’t live in New York. After all, measles is on the rise all over the world and it is still just a plane ride away. And there are plenty of other communities with low immunization rates where folks are at risk for outbreaks.

Also consider that even without the big outbreaks, this would still rank as a big year for measles.

Bottom line?

Get vaccinated and protected and stop the outbreaks. The MMR vaccine is safe, effective, with few risks. And it is obviously necessary.

Who Gets SSPE?

Have you heard that you can get SSPE from the MMR?

Apparently it’s in the vaccine insert…

Who Gets SSPE?

Subacute sclerosing panencephalitis (SSPE) occurs after a natural measles infection.

You won't get SSPE if you don't get measles.

It is not caused by MMR or any measles containing vaccine.

Of course, the measles vaccine is not 100% effective, so it is possible that you could still get measles after being vaccinated. And those folks who get measles after getting vaccinated could be at risk to get SSPE, but even then, their SSPE would be caused by wild measles virus, not a vaccine strain.

“Available epidemiological data are consistent with a directly protective effect of vaccine against SSPE mediated by preventing measles.”
Subacute sclerosing panencephalitis and measles vaccination

Again, SSPE is caused by natural measles infections and the wild type measles virus.

Tragically, after big outbreaks of measles, we start to see more cases of SSPE, with the greatest in children who get measles at a young age.

And SSPE is universally fatal in these children, who develop symptoms about six to eight years after recovering from having measles.

That the symptoms of SSPE don’t develop until long after you have recovered from measles is why the condition is often described as a time-bomb.

A time-bomb that you can’t stop.

Want to avoid getting SSPE? Get vaccinated and protected against measles.

Is Measles Dangerous If You Are Pregnant?

While folks often try and make it seem like measles is a common childhood illness, we know that it can be dangerous.

“One of the patients was a 20-year-old pregnant woman who had rash onset on January 5 following exposure to her 12-year-old brother. After delivering a healthy baby on January 6, the mother developed severe pneumonia that was followed by respiratory arrest. She was resuscitated and transferred to an intensive care unit in a larger hospital nearby in Tennessee.”
Epidemiologic Notes and Reports Transmission of Measles Across State Lines — Kentucky, New Hampshire, Tennessee, Virginia

Rarely do people who have really had measles describe it as just a fever and a rash. They remember that it was called a harmless killer for a reason.

Is Measles Dangerous If You Are Pregnant?

And there are some situations in which measles can be especially dangerous, including if you get sick when you are very young, very old, or have immune system problems.

Pregnant women should be screened for measles immunity.

And what if you are pregnant when you get measles?

“The Health Department announced today that the number of measles cases has grown to 390, including two pregnant women diagnosed with the infection, one diagnosed in mid-April.”
The Number of Measles Cases Grows to 390

If you are pregnant and you are exposed to someone with measles, you can get IVIG post-exposure prophylaxis to prevent you from actually getting measles, but this typically only works if given within six days of the exposure.

“To date, studies have not identified an increased risk for birth defects when pregnant women get the measles during pregnancy. However, studies suggest that measles infection is associated with an increased risk for miscarriage, stillbirth, prematurity and the baby being born with a measles infection.”
When Measles Strike, It’s Not The Happiest Place On Earth For Pregnant Women

Unlike a rubella infection during pregnancy, a measles infection is not thought to cause birth defects. Tragically, it can, like rubella, lead to an increased risk for having a miscarriage.

“Infants who develop congenital measles are at increased risk for mortality and for subacute sclerosing panencephalitis, which is more common when measles is diagnosed in infancy. In addition, subacute sclerosing panencephalitis in newborns infected with measles either congenitally or shortly after birth appears to be more severe, with a shorter latency and rapidly progressive course.”
What Obstetric Health Care Providers Need to Know About Measles and Pregnancy

And if the mother gets measles very late in her pregnancy, it can also lead to a case of congenital measles, or a baby being born with an active measles infection.

“In 52% of cases, measles was likely acquired from a relative. Complications included pneumonia in one child; two pregnant women required hospitalization, including one who miscarried.”
Notes from the Field: Measles Outbreak Among Members of a Religious Community — Brooklyn, New York, March–June 2013

Don’t take the risk that you might get measles while you are pregnant.

Make sure you are vaccinated and protected before you ever start thinking about getting pregnant, as pregnancy is a contraindication to getting the MMR vaccine. And you should wait at least 4 weeks after getting vaccinated before getting pregnant.

VAXOPEDIA

How Do You Know If You Have Measles Immunity?

How Do You Know If You Have Measles Immunity?