Post #45 How to be Optimally Measles Immunized

Measles is a highly contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes – the kicker is this can happen 2 hours AFTER said person has left the room. Measles starts with a fever; soon after, it causes a cough, runny nose, and red eyes. Then a rash of tiny, red spots breaks out which starts at the head and spreads to the rest of the body.

It is important to recognize that fever and rash are extremely common in children and the vast majority of fever/rash cases will not be Measles. Unless you are reading about local cases of Measles in the news – it is highly improbable that your child has Measles, especially if they are vaccinated.

Per the CDC, two doses of the MMR (Measles/Mumps/Rubella) vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

The typical pediatric office will offer the first MMR at the 1yo check-up and the second MMR at the 4yo check-up. Note that the 4yo MMR is typically administered as part of a combination vaccine which includes both the MMR vaccine and the Varicella (Chicken Pox) vaccine, while the 1yo MMR is not part of a combination vaccine – so they may show up in different parts of your vaccine record.

If you are concerned about the current measles outbreak and you would like to proactively make sure your child’s MMR vaccine coverage is optimal, below are some options:

1. If your child is under 6 months of age, MMR is not recommended. At this age the antibodies of the mother against Measles (which are the protective proteins your immune system makes in response to vaccines) are still quite prevalent in the baby, thus rendering the immunization mostly ineffective.
2. If your child is 6-12 months of age, an early MMR dose can be given for protective purposes. By 6-12 months of age, the maternal antibodies are less prevalent (but not completely gone) and thus an early MMR can be beneficial – one prospective randomized trial showed an 87% level of protection at 9 months of age. The early MMR is recommended for any 6-12 months of age baby traveling internationally. Please note that any MMR given before 12 months will not count towards the completion of the routine MMR series and the normal 1yo and 4yo MMR vaccine should still be given in the future. Unless you have concern for exposure to non-vaccinating populations, at this time, this vaccine is not routinely warranted by current CDC recommendations.
3. If your child is 1-4 years of age, two doses of the MMR vaccine, separated by 28 days can be given. Typically the two doses are given at the 1yo and 4yo check-up; however, the 2nd MMR dose can be given early. If the 2nd dose is given early it does satisfy the CDC criteria for future school enrollment and does not need to be repeated. The early 2nd MMR is recommended for any 1-4 year old child traveling internationally. A small percentage of children will not respond adequately to the first MMR; however, nearly all children who do not respond to the first MMR will respond adequately to the second MMR. Unless you have concern for exposure to non-vaccinating populations, at this time, this vaccine is not routinely warranted by current CDC recommendations.
4. If your child is over 4 years of age and two doses have been given, no further MMR vaccines are recommended. A third dose may sometimes be recommended during a MUMPS outbreak, but it does not help increase the protection against measles.
5. If you are an adult born after 1957 but before 1989, you may need an additional MMR vaccine. Most people born before 1957 are assumed to have naturally been infected with the virus through Measles outbreaks. Anyone born 1989 or later should have received two MMR vaccines, as that is when the CDC changed routine recommendations from one MMR to two MMRs. However, if you were born between 1957-1989, there is a good chance you only received one MMR vaccine and to give yourself the best protection it would be prudent to get a second MMR. If you are unsure or cannot find your record, you can either get a blood test to measure the level of your protection, or it would probably be simpler to get an MMR booster as there is no harm in getting extra MMR immunizations.

Bottom line is if you have some concern for exposure to non-vaccinating populations or you are traveling internationally, a proactive early first or second MMR is reasonable. But in most cases, unless there is a known outbreak in the community, following the routine CDC schedule for MMR is sufficient.

Per Uptodate.com: Concern has been raised about a possible link between measles, mumps, and rubella vaccination and autism and other chronic diseases. Multiple studies have failed to demonstrate any such association. However, there is an association between congenital rubella syndrome and autism, highlighting a potential role for rubella immunization in the prevention of autism spectrum disorders.

To find out more about measles, please visit the CDC Measles FAQ page at www.cdc.gov/measles/about/faqs.html