Measles is an age-old scourge to humanity, thought to be the most infectious illness in humans. The US was said to have "eradicated" measles in 2000. However, what that means is that in the US there were enough people immunized (and therefore immune) to stop measles from spreading when it came into the country. Since our immunization rate has decreased, the immunity has decreased and measles can now spread.

What it looks like:

After exposure, measles incubates in the exposed person for about 10 days (can be 6-21 days).

Then the person develops a fever, cough, coryza (runny nose) and conjunctivitis (red eyes) for 4 days.

Koplik spots (white-grey spots on the inside of the mouth) can occur during this time, but they are not always present.

After 4 days of persistent fever, cough, coryza and conjunctivitis, the rash develops. It begins on the face and neck, then body, then extremities.

People are contagious for 4 days before and 4 days after the rash.

Thereafter, the person either gets worse or better.

What worse looks like:

• 1 in 5 people are hospitalized, usually from viral pneumonia or encephalitis (infection of the brain), though it can also be from secondary infections (bacterial infection on top of viral illness).
• 1 in 500 people that catch measles die due to that immediate illness.
• 1 in 500 people that have had measles die from subacute sclerosing panencephalitis: a slow death 10 years after measles from a late, inappropriate immune response, causing progressive loss of body and brain function.
• Measles causes Immune Amnesia, especially in children: measles targets immune memory T cells, so that people with measles lose the immunity already established by past vaccines or past illnesses. People then become defenseless to most all infections. Immune Amnesia contributes to death from measles, as secondary infections occur more easily.

How you Get It:

Measles is spread through respiratory droplets. These droplets remain in the air 2 hours, so that a person can easily become infected long after the contagious person has left the vicinity.

Testing for measles:

Providers will need to do a viral PCR test (nasal swab sent to Huntsville Hospital or Diatherix) as well as a venous blood test to send off IgG and IgM antibodies.

Treatment for Measles:

We don't have any.

Prevention:

• MMR vaccine given at 1 year of age is 93% protective. A second MMR vaccine given at least 28 days after the first dose is 97-99% protective. The second dose is usually given at 4 years of age, but can be given much earlier.
• The 2 vaccines after 1 year of age are believed to offer life-long immunity. There is no harm in getting a 3rd dose, but it is not currently thought to be needed.
• Infants 6-12 months of age may have an MMR vaccine. This is called Dose 0 because it does not offer life-long immunity, so it cannot replace the other 2 vaccines. However, it helps in the short-term.
• There is NO preservative in the MMR vaccine or the diluent used to mix it.
• For the unvaccinated: Post-exposure prevention with an MMR vaccine within 72 hours of exposure may help lessen the measles severity.
• Also, IVIG or IMIG (antibodies collected from people who have been vaccinated and administered IV or as a shot) given up to 6 days post-exposure may help lessen the measles severity.
• Pregnant women and immunocompromised people cannot take an MMR vaccine. They can have IVIG, IMIG if they are exposed.

Information above is from Dr David Kimberlin, Co-Chair of Pediatric Infectious Disease at UAB and also editor of the Red Book of Infectious Disease.

At HPA, we have the MMR vaccine and providers ready to give it! Due to the case of measles in North Alabama, it is reasonable to finish the 2-dose MMR series early. This is safe and effective, offering no drawbacks. Additionally, the early MMR vaccine for infants 6-12 months offers some protection to our most-vulnerable. Send a portal with questions or to schedule a shot-clinic appointment for your child.