Many parents around the U.S. are asking what to do about a possible measles exposure with a baby at home who is too young to be immunized. Should they stay home? Can they travel? Should they cancel that trip to Utah or to Vermont or even to Disney next month? Can they head out to the store without worry? Are they “safe?”
I hate that I can’t completely say they are safe. Measles is wildly contagious and during an outbreak it can spread, especially to older infants who aren’t vaccinated yet. The good news is that risk is low (more than 90% of us won’t get measles because we’re vaccinated so we also won’t spread it to you!). Some parents are also wondering about getting the vaccine before the baby turns 1 year because they’ve heard the recommendation for infants traveling abroad: infants traveling outside the U.S. are recommended to get an MMR (measles, mumps, rubella) shot if they are over 6 months of age (of note, babies who get the shot as an infant also get the usual shot again at 12 months of age). Without travel plans we wait to immunize babies with their first MMR vaccine until they are 12 months of age. Over 95% of babies who get the shot at 12 months of age are protected against measles and over 99% are protected for a lifetime after the 2nd dose (given at least 1 month later). Wow, right?
“This is not going to be the end-all-be-all post on protecting your infant or child from measles'” Dr Matthew Kronman, a pediatric infectious disease expert at Seattle Children’s, reminded me as we chatted today. Advice and guidance for protecting babies and children will change as we learn again how to protect our population from measles infection while unvaccinated pockets of people remain.
The CDC warns that the outbreak could grow (there’s over 100 cases in 14 states as of today) and nationally there’s a palpable dialogue going on between the herd (those immunized) and those not. Politicians are involved — Governor Christie talked today about “choice;” Obama is urging parents to immunize right along side the president of the American Academy of Pediatrics who released another urgent statement. Pediatricians, family docs, nurse practitioners and health workers everywhere are encouraging parents to get shots up-to-date to protect their own children and vulnerable populations (this includes infants). Here’s a bit of evidence and information that can hopefully curb anxiety for parents to babies. I teamed up with Dr Edgar Marcuse, a lifelong scholar with vaccines, former pediatrician at Seattle Children’s and an emeritus professor of pediatrics at University of Washington and Dr Matthew Kronman. Here are 7 tips about infants and families that may help shape your thinking:
7 Things To Consider During A Measles Outbreak
- For Babies Under 6 Months of Age: If a baby’s mother has had her MMR shots and/or had measles infection in her life she passed antibodies to her baby during fetal development while in-utero and continues to pass them passively while breastfeeding. Those antibodies provide protection for young infants and typically are thought to protect infants for up to 6 months or more. The reason babies don’t get the MMR shot sooner than a year of age is because of the persistence of these maternal antibodies — if you put a vaccine in while maternal antibodies are still around the vaccine won’t stimulate the baby’s own immune system to respond, it will just get soaked up by the maternal antibodies doing their job.
- Babies Over 6 Months of Age: MMR shots for all infants over 6 months of age are not recommended at this time. The current outbreak has not changed recommendations on when to get MMR vaccine for children in the U.S. If the outbreak turns to an epidemic, it is possible recommendations would change. Babies who get a MMR shot between 6 and 12 months of age after a measles exposure or for travel will still need to get their MMR shot at 12 months of age.
- Disney? Safe to go? Yes, it is. Parents have asked if babies, age 6 to 12 months should get the MMR shot prior to a trip to Disneyland. No. Dr Marcuse frames it nicely saying, “While Disneyland was the site of exposure for what is turning out to be a remarkable number of cases, the visitors who transmitted measles and those exposed during the original cases during December have dispersed.” Currently there isn’t an ongoing outbreak in Disneyland. Dr Marcuse again explains, “While secondary cases are still being reported, particularly in California and some among Disneyland employees, these do not meet the criteria for an epidemic or continued extensive [person-to-person] transmission which would warrant immunization of infants 6-12 months of age.” So for now it’s still a great plan to explore and take a holiday and there’s no need to get an early MMR shot for your infant.
- Okay To Go To The Grocery Or Have A Playdate With Your Infant? Yes! With a few caveats, of course. If you’re in a county where multiple cases of active measles have been recently reported (Southern California, Orange County, for example has had 22 cases alone) you may take more caution disallowing strangers to hold your baby and/or steering clear of anyone with a cough. Measles is infectious on surfaces and in the air for 2 hours after an infected individual is there so it’s tricky to provide solid guidelines of how to avoid it if it’s around. If ever ANY concern for exposure, call your pediatrician to discuss a visit. Like everything in life we balance risk with benefit and being out and about in the world. If planning on visiting with guests or sharing in on a playdate, why not ask parents to children involved, “Is everyone here immunized against measles that can be?
- If traveling with or living with children should I get labs (“titers”) to prove my children’s MMR shot worked? For those who have 2 documented doses of MMR vaccine blood testing for immunity is not recommended. If an individual has 2 documented doses of MMR vaccine and has blood testing that is done that finds a negative or equivocal measles titer results (unsure proof of immunity), it is still not recommended that the person receive an additional dose of MMR vaccine. Officially, recommendations suggest that such persons should be considered to have presumptive evidence of measles immunity. Dr Marcuse clarifies, “Documented age-appropriate vaccination supersedes the results of subsequent blood testing.” This official recommendation is from the CDC recommendations for healthcare workers. Further, it should also be noted that additional doses of measles vaccine are not harmful so in some cases a clinician may decide to provide another immunization to trigger immune response. One expert Dr Marcuse conferred with only performs measles titers in immunocompromised patients, regarding such testing in others as “a slippery slope.” Reason being, the best test for measles immunity is a neutralizing antibody titer, whereas commercial labs report enzyme immunoassay (EIA) that may not be as accurate. Note that the guidelines discussed here were created in the spirit of protecting the public at large. Unfortunately Dr Marcuse reminds, “Occasionally, a person who meets the criteria for presumptive immunity can acquire and transmit disease.” This is rare as the vaccine is so wildly successful and durable. Simply put Dr Kronman says, “2 doses of the shot is presumptive immunity, so there’s no place is recommending getting titers if you have had both shots.” Reason being, the most commonly used test for blood proof (titers) isn’t the best measure of immune status. Having low titers can occur even in a person who still is protected from measles and may create false worry.
- Is my child’s school protected against a measles outbreak? In many states you can track vaccination status for your child’s school because exemptions (those opting out of immunizaton for medical or philosophical reasons) are tracked. In Washington State parents can check to see what percent of children are up to date on immunizations in kindergarten by searching SchoolDigger or the VaxNorthwest website (on the right side) by school name. When I checked my own son’s school it had data for the 2012-2013 school year, which I found reassuring. Because vaccination status is tracked at the state level, many other states provide this service (some are up on School Digger). To find your data, start at school digger or try a search on the state’s Department of Health website for more. If you’ve run into a roadblock or can’t find the information, it’s always your right to request the numbers from school administration or the school nurse.
- As a parent, do I need another MMR shot? What If I’m pregnant? It’s unlikely you need more MMR shots if you were born after 1957 when vaccination was universal, most of us all got the shot as children. In 1989 we also started to do a 2nd dose of MMR to get more people protected (closer to 100% of population). Only adults working with vulnerable populations and in health care need to go and get 2nd dose now. If you have ZERO written documentation anywhere that you’ve had MMR shot, talk with your doctor. In addition, if pregnant now, no MMR shot until after the baby’s born if you’re concerned you may not be protected. You can get a MMR shot safely while breastfeeding. Here’s a nice post for parents from Dr Burgert, a pediatrician in Kansas City with more.
A nice post here about “Protecting Your Child During A Measles Outbreak” from Healthychildren.org for more.
Phil Waligora says
Thank you very much for this post. We are personally quite concerned about taking our son to Disneyland. He is 7 months old today. We had planned to run a half-marathon there in May and for him to participate in the diaper dash (his first race!). However, with all of the news, it is just too scary. He caught some kind of virus at 10 weeks old and ended up in the hospital for two weeks. We just don’t want to risk him getting sick with something even more serious. This is just gut feeling, but does it make sense to go with that? We were going back and forth but for the most part are decided against going until he is old enough for the MMR vaccine.
Lisa Meneses says
Thank you for this post from a pediatrician and mother of a 7 month old and 2 year old!
Julian says
So we recommend MMR for 6-12mo traveling outside the U.S. but not to SoCal? Hmm.
How many more cases would it take?
Wendy Sue Swanson, MD, MBE says
You ask a great question and one I’ve been asked many times in the last 24 hours. Looking to get more answers on this. The ACIP (advisory comm on immunization practices) and CDC and AAP make vaccine decisions together. As I understand it, it would take epidemic level numbers of infection to change recommendations.
Looking on getting a more official response from AAP/CDC. Stay tuned.
Maricela says
The information regarding breastfeeding is very interesting. Does the level of immunity provided by breastmilk only wane once solids are introduced? My son didn’t start solids until 8 months, so did that provide two more months of protection? Also, my son didn’t fully self-wean until he was 4.2. Does that make vaccines he got during that time ineffective? This isn’t just being asked for the sake of hindsight. I now have a 2.5 month old and certainly don’t want to give her vaccine injections that may be invalidated by our breastfeeding.
Wendy Sue Swanson, MD, MBE says
Sorry if comments in the blog were misleading. Breastfeeding is a benefit and may provide small, passive immunity but is NEVER a contraindication to immunization.
Anna says
Do you have a response from AAP/CDC?
Wendy Sue Swanson, MD, MBE says
yes, here’s a link that includes breast-feeding moms are safe to get MMR vaccine:
https://www.cdc.gov/vaccines/vpd/mmr/public/index.html
Katie says
You mentioned that you don’t give the shot while they are 6 months and breastfeeding.. What if at a year you are still breastfeeding when he comes due for the shot? Will the maternal antibodies still interfere.. Should you wait till they are done breastfeeding to get the MMR
Wendy Sue Swanson, MD, MBE says
Breastfeeding likely has little immune protection. Maternal antibodies at 12 months of age will likely NOT interfere, nor will breastfeeding. 12 months is the time when research in the past has shown it best to immunize (maternal antibodies gone and the earliest it makes sense to immunize the population at large). Of note, one interesting scientific point I learned while talking with Dr Kronman was that in the early years of MMR immunization, it was given at 15 months because more of the mothers had experienced live measles INFECTION as opposed to immunization. The live infection creates more antibodies and so it was better in the beginning to have babies wait for those to subside prior to immunization (so they waited to 15 months). Now that mothers have all been immunized the maternal antibodies are mostly all gone by 1 year of age hence the immunization being moved up to protect infants sooner.
Becca says
This is interesting. I grew up with Christian Science parents and did have the measles as a child. Should I talk to my pediatrician about delaying till 15 months? I’m hesitant because of the current outbreak, but I also want to make sure my son is best protected. He’s 8 months currently.
Christina says
Thanks for the helpful information. I used the tool to look up my child’s elementary school and the results for kindergarteners for MMR is only 82% and the protected population calculation is 67% for the school. There are 9% of students with exemptions and 24% whose status is unknown. That seems like a very high number to me. Especially the unknown. Do you have recommendations for how to follow up with the school community?
Wendy Sue Swanson, MD, MBE says
Hi Christina,
I’d go today and talk with school nurse. Find out if you can get a message out to the families (via email) or via messages at school entrance about getting the community better protected. Get other families you know on Facebook to start talking about it. These mom-to-mom dad-to-dad, parent-to-parent education go a long way in changing a community’s protection!
Tedra says
I’m interested to see what you think about Dr Suzanne Humphries article and video. She’s from Lilipoh Magazine. You can check my facebook page for the links. Thank you
Wendy Sue Swanson, MD, MBE says
If you want people to see the link and respond I suggest you include it in a comment. thanks!
E Canfield says
I wonder if the vaccine would be effective for exclusively formula fed babies under 6 months. Moot point for us, my kiddo’s 15 mo and already had his 2nd dose
Joe says
Yes my grad daugther is 2 months old and is formula feel. Can maternal immunity last for 6 months then?
Also what would be the down fall, with this measles outbreak, to play it safe and immunize at birth? If the moms immunity is there than it won’t help but if its no,t why not immunize? Do the potential risk outway the benefit?
Thanks Joe
Wendy Sue Swanson, MD, MBE says
Maternal antibodies gradually circulate and fade away over a series of months. Some babies will lose many of them by 3 to 4 months where other babies may have them for over 6 or more months. Breastmilk likely doesn’t have much to do with it.
We don’t immunize babies at birth because of the maternal antibodies (as explained in the post — #5) as the immunization (a live virus vaccine) wouldn’t work.
So for now, babies leaving the US would qualify to get a dose at 6month of age and all other babies get the first dose at 12 months
Lisa Schmidt says
Thank you for the information. I was also very intrigued by the information about breastfeeding and maternal antibodies that are passed to the baby. I’m curious if this is the same or different for other vaccines? You stated,
” if you put a vaccine in while maternal antibodies are still around the vaccine won’t stimulate the baby’s own immune system to respond, it will just get soaked up by the maternal antibodies doing their job.”
Is there something different about the MMR vaccine? OR Is this also the case for the vaccines given at birth, 2months, & 4 months? If this is the case, why are vaccines given at those ages, if it is known that they will not stimulate the baby’s own immune system to respond? I am not trying to start a debate on the issue, just trying to understand this better. Thank you!
Wendy Sue Swanson, MD, MBE says
Lisa, Good questions. As I understand it this is specific to MMR — the persistence of maternal antibodies after birth is robust with a Netherlands study finding 97% of babies still had great immunity at 3months of age, and then gradually the antibodies fade. The MMR vaccine is a live virus vaccine — if given when lots of maternal antibodies are around, the antibodies (from mom) will take care of the live virus in the vaccine and therefore it won’t trigger a new antibody response to be created from baby’s own immune system that sticks around for a lifetime. Complex immunology — hope that makes sense!
klp says
Can you comment on the reasons that one can lose her immunity? Or provide a reputable source? I’ve only been able to find anecdotal explanations. I’m pregnant with my second child and tested non-immune, whereas with my first, I tested immune. (I read tip #5,thoroughly)
If I am given a booster soon after delivering, will I pass any antibodies on to my newborn?
Thank you for this and the prior post!
Wendy Sue Swanson, MD, MBE says
Hi KLP,
A couple possibilities — like mentioned in the post, the blood tests that are commercially available may not be the best indicators of immunity. They may underestimate it….So option 1 is that you are still immune, just not testing that way in your blood, or for complex reasons the antibodies or immune response you mounted originally when immunized as a baby are fading. All people loose parts of their robust immune system with age — just as we don’t have as robust an immune system when we’re very young as we’ve not been exposed to as many infections and/or vaccines. You will not pass much immune support to baby from a vaccine you get after delivery unfortunately. There is some data in flu shots that there is both inutero transfer of immunity and some transfer in breastfeeding after immunization, but with measles I am unaware of similar data.
mariah says
This really makes me feel 100% better I have a 4 month old and everything these days are scary …
SF says
Thank you for this post! It’s the most helpful I’ve found on the topic. I have an additional, more specific question:
I have plans to travel to Northern California from Washington, D.C. with my breastfed 9 month old daughter in a couple of weeks. Should I get her an early MMR? I’m mostly concerned with the time we’ll be spending in large international airports and on the airplane.
Todd Perry says
What they are not telling is that people who have received the CDC
recommended doses of vaccine are still catching and passing on measles
to others.
—The MMR vaccine insert itself lists the following side effects: MEASLES ,
measles like rash, diabetes, encephalitis, Guillain–Barré syndrome,
pneumonia and even death.
—Last year was no different the Hooping Cough outbreak was yet again traced back to the very same vaccine used to prevent it and the Enterovirus D-V 68 that put all of the children in the hospital all across the US was also traced back to a vaccine.
—People need to do the research for themselves and quit believing sites and
news agencies like this one who are controlled and paid of to tell lies
to your faces.
JoJo says
Hi – this post has been very helpful! Thank you! I am just wondering about the maternal antibodies – my baby is 9-months old and still breastfeeding well. She started immunizations (HIB and DTaP) at 6-months of age. I know the CDC recommends this but do these immunizations also interfere with maternal antibodies or is the MMR the only one at risk? Thank you.
JoJo says
Sorry – I just wanted to clarify – I know the CDC recommends a schedule with certain vaccines starting at 2-months but this statement has me curious: “The reason babies don’t get the MMR shot sooner than a year of age is because of the persistence of these maternal antibodies — if you put a vaccine in while maternal antibodies are still around the vaccine won’t stimulate the baby’s own immune system to respond, it will just get soaked up by the maternal antibodies doing their job.” and so I wonder is the MMR the only vaccine this applies to? Thank you again.
Wendy Sue Swanson, MD, MBE says
No — timing of vaccination is based on research of when the earliest time a child can safely and effectively be immunized. They all vary, of course but timing for MMR is similar to how the timing of chicken pox (Varicella) immunization is recommended.
MP says
Thank you at least there is some dialog about what do to out there instead of political news-mercials by Hillary or Chris C… on what they think or don’t think is good, while parents of children too young to be vaccinated children are home wondering how sever this is and what direction to take on keeping them safe as possible. Why the news and political leaders think health information is something to bicker about should put us in question of if any of them truly should run the country.
We were supposed to visit SoCal on the 10th-20th we canceled our trip. I’m not sure if the media hype or my ped opinion steered us but figured if by chance she got it we would feel terrible. She is turning 12 months on the 14th, they said if they gave her the shot now she would still have to get two additional shots as a child, we just don’t want to over do it either figured it was best to cancel. It would have been nice to get a better sense on the true situation early on however.
Kristin says
I have a two year old who received her first MMR vaccine at 12 months as scheduled, but now we’re wondering if we should consider accelerating the second shot. Is there a reason to wait until four to six, rather than doing it sooner, since it only has to be a least one month past the original shot date?
Also, what about grandparents born before 1957? Should they be looking into getting the vaccine now?
sue says
If the MMR vaccine is live, then is a vaccinated child able to infect an unvaccinated infant since they contract a mild case of measles and it is excreted in their feces?
Caitlin says
Hi, I am one of the few people that was vaccinated as a child but is not immune. I am pregnant and just found out that I am not immune to Rubella. I live in Seattle but all of my family is located in southern California (Very close to Anaheim and Huntington Beach). I do have a few relatives that do not believe in vaccinating their children. Should I avoid travel during my pregnancy. I just finished my first trimester and was planning to visit in the next month and again for a baby shower.
IGBM says
Thank you for the article, best info I have gotten so far on the topic.
We are highly considering an early MMR shot for our 9 month old twins as we live in Sonoma County CA and also spend tons of time in Marin County CA, two counties with high rates of non-vaxers.
What do you think? Our twins are healthy & were born at 36w5d gestation. Our three yr old had an early MMR shot at 10 months due to travel & she had no side effects. Any insight would be helpful & appreciated
Libby Page says
Hi Dr. Swanson.
Re: item #6, In addition to Schooldigger and VaxNW, Public Health Seattle & King County has posted several detailed school immunization coverage maps (including a kindergarten MMR coverage map) at http://www.kingcounty.gov/school-immunizations.
Kara Gelman says
Thank you for this! I live in Southern California and am due in 3 weeks. I am pretty certain I did not get a second MMR in my life. Is it safe to get a second MMR while breastfeeding? I’m nervous about catching it myself and exposing my baby.
Wendy Sue Swanson, MD, MBE says
Breastfeeding is NOT a contraindication for MMR, talk with your doctor!
Angela S says
I’m traveling with my 7 month old this weekend. Should I try to get him to wear a face mask while in the airport and/or on the airplane? Just a quick flight to SF, but considering how contagious measles is, I want to be very careful.
CEC says
We have a close family member who has 2 children that are not fully vaccinated. A 4 year old with severe allergies and autism who has not been vaccinated since I believe her 4 week shots when she had a reaction and a 6 year old who stopped getting shots when her sister had the reaction (so when she was about 2). I have a fully vaccinated 3 year old and a 5 month old. They are over to our house often, but it makes me nervous because of my baby. Should I be avoiding contact with them? I have already been keeping my kids home because of the flu. I have actually not been in to get my baby his 4 month shots because being around a bunch of flu patients in the doctor’s waiting room gives me anxiety. I’m trying to wait for it all to pass.
Andrea Burkly says
Thank you SO MUCH for this article. Since I’m in the NW Suburbs of Chicago, I have to say that I’m not feeling very confident bringing my 10-month-old out these days. I’m also very frustrated that it’s very very easy to refuse vaccines, but I can’t get a vaccine for my baby because the CDC has not updated their recommendations to reflect the fact that Measles is in our country. Is there anything concerned parents can do to help drive a change to these recommendations?
Michelle T says
So a baby that’s 7-11 months old is still able to catch Measels even when being exclusively breastfed? I just want to make sure.
Adrienne says
What are the pros and cons of vaccinating a child of eight months? He was born full-term at 38.5 weeks and is exclusively breast-fed with some solid foods.
Mary says
If I know a family who chooses not to vaccinate their children, is my 10 month old baby, who is not vaccinated yet, at risk by being around those children? Also, when my baby does get the vaccine, is it true that since the vaccine contains a live virus, he could shed the virus to those unvaccinated children?
Kelly S says
This is the best post I’ve read about babies and measles regarding this recent outbreak.
We are trying to decide whether to take our 3 month old to Disneyland. Our older toddler is already vaccinated. Tough decision. Sounds like there’s lots of immunity possibility at that age, still, but don’t want to be silly. We live just down the road from Disneyland and have annual passes so it’s not like we’re canceling a “once in a lifetime” trip, but would sure enjoy being able to go.
Liz says
My child was exclusively breastfed until 12 months ( I’m talking no solids). I choose to follow a different vaccination schedule when it comes to the MMR ( after age two). Does my child have my antibodies because I’m vaccinated? I also had the booster as a teen. I know that most mothers do not breast feed exclusively for that period of time, so I’m sure the reccomendations take that into account.
Gina Rao says
I am a PA-C, working in a rural county in Eastern Washington. I am a primary care provider so do see most of the acutely ill patients of all ages in our little clinic. In 3 days, there is child’s piano recital I have been invited to. She is a member of a rather large family that doesn’t immunize their children. I am wondering how safe it is for my patients, if I am in close contact with this family.
Carrie says
Our 4 1/2 month old daughter is adopted domestically. My husband, 3 year old daughter and I have all had our MMR vaccines. We have no records of our baby’s birth mother’s immunizations. We have to fly to her birth city in a month and a half to finalize her adoption and I’m very worried about flying with her. Is there anything I can do to protect her from measles?
Adrienne says
What are the pros and cons of vaccinating a child of eight months? He was born full-term at 38.5 weeks and is exclusively breast-fed with some solid foods.
I’m considering vaccinating now (with his doctor’s approval) and again at the recommended age.
shell says
My child is 2 and 1/2. He has had the first vaccine. Should he get the second vaccine for MMR if we want to go to disneyland?
Wendy Sue Swanson, MD, MBE says
Likely no reason not to — but remember, Disney no more dangerous than your grocery store — no active cases there we know of. Talk w your pediatrician — just need 28 days between first and second dose.
amber perez says
My son is 2 1/2 months old and breast fed, im sure i got my mmr as a child. My question is should i get another one as an adult, to pass it onto my son to help prevent him from getting the measles>?
Cindy Hamilton says
Thank you for all you do! Really appreciate your informative articles. Keep standing up!!
Wendy Sue Swanson, MD, MBE says
You’re welcome. Thank you so much for leaving a comment.
Pamela says
Thanks for writing this. I’m a RN in NYC and all my new moms are freaking out. There is way to much conflicting info. I just posted this to my mothers board and so far everyone said it was easy to understand and straight forward. Thx!
Amanda Lillemoe says
Very helpful. Thank you. I will be flying to Phoenix this week with my five month old. I plan to use Clorox wipes to clean the surfaces we will be sitting near on the plane (windows, seat backs, tray tables, arm rests, etc.). I am wondering if I should try keep him under a muslin blanket to avoid airborne opportunities for contacting anything. Thoughts on this or any other airport/airplane safety tips?
Wendy Sue Swanson, MD, MBE says
I wouldn’t suggest thinking that a muslin blanket would do much for droplet and airborne transmission of infections. I think you’re smart to wipe off the surfaces on the plane because of how your 5 month-old will explore them with his hands and mouth! But the muslin blanket, even a mask, likely wouldn’t protect against other respiratory diseases.
Becky says
I was born after 1957, received the mmr shot as a child, yet still was told I wasn’t immune when they tested me when I was pregnant with my first child. It wasn’t until I received 2 mmr shots after the birth of my child that I was told I was now immune. I have heard other mothers younger than myself have similar experiences. Based on this, I suspect there are a lot of adults out there thinking they are immune and they aren’t.
Jenn C says
Hi. I have a 8 month old and we will be traveling to Chicago from Southern California. We will be going to Cook County in IL where this week there have been 6 recent outbreaks in infants. My question is, do you think we will be a canidate for the early dose? My daughter will be 10 months when we go.
Wendy Sue Swanson, MD, MBE says
It’s my advice for you to talk with your pediatrician. Every state (every county) is handling this differently so I’d call to schedule an appt to inquire abt getting your infant an MMR before 12 mo
Mandy says
Something concerned me in this article, and I was wondering if you could shed some light. “if you put a vaccine in while maternal antibodies are still around the vaccine won’t stimulate the baby’s own immune system to respond, it will just get soaked up by the maternal antibodies doing their job.”
Surely my antibodies were still in my milk at 12 months, and both my kids were still nursing and continued to nurse (one still nursing)while they had the shot. Does that mean their shots were less effective? What about other vaccines? Does that make their other vaccines less effective? I have just never heard that before.
Wendy Sue Swanson, MD, MBE says
No. Breastfeeding is not a contraindication to immunization and as I understand it certainly won’t get in the way of a child responding the vaccine at 12 or 15 months.
Maternal antibodies (in blood) gradually fade throughout infancy — some studies find that nearly all infants have anti-measles antibodies at 3 months, and then gradually as infancy progresses, the antibodies fade (this includes in breastfed infants). Part of the reason for the timing of the immunization is that studies have found toddlers at 12 and 15 months respond well to the vaccine and make their own protection!
East Sider says
You state that “90% won’t get measles because we’re vaccinated”, “99% [of babies] are protected for a lifetime after the 2nd dose”, and “[vaccinated people] won’t spread [measles] to you”.
Your belief in these statements is very important to the conclusions you draw and, consequently, to the advice you give in this article. But the statements are not true.
1. Studies show that the effects of the vaccine wears off. See LeBaron (2007) https://www.ncbi.nlm.nih.gov/pubmed/17339511.
2. Twice vaccinated individuals can transmit measles to other twice vaccinated individuals. Rosen (2014) https://www.jwatch.org/na34349/2014/04/14/measles-acquisition-and-transmission-despite-evidence
So many of us will not acquire lifetime immunity to measles from the MMR vaccine. And vaccinated populations can carry the disease and infect each other. As an MD who has written quite a few articles on this topic one would hope that you would at least have these facts straight.
As a result of your incorrect facts, you focus on “pockets of unvaccinated”. It is difficult to understand how these “pockets” pose a greater risk than the adults who no longer have immunity (5% and growing at 10 years after vaccination based on LeBaron’s study). This theory is even more confusing when studies have shown that fully vaccinated people are perfectly capable of transmitting measles to other fully vaccinated people, let alone the unvaccinated and/or immunocompromised. In one school outbreak, all 411 kids at the school were fully vaccinated. https://www.cdc.gov/mmwr/preview/mmwrhtml/00000359.htm So we need to recognize that measles is a risk for everyone, all the time – vaccinated or unvaccinated.
We have had a brief measles holiday due to the fact that the older population had real, lifelong immunity from having the full blown disease and the younger population had relatively fresh vaccinations. Now that the vaccinated individuals are older and their immunity is wearing off, we have significant populations of people with no immunity. So we need to look beyond blaming parents who have elected not to vaccinate their kids and find other ways of stopping the spread of this disease.
Julian says
And how would that plan NOT involve increasing vaccination rates? Are you suggesting measles parties?
Sorry, people who choose not to vaccinate still get blame. The small percentage who vaccinate but that don’t respond to 2-shot series, or those with waning immunity (please note that declining titer does not equal completely unprotected) did their part, at least.
Jen says
Thank you for a detailed and reassuring post.
My son turns 1-year two weeks before we are scheduled to travel from DC to my hometown in San Diego. I expressed my concern about getting the MMR so close to our travel date to my pediatrician and she consulted with the infectious diseases pediatrician (I have Kaiser) and he advised me to get the MMR now and again at 12 months.
I am pro-MMR and pro-vaccine (my first job at out of undergrad was working in the grad school of public health at University of Pittsburgh where Salk discovered the Polio vaccine–I have a GREAT appreciation for vaccines!), but only spacing the vaccine 5 weeks apart makes me anxious. This is a vaccine that’s spaced by 3 years and I’m narrowing that gap dramatically. I expressed my concern to my pediatrician and she referred me to the CDC. I have to rely on my faith in science at this point and trust the doctors.
No question here. Venting, I guess; irate that I have to subject my poor baby to an additional round of MMR shots.
Emily says
Can vaccinated adults transmit measles to unvaccinated infants? My children (3 yrs w/1 MMR dose, and 3 months so no MMR) attend a KinderCare location in the south suburbs of Chicago. The company had insulated the infant room and only allows vaccinated staff and parents to enter the room. I appreciate the efforts they’ve made, but I wonder about any staff exchange. So if a vaccinated administrator visits another location (like the Palatine facility that’s had 8 reported cases) and is exposed to but not infected with measles, and within two hours visit the same place as my infant, is my infant at risk?
Wendy Sue Swanson, MD, MBE says
Unlikely that they would transmit infection back to another community while vaccinated and protected themselves. That being said, this is one reason you always hear about import around hand-washing, removes any risk that secretions move around!
Meghan says
Hi-
I am planning on traveling to Florida with my 3 month old in March. Would you not risk taking her on a plane because of the measles outbreak?
Meghan says
To add to my last question- we are leaving from Connecticut, I was vaccinated as a child and my daughter is EBF.
NM says
My daughter (20 months) and I live on the east coast, but we are planning to visit relatives in California in a few months. She had her first MMR vaccine between 12-15 months as recommended. Since there has been a measles outbreak in California, I am a bit concerned about her vaccination level. I know that you can get the second dose of the vaccine anytime 4 weeks after but I’m a little concerned. Are there risks with doing it earlier (before age 4-6)? I am pro-vaccination, but I’m just a little worried about giving a dose three years early. I really appreciate your help here.
Rita says
I had an MMR booster shot about 3 months before I got pregnant. Does this affect my baby’s immunity?
Natalie says
I’m in the small percentage of people who did not respond to the measles vaccine and booster shot and therefore still caught measles as a child. What are the implications for my children? Are they less likely to respond to the vaccine as well, putting them in greater danger for contagion? Also, does my resistance make it more likely that my immunity from having been sick has waned two decades later? Thank you for your response. There is a current outbreak in our area.
Julian says
Lots of questions/concerns about breastfeeding and measles immunity / immunization.
It’s important to remember that placental immunity involves transfer of IgG antibodies (similar to those made by immunization) in the last trimester, which lasts several months. Breastmilk primarily transfers IgA (mucosal immunity). There’s some IgG in breast milk but not much, and it probably doesn’t survive the infant’s digestive tract the way IgA antibodies can.
That’s why nursing isn’t reliable protection against measles, and doesn’t interfere with immunization.
Wendy Sue Swanson, MD, MBE says
Thanks for this, Julian.
Stephanie says
My husband and I are flying to Utah on Wednesday to pick up our adopted child. We are EXTREMELY nervous about flying with him to begin with, nonetheless adding the measles concern. Any suggestions?
Thank you!
Wendy Sue Swanson, MD, MBE says
Congratulations, Stephanie! What an amazing time in your life. Remember that this outbreak, although concerning for vaccine coverage and vaccine issues at large, is in pockets of 17 states, not on every airplane. Being smart by staying away from people who are ill and also knowing that young infants (if your child is a young infant) are protected by passive maternal antibodies if biologic mother has had MMR vaccine in her lifetime (which nearly all of us have).
Enjoy the amazing transition!
Ashley says
Hi I am leaving for California with my 5 and half month old next week! is there anything that I can do to protect hem as much as possible with the outbreak? I am nursing hem how much does the protect hem? my family and I are all vaccinated!
Marie Ann says
Me and my 6 month old baby will be traveling to philippines next month. I asked her pediatrician about the measles vaccination..and she said my daughter don’t need it even though we’re going to philippines. I’m just worried because philippines is known also for measles ….
Is my daughter gonna be fine there in Philippines?
Wendy Sue Swanson, MD, MBE says
MMR vaccine is recommended to all babies between 6-12 months when traveling internationally
Doro says
Hi!
My older son (15 month old) is scheduled for his MMR vaccination one week before I am due to give birth. It is a live vaccine, and I am worried than if something goes wrong, the newborn might also be in danger. What should I do? I really don’t want to reschedule the vaccination. The date was changed several times already due to ill health of the older child.
Wendy Sue Swanson, MD, MBE says
It is safe (and recommended) for your son to get his MMR shot now. Talk with your son’s pediatrician if any more concerns but here is also a list of contraindications to getting the vaccine on the CDC page:
https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-contraindications-shell.html#f3
Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy,4 or patients with HIV infection who are severely immunocompromised)
Pregnancy
Moderate or severe acute illness with or without fever
Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product)5
History of thrombocytopenia or thrombocytopenic purpura
Need for tuberculin skin testing6
Sarah B says
A bit disappointed/saddened about the lack of information for babies who are formula fed. Without this becoming a debate (in the comments) over the virtues of breastfeeding, what advice might you have for mothers whose babies are formula fed, are < 1 year old and who live in states where cases of measles have been confirmed (2 in DC)? Any info helpful. Thanks!
Wendy Sue Swanson, MD, MBE says
Hi Sarah B,
Wasn’t meant to exclude nor disappoint. As a mom who wasn’t able to exclusively breastfeed my baby like I wanted, I sure NEVER want to contribute to those feelings. I don’t believe that breastfeeding provides significant protection that warrants unearthing that debate at this time. Although there is some antibodies that pass in breastmilk, the amount of anti-measles antibodies if a mom is not infected with measles is likely VERY low. The most powerful protection babies get come from maternal antibodies passed while in-utero and then their own immune system that is triggered once immunized.
For now, this decision (to immunize an infant in the US between 6-12 months of age) with MMR during this outbreak is one that resides between parents and their pediatrician. If you remain concerned, I’d suggest making an appointment to meet with your pediatrician to see what they recommend for your baby, knowing that if you do immunize now, your baby will also get the MMR dose as recommended by the schedule at 12-15 months of age.
N Savidge says
I am an occupational health nurse. One of my employees just vaccinated her son with his first MMR, 7 days later he has classic measles symptoms. My employee have equivocol immunity to Rubeola, can she contract measles from her son?
MCNC says
Hello! Im a student from the Philippines who will be travelling to the US for internship.
Am I still required to get a new MMR vaccine shot when I received one when I was little?
Jenn Graham says
Hi–great post! Thank you for the info, I’m wondering though, who poses the greater risk of infecting others–a child who hasn’t been vaccinated or an adult who’s not had their boosters? And why?
Wendy Sue Swanson, MD, MBE says
Anyone with NO exposure to the vaccine nor any history of measles infection is at greater risk for getting it if exposed (90% of people who haven’t had the shot and are exposed to measles get it — and then can spread it). Therefore if an adult has had one immunization or had measles as a child they are lower risk for getting (and spreading) measles.
Vu says
If I believe my child just went through a case of the measles. Should I still get him vaccinated for it? He has never had a mmr shot.
Wendy Sue Swanson, MD, MBE says
I would recommend you see your child’s health care provider. If measles is confirmed there is no need to vaccinate.
Faith says
hello. please my 10months old baby had measles some weeks ago and have not been immunized. can she get it now? thank you.
rebecca says
Hello.My son is 3months old and was given measles vaccine by mistake. what are the effects of giving a measles vaccine to a 3months old? Am really worried.
Amy says
Thank you for this great article!!
You’ve mentioned it’s safe to give the MMR vaccine from 6 months of age. However, my husband and I are required to travel to India (!) of all places when our baby will be 5 months – I’m guessing this is too early to vaccinate, but I worry that some of the maternal antibodies will have gone by this point. We’re not sure it’s better to go without, or to go with the vaccine at 5 months (JUST before we leave).
Would be immensely grateful for your insight!
Wendy Sue Swanson, MD, MBE says
The vaccine is not licensed to be used before 6 months so if you travel prior with your baby then the advised and only option is to go without an MMR vaccine
Emma says
My baby is 6 months, i am planning to go in my country in europe on July. Should I give her the MMR vaccine before traveling?
Thanks
Wendy Sue Swanson, MD, MBE says
Here’s the link for the recommendation for international travel
Yes, infants between 6-12 mo of age should get an MMR shot before travel but they still need their 12 month dose as well!
https://www.cdc.gov/measles/travelers.html
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Emma says
I want to travel in europ , and my baby is 6 months and a half. Do I need to give her the MMR vaccine? I don’t know what to do…
Wendy Sue Swanson, MD, MBE says
Here’s the immunization recommendations.
https://www.cdc.gov/vaccines/schedules/easy-to-read/child.html
Recommendations for infants traveling outside of US between 6-12 months of age are to get an MMR shot prior to travel and then do the regular doses of MMR at 12 months and 4-6 years of age. (the 6-12 month dose prior to travel doesn’t replace the 12 month or older dose)
Tessa says
The information in the original blog post about breastfeeding providing antibodies for six months is not accurate. I know that commentators have tried to correct it in the comments, but given that this is coming from a reputable hospital, why do you not correct the original blog post? The information is very misleading and could encourage people to delay or avoid vaccination, which of course is how we got here in the first place.
Wendy Sue Swanson, MD, MBE says
Hi Tessa,
I’m not sure I understand what in the original post you deem is misleading. The data on maternal antibodies against measles isn’t inaccurately reported here. Maternal antibodies to measles (if a mom had MMR or the actual infection) likely gradually fade away in infants in the first year. Only a handful of studies to detail this — and individual of course vary. No reason to wait on an immunization but immunizing for measles, in early infancy, would likely not protect the infant. The explanations in the post are accurate to explain why the timing for high-risk babies who travel (get MMR at 6 months) exist but why even if we immunize at 6 months, we re-do it at 12 months after the maternal antibodies are likely gone.
Therefore, each baby is different but timing of immunization is based on earliest date that we can effectively protect an infant. It’s my rec that no parent should wait after 12 months to immunize against measles, mumps, and rubella. And it’s my rec to immunize babies in high-risk exposures (International travel, etc) between 6-12 months of age.
Anna says
Hello –
I’ve stumbled on this post and in desperate need of advice. I live in New England and I am going to Disney World in Orlando. My child will be 11 months old, turning 12 months that same month. The pediatrician has recommended she get an MMR shot a few weeks prior, which means she will be just turning 11 months. My other did did not get theirs until 15 months (I opted on the end of the 12-15 month range). In addition, I would have to still get the regular 2 shots at 15 months (likely) and 4-5 years.
I have to decide before next month and haven’t the slightest clue what to do. Is it too much hype? I mean this is WDW not WDL. It’s not international but there are a lot of international travelers. We’re not flying, so that’s not in the equation.
What to do? I don’t want to think about her getting sick because I was against it. Yet, the thought of pumping 3 of these into her kills me.
Help!
Anna says
Help! Help! 🙂
Agatha says
I’m worried my baby is exposed to measles outbreak is there a possibility that measles can repeat itself to a vaccinated baby
Stacey Ulacia says
“Two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.” More info from the CDC on the effectiveness of the MMR vaccine here: https://www.cdc.gov/measles/vaccination.html
Anna says
Can my unvaccinared 11 month old catch measles, mumps or rubella from a recently vaccinated child – whom they will be on vacation with?
Wendy Sue Swanson, MD, MBE says
No, a healthy 11 month-old is safe to be around anyone receiving an immunization!
Cheska says
Hi, I’ve had mumps when i was young and I’m not sure if I’ve only experienced it once or twice then. But i think I have been exposed to it again and I’m not sure whether i had an mmr vaccine. I have shown visible symptoms and it’s really painful. I’m afraid that my 5 month old baby will catch it too and cause complications or pain on him
Adam Price says
Dr. Swanson – You said “Those antibodies provide protection for young infants and typically are thought to protect infants for up to 6 months or more. ” Then in a comment response, you said ” the persistence of maternal antibodies after birth is robust with a Netherlands study finding 97% of babies still had great immunity at 3months of age, and then gradually the antibodies fade.”
Can you provide links to the studies supporting the statements above? Not that I don’t believe you – I just like to go straight to the source on these things. The only one I have found (I don’t have access to a decent LitSearch Engine) suggests that by 6 months, there is basically no transferred immunity, especially for children whose mothers received immunity via vaccine: https://www.bmj.com/content/340/bmj.c1626
Wendy Sue Swanson, MD, MBE says
I, like you, had a hard time pinning down lots of data to say when exactly it wanes. My inconsistency here reflects that. I would say on a case by case basis we don’t know. And your point is well taken that many/most moms of course have immunity to measles from live virus vaccination and the durability of that with passing humoral immunity may not be as robust. The bottom line, infants are a vulnerable population during an outbreak.
Madison Divine says
I live in Clark County Washington with my 6 month old baby and my husband, and we are in the middle of a measles outbreak. Since January 1st there have been 51 confirmed cases of measles and 13 suspected cases, as of today (2/8/19). We have been cooped up indoors in our tiny little house since this whole mess started. The only places that we bring baby are to my Mom and Dad’s, because we know that they vaccinate, and to the park to go for walks. I have not been able to bring baby to go grocery shopping or visit my friends some of which have kids who aren’t vaccinated. The first few months after having baby I struggled with postpartum depression, and now this measles outbreak is keeping us from living our life. All 3 of us (myself, husband, and baby) vaccinate, but she can’t receive her mmr vaccine for another month because the rotavirus live vaccine she was given at her 6 month appointment would interfere (according to her pediatrician). She is also exclusively breastfed, so it might not be very effective anyway. I am furious with all of the parents who choose not to vaccinate. Their “right” to not vaccinate is infringing on everyone else’s rights to live their normal day to day life. Any mothers with babies, or any immunocompromised individuals have had their right to move about freely in their community taken away. My daughter runs high fevers after everytime she’s been vaccinated (it’s a natural part of the body’s immune response) and I still get her vaccinated. How long do measles outbreaks last? 6 months? A year? I am scared to bring her anywhere because of the effects that measles have on infants (encephalitis, brain damage, seizures, pneumonia and even death). What do I do???
Adam Price says
Dr. Swanson – Thanks for your response. Three followup thoughts:
1. I think you acknowledge the uncertainty more openly in the comments than you do in the article. (“If a baby’s mother has had her MMR shots and/or had measles infection in her life she passed antibodies to her baby during fetal development while in-utero and continues to pass them passively while breastfeeding.”) I have seen this article cited in multiple facebook groups as evidence that babies are fully protected as long as they are breastfeeding.
2. In further research I found more studies that indicate passive immunity is essentially gone AT six months or even earlier:
Dutch Study: https://www.bmj.com/content/340/bmj.c1626
Nigerian Study: https://academic.oup.com/tropej/article/51/1/45/1697841
German Study: https://www.ncbi.nlm.nih.gov/pubmed/11075412
Swiss study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC95790/
Do you have ANY studies that indicate that passive immunity persists longer? If not, then it seems like the uncertainty could be bracketed a little more toward the younger end. Again, there are parents who read your article and think it is telling them that their babies are protected if they are breastfeeding.
3. “No reason to wait on an immunization but immunizing for measles, in early infancy, would likely not protect the infant.” If the vaccines fail due to the presence of maternal antibodies, then vaccinating younger would take away some of the uncertainty, wouldn’t it? Either the maternal antibodies are missing, in which case the vaccine would work, or they are present, in which case no harm done.
Rani Dougherty says
Thank you for your informative post?
Is air travel (domestic or international) a risk factor for exposure in infants? Many reported exposures seems linked to airports. Would you consider giving an infant MMR shot earlier (prior to 12 no but older than 6mo) because of air travel?
Thank you!
Joy says
Leave your comment here… I am a breastfeeding mom. my baby is just 3month and 2weeks and i am down with measles.
am really confused. as to ether stop breastfeeding or continue.