Measles in Denver: What parents should know

Note from Laura: I know this is a heated topic. But it’s incredibly important. I work with families across the spectrum with vaccination status, but It’s so important to know that times and seasons change when making risk/benefit decisions for your family. Before, it may not have mattered as much if you chose to delay the MMR a while. But now it’s a different ballgame. And while people can have measles and be ok, the complication rate is concerning (which is why we vaccinate in the first place!). International travel is also a huge risk for measles right now, so if your family wants to travel, it’s not a benign decision to travel without coverage for measles. Every decision has risk (even if it’s not doing something!). It’s my job to help families with making these decisions, so I’m going to do my best! What is measles, anyway? Measles is a virus - actually the most contagious virus we know! If one person has measles, up to 9 out of 10 people nearby will become infected if they are not protected. It is so contagious that people can catch measles simply by being in the same airspace as a contagious person was within 2 hours of when they LEFT the space.

What does measles look like?

7-14 days after exposure, a vulnerable person begins to develop symptoms: 

Cough

Runny nose

Red eyes

Fever

Fatigue

White spots in the mouth

….Then there is a very characteristic rash that starts on the head and moves down to the trunk and extremities. Look here for examples: https://www.cdc.gov/measles/signs-symptoms/photos.html

People are considered contagious up to 4 days before and 4 days after the rash appears How can I protect my child? The good news is the MMR vaccine is really really effective at protecting against measles. No vaccine is perfect, but one dose makes most people 93% protected against catching measles, and two doses make people 97% protected! However, the vaccine is what we call a live attenuated vaccine, meaning that the virus is alive but weakened. This means that certain people (pregnant, immune compromised such as kids with cancer) cannot get the measles vaccine. 

When not in an outbreak, kids are recommended to get the measles vaccine at 12-15 months of age and then a booster vaccine at 4-6 years of age. In some special situations, babies from 6 months to 1 year can get an early dose of the measles vaccine to protect them if they are in a high risk situation, such as a community outbreak or international travel. Babies are considered protected by maternal antibodies initially, although this immunity is mostly gone by 6 months of age (some children may have maternal protection a little longer).

Should I vaccinate my baby early (before 12 months)? It depends on the baby’s age and risk factors. One consideration is that immune response from very early vaccination (6-8 months) is not nearly as good as 12+ months of age, and there is some evidence that vaccination before 9 months of age might decrease immune response in some kids (https://pmc.ncbi.nlm.nih.gov/articles/PMC6639599), meaning they have protection for the short term but lower long term protection (until they have a later booster).

So generally, if there is no ongoing transmission in the community or travel to outbreak areas, it’s best to wait until 12 months of age for the first vaccine, but in high risk situations (lots of travel, especially international, or ongoing community transmission) the benefits of early vaccination may outweigh the risks.

If your baby got an early vaccine and you are wondering if they are protected, you can always check your child’s titers for measles (a blood draw is required to test titers). For older kids, the second dose of MMR can be given as early as 28 days after the first dose,, but again, this is only recommended in an active outbreak.

What to do if your child is exposed

If your child is exposed to measles and is older than 6 months, they can get a vaccine within 72 hours of exposure which will protect them. After 72 hours and within 6 days of exposure (or for those who cannot be vaccinated), they can be treated with immunoglobulin.

After that, if your child develops measles, contact your trusted healthcare provider and look out for symptoms of complications like pneumonia or encephalitis. (Check out a great summary of timeline and possible complications here: https://www.cdc.gov/measles/signs-symptoms/index.html)

Should I bring my child into the ER if I think they have measles?

If you are concerned your child is sick with measles and is having trouble breathing or having concerning symptoms like changes in behavior or headache, bring them to the ER. If possible, you should call ahead to the ER so they know to prepare for your child, who could be very contagious!

If you are concerned your child has measles but is otherwise acting normally and having no trouble breathing, please call your pediatric care provider first - they may be able to arrange testing without exposing other children to measles!

Final note: I know a lot of parents are anxious about measles right now. All you can do is your best, and make a decision you feel is reasonable for you and your family. The rest you can't control! You are doing great, and don't let worry steal away your confidence that you are the best parent for your baby. I hope this helps!