For the most part, most measles outbreaks shouldn’t alter your preconceived notions on the illness and the vaccine. The current measles outbreak in Texas doesn’t need to impact your vaccine decisions either unless you live in the same city as an outbreak or are directly exposed. But let me qualify that statement, because it’s important for you to be aware of all the implications.
WE HAVE SMALL OUTBREAKS EVERY YEAR
First, realize that we have measles outbreaks in the U.S. every year. Last year (2024) we had 159 cases as of the end of June, and many people were worried. This year’s outbreak in Texas is now over 250 cases. We’ve averaged about 175 cases a year for the past 25 years. Our highest year had 1274 cases in 2019, and our lowest year was, you guessed in, 2020 – only 13 cases. So why is measles making the news now? It makes the news every year – you simply may just not have paid attention until you actually have a child who hasn’t yet had the vaccine. So now you are thinking about it, and that’s good.
The outbreak in 2023 was also newsworthy because a contagious person traveled through an airport, thus potentially spreading the illness to others who were traveling far and wide. This year, in Texas, it’s newsworthy because the outbreak is early in the year and larger-than-average for one area, and, tragically, a child has been reported to have died from multiple infectious complications in a hospital, and was also positive for measles. The news has reported the school-age child was not vaccinated and lived in a large community of unvaccinated families.
The news doesn’t typically report all yearly outbreaks. They mainly focus on it when something unique happens, such as measles visiting Disneyland, an airport, or any venue that might cause a larger and wider outbreak. However, the news primarily reports measles outbreaks as a shocking surprise that everyone should be very afraid of, when, in reality, each year is no different than many other years over the past few decades.
UNDERSTANDING AND REDUCING YOUR OWN CHILD’S RISK OF MEASLES
Here are a few perspectives to help you understand your child’s risk of measles:
The vast majority of cases in any outbreak are restricted to one community. Whenever we’ve had our highest years, almost all the cases are in one city or county, or sometimes two communities. Large numbers of cases don’t spread far and wide. Wider outbreaks tend to just involve a few people. The reason this is important for anyone who chooses to raise their child without the MMR vaccine is this: even in a high year, the chance that measles is going to come near your own particular child is extremely low unless you live where the outbreak is. So, you certainly could talk to your doctor about vaccinating if you live within a large outbreak, but if you don’t, then these yearly outbreaks don’t need to weigh heavily on your decision to not do the vaccine. Yes, you could “do your part” and go out and get vaccinated as the media and medical community advise, but my point is that your own particular child’s risk is no higher this year than any other year (unless you live in an outbreak). So if you didn’t vaccinate your child during last year’s outbreak, or the year before that, or in 2019 when it was the highest, then THIS year doesn’t need to impact your decision.
Also, realize that children who are Vitamin A-deficient tend to fare worse with measles, so giving your child a daily dose of Vitamin A for a couple months around a measles outbreak would be a good idea. I don’t have a favorite brand to recommend – you’ll have to shop around yourself. The daily dose for an infant or child is about 1000 IU daily. For teens and adults it’s about 3000 IU daily. Taking an amount that would be in any multivitamin appropriate for your child’s age would also be fine. You can also get Vitamin A in the following foods: liver, cod liver oil, carrots, some fish, butternut squash, sweet potatoes, leafy greens, eggs, apricots, red bell peppers, tomatoes, mangoes, and others. It’s okay to supplement and increase your vitamin A foods just to be safe.
Finally, realize that measles has a very low fatality rate: about 1 in 10,000. So why do the media falsely label it as a deadly disease that is killing thousands? Measles is very serious for malnourished children in developing countries. The news doesn’t specify where those thousands of children are dying, just that they are dying. They don’t reassure you that your specific child here in the U.S. is safe. The CDC also provides a fatality statistic of 1 in 1000. Why? This statistic is based on fatality rates of children in the U.S. who are hospitalized for measles. But given that over 90% of children with measles have mild cases that don’t require hospitalization, the true fatality rate for all cases is about 1 in 10,000. The last child to die from measles in the U.S. was in 2003 – until now.
To clarify, this doesn’t mean an American child can’t die from measles or suffer harm. It simply means that the risk of this is extremely low.
WHAT TO DO IF EXPOSED OR INFECTED
One of the most important things you can do if your child is directly exposed to measles or is diagnosed (besides talking to a doctor for advice) is to give your child high dose Vitamin A therapy for 2 days. Infants younger than 6 months would get 50,000 IU once a day for 2 days. Infants 6 to12 months would get 100,000 IU once a day for 2 days. Children 12 months and older would get 200,000 IU once a day for 2 days. These are CDC/WHO guidelines for treatment dosing in the case of illness or direct exposure. Notice that these doses are 100 times the usual RDA or more. That is intentional. Since it’s only for 2 days, it’s not considered an overdose. I can’t tell you what brand to buy, but you can generally find Vitamin A drops that have 5000 IU per drop.
If you use the 5000 IU per drop version, here is info on the number of drops you would use:
— Infants younger than 6 months – 10 drops (50,000 IU) once a day for two days only.
— Infants 6 through 11 months – 20 drops (100,000 IU) once a day for two days only.
— Everyone else who is 12 months and older – 40 drops (200,000 IU) once a day for two days.
IF you are extremely worried and don’t want to wait until your child is actually exposed to do these preventive doses, that’s up to you. These high doses are also recommended by the CDC and WHO as a prevention, even prior to exposure, in areas where children are malnourished. So, it would be okay to give preventively in your child if you are concerned about exposure. Just don’t do it more than 2 days. Otherwise, simply start feeding the above Vitamin A foods and also start normal supplement dosing as above.
UNDERSTANDING THE DISEASE
The best way for you to understand the disease and see pictures of how to identify it is on www.CDC.gov and search for Measles under M in the Diseases section.
Average incubation period for your child to begin feeling sick after coming into contact with measles is 10 to 12 days, but can be as early as 7 days and as late as 21 days. It is easily spread, even by being in the same indoor space as an infectious person who was there up to an hour before you. It is spread though air.
Symptoms to watch for are: Fever, Sore throat, Runny nose, Cough, Red eyes. These are identical to the flu, and there’s no way to know if it’s measles yet. One main clue if you live near an outbreak is the RED EYES along with the other symptoms. But unless you know that your child has been directly exposed to measles, it is unlikely that your child does have it. However, prior to walking into any public area or medical facility, let your doctor’s office know that you suspect measles so they may evaluate your child outside. Two to five days after the above symptoms, the rash appears. It is red spots that start on the face around the hairline, then move down onto the body then the arms and legs. Look at pictures on CDC site.
Is measles dangerous? It can be yes, especially if your child is extremely malnourished or severely vitamin A deficient. However, most cases in healthy children pass without any consequences. Fatality rate out of all cases in the United States is 1 in 10,000 cases. Fatality rate in those sick enough to seek medical care may be as high as 1 in 500 or 1 in 1000. Fatality occurs far more often in third-world countries, but is virtually unheard of in the U.S. As for complications, the most common one is diarrhea or ear infection, which are easily treatable. The next most common is pneumonia, which is also treatable. Serious complications occur in less than 1%. You will hear that some people have to be hospitalized, but this is mainly for hydration or for treating pneumonia if it gets serious. Overall, the media hypes up the dangers of the disease. Yes, it CAN be dangerous, but rarely is.
It is most serious for infants less than 1 year, for pregnant women (it can cause miscarriage in the early months of pregnancy, but does not cause birth defects or harm a baby otherwise), and for those who are immunocompromised (such as on chemotherapy or an immune disorder).
HOW TO TELL IF YOU HAVE MEASLES
- Main symptoms: usually starts with high fever, runny nose, cough, and red eyes – often all starting together on the first day. Onset is usually 7 to 14 days after contact with a contagious person.
- Rash starts 3 to 5 days after the initial symptoms, with flat red spots along the hairline of the forehead and sides of the face. This spreads during that first day down to the neck, trunk, arms, legs and feet. Small bumps that are slightly raised may appear on each flat spot. Individual spots may merge together into large splotches as the rash moves down the body.
- Fever may continue for 5 to 7 days total.
- The contagious period is from about 4 days before the rash first starts (typically also with the onset of the first respiratory symptoms) to 4 days after the rash starts – so, about an 8 day period.
THE MMR VACCINE
If your child has already received one dose of MMR, there is a 95% chance of being immune. If two doses of MMR, a 98% chance. The vaccine begins working right away, but takes a few weeks to kick in and provide this full immunity. If you do end up hearing that your child is exposed and not vaccinated, the vaccine will help prevent the disease if given within 72 hours of the exposure.
In the U.S., the vaccine only comes as the MMR. You can’t get a measles-only vaccine anymore in the United States. The decision whether or not to vaccinate is yours. We will provide your child with the vaccine if you choose to get it.
We understand that at one of your previous appointments you may have decided to opt out of this vaccine. If it has always been your plan to NOT get the vaccine, especially while your child is young, then you can consider that this Texas outbreak does not significantly affect your child and the chance your child will catch measles and pass it to others is small. Please make an appointment with us to discuss this further in person if you would like to go over the pros and cons of this vaccine again.
Side effects of the vaccine can best be read in the MMR chapter of The Vaccine Book. If you don’t have it, another good place to read is by searching MMR vaccine on the CDC.gov website or reading the MMR vaccine package insert on the FDA website. The side effects are too complex to list here, and way too numerous for us to list for you over the phone. Feel free to stop by the office and read the MMR section in The Vaccine Book if you don’t have a copy. You can also read about it under the Information Center tab on Immunity Education Group’s website.
If all of this information is not enough for you and you need more information than this, please make an appointment with Dr. Bob to discuss. Our staff is unable to share MORE information than this over the phone.
