2019 Measles Outbreak: Information for Parents

Measles, measles, and more measles. I know, it seems like all I’m writing about.  I’ve been doing media interviews for weeks now on measles infections and there doesn’t seem to be a slowdown yet. As it stands, there are currently 839 measles cases in the U.S. and children under age 5 years old account for about half of the cases. The vast majority of cases are in those who are unvaccinated. I’ve been asked: “Is the situation improving?” The answer is…no…sadly. The 75 new cases this week are a higher bump than in the previous two weeks, when about 60 additional cases were reported each week. Measles is wildly contagious. It spreads when a person infected with the measles virus breathes, coughs, or sneezes. You can catch measles just by being in a room where a person with measles has been, up to 2 hours after that person is gone.
The great news, as always, is that we have a vaccine for this! We can prevent this from ever happening in the first place! Parents and children who are immunized are well protected and don’t need to worry right now.
This is the greatest number of cases reported in the U.S. since measles was eliminated from this country in 2000.  The high number of cases in 2019 is primarily the result of a few large outbreaks – one in Washington State and two large outbreaks in New York that started in late 2018. New York has the biggest outbreak, accounting for almost 700, or more than 80%, of the cases nationwide. There are 4 new confirmed measles cases in western Washington involving people who spent time at the Seattle-Tacoma International Airport. If you’re concerned you could have been exposed, talk with your doctor.
If you wonder if you’re up-to-date on MMR vaccines talk with your doc about a blood test to prove your immunity or repeating/starting the MMR shot. Here’s info on MMR shot.
Perhaps one shining light that has come from this awful outbreak is that new laws are being passed to increase safety in our schools and communities. Last Friday, in my home state, Washington’s governor signed a law that says parents with children heading to daycare or school will no longer be able to claim personal or philosophical objections to the measles, mumps and rubella vaccine — schools will increasingly be the LAST place your child would ever get exposed to measles. Big win!

Children Too Young To Be Immunized:

The question I may have received the most is surrounding protection for babies too young to be immunized. Can I travel with my baby? Should I avoid the grocery store? Can they go on playdates? My answer is a little complicated — but yes, even during this outbreak we can live mostly as we normally do. You do not need to hunker down at home.
I hate that I can’t completely say infants are perfectly safe during an outbreak. Infants are a vulnerable population during a measles outbreak …however, newborns are well protected by the antibodies their mom passed onto them. With each month after birth, infants gradually lose some of those maternal antibodies and they become more at-risk if, in the rare case, they are exposed. Breastmilk has immune protection but it isn’t thought to be enough to protect an infant alone.
Measles is wildly contagious and during an outbreak, it can spread, especially to older infants and children who aren’t vaccinated yet. The good news is that risk of exposure outside of areas during an outbreak is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t also spread it to your baby). If you don’t live in an area where there is an active outbreak, I would say, yes, take your baby grocery shopping and go on your vacation. If you are traveling internationally, and your baby is 6 months of age, we recommend they go get the MMR vaccine a little early (typically given at 12 months of age). Here’s some more information I wrote when the outbreaks started about infants and young children.

What About Infants 6-12 Months Who Live Where Outbreaks Are Occurring?

You can always talk with your own pediatrician about this. The short answer is there is no need to accelerate the vaccine schedule for your baby (no need to get an “early shot” of MMR) right now in the US and in fact, there may be more reason not to. Here’s how the state of Washington Dept of Health explains it that I’ve just learned:

“Although there is urgency to protect the public, there is currently no Washington State Public Health recommendation to immunize infants below the age of 12 months earlier than the recommended schedule.  Although the Advisory Committee for Immunization Practice (ACIP) recommendations include vaccinations for children in this age group related to international travel and for prophylaxis within three days of exposure to measles, there are risks associated with receiving MMR vaccine under the age of 12 months.  A review of Washington Immunization Information System (WA IIS) indicates a higher number than usual children below the age of 12 months received the MMR vaccine in January and February 2019. The vast majority of these doses were not given as prophylaxis in the three days following an exposure to a measles case, and only a few are likely to be related to international travel. This is of concern because administration of MMR below the age of 12 months has been associated with blunting of the immune response to subsequent doses administered according to the routine ACIP recommendations.”

This means that there is no need to get the vaccine early (in a healthy 8 month-old baby living in Seattle, for example) as the early immunization may make the later immunization less effective and durable. Because the risk is still SO LOW in getting measles, it’s not recommended. If an infant is exposed to measles, then we would immunize early because the risk is so increased in getting measles that it’s worth the small risk in it “blunting” the later immunizations to avoid an infection now.
Bottom line: talk with your pediatrician if any concerns but no need to change the vaccine schedule, even as we see more local cases and additional cases sporadically around the country. I’ll keep you posted if this changes.
Nice 1-page handout on measles and the vaccine for you for sharing!

MMR Vaccine Recommendations:

Routine vaccination

• 2-dose series at 12–15 months and again at 4–6 years
• Dose 2 may be administered as early as 4 weeks after dose 1.

Catch-up vaccination

• Unvaccinated children and adolescents: 2 doses at least 4 weeks apart

Special situations & International travel

• Infants age 6–11 months: 1 dose before departure; revaccinate with dose 2 at 12–15 months (12 months for children in high-risk areas) and dose 3 as early as 4 weeks later.
• Unvaccinated children age 12 months and older: 2-dose series at least 4 weeks apart before departure

• What should be done if someone is exposed to measles? Notification of the exposure should be communicated to a doctor. If the person has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure. Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within six days of exposure.