You may also have heard that some of the folks getting caught up in these outbreaks weren’t actually anti-vaccine, but were people who thought they already had measles or thought they were already vaccinated and protected.
How to Avoid Getting Caught up in a Measles Outbreak
Are you and your family protected against measles?
You might be thinking, “of course we are, we get all of our vaccines!”
But you still might want to double check, keeping in mind that:
only people born before 1957 are thought to have natural immunity to measles, because measles was very common in the pre-vaccine era
the original measles vaccine that was used between 1963 and 1967 was not thought to be effective, so if that’s the only dose you had, it should be repeated
a recommendation for a second dose of MMR didn’t come until 1990, so many people born before that time have only had one dose, especially since there was never a catch-up program to make sure older people had two doses. Even now, adults don’t necessarily need two doses of MMR unless they are in a high-risk group (foreign travel, healthcare workers, living with someone who has a compromised immune system, people with HIV, and students).
children don’t routinely get their first dose of MMR until they are 12 to 15 months old (one dose is 93% effective at preventing measles), with a second dose at age 4 to 6 years (two doses are 97% effective)
a third dose of MMR isn’t typically recommended for measles protection
Still think you and your family are protected?
In addition to routine recommendations, to avoid measles in a more high risk setting (traveling out of the country or during an outbreak), you should:
get infants an early MMR, giving them their first dose any time between 6 and 11 months of age (repeating this dose at age 12 to 15 months)
get toddlers and preschoolers an early second dose of MMR, giving them their second dose at least 28 days after the routine first dose that they received when they were 12 to 15 months old, instead of waiting until they are 4 to 6 years
get older children and adults two doses of MMR if they haven’t already had both doses
Younger infants who are less than six months old can get a dose of immunoglobulin within 6 days if they are exposed to measles. Older infants, children, and adults can get a dose of MMR within 72 hours if they are not vaccinated and are exposed to someone with measles.
The MMR vaccine protects people against measles, mumps, and rubella.
It has been available since 1971, first as a single dose, then with a second dose added to the immunization schedule in 1990.
Who Needs an MMR Vaccine?
With the rise in measles cases and outbreaks, you might be wondering if you need an extra dose of the MMR vaccine.
Are you fully vaccinated and protected against measles?
Have you had one dose or two doses of the MMR vaccine?
Are you traveling out of the country or do you have any other risk factors for getting measles?
Did you get one of the original, inactivated measles vaccines that were used between 1963 and 1967, before the live vaccine became available? If you did, or you aren’t sure which vaccine you got at that time, you likely aren’t fully protected and need another dose.
In general, adults who have had two doses of MMR are considered to be fully vaccinated. You do not need to check your titers and you do not need another dose for measles protection.
So to be considered fully vaccinated and protected against measles, these high risk adults should have two doses of MMR.
What about kids?
If following the immunization schedule, kids will get two doses of MMR, with the first dose at age 12-15 months and a second dose when they are 4-6 years old.
There are situations in which they should get an early dose of MMR though, including:
infants 6 through 11 months of age who are traveling out of the United States should receive one dose of MMR vaccine, a dose that will have to be repeated when they are 12 months old.
children 1 to 3 years of age and older who are traveling out of the United States should receive two doses of MMR vaccine (instead of waiting to get the second dose when they are 4-6 years old), separated by at least 28 days. This second dose doesn’t have to be repeated.
Being exposed to measles or simply getting caught up in an outbreak might be another reason for young children to get an early first or second dose of MMR and for adults to get caught up.
What if you aren’t traveling out of the country, but are traveling to an area inside the United States that is experiencing a large outbreak of measles?
If you can’t delay your travel plans, check the local health department recommendations, and talk to your pediatrician if your child needs an early MMR.
“Existing evidence on the safety and effectiveness of MMR vaccine supports current policies of mass immunisation aimed at global measles eradication and in order to reduce morbidity and mortality associated with mumps and rubella.”
Cochrane Systematic Review on Vaccines for measles, mumps and rubella in children
Let’s see if you still are after we get all of your questions about the measles vaccine answered…
How long has the measles vaccine been around? The very first measles vaccine was licensed by John Enders in 1963. An improved measles vaccine was developed by Maurice Hilleman and licensed in 1968, and that is the measles vaccine that we still use today, at least in the United States. It was combined into the MMR vaccine in 1971.
How effective is the measles vaccine? A single dose of the measles vaccine is about 93% effective at preventing a measles infection. Two doses (the second dose was added to the routine immunization schedule in 1994) are up to 97% effective. That’s why almost all of the people who get measles in an outbreak are unvaccinated.
How long does immunity from the measles vaccine last? Immunity from the measles vaccine is thought to be life-long. It is important to understand that the second dose isn’t a booster dose, but is instead for those few folks who don’t respond to the first dose.
Who should get the measles vaccine? Everyone without a true medical contraindication should get the measles vaccine (MMR), with the first dose at 12-15 months and a second dose at 4-6 years.
Can my kids get their measles vaccine early? An advanced immunization schedule is available for kids in an outbreak or if they will be traveling out of the country. The first dose can be given as early as age 6-months, but is repeated when the child is 12 months because of concerns of interference with maternal antibodies. The official second dose can be given early too, as early as 4 weeks after the first dose, as long as the child is at least 12 months old.
Do I need a booster dose of the measles vaccine? People who are fully immunized do not need a booster dose of the MMR vaccine, but it is important to understand whether or not you are really fully immunized to see if you need a second dose. Some adults who are not high risk are considered fully vaccinated with only one dose, while others should have two doses. Are you at high risk to get measles? Do you travel, live in an area where there are measles outbreaks, go to college, or work as a health care professional?
Should I check my measles titers? In general, it is not necessary to check your titers for measles. If you haven’t had two doses of the MMR vaccine, then get a second dose. If you have had two doses of the MMR vaccine, then you are considered protected. Keep in mind that there is no recommendation to get a third dose of MMR for measles protection, although it is sometimes recommended for mumps protection during a mumps outbreak.
If my child gets a rash after getting his MMR, does that mean that he has measles? No. This is a common, very mild vaccine reaction and not a sign of measles.
Can the measles vaccine cause seizures? The MMR vaccine can cause febrile seizures. It is important to remember that without other risk factors, kids who develop febrile seizures after a vaccine are at the same small risk for developing epilepsy as other kids. And know that vaccines aren’t the only cause of febrile seizures. Vaccine-preventable diseases can cause both febrile seizures and more serious non-febrile seizures.
Why do people think that that the measles vaccine is associated with autism? It is well known that this idea originated with Andrew Wakefield, but the real question should be why do some people still think that vaccines are associated with autism after so much evidence has said that they aren’t?
What are the risks of the measles vaccine? Like other vaccines, the MMR vaccine has mild risks or side effects, including fever, rash, and soreness at the injection site. Some more moderate reactions that can rarely occur include febrile seizures, joint pain, and a temporary low platelet count. More serious reactions are even rarer, but can include deafness, long-term seizures, coma, or lowered consciousness, brain damage, and life-threatening allergic reactions.
When did they take mercury out of the measles vaccine? Measles vaccines, including the MMR, have never, ever contained mercury or thimerosal.
Why do we still have outbreaks if we have had a measles vaccine since 1963? In the United States, although the endemic spread of measles was declared eliminated in 2000, many cases are still imported from other countries. As measles cases increase around the world, that is translating to an increase in outbreaks here. Even though overall vaccination rates are good, because there are many pockets of susceptible people in areas that don’t vaccinate their kids, they get hit with outbreaks.
Can we eradicate measles? Because measles is so contagious, the vaccine does have failures, and some folks still don’t get vaccinated, there is some doubt that we can eradicate measles without a better vaccine. That doesn’t mean that the current measles vaccines can’t prevent outbreaks though…
Are you ready to get your kids their MMR vaccine so that they are vaccinated and protected against measles, mumps, and rubella?
Either way, it is important to understand something he leaves out. There are few deaths from measles these days because most folks are vaccinated!
Whatever his motivation, let’s take a look at what Dr. Bob is saying about measles…
“Measles hysteria is everywhere. And it’s clear the hysteria is a result of media fear around this disease, a disease every child used to get (and handle virtually without complication) not that long ago.”
Dr. Bob Sears
Not that long ago?
I’ve been a pediatrician for 22 years and I have never seen a child with measles. Neither did I have measles, as I was fortunate enough to grow up in the post-vaccine era for measles – a vaccine that has been available for since the 1960s.
Anti-vaccine folks try to hide the risks of measles in mortality rates, but the reality of it is that about 500 people died each year up until the early 1960s when the first measles vaccine was developed.
“There is another side to this measles conversation: how we’ve unintentionally shifted the burden of disease to babies and adults, both groups who are more likely to experience complications, by vaccinating all schoolchildren and losing natural immunity.”
After all, the MMR vaccine provides life-long immunity to most people. That’s not the problem.
If we went back to the pre-vaccine era, when everyone got measles naturally, as Dr. Bob seems to be advocating for, not only would those kids have to earn their immunity, but many babies (those who hadn’t had measles yet) and adults (those with immune system problems) would still be at great risk.
And while measles was cyclical in the pre-vaccine era, it shouldn’t be when folks are vaccinated and protected. What happened to the cycles between 1997 and 2007?
“Unlike natural immunity, the measles vaccine does NOT offer lifelong protection. Estimates of its protection average around 15 years, and describe a phenomenon in the vaccine world known as “waning immunity.”
“The other trend we’ve seen over the past 10 years is an increase in adult measles cases. “
Dr. Bob’s sidekick neglects to mention that in addition to unvaccinated kis with measles, the trend is an increase in measles cases in unvaccinated adults! After all, most folks who get measles in these outbreaks are unvaccinated.
“To recap: by losing natural immunity for measles for children 5-19 years old, we’ve exposed babies, pregnant women, and adults to measles—all vulnerable groups who are more likely to experience serious complications from the disease.”
Perhaps the only true statement that they make – “we’ve exposed babies, pregnant women, and adults to measles—all vulnerable groups who are more likely to experience serious complications from the disease.”
And no, vitamin A is not a proven therapy or measles in developed countries. It mainly helps prevent complications in kids who have a vitamin A deficiency.
It is not news that we have been seeing more cases of mumps in recent years.
It is also isn’t news that many of these folks are vaccinated.
“Long Beach has been hit with a mumps outbreak that is vaccine-resistant. According to health officials in the Long Island town, almost two dozen individuals are believed to have contracted the virus, with four confirmed cases and at least 14 suspected ones.”
“We are actually to the point that we are worried that this vaccine may indeed not be protecting against the strain of mumps that is circulating as well as it could.”
Dr. Dirk Haselow, Arkansas State Epidemiologist
Of course, to say that the vaccine may not be protecting folks “as well as it could” doesn’t mean it doesn’t work because the wild type mumps virus has evolved or mutated enough to surmount our current MMR vaccine.
Is Mutating Mumps More Than the MMR Can Manage?
Although anything is possible, we fortunately have plenty of research that says that the mumps virus hasn’t mutated and that the MMR still works.
In fact, although the MMR vaccine is made from the A strain or genotype of mumps, it provides good protection against all 12 known strains of wild mumps viruses, including genotype G that has been causing most of the recent outbreaks.
But how can it cover a different strain of virus that isn’t in the vaccine?
Because not all viruses and vaccines are like influenza.
“The genotyping of the mumps virus is based on the Small Hydrophobic (SH) protein, a nonstructural protein and genetically the most variable one. Based on the SH-protein 12 different mumps viruses were detected up to now. In recent epidemics in Western countries the genotype G was mainly detected, while the mumps viruses used in the live attenuated mumps vaccines belong to genotype A (Jeryl Lynn) and to a lesser extent to genotype B (Urabe). However, antibodies against the SH protein have not yet been observed in human serum. It is, therefore, unlikely that antibodies against the SH protein play an important role in antibody-mediated virus neutralization.”
Sabbe et al. on The resurgence of mumps and pertussis
It is well known that you need a very specific match of the flu vaccine to the wild flu virus that is going around to get good protection, but for many other viruses, the differences that determine the strain or genotype have nothing to do with how antibodies will recognize the virus.
“Since mumps virus is monotypic, vaccine from any strain should provide lifelong protection against subsequent infection.”
Palacios et al. on Molecular Identification of Mumps Virus Genotypes from Clinical Samples: Standardized Method of Analysis
“Studies have demonstrated that blood sera from vaccinated persons cross-neutralizes currently circulating mumps strains.”
CDC on Mumps for Healthcare Providers
And like measles, the mumps vaccine (MMR), protects against all strains of wild mumps viruses.
“Compared with attack rates of 31.8%–42.9% among unvaccinated individuals, attack rates among recipients of 1 dose and 2 doses of the Jeryl Lynn vaccine strain were 4%–13.6% and 2.2%–3.6%, respectively.”
Dayan et al. on Mumps Outbreaks in Vaccinated Populations: Are Available Mumps Vaccines Effective Enough to Prevent Outbreaks?
And like other vaccines, the mumps vaccine (MMR) works.
“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.”
CDC on Transmission of Measles
Unlike measles, which is so contagious that you can get it if you are simply in the same room with someone that is sick, mumps typically requires prolonged, close contact.
“When you have mumps, you should avoid prolonged, close contact with other people until at least five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work or school. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can.”
CDC on Mumps Outbreak-Related Questions and Answers for Patients
How do you get mumps?
Since the virus spreads through saliva and mucus, you can get sick if you are in close contact with someone with mumps and they:
cough or sneeze
use a cup or eating utensil that you then use
touch an object or surface that you then touch (fomites)
And like many other vaccine-preventable diseases, people with mumps are usually contagious just before they begin to show symptoms.
“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”
CDC on Mumps for Healthcare Providers
The need for prolonged, close contact is likely why most outbreaks these days are on college campuses.
Is Your Child Protected Against the Mumps?
The MMR vaccine protects us against mumps – and measles and rubella.
One dose of MMR is 78% effective at preventing mumps, while a second dose increases that to 88%. Unfortunately, that protection can decrease over time.
Kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.
“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”
CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices
And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.
What to Do If Your Unvaccinated Child Is Exposed to Mumps
To be considered fully vaccinated and protected against mumps, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.
“Although mumps-containing vaccination has not been shown to be effective in preventing mumps in persons already infected, it will prevent infection in those persons who are not yet exposed or infected. If persons without evidence of immunity can be vaccinated early in the course of an outbreak, they can be protected prior to exposure.”
Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed. They should still get an MMR though, as it will provide immunity against measles and rubella, and mumps if they don’t get a natural infection.
“Persons who continue to be exempted from or who refuse mumps vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”
Manual for the Surveillance of Vaccine-Preventable Diseases
Unvaccinated kids who are exposed to mumps will likely need to be quarantined, as you watch for signs and symptoms of measles developing over the next 12 to 25 days.
If your exposed child develops mumps, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to mumps. Your child with suspected mumps should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office.
It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with mumps could expose others, it just reduces the risk. You still want to avoid other people!
What to Do If Your Vaccinated Child Is Exposed to Mumps
If your fully vaccinated child is exposed to mumps, does that mean you are in the clear?
Again, it depends on what you mean by fully vaccinated.
It also depends on what you mean by exposed. Is it someone in the same school that your child has had no real contact with or a sibling that he is around all of the time?
And is your child fully vaccinated for his age or has he had two doses of MMR?
Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against mumps, even if they are not skipping or delaying any vaccines.
“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”
Ask the Experts about MMR
In most cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.
And one dose of MMR is about 78% effective at preventing mumps infections. A second dose does increase the vaccine’s effectiveness against mumps to over 88%.
An early second dose is a good idea though if your child might be exposed to mumps in an ongoing outbreak, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.
“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”
Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak
This third dose of MMR is not for post-exposure prophylaxis though, which again, doesn’t work for mumps. It is to prevent mumps from ongoing exposures.
You should still watch for signs and symptoms of mumps over the next 12 to 25 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.
Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to mumps will depend on your local or state health department.
What to Know About Getting Exposed to Mumps
Talk to your pediatrician if your child gets exposed to mumps, even if you think he is up-to-date on his vaccines, as some kids need a third dose of the MMR vaccine during on-going mumps outbreaks.