Measles vaccinations are on everybody’s minds. We need to know the schedule in order to fully protect our children.

 

My next patient, was a baby girl coming in for her 9 month well-check.Looking at the chart I noticed that she was only 8 months old. When I questioned the parents why she was coming in so early they nervously asked if she could get her MMR shot (measles mumps and rubella) early. They were going to fly to Phoenix in a few weeks and were scared to death about the measles outbreak. The MMR is routinely given at one year.

 

Measles is a highly contagious and preventable viral illness that was virtually eradicated in the United States. Because of parents refusing to immunize their children and the influx of people from other countries, measles is once again rearing its ugly head in this country.

 

The symptoms of measles begin 7-10 days after one is exposed to someone who has the disease. It starts with a very high fever, up to 104 degrees, runny nose, red weepy and watery eyes and a bad dry cough. There are usually enlarged lymph nodes behind the ears–posterior occipital nodes. Two-to-three days into the illness one may see Kopek spots which are described as tiny grains of salt on a red base. These are best seen inside the mouth opposite the molars. Then 3-5 days later a rash develops– a red morbiliform rash that starts behind the ears and along the hairline. It spreads from the face to the trunk and then down the extremities. A patient with measles looks very ill, and they feel miserable. They are sick for 10-14 days.

 

The virus lives in the mucus of the nose and throat. It is HIGHLY contagious. It can survive in the air after a cough or sneeze for up to 2 hours.

 

Studies have shown that 90% of unprotected people will contract measles by just being around someone who has them. One of the reasons that it is so contagious is that a patient with the virus is spreading it from 4 days before the rash starts until 4 days after the rash appears. They are shedding the virus and are contagious for 1-2 days before they have ANY symptoms. Measles can have serious complications. These include diarrhea, pneumonia, croup, encephalitis (inflammation of the brain) and corneal ulcers that may permanently affect vision.

 

The measles vaccine program started in the United States in 1963 and has been very successful. Prior to 1963, there were a reported 3-4 million cases of measles in the U. S. each year. Of these cases, only 500,000 were actually reported and of the reported cases, there were 400-500 deaths, 48,000 hospitalizations, and 1000 cases of encephalitis.

 

By the 1990s measles had virtually been wiped out in this country. From 2000 to 2010 there were about 60 cases a year in the whole United States.

 

Two doses of the vaccine are given. One at a year of age which will provide protection in 93% of recipients and a second vaccine between 4-6 years of age which will protect 97% of recipients. The second shot is NOT a booster but is given to cover the 7% that were not fully protected with the first vaccine. The reason the vaccine is not given until one year of age is that a pregnant mother passes her protective measles antibodies to the developing fetus. These antibodies will stay around for many months.If the infant is given the vaccine, mom’s antibodies will prevent the vaccines effectiveness. This schedule of a MMR at 1 year and 4-5 years worked well while there were no measles in the United States. With the resurgence of the disease this may have to be revised.
 

The current modifications for the measles vaccine by the Center for Disease Control pertains to international travel only. If an infant is traveling internationally, it is recommended that they received a MMR between 6-11 months, with another vaccine between 12-15 months. This should be followed by the regular vaccine between 4-5 years of age. For those infants over a year of age, it is recommended that they get a MMR immediately, and another vaccine 28 days later. They would not need another vaccine between 4 and 5 years–97% should be fully protected. In the case of the baby under a year of age, there is no predicting how effective the first vaccine will be because of the possible interference from mom’s antibodies. That is why they would need a total of three shots.

 

After discussing this in great detail, my patient’s parents were relieved and dad said, “Well, we’re going to Phoenix,” and then mom added, “Yes, but I am making her one year well-check ON HER BIRTHDAY, because I want her to get it as soon as possible!”