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Home , Measles, Measles vaccine, MMR vaccine, Mumps vaccine, Rubella vaccine

: Questions and AnswersQ&A information about the and

What causes measles? Measles can be especially severe in persons with Measles is caused by a . compromised immune systems. Measles is more severe in malnourished children, particularly those How does measles spread? with deficiency. In developing countries, the fatality rate may be as high as 25%. Measles is spread from person to person through the air by infectious droplets; it is highly contagious. How is measles diagnosed? How long does it take to show signs of measles Measles is diagnosed by a combination of the patient’s after being exposed? symptoms and by laboratory tests. It takes an average of 10–12 days from exposure to Is there a treatment for measles? the first symptom, which is usually . The measles There is no specific treatment for measles. People doesn’t usually appear until approximately 14 with measles need bed rest, fluids, and control days after exposure, 2–3 days after the fever begins. of fever. Patients with complications may need treat- What are the symptoms of measles? ment specific to their problem. Symptoms include fever, runny nose, , loss of How long is a person with measles contagious? appetite, “pink eye,” and a rash. The rash usually lasts Measles is highly contagious and can be transmitted 5–6 days and begins at the hairline, moves to the from four days before the rash becomes visible to face and upper neck, and proceeds down the body. four days after the rash appears. How serious is measles? What should be done if someone is exposed to Measles can be a serious disease, with 30% of measles? reported cases experiencing one or more complica- tions. Death from measles occurs in 2 to 3 per 1,000 Notification of the exposure should be communicated reported cases in the . Complications to a doctor. If the person has not been vaccinated, from measles are more common among very young measles may prevent disease if given within children (younger than five years) and adults (older 72 hours of exposure. Immune globulin (a blood than 20 years). product containing antibodies to the measles virus) may prevent or lessen the severity of measles if What are possible complications from measles? given within six days of exposure. is the most common of How common is measles in the United States? measles (occurring in 8% of cases), especially in young children. Ear occur in 7% of reported Before the vaccine was licensed in 1963, there were cases. , occurring in 6% of reported an estimated 3–4 million cases each year. In the cases, accounts for 60% of measles-related deaths. years following 1963, the number of measles cases Approximately one out of one thousand cases will dropped dramatically with only 1,497 cases in 1983, develop acute , an inflammation of the the lowest annual total reported up to that time. brain. This serious complication can lead to perma- By 2004, only 37 cases were reported – a record low. nent brain damage. However, new cases continued to be reported, pri- marily in populations that have refused Measles during increases the risk of for religious or personal belief reasons. From 2001 premature labor, , and low-birth-weight through 2011, an average of 63 measles cases (range, infants, although birth defects have not been linked 37 to 220) and four outbreaks were reported each to measles exposure. continued on the next page �

Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4209.pdf • Item #P4209 (11/18) Measles: Questions and Answers (continued) page 2 of 4

year in the United States. Of the 911 cases, a total documentation of vaccination or other evidence of 372 (41%) were imported from outside the U.S. of . Additionally, some healthcare personnel and an additional 432 (47%) were associated with who were born before 1957 may also need proof of importations. Hospitalization was reported for vaccination or other evidence of immunity. 225 (25%) cases. Two deaths were reported. Most cases occur among people who declined vaccination What kind of “evidence of immunity” can because of a religious, or personal objection. substitute for MMR vaccination? The U.S. experienced a record number of measles Evidence of immunity can be shown by having labo- cases during 2014, with 644 cases reported from ratory evidence of immunity to measles, , 27 states. This is the greatest number of cases since and/or or laboratory confirmation of disease. measles elimination was documented in the U.S. However, if a person doesn’t have evidence of immu- in 2000. In 2015, the U.S. experienced a large, multi- nity to all three (e.g., measles, mumps, and state outbreak of measles linked to an amusement rubella), they would still need to get vaccinated with park; for up-to-date case counts and outbreak infor- MMR since the vaccine is not available as a single mation, visit CDC’s Measles Cases and Outbreaks antigen product in the U.S. web page at www.cdc.gov/measles/cases-outbreaks.html. At what age should the first dose of MMR be given? Can someone get measles more than once? The first dose of MMR should be given on or after the No. child’s first birthday; the recommended age range is from 12–15 months. A dose given before 12 months When did vaccines for measles, mumps, and of age will not be counted, so the child’s medical rubella become available? appointment should be scheduled with this in mind. The first measles vaccines (an inactivated and a live virus product) became available in 1963, both When should children get the second MMR shot? of which were largely replaced by a further attenu- The second dose is usually given when the child is ated live virus vaccine that was licensed in 1968. 4–6 years old, or before he or she enters kindergarten The first became available in 1967, or first grade. However, the second dose can be followed by the in 1969. These given earlier as long as there has been an interval three vaccines were combined in 1971 to form the of at least 28 days since the first dose. measles-mumps-rubella (MMR) vaccine. A vaccine that combines both MMR and varicella () How effective is this vaccine? vaccines, known as MMRV, became available in The first dose of MMR produces immunity to measles 2005. Single antigen measles, mumps, and rubella and rubella in 90% to 95% of recipients. The second vaccines are no longer available in the U.S. dose of MMR is intended to produce immunity in those who did not respond to the first dose, but a What kind of vaccine is it? very small percentage of people may not be protected MMR vaccine contains live, attenuated (or weakened) even after a second dose. strains of the measles, mumps, and rubella . Which adolescents and adults should receive How is this vaccine given? the MMR vaccine? This vaccine is a shot given subcutaneously (in the All unvaccinated adolescents without a valid contra- fatty layer of tissue under the skin). indication to the vaccine should have documentation of two doses of MMR. All adults born in or after Who should get this vaccine? 1957 should also have documentation of vaccination All children, adolescents, and adults born in 1957 or other evidence of immunity. or later without a valid contraindication should have continued on the next page �

Immunization Action Coalition • Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4209.pdf • Item #P4209 (11/18) Measles: Questions and Answers (continued) page 3 of 4

Adults born before 1957 are likely to have had measles rubella immunity or laboratory confirmation of and/or mumps disease as a child and are generally previous disease. These facilities should vaccinate (but not always) considered not to need vaccination. healthcare personnel with MMR during an outbreak of any of the diseases, regardless of birth year. Which adults need two doses of MMR vaccine? Certain adults are at higher risk of exposure to mea- Who recommends this vaccine? sles, mumps, and/or rubella and may need a second The Centers for Disease Control and Prevention dose of MMR unless they have other evidence of (CDC), the American Academy of Pediatrics (AAP), immunity; this includes adults who are: the American Academy of Family Physicians (AAFP), • students in postsecondary educational institutions the American College of Obstetricians and Gyne- (for measles and mumps) cologists, and the American College of Physicians (ACP) have all recommended this vaccine. • healthcare personnel (for measles and mumps) • living in a community experiencing an outbreak How safe is this vaccine? or recently exposed to the disease (for measles Hundreds of millions of doses of measles, mumps, and mumps) and rubella vaccine prepared either as separate • planning to travel internationally (for measles and vaccines or as the combined MMR have been given mumps) in the United States, and its safety record is excellent. • people who received inactivated (killed) or measles vaccine of unknown type during What side effects have been reported with this 1963–1967 should be revaccinated with two doses vaccine? of MMR vaccine. Fever is the most common side effect, occurring in • people vaccinated before 1979 with either killed 5%–15% of vaccine recipients. About 5% of people mumps vaccine or mumps vaccine of unknown type develop a mild rash. When they occur, fever and who are at high risk for mumps (e.g., rash usually appear 7–12 days after vaccination. persons who are working in a healthcare facility) About 25% of adult women receiving MMR vaccine should be considered for revaccination with 2 doses develop temporary joint pain, a symptom related of MMR vaccine. to the rubella component of the combined vaccine. Joint pain only occurs in women who are not immune Why do healthcare personnel need vaccination to rubella at the time of vaccination. MMR vaccine or other evidence of immunity to measles, may cause thrombocytopenia (low platelet count) mumps, and rubella? at the rate of about 1 case per 30,000–40,000 vacci- nated people. Cases are almost always temporary People who work in medical facilities are at much and not life-threatening. More severe reactions, higher risk for being exposed to disease than is the including allergic reactions, are rare. Other severe general population. Making sure that all employees problems (e.g., deafness, permanent brain damage) are immune to these diseases protects both the occur so rarely that experts cannot be sure whether employee and the patients with whom he or she they are caused by the vaccine or not. may have contact. All people working in a healthcare facility in any capacity should have documentation If a child develops a rash after getting the MMR of vaccination or evidence of immunity, including vaccine, is he contagious? full- or part-time employees, medical or non-medical, paid or volunteer, students, and those with or without of the vaccine viruses does not occur direct patient responsibilities. from a vaccinated person, including those who develop a rash. No special precautions (e.g., exclusion Facilities should consider vaccinating with MMR from school or work) need be taken. vaccine healthcare personnel born before 1957 who continued on the next page lack laboratory evidence of measles, mumps, and �

Immunization Action Coalition • Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4209.pdf • Item #P4209 (11/18) Measles: Questions and Answers (continued) page 4 of 4

Who should NOT receive MMR vaccine? reviews have concluded that there is no association Anyone who had a severe allergic reaction (e.g., gen- between MMR vaccine and . eralized hives, swelling of the lips, tongue, or throat, For a summary of the issues on this topic, please difficulty breathing) following the first dose of MMR read “Do Vaccines Cause Autism?” on the website should not receive a second dose. Anyone knowing of the Vaccine Education Center at Children’s Hospital they are allergic to an MMR component (e.g., , of Philadelphia. This discussion can be accessed ) should not receive this vaccine. at www.chop.edu/centers-programs/vaccine-educa- As with all live virus vaccines, women known to be tion-center/vaccines-and-other-conditions/vaccines- pregnant should not receive the MMR vaccine, and autism.html pregnancy should be avoided for four weeks following Dr. Ari Brown has written a good piece for parents vaccination with MMR. Children and other household questioning the safety of vaccines. To access “Clear contacts of pregnant women should be vaccinated Answers & Smart Advice about Your Baby’s Shots,” according to the recommended schedule. Women go to: www.immunize.org/catg.d/p2068.pdf. who are breast-feeding can be vaccinated. For more information, visit CDC’s web page about Severely immunocompromised people should not be at www.cdc.gov/vaccinesafety/ given MMR vaccine. This includes people with con- concerns/autism/index.html ditions such as congenital , AIDS, , lymphoma, generalized malignancy, and Can the live virus in the vaccine cause measles, those receiving treatment for cancer with drugs, radi- mumps, and/or rubella? ation, or large doses of . Household Because the measles, mumps, and rubella viruses contacts of immunocompromised people should be in the MMR vaccine are weak versions of the disease vaccinated according to the recommended schedule. viruses, they may cause a very mild case of the disease Although people with AIDS or HIV infection with they were designed to prevent; however, it is usually signs of serious should not be much milder than the natural disease and is referred given MMR, people with HIV infection who do not to as an adverse reaction to the vaccine. have laboratory evidence of severe immunosuppres- sion can and should be vaccinated against measles. What if a pregnant woman inadvertently got the MMR vaccine? Can individuals with receive MMR Women are advised not to receive any live virus vaccine? vaccine during pregnancy as a safety precaution In the past it was believed that people who were based on the theoretical possibility of a live vaccine allergic to eggs would be at risk of an allergic reaction causing disease (e.g., leading to from the vaccine because the vaccine is grown in congenital rubella syndrome [CRS]). tissue from chick embryos. However, recent studies Because a number of women have inadvertently have shown that this is not the case. MMR may be received this vaccine while pregnant or soon before given to egg-allergic individuals without prior testing conception, the Centers for Disease Control and or use of special precautions. Prevention has collected data about the outcomes of their births. From 1971–1989, no evidence of Does the MMR vaccine cause autism? CRS occurred in the 324 infants born to 321 women There is no scientific evidence that measles, MMR, who received rubella vaccine while pregnant and or any other vaccine causes autism. The question continued pregnancy to term. As any risk to the about a possible link between MMR vaccine and fetus from rubella vaccine appears to be extremely autism has been extensively reviewed by independent low or zero, individual counseling of women in this groups of experts in the U.S. including the National situation is recommended, rather than routine Academy of Sciences’ Institute of Medicine. These termination of pregnancy.

Immunization Action Coalition • Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p4209.pdf • Item #P4209 (11/18)