The Return of Measles: Outbreaks, Risks, and the Power of Vaccination

The recent measles outbreak in Texas with cases now reported in Colorado has brought this highly contagious illness to the forefront again. Widespread use of measles vaccine drastically reduced disease rates in the 20th century. The United States has maintained measles elimination status for over 20 years. Measles cases in the United States originate from unvaccinated international travelers. Prior to a vaccine becoming available in 1963, nearly all children got measles by the time they were 15 years old. Among reported measles cases each year, an estimated 400 to 500 people died, 48000 were hospitalized and 1000 suffered encephalitis (swelling of the brain).

Dr. Jason Kalan - Author

Measles is not just a mild viral illness. It is highly contagious and can live up to 2 hours in an airspace after an infected person leaves the area. Call your doctor immediately if you think you or your child have been exposed. Measles symptoms appear 7 to 14 days after contact with the virus. Measles typically begins with:

High fever (may spike to more than 104°)

Cough

Runny nose (coryza)

Red, watery eyes (conjunctivitis)

2–3 days after symptoms begin: Koplik spots

Tiny white spots (Koplik spots) may appear inside the mouth two to three days after symptoms begin.

3–5 days after symptoms begin: measles rash

Measles rash appears 3 to 5 days after the first symptoms. It usually begins as flat red spots that appear on the face at the hairline. They then spread downward to the neck, trunk, arms, legs, and feet.

Small raised bumps may also appear on top of the flat red spots. The spots may become joined together as they spread from the head to the rest of the body. When the rash appears, a person's fever may spike to more than 104° Fahrenheit.

Common complications from measles are:

Ear infections occur in about 1 out of every 10 children with measles. Diarrhea is reported in less than 1 out of 10 people with measles.

Measles can be serious in all age groups. However, there are several groups that are more likely to suffer from measles complications:

Children younger than 5 years of age

Adults older than 20 years of age

Pregnant women

People with weakened immune systems, such as from leukemia or HIV infection

There can be severe complications in children and adults, such as pneumonia (infection of the lungs) and encephalitis (swelling of the brain). They may need to be hospitalized and could die. About 1 in 5 unvaccinated people in the U.S. who get measles is hospitalized. As many as 1 out of every 20 children with measles gets pneumonia, the most common cause of death from measles in young children. About 1 child out of every 1,000 who get measles will develop encephalitis (swelling of the brain). This can lead to convulsions and leave the child deaf or with intellectual disability. Nearly 1 to 3 of every 1,000 children who become infected with measles will die from respiratory and neurologic complications.

If you are pregnant and have not had the MMR vaccine, measles may cause birth prematurely, or have a low-birth-weight baby.

Long-term complications include subacute sclerosing panencephalitis (SSPE) a very rare, but fatal disease of the central nervous system. It results from a measles virus infection acquired earlier in life.

SSPE generally develops 7 to 10 years after a person has measles, even though the person seems to have fully recovered from the illness. SSPE is characterized by mental deterioration, muscle jerks (myoclonus), and seizures. SSPE causes a slow but steady decline in cognitive and motor function, eventually leading to coma and death. The measles virus is believed to persist in the brain and slowly damage it, leading to the symptoms of SSPE. Subacute sclerosing panencephalitis (SSPE) is a rare, progressive, and usually fatal brain disorder that can develop years after a person has been infected with the measles virus. SSPE is characterized by mental deterioration, muscle jerks (myoclonus), and seizures. Symptoms of SSPE include mental deterioration, myoclonic jerks (sudden muscle contractions), seizures, behavioral changes (e.g., distractibility, forgetfulness), progressive cognitive decline, motor problems (e.g., gait abnormalities), vision loss and in advanced stages, coma and death.

Vaccination against measles is the most effective way to prevent SSPE, as it protects against the initial measles infection that can lead to the development of the condition.

The best way to prevent measles and its complications is to get vaccinated. The vaccine is safe and effective. There is no link between the MMR vaccine and autism. Two doses of MMR vaccine are recommended. In childhood this is usually done at 12-15 months then between 4-6 years of age. One dose of MMR vaccine is 93% effective against measles while two doses are 97% effective. Anyone traveling internationally should be fully vaccinated before traveling. Infants 6-11 months old should get 1 dose of the MMR vaccine before travel, then they should get two more doses after their first birthday.