Measles outbreaks are popping up across the United States. From January 1 to March 7, 2019, 228** individual cases of measles have been confirmed in 12 states: California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington. Six outbreaks (defined as 3 or more linked cases) have been reported, in Rockland County, New York; New York City, New York; Washington; Texas; California and Illinois.
What Is Measles, and What Are the Risks?
Measles, also called rubeola, is a highly contagious respiratory infection caused by a virus. Symptoms of measles include fever, runny nose, cough, red eyes, sore throat, sensitivity to light, and a rash that spreads over the whole body. It is one of the most contagious diseases in existence—so contagious that if one person is infected, 90% of the people around them who are not immune will also contract it.
The high number of measles cases in the U.S. in the first two months of the year is certainly cause for concern. Before the vaccine was introduced in 1963, an average of 400 to 500 people died from measles every year, 48,000 were hospitalized, and 1,000 developed encephalitis (brain swelling) resulting from the disease. Thanks to an effective vaccination program, the number of measles cases dropped from 441,703 cases in 1960 to only 138 cases in 1997. In 2000, measles was officially declared eliminated in the U.S. Each year since then, however, there have been an average of 124 cases of measles each year across the country.
Why Are We Seeing More Cases?
Though the number of measles cases in the U.S. has declined overall since the vaccine became widely used, there has been a recent uptick in cases. This is due in part to lagging immunization rates and an increase in unvaccinated travelers who contract the disease while abroad and bring it to the U.S. Many countries whose measles vaccination rates are low have recently experienced large outbreaks. For instance, in 2018, there were 82,596 cases of measles in 47 countries across Europe. An outbreak of 133 cases in New York began when an unvaccinated child visited Israel, where a large outbreak is occurring, and brought the disease back to a community with low vaccine protection. Small pockets in the U.S. with low vaccination coverage are especially susceptible to outbreaks. For instance, many of this year’s cases stem from an outbreak in Washington state, and nearly all of those involve children who weren’t vaccinated.
In response to the high number of cases in the U.S. so far this year, the Centers for Disease Control and Prevention (CDC) is asking for clinicians’ help to ensure that all patients are up to date on the MMR vaccine. When it comes to vaccinations, parents trust the expertise of their doctor more than anyone else.
What Can I/My Practice Do to Prevent Measles Among My Patients?
- Explain that MMR vaccine is the best protection against measles infection.
- Discuss the importance of MMR vaccine with parents. Listen and respond to parents’ questions. When parents have questions, it does not necessarily mean they won’t accept vaccines. Sometimes, they simply want your answers to their questions.
- Ensure all patients are up to date on measles, mumps, rubella (MMR) vaccine.
- Children need 2 doses of MMR: one dose at 12-15 months and another dose at 4-6 years.
- Before any international travel, infants 6-11 months need 1 dose of MMR vaccine, children 12 months and older need 2 doses separated by at least 28 days, and teenagers and adults who do not have evidence of immunity against measles need 2 doses separated by at least 28 days.
- Consider measles in patients presenting with febrile rash illness and clinically compatible measles symptoms (cough, coryza, and conjunctivitis), and ask patients about recent travel internationally or to domestic venues frequented by international travelers, as well as a history of measles exposures in their communities.
- Promptly isolate patients with suspected measles to avoid disease transmission and immediately report the suspect measles case to the health department.
- Obtain specimens for testing from patients with suspected measles, including viral specimens for genotyping, which can help determine the source of the virus. Contact the local health department with questions about submitting specimens for testing.
Additional Resources for Clinicians:
- Guidelines for patient evaluation, diagnosis and management
- Web tools for healthcare professionals
- Provider Resources for Vaccine Conversations with Parents
- Talking with Parents about Vaccines for Infants
- Preparing for Questions Parents May Ask
- Infant Immunization FAQs in English and Spanish
- Measles fact sheet for parents in English and Spanish
- Resources for parents (including printable fact sheets, posters, and infographics