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Why is measles dangerous?

The recent measles outbreak underscores the need for every child to be vaccinated. Jesse Couk, M.D., a Piedmont infectious disease specialist, explains why measles is such a dangerous illness and how it can be prevented.

What makes measles so threatening?

Measles is a virus that is one of the most contagious agents known to man. There are case reports of individuals who became infected with measles from others roughly an hour after visiting the same location, without the two individuals ever having come into contact. Measles can cause pneumonia and encephalitis, which can be fatal. Pneumonia occurs in 6 percent of measles cases and is the most common cause of death. Neurologic infection is rare, occurring in only 1 out of 1000 measles cases, but with a much higher risk of permanent harm including death.

Following measles infection, there is a loss of immune memory that results in immunosuppression, which increases risk for mortality for up to three years after measles infection. Additionally, rare but potentially fatal complications can occur after infection, including a demyelinating disease called acute disseminated encephalomyelitis (ADEM), which can occur two weeks after infection, and subacute sclerosing panencephalitis (SSPE), which typically occurs 7-10 years after infection.

How can people avoid catching measles?

Immunization is very effective. Measles could be eradicated if we can promote global immunization efforts, but the recent anti-vaccination movement has resulted in a global increase in measles cases as well as the return of measles in locations where it had been eradicated.

How is measles spread?

Measles is spread from person to person and is airborne, meaning it can be spread without touching any surfaces or exposed to any particulates. Measles can remain live within the air for up to two hours after a person infected with measles coughs or sneezes. Individuals are considered contagious from four days before through four days after the rash appears.

Are adults at risk for measles, too?

Adults who have not been vaccinated or who had their immune system compromised following organ transplant or chemotherapy are at risk.

Where can you get the vaccination? How long does it take to "kick in"? Are there any side effects of the vaccination to be aware of?

The measles vaccine is part of a live virus vaccine series called MMR. MMR requires at least two doses and is typically given between 12-15 months and 4-6 years of age. However, the second dose can be given earlier as long as it is separated by at least 28 days.

Is this measles outbreak concerning? 

Yes. The measles outbreak is particularly concerning given how easily it is spread and that it is potentially fatal. Even more concerning is the continued anti-vaccination movement, which results in hesitance to immunize children even among parents who would not describe themselves as part of the movement. At this point I don’t see any evidence that the movement will shrink, despite severe health outcomes directly caused by the movement and substantial literature revealing the safety of immunization.

Do you expect this measles outbreak to be contained? 

Because MMR is extremely effective, we will be able to contain the current outbreaks, but future outbreaks in other locations will continue unless we can eradicate measles through global immunization efforts. At this point I am not optimistic, given the hard line anti-immunization attitudes among a small but not insignificant number of individuals.

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