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 dangerous 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% 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 the risk for mortality for up to three years after measles infection. Rare but potentially fatal complications can occur after infection, including ADEM about two weeks later and SSPE, which usually develops 7–10 years afterward.

How can people avoid catching measles?

Immunization is very effective. If we can promote global immunization efforts, measles could be eradicated. Still, the recent anti-vaccination movement has resulted in a worldwide increase in measles cases and the return of measles in locations where it had been eradicated.

How does measles spread?

Measles is spread from person to person and is airborne, meaning it can spread without touching surfaces or exposure to particulates. Measles can remain live in 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 are not vaccinated or who have their immune system compromised following organ transplant or chemotherapy are at risk.

When should I be vaccinated for measles?

The measles vaccine is part of a live virus vaccine series called MMR. MMR requires at least two doses; children typically receive it at 12-15 months and 4-6 years. However, doctors can give a second dose earlier if separated by at least 28 days.

Is this measles outbreak concerning? 

Yes. The measles outbreak is particularly concerning given how easily it spreads and 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. Doctors 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 to contain this measles outbreak? 

Because MMR is highly effective, we can contain the current outbreaks, but future outbreaks in other locations will continue unless we can eradicate measles through global immunization efforts. Doctors are not optimistic at this point, given the hard-line anti-immunization attitudes among a small but not insignificant number of individuals.

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