Measles Serves as a Reminder of the Importance of Vaccination
Although measles was declared eliminated in the United States in 2000, almost 1,300 cases of measles were reported in 31 states in the U.S. in 2019— the greatest number since 1992. The 2019 U.S. measles outbreaks were all linked to travel-related cases that reached at-risk populations (un- or under vaccinated against measles) in the United States.
Measles is more easily spread than almost any other disease. The virus that causes measles lives in the nose and throat and is sprayed into the air when an infected person sneezes, coughs or talks. It can stay in the air for up to 2 hours. Other people nearby can then inhale the virus. Touching tissues or sharing a cup used by someone who has measles can also spread the virus. People with measles can spread the disease 4 days before the rash begins until 4 days after rash onset. The first symptoms appear 10 – 14 days after a person is exposed.
Outbreaks can happen in areas where people may be unvaccinated or under-vaccinated, including the United States. Right now, measles outbreaks are occurring in every region of the world. Measles can enter the United States through infected travelers entering or travelling through to the U.S. as well as through infected U.S. travelers returning from other countries.
According to the Centers for Disease Control and Prevention (CDC), over 61 million doses of measles-containing vaccine were postponed or missed from 2020 to 2022 due to COVID-19 related delays in supplementary immunization activities. This increases the risk of bigger outbreaks around the world, including the United States.
Measles in Massachusetts
In April of 2019, during the above-mentioned measles outbreak, the Massachusetts Department of Public Health (MA DPH) investigated more than 60 suspected cases of measles, nearly triple the number of suspected cases from the previous year. According to the World Health Organization, there was a 300 percent increase in measles world-wide in 2019 compared to 2018. At the time, MA DPH urged all Massachusetts residents to take the outbreak seriously and determine whether they had evidence of immunity to measles.
What is “Evidence of Immunity”?
Evidence of immunity includes written documentation of two doses of MMR vaccine, a positive blood test called a titer which shows immunity to measles, or a previous laboratory-confirmed diagnosis of measles. Anyone who does not have evidence of immunity to measles and is over 12 months of age should get a dose of MMR vaccine as soon as possible. Children six months through 11 months who are going to be traveling internationally should also receive at least one dose of MMR vaccine.
Measles is very contagious. Early symptoms of measles occur 10 days to 2 weeks after exposure and may resemble a cold (with fever, cough, runny nose, and red eyes) and a rash occurs on the skin 2-4 days after the initial symptoms develop. The rash usually appears first on the head and then moves down the body. The rash typically lasts a few days and then disappears in the same order. Medical complications can include pneumonia and encephalitis. Some people need to be hospitalized. People with measles may be contagious for up to four days before the rash appears and for four days after the day the rash appears.
Another Measles Outbreak in 2024?
As of March 14, 2024, a total of 58 measles cases were reported by 17 jurisdictions: Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York City, Ohio, Pennsylvania, Virginia, and Washington.
In a given year, more measles cases can occur for any of the following reasons:
- An increase in the number of travelers who get measles abroad and bring it into the U.S., and/or
- Further spread of measles in U.S. communities with pockets of unvaccinated people.
Preventing Measles: the Importance of Vaccination
The 2019 outbreak of measles was the greatest number of cases reported in the U.S. since 1992. The majority of cases were among people who were not vaccinated against measles. Measles is more likely to spread and cause outbreaks in U.S. communities where groups of people are unvaccinated.
The Massachusetts Department of Health recommends the following:
- Get vaccinated. Measles vaccine is usually given in a shot called MMR, which protects against measles, mumps and rubella. There are now many fewer cases of these three diseases because children get the MMR vaccine. Protect your children by having them vaccinated when they are 12 – 15 months old, and again when they are about to enter kindergarten. According to the US Centers for Disease Control and Prevention (CDC), two doses of MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.
- State regulations require certain groups to be vaccinated against measles. Some health care workers and all children in kindergarten – 12th grade and college need to have 2 doses of MMR vaccine for school entry. Children in childcare and preschool need 1 dose of MMR and childcare workers also need to have 1 or 2 doses of measles containing vaccine, depending on their age and other factors. A blood test or other laboratory result that provides evidence of immunity can also be used to fulfill this requirement for all groups.
- People in high-risk groups such as health care workers (paid, unpaid and volunteer), health science students and international travelers should have 2 doses of MMR, regardless of year of birth. Infants six months through eleven months of age should receive one dose of MMR vaccine prior to international travel.
- Adults born in or after 1957 should have at least 1 dose of MMR.
- Women who plan to have children and are not immune should get MMR at least 4 weeks before getting pregnant.
- If you have been exposed to someone with measles, talk to your doctor or nurse right away to see if you need a vaccination. If you get the vaccine within 3 days (72 hours) after being exposed, it will help protect you against measles. People who cannot be vaccinated can be treated with immune globulin (IG antibodies) up to 6 days after exposure. IG may not prevent measles, but it does make the disease milder.
- People with measles should avoid all public activities until they are well again. State regulations require anyone who catches measles to be isolated for 4 days after the rash appears. That means they stay away from public places like day care centers, school and work.
- Because measles is more common in other parts of the world, people who travel to other countries should make sure that they are protected before traveling.
- All travelers 12 months of age and older should have 2 doses of MMR given at least 28 days apart or a blood test showing immunity.
- Children 6 through 11 months of age should receive 1 dose of MMR before traveling. These children will still need to get their 2 routine doses of MMR at 12-15 months and 4-6 years of age.
Who should NOT get the measles vaccine?
- People who have serious allergies to gelatin, the drug neomycin or a previous dose of the vaccine.
- Pregnant women or women who are trying to get pregnant within 4 weeks should not get MMR vaccine until after they deliver their babies.
- People with a severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised) should check with their doctor or nurse before getting vaccinated.
- People who have recently had a transfusion or were given other blood products should check with their doctor or nurse before getting vaccinated.
- People with high fevers should not be vaccinated until after the fever and other symptoms are gone.
Where can I get more information?
- Your doctor, nurse or clinic, or your local board of health (listed in the phone book under local government).
- The Massachusetts Department of Public Health, Bureau of Infectious Disease and Laboratory Sciences at (617) 983-6800 or on the MDPH Website.
- Boston providers and residents may also call the Boston Public Health Commission at (617) 534-5611.
- CDC National Contact Center Hotline (Monday-Friday 8 a.m.-8 p.m.):
- CDC-INFO: 1-800-CDC-INFO (800-232-4636) (English or Spanish)
- TTY: (888) 232-6348
- E-mail address: cdcinfo@cdc.gov
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