Measles

June 11, 2019
J. Davis Allan, MD

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Measles, caused by the rubeola virus, is a highly contagious and serious infection that can be deadly.  It is spread primarily in mucous and phlegm by coughing and sneezing.  The virus can live for up to 2 hours in the air and on surfaces in the environment where a person with measles coughed or sneezed.  Measles typically causes conjunctivitis (inflammation of the membranes covering the eyes) a runny nose, fever (103-105 degrees), cough and a rash that usually begins at the head and spreads out to the remainder of the body.  The rash does not itch.  Serious complications of measles include pneumonia and encephalitis (inflammation of the brain).  After exposure to measles, symptoms typically develop 10-14 days later although it may be longer in adults.  Persons who are infected can spread the virus beginning 4 days before the rash appears.  It is estimated that 90% of individuals who are not immune and get exposed to a person infected with measles will also become infected.  While measles remains a serious problem in many countries in the developing world, it has generally been well-controlled in the United States since introduction of an effective vaccine in 1963.  In recent years, however, there have been a growing number of cases in the United States.  A measles outbreak as defined by the CDC is 3 or more cases in a one community.  So far in 2019, measles outbreaks have been reported in New York State, New York City, Washington state, New Jersey, California and Michigan.  To date (4/27/19), a total of 626 cases of measles have been reported to the CDC in 2019.  This is a very large increase over previous years where there were total of 372 cases in 2018, and 120 cases in 2017.  It seems very likely that there will be more cases of measles reported in the United States this year than in over a decade.  Most outbreaks are the result of individuals who travel overseas and return with measles from another country.  Spread is facilitated by the presence of unvaccinated individuals in the United States.

In April, the first case of measles in Tennessee in 2019 was documented in an unvaccinated individual who visited Hattiesburg from April 9 to April 11 and did spend some time in Knox County.  This has raised local concerns, but so far there have been no secondary cases reported.

To protect yourself and others, you should be certain that you are adequately immunized.  The standard vaccine is known as MMR and vaccinates against measles, mumps and rubella.  All children should receive at least 2 vaccines typically the first between ages 12 and 15 months and the second between age 4 and 6.  Individuals in the United States born before 1957 are considered to be immune because the vast majority of them had measles in childhood.  Everyone else should have documentation of adequate measles vaccination in the past.  A blood test can indicate if you are immune to measles.  If you are not certain about your immunization status, your physician can order this test.

Anyone traveling to a country where measles is present should verify their immune status before departure or receive an MMR booster.  Similarly, if there are cases of measles in your community, you should verify your immune status.  If you are not immune, you should receive immunization.

If you are exposed to measles and are uncertain of your immune status, you should contact your physician’s office and avoid exposing any other individuals until your status can be confirmed.