Measles - what you need to know

In 2000, the World Health Organization reported that measles had been eliminated in the United States. Today, however, rising cases of measles across the nation - 447 confirmed by the Centers for Disease Control as of March 28 with the majority of cases seen in unvaccinated individuals - has health authorities concerned, and wanting to remind the public what they can do to help prevent the spread of the disease. While in Iowa there have been no reported cases of measles since 2019, as of last year only 84% of Iowa children turning 2 had received their first MMR dose, which is below the average 95% coverage needed to effectively prevent outbreaks.

What is measles?

Measles is a highly contagious viral respiratory illness that is spread through contact with infected air droplets, such as from an infected person’s sneeze, cough or breath. The virus can remain in the air for up to two hours. According to the CDC, if one person has measles, up to nine of 10 people nearby will also become infected if they are not immune to it.

Measles often shows as a rash and high fever. Prior to a rash and fever, it is common for the infection to first present with a cough, runny nose and red, watery eyes. These symptoms begin to appear one to two weeks after contact with the virus. In instances of the rash, it often spreads from the head down the torso and to the lower parts of the body. Most patients are considered contagious from four days before the rash appears to four days after; not all who contract measles will develop a rash.

Measles is considered to be very dangerous, especially in young children and babies. Those with weakened immune symptoms are also more susceptible to measles. In serious cases, patients can develop pneumonia or encephalitis. While deaths from measles are not overly common, the CDC estimates that one to three of every 1,000 children who contract measles will die from complications.

Unlike the flu where there is a season of increased risk, the same is not true of measles. It can spread more easily during high travel times or when several unvaccinated people are together in close quarters.

Vaccination

In 1963, John Enders and colleagues were successful in transforming a strain of the measles virus into a vaccine; the vaccine had been created after they successfully isolated measles in a 13-year-old boy. Five years later, Maurice Hilleman and colleagues developed an improved vaccine that was refined to use a live, attenuated virus. This created a weakened form of the virus that stimulated people’s immunity without causing disease when receiving the vaccination. That vaccine is the only one to be used in the United States since that time. A vaccine that targets measles, mumps and rubella - MMR - was developed by Hilleman in 1971. Since its development, the vaccine has been given 575 million times to people around the globe.

The CDC set a goal in 1978 to eliminate measles in the United States by 1982. At the time, only one dose of the MMR vaccine was administered and while the deadline date was not met, 1981′s numbers showed an 80% decrease in reported cases compared to the prior year. An outbreak in 1989 among school children who had been vaccinated prompted the recommendation for two doses of the vaccine which helped to further decrease the cases.

Today, most children who receive vaccinations will have had two doses by the time they are six, which the CDC considers as protection against the measles. Those who were born before 1957 were likely exposed to the measles and are considered to probably be immune - presumptive immunity - from the virus. Younger adults should have evidence of the infections, evidence they have positive antibody blood tests or a history of vaccination. If adults born after 1957 don’t have that information, they should consider at least one dose of the measles vaccine.

Overall, one dose of MMR had a 93% effectiveness against measles; two doses increases the effectiveness to 97%. For some people, their bodies will not produce the needed long-term antibodies to keep the measles virus at bay. Prolonged exposure to someone ill with measles can also make the vaccine less effective.

While vaccinations are not mandatory, Iowa law does require students to have proof of immunizations against several diseases, including measles (except in cases of religious exemption). The CDC additionally recommends anyone traveling internationally to make sure they are fully vaccinated before doing so. Immigrants seeking permanent residence in the United States are required to receive vaccinations, including one against measles.

Am I immune?

To check for your immunity against measles, doctors offices can perform a titer test, which measures the antibodies in your blood to see if you are still immune. Alternatively, a person can receive a booster for measles if they don’t want to have a titer test performed. For those born after 1957, they are considered to have presumptive immunity if they have two documented doses of the MMR vaccine.

In Clarke County, Clarke County Public Health participates in the Vaccines for Children program, which provides all vaccinations including MMR to children aged zero to 18 who have no insurance, are on Medicaid or are under-insured. Vaccines are also available for uninsured adults, or CCPH can bill for vaccines through Medicaid and Blue Cross Blue Shield of Iowa. CCPH can check records for individuals to help determine if one has presumptive immunity or not.

Since September, CCPH has participated in the Iowa Vaccines for Adults Program, which offers no-cost vaccines to eligible adults, being those who have no insurance or insurance that does not cover vaccination costs. CCPH Administrator Nicole Jimmerson, RN, reported that since Public Health began the program, they have administered 1,500 immunizations including 121 MMR vaccines.

Clarke County Hospital and Clinics also offer Vaccines for Children.

Vaccinations are offered at CCH during clinic visits for those with insurance, including MMR.

Appointments can be made at either location for vaccinations by calling CCPH: 641-342-3724 or CCH: 641-342-2128.

Unsure if you’re sick?

If you think you have the measles, it is recommended to call a healthcare provider to discuss your symptoms to discuss their suggestions. If you do have measles, it is important to stay home to prevent spreading it to other people. Regular hand washing, covering your mouth and nose, avoiding sharing drinks or utensils and disinfecting frequently touched surfaces are important to help kill and stop the spread of the virus.

Clarke County Public Health contributed to this article.