Measles is a very serious, highly infectious disease. Vaccines have been available since 1960. Because of the vaccine’s success, measles was essentially eradicated by childhood vaccination by 2000. Until now,  the only rare cases seen have been through transmission from unvaccinated persons from outside the US.  Now we are seeing a record number of outbreaks which started in of all places Disneyland in California, where most of the nationwide outbreaks have been linked to.

The measles outbreak tied to Disneyland continued to spread anxiety as two new cases emerged overnight in Marin County, California — along with at least one in Nebraska — while Arizona officials warned that at least 1,000 people may have been exposed to the virus through seven others in that state.

Since Jan. 1, the federal Centers for Disease Control and Prevention (CDC) have confirmed 84 measles cases in 14 states. California’s health department, which is updating a measles count more frequently, has found more than 90 cases in the United States and Mexico so far, with 52 linked to the Disneyland outbreak.  Concern about the highly contagious disease intensified Friday in several states, including Minnesota, where health officials are notifying hundreds of people who may have come into contact with a University of Minnesota student with measles. A New York college student with measles boarded an Amtrak station from Penn Station end of Jan and may have exposed other passengers to the contagious virus.


Measles Virus Under a Microscope

Measles Virus Under a Microscope

What is Measles?

Measles (RUBEOLA) is one of the most contagious infectious diseases known, in fact 90% of susceptible people exposed to measles will get it. The measles virus is transmitted through direct contact with infectious airborne droplets. However, because the measles virus can survive for up to 2 hours, measles can be caught via these droplets even without face-to-face contact. The incubation period ranges from 7 to 21 days.


Persons with measles are contagious from 4 days before to 4 days after appearance of rash. Many people can be infected by someone who will have the measles before the rash which is the most recognizable symptom.  Until recently most children in the US have vaccinated . Over the last 5 years some parents have not vaccinated their children because of concerns of a link between the vaccine and autism which many studies have determined to be unfounded. High vaccination coverage is essential to prevent spread after importation. However, coverage with measles, mumps, and rubella (MMR) vaccine varies by state.

Koplik Spots

Koplik Spots (Early Symptom of Measles)

Signs and Symptoms of Measles

The first signs of infection are a bad cough, runny nose, fever, and red, watery eyes. Sometimes, at this stage, small red spots with blue-white centers appear inside the mouth (“Koplik spots”). After 3–4 days, a rash begins with red spots, first appearing behind the ears and at the forehead, spreading down the neck, arms, trunk, and finally the legs. The red spots can merge together on the face. Measles does not usually itch.


Histopathology of measles pneumonia

Histopathology of measles pneumonia

Complications from Measles

Complications from measles more commonly occur in children aged younger than 5 and adults older than 20. Serious complications of measles include blindness, inflammation of the brain caused by infection (encephalitis), seizures, severe diarrhea that may potentially lead to dehydration, ear infections, and severe respiratory infections. The most common cause of death associated with measles is from pneumonia, however, there are serious disabilities including: blindness, deafness and seizures.


Because measles has not been seen by providers for many years, the CDC has been trying to update providers on the clinical appearance of measles which many of us have never seen. Susanna Thomas has had measles but has never seen a case and Melissa Gionfriddo who had a long stint in the Yale Pediatric ER has never seen a case either. If measles is suspected, airborne precautions should be implemented immediately. Such precautions include appropriate patient isolation. Their contacts need to be tracked down (not an easy task on an Amtrak train ride).


Vaccine Recommendations

Vaccine Recommendations

Vaccine Recommendations

Why is MMR vaccine given after the first birthday?
Most infants born in the United States will receive passive protection against measles, mumps, and rubella in the form of antibodies from their mothers. These antibodies can destroy the vaccine virus if they are present when the vaccine is given and, thus, can cause the vaccine to be ineffective. By 12 months of age, almost all infants have lost this passive protection.


What is the best age to give the second does of MMR vaccine?
The second dose of MMR can be given at any time, as long as the child is at least 12 months old and it has been at least 28 days since the first dose. However, the second dose is usually administered before the child begins kindergarten or first grade (4-5 years of age) or, before entry to middle school (11-12 years of age). The age at which the second dose is required is generally mandated by state school entry requirements.

As an adult, do I need the MMR vaccine?
You do not need the MMR vaccine if you:

  1. Had blood tests that show you are immune to measles, mumps, and rubella
  2. Are someone born before 1957
  3. Already had two doses of MMR or one dose of MMR plus a second dose of measles vaccine
  4. Already had one dose of MMR and are not at high risk of measles exposure

You SHOULD get the measles vaccine if you are not among the categories listed above, and:

  1. Are a college student, trade school student, or other student beyond high school
  2. Work in a hospital or other medical facility
  3. Travel internationally, or are a passenger on a cruise ship
  4. Are a woman of childbearing age

Why are people born before 1957 exempt from receiving MMR vaccine?
People born before 1957 lived through (it does NOT apply to rubella) several years of epidemic measles before the first measles vaccine was licensed. As a result, these people are very likely to have had the measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Note: The “1957 rule” applies only to measles and mumps, NOT to rubella.

Do people who received MMR in the 1960’s need to have their does repeated?
Not necessarily. People who have documentation of receiving LIVE measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective.

Please ask your medical provider about what immunizations you need.

CDC Measles VideoMore Measles Information

Video – Dr. Raymond Strikas, CDC, describes clinical features of measles infection.
Watch here:
All about measles from the CDC

Images courtesy of the Centers for Disease Control and Prevention – Public Health Images

Information provided on this website and in the Doctor’s Blog is for informational and educational purposes only. It is not intended as and does not substitute for medical advice. Please consult your health care professional for evaluation of your individual case.