Why Measles Protection Absolutely Still Matters

You've seen the images: hundreds of tiny red dots clumped so closely on the skin that they merge into blazing swaths on a child's face, back, torso and limbs. Although startling, these photos of measles may seem almost retro, like illustrations from a 1950s medical textbook.

In 2000, health officials declared that measles was eliminated from the U.S. That welcome news meant measles was no longer endemic, or constantly present, nationwide. A highly effective measles vaccine with the support of a strong immunization program reaching most children enabled this success, according to the Centers for Disease Control and Prevention.

Even so, measles outbreaks are still making U.S headlines in 2018. Although measles incidence remains low overall, outbreaks have steadily increased, most notably since 2010, according to research published October 2017 in the Journal of the American Medical Association. The combination of global travel, infected passengers and local pockets of unvaccinated people is a recipe for measles contagion.

[See: 10 Things Pediatricians Advise That Parents Ignore and Really Shouldn't.]

Harm from measles may extend far beyond a skin rash and fever. The viral infection can cause severe complications such as pneumonia, deafness and brain swelling, or encephalitis. Measles complications can kill. Although it seems like a mixed message, here's the reality: Homegrown measles is eliminated in the U.S., but you still need to protect yourself and your family.

Parents and travelers play a key role in shielding children, neighbors and entire communities from measles. Vaccination according to schedule is the key. Make sure you and your children have the appropriate MMR vaccinations. If you're planning overseas travel, take steps to prevent measles from spreading where you live.

Hubs for Measles

Unfortunately, airport screening doesn't detect the measles virus in incoming passengers. In many parts of the world, measles is still common, including areas in Europe, Asia, Africa and the Pacific. A January travel alert from the CDC highlighted measles outbreaks in Italy, Romania, Indonesia, Ukraine and the Democratic Republic of Congo. In its March 2018 report on ongoing measles outbreaks, the European Centre for Disease Prevention and Control listed Germany and Greece as well. In Latin America, measles outbreaks in Venezuela have spread to Brazil, according to July reports from the Associated Press.

"Until measles is eliminated from the planet, it will remain one of the very most infectious of pathogens -- viruses in this case," says Dr. David Kimberlin, a pediatrician at the University of Alabama at Birmingham and Children's of Alabama. "It's always going to be a risk in a world where an airplane can arrive within 18 hours from any corner of the globe and potentially be bringing someone who has measles in close contact with someone here in the United States."

In March, passengers and travelers who visited airports in Memphis, Tennessee; Newark, New Jersey; and Detroit were warned of potential measles exposure. In January, Chicago O'Hare International Airport was the site of possible exposure to a traveler with a confirmed case of measles. Cases like these periodically crop up. Some are eventually connected to U.S. outbreaks.

A recent study provided an in-depth look at a 2013 measles outbreak in New York City. An unvaccinated adolescent infected with measles who returned to New York from a trip to London was the source of the outbreak, according to the study published July 30 in JAMA Pediatrics. More than 3,300 people in a close-knit New York community were identified as contacts exposed to the virus. Nearly 60 cases of measles resulted, including several with serious health consequences, including a case of pneumonia and a miscarriage.

"There was a pregnant woman who lost her baby," says study co-author Dr. Jane Zucker, assistant commissioner of the Bureau of Immunization at New York City Department of Health and Mental Hygiene. "And then there was another pregnant woman who had developed measles, and her newborn had evidence of measles infection."

Overseas travelers should consider measles protection, Zucker says, just as someone going on a safari would consider the potential for contracting malaria. "They would ask their doctor: Do I need any shots?" she says. "They would ask about malaria pills. But people don't realize that measles is still common in Europe. You should be up-to-date on your measles vaccine for traveling there."

If you're planning an overseas trip, here's what you can do to reassure and protect yourself:

-- Go through your immunization records to determine your measles status.

-- Check with your health care provider if you're not sure whether you've been vaccinated.

-- If your vaccination status isn't clear, a simple blood test can show whether you're immune.

-- Get the measles vaccination if needed.

-- Look through the latest CDC travel notices on measles.

According to the CDC, any adult who doesn't have evidence of immunity should get at least one dose of the MMR vaccine, which prevents measles, mumps and rubella. Before international travel, such teens and adults should receive two MMR vaccinations at least 28 days apart.

Parents traveling with young children should make sure they're protected, too, says Kimberlin, who is the editor of the American Academy of Pediatrics' "Red Book," a widely used resource on pediatric infectious diseases and vaccine-related issues.

Most kids will already be up to date on their MMR vaccinations as part of routine care from their pediatrician. For the two-vaccination series, the standard recommendation is for children to receive their first dose at 12 to 15 months of age, Kimberlin says. The second dose is given between the ages of 4 to 6 years. However, he adds, if you live in an outbreak setting, the second MMR dose can be given closer to the first. Traveling can also mean tweaking the schedule.

"If you're traveling internationally, the recommendation is that you get a measles vaccine dose at 6 months or older," Kimberlin says. "But if you're between 6 months and 12 months, it does not count as one of the two [routine] doses."

Infants under 6 months old cannot receive the measles vaccine, Kimberlin notes. In that case, "If at all possible, please don't travel," he urges. "In Europe -- with 21,000 cases in 2017 -- 35 children died. Children who were fine before they got the measles, and they're dead. This is life-or-death stuff."

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Persistent Public Health Menace

The elimination of endemic measles at the turn of the millennium represents a major win for U.S. public health. But that victory comes with an asterisk, because outbreaks still happen. However, the possibility of measles may seem remote to people who don't realize how dangerous it can be.

"Any parent of children who were born in the 60s, 50s or 40s knew that -- because it was so infectious and so common that literally everybody got measles," Kimberlin says. "So when the vaccine came out, especially the live attenuated vaccine, it was a real game-changer and parents flocked to get it. The problem now is that parents don't see measles as a real entity anymore, many of them."

In today's era of vaccine-hesitancy and controversy -- with a minority of parents refusing or delaying vaccinations for their kids -- measles imported from abroad may have a better chance of taking hold in U.S. communities.

"There are areas of states, or even within certain counties, across the United States where the immunization rates are very low -- much too low for a virus like measles," Kimberlin says. "If it gets into there, it's like throwing a match onto dry grass. The fire starts immediately."

High immunization rates for a state might provide false reassurance, Kimberlin adds. "That doesn't mean rates are high in every pocket or every little area of the state," he says. "They might be quite low in some areas. And when someone comes into the area with measles, the measles virus will find those people who are susceptible."

[See: 8 Secrets of People Who Don't Get Sick.]

Public health agencies, pediatricians and other health care providers still have their work cut out against measles. "A lot of what the health department does is promote vaccination," Zucker says. Information on their website, pamphlets distributed at health fairs, phone calls with concerned parents are all geared toward increasing public understanding of diseases like measles and why prevention is so important. Health departments also work closely with day care providers and schools to clarify immunization requirements.

"My recommendation is that parents follow the advice of their pediatricians," Kimberlin says. "And their pediatricians will say that [children] should be fully immunized against measles and against all vaccine-preventable diseases."

For complete information on suspected measles and MMR vaccination, consult your pediatrician and visit the CDC website.

Lisa Esposito is a Patient Advice reporter at U.S. News. She covers health conditions, drawing on experience as an RN in oncology and other areas and as a research coordinator at the National Institutes of Health. Esposito previously reported on health care with Gannett, and she received her journalism master's degree at Georgetown University. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.