What You Should Know as Measles Cases in the U.S. Surge

By Valerie C. Cluzet, MD  |  4/23/2019

What You Should Know as Measles Cases in the U.S. Surge

From January 1 to April 19 of this year, there were 626 cases of measles confirmed in 22 U.S. states, representing the second largest number of reported cases in the nation since the measles was eliminated in 2000, according to the U.S. Centers for Disease Control and Prevention. Many of these cases have been reported in the Hudson Valley, primarily in Rockland County. We spoke with Dr. Valerie Cluzet, an infectious disease specialist with Health Quest Medical Practice on this recent outbreak and how best to protect yourself and your loved ones.

HQ: What are the measles and how serious are they?

Dr. Cluzet: The measles is an infection caused by a virus and is spread through infectious droplets when an infected person breathes, coughs or sneezes. It is HIGHLY contagious and can be spread by just being in the same room as someone who is infected, even if they are no longer in the room (measles droplets can float around in the air for up to two hours). If you are exposed to measles and are susceptible (you have not been fully vaccinated or infected in the past), you are 90 percent likely to get infected.

A measles infection can be serious. Up to one in 20 can get pneumonia. A more rare but serious complication is a brain infection called encephalitis. About one to two out of 1,000 children who get the measles will die. There is also a very rare but fatal, long-term nervous system complication called subacute sclerosing panencephalitis (SSPE) that can develop seven to 10 years after the illness. Those at highest risk for complications are children under five, adults older than 20, people with weakened immune systems (from leukemia, HIV, chemotherapy, etc…) and pregnant women.

HQ: What are the symptoms of measles and how soon do they appear after exposure?

Dr. Cluzet: The measles virus typically causes fever, malaise, cough, runny nose and conjunctivitis, followed by a typical rash, which starts at the head and/or face and moves down the body.  Symptoms usually start about 10 to 12 days after exposure, with a rash developing about 14 days after exposure. Infected individuals are contagious for about four days before the rash appears and any symptoms start and for four days after. 

HQ: How are measles treated?

Dr. Cluzet: Unfortunately, there is no treatment for the measles. Patients receive supportive care until they recover on their own. They should be monitored for complications, such as pneumonia or brain infection.

HQ: How are measles prevented?

Dr. Cluzet: We have a very effective vaccine that provides about 97 percent protection against the measles after two doses. The measles, mumps, rubella vaccine, or MMR, is typically given at 12 to 15 months of age and at four to six years of age. One dose is about 93 percent effective at preventing the measles. In the US, introduction of the measles vaccine resulted in a decrease in the incidence of measles by 99 percent. It is critical that we maintain high rates of vaccination (90 to 95 percent) so that those who cannot get the vaccine (infants) or who have weak immune systems will also be protected. This is what is known as herd immunity.

HQ: I've been exposed to someone who has measles, what should I do?

Dr. Cluzet: Call your doctor. If you have had measles in the past or are fully vaccinated and have a normal immune system, you are very unlikely to develop measles. If you are unsure about your vaccine or infection history, then your doctor can check for protective antibodies.

If you do NOT have protection against measles or are unsure, then you should receive the vaccine within three days of exposure to try to prevent infection. Individuals at risk for serious complications, such as infants under 12 months, pregnant women and people with compromised immune systems can receive protective antibodies (within six days) to try to prevent measles infection after exposure. You should stay home from work/school/daycare for two weeks to ensure you have not developed the infection.

HQ: If I've been vaccinated, am I fully protected? Should I get a booster?

Dr. Cluzet: The vaccine is about 97 percent effective at preventing infection after exposure. Those who do develop infection (three in 100), usually have a milder illness. If you have had two doses of the MMR, then there is no need to get a booster. If you are unsure of your vaccine history, you can either get a dose of the MMR or your doctor can check your blood to see if you have protective antibodies.

HQ: Why has there been an increase in measles cases in the U.S. and in this region in recent years?

Dr. Cluzet: In general, measles vaccine coverage rates in the U.S. have been over 90 percent. However, in many of the cases seen, there are pockets of unvaccinated people. The infection spreads quickly in those communities. Typically, outbreaks occur when someone gets infected after traveling abroad to a country that is experiencing a measles outbreak.

HQ: With this recent outbreak, how can I protect myself and my children?

Dr. Cluzet: The most important thing you can do is make sure you and your children are fully vaccinated. In outbreak settings, it is recommended to give the measles vaccine to infants as young as six months (they will still need to get it again at 12-15 months and 4-6 years). You can also help educate others on the importance of vaccination to prevent these outbreaks and complications. If you live in an area where there are current outbreaks and are pregnant, have a weakened immune system or have unvaccinated or under-vaccinated (only one dose) children, try to avoid public spaces where there will potentially be a lot of people. 

HQ: Where can I find more information about the measles?

Dr. Cluzet: The Centers for Disease Control and Prevention (CDC) has a lot of useful information about the measles. You can go to their website https://www.cdc.gov/measles/index.html