Measles in the US: Vaccines, treatment, and what to do to protect your family – Vox.com

So far this year, the Centers for Disease Control and Prevention (CDC) has reported 45 measles cases from 17 jurisdictions. Thats a lot compared with 2023, when 58 cases were reported over the entire calendar year.

Its been nearly 25 years since measles was officially eliminated in the US. The declaration meant the infection hadnt been transmitted continuously anywhere in the country for more than a year. However, it doesnt mean measles couldnt come back: Under certain conditions lots of cases imported from abroad, not enough people vaccinated against the infection, and not enough tools to fight back measles could re-entrench itself stateside.

Thats why public health authorities monitor measles cases and vaccination rates against the infection. And why, when cases rise while vaccination rates drop, they fret.

Measles is a viral infection that causes fever, rash, and cough, which can be complicated by severe, life-threatening infections of the ears, lungs, and brain. Its particularly likely to cause severe disease in children under 5 years old and in immunocompromised people. To make matters worse, its one of the most contagious diseases out there: Infectious particles can hang out in the air or on surfaces for hours, and, on average, each infected person infects another 12 to 18 people.

When measles turns up in the US, its because it was brought to the country from the outside more often than not, by US residents returning from travel abroad. Theres a lot of measles in the world: In 2022, the infection caused more than 9 million cases and killed more than 136,000 people globally, most of them children. Although countries in Eastern Europe, the Middle East, and South Asia currently top the list of measles cases globally, there have also been multiple outbreaks in Western Europe over the past year.

Theres a highly effective vaccine to prevent measles but to protect the youngest babies and immunocompromised people in any population, everyone around them needs to have been vaccinated. Part of whats keeping US public health experts up at night is that, increasingly, thats not the case. Still, its a situation people can do something about if they know how and understand the stakes.

Heres what you need to know.

Unvaccinated children and immunocompromised people especially those receiving certain cancer treatments face the highest risk when measles is in circulation.

Even an uncomplicated case of measles is really awful, said Sarah Lim, an infectious disease doctor and medical specialist at the Minnesota Department of Health, during a press conference on March 12. Measles infections are so often severe that about one in five unvaccinated people who get infected are hospitalized, and between one and three of every 1,000 measles infections end in death.

In its early stages, measles infection can cause a range of symptoms, including high fevers, cough, runny nose, red eyes, and full-body rash. About one-third of infected kids get complications, which can include severe diarrhea, ear infections, and pneumonia. Brain infection that can lead to brain damage and epilepsy, called encephalitis, occurs in about one of every 1,000 kids who get infected with measles.

Measles can also do something else that few other infections are known to do: It can wipe out kids immune memory, leaving them unprotected from other bacterial and viral pathogens. That effect, and the increased susceptibility to other infections that comes with it, can last for years after infection.

Travel to parts of the world where measles circulates widely increases the risk of infection. That makes it important to ensure you and your family are protected from measles in addition to all the other things prior to travel.

The biggest number of measles cases the US has seen over the past 25 years was in 2019, when nearly 1,300 infections were reported over the course of the year. That year, nine out of every 10 cases occurred in unvaccinated people living in close-knit communities. A single outbreak in an Orthodox Jewish community in New York involved 649 cases; another outbreak involving 71 cases occurred in a Washington State community of recent immigrants from the former Soviet Union.

Whats different so far about this years US measles cases is that theyre occurring in lots of little sparks across the nation, as Katelyn Jetelina put it in her recent newsletter. The more embers, the more likely it is that they find unvaccinated pockets and spread like wildfire, she wrote.

We dont yet know whether spread among close-knit communities is contributing to transmission in the US. Although the CDC is reporting where cases are taking place, it hasnt reported the ages or any other demographic information about the people whove been infected. An agency representative declined to share this information with Vox when we reached out on March 12.

Another concerning feature about this years cases is that theyre happening at a time when a relatively large proportion of kids are going unvaccinated against measles. In a November publication, CDC scientists reported 7 percent of kindergarteners hadnt been vaccinated against measles during the 2022-2023 school year. At the same time, vaccine exemptions reached an all-time high, with more than 5 percent of kids exempted in 10 states.

To make matters worse, according to recent reporting in the LA Times, a lot of parents are choosing to delay measles vaccination in their infants, which increases vulnerability to the most severe effects of measles in a group thats already at the highest risk of complications.

The World Health Organization (WHO) cautions that the risk of a measles outbreak increases dramatically if more than 5 percent of people in a community arent vaccinated, which makes these numbers pretty concerning. Whats even more alarming is that these numbers are averages: In some states, as many as 22 percent of people are unvaccinated, and that number is likely much higher in some smaller geographic pockets.

Thats where youre really talking about throwing a match [into a pile of kindling] and having a large fire, says Jane Zucker, an infectious disease doctor and epidemiologist who retired in 2023 after 30 years with the New York City health departments Bureau of Immunization. Thats what youre really most anxious about.

Theres no medicine to treat measles infection once its taken hold, which makes prevention the main strategy for avoiding the virus worst effects.

The best news about measles and the reason most of us have no idea what it looks like is that the vaccine that prevents it is extremely effective and safe.

That vaccine, called MMR because it protects children from measles, mumps, and rubella is what experts call a live-attenuated vaccine. That means its made using a weakened version of the measles virus that cant actually cause the disease. Because they so closely replicate the actual virus, these kinds of vaccines induce the strongest and longest-lasting response of any type of vaccine including Covid-19 vaccines. MMR vaccines are 97 percent effective at preventing symptomatic measles infections.

These vaccines can even protect people after theyre exposed to measles if theyre given within 72 hours of exposure, and theyre extraordinarily safe.

Who should get vaccinated against measles? Babies (lifelong immunity comes after two shots, the first at 12 months old and the second at 4 to 6 years of age) and almost everyone else who doesnt have proof that theyve been vaccinated before should get vaccinated, according to the CDC.

Thats especially true if those people without vaccination proof work in health care or are about to travel to places where theres lots of measles in circulation which these days includes Europe, says Zucker. Babies 6 to 12 months should also get an MMR shot if theyre going to be traveling; because their immune systems arent mature enough at that age for the vaccine to take, theyll still need another two-shot series after their first birthday.

Many adults whove already been vaccinated wont ever need another measles vaccine. Thats because all the versions of measles vaccines in use since 1968 have been strong enough to give lifelong protection against infection. So long as youre certain youve had two vaccines in the years since then that is, its documented somewhere in your medical record that you got them you dont need a repeat. The exception is for adults who only got vaccinated between 1963 and 1967: Because the version used during those years was too weak to give lifelong immunity, theyre not considered protected unless theyve gotten at least one dose of a newer version of the vaccine.

Another group that doesnt need to worry about vaccination is most adults over 65. Measles was so common before the vaccine was available that experts assume people born in those years were exposed and are immune. So if you were born before 1957, you dont need a vaccine unless youre in a high-risk situation for example, you work in health care or youre about to travel to a place where theres a lot of measles in circulation.

There are some people who should wait to get an MMR vaccine if theyre unvaccinated or if their vaccine history isnt clear. Live vaccines like this one are typically not recommended for people with weakened immune systems, which include pregnant folks and some immunocompromised people. Some other conditions also make it sensible to hold off on vaccination have a look at the CDCs answers to Who Should Not Get MMR Vaccine? here and talk to a health care provider if youre not sure what to do.

A blood test called a measles serology can measure the level of measles antibodies in a persons blood. If the level is high, its safe to assume that person is immune to measles, either as a result of vaccination or past infection. But low scores on these tests may not be very meaningful, says Zucker: Many people with low levels of measles antibodies actually have measles protection due to prior vaccination, making it a bad test for determining whether immunizations documented a long time ago are still providing protection. For that reason, the CDC says a history of vaccination supersedes a serology result when it comes to determining whether a person is protected from measles.

Health experts sometimes administer these tests in outbreak settings and during pregnancy, but the results are typically used in ways specific to those scenarios. So you dont need a serology to prove youre vaccinated if the shots are documented in your medical record and in any case, its harmless to get a repeat vaccination even if youve been vaccinated before. If you dont know if youre immune, says Zucker, its easier to just get yourself vaccinated.

Where US measles cases go is really up to us.

Theres hope for controlling measles damage in the US if more parents opt to vaccinate their babies as soon as theyre eligible, if they keep unvaccinated kids home from school, and if they vaccinate their unvaccinated children as soon as they hear about a potential exposure.

Itll also help if public health authorities have adequate support and staffing to educate the public about measles, provide and document vaccination as with immune registries and intervene when outbreaks happen.

However, last years national debt ceiling deal resulted in cuts to states child vaccination programs. Furthermore, the wild nonsense on vaccines that pervades social media and, occasionally, official messaging, as in the case of Floridas surgeon general makes it challenging for many parents to disentangle the common-sense guidance from the crap.

Joshua Barocas, an infectious disease doctor at the University of Colorado, said during March 12s press conference that pushing back against measles is a team effort and that removing shame from the equation is key. Parents are flooded with tons of information, some of that [being] misinformation and so if you are a parent whos been on the fence, now is the time to catch up on your kids delayed vaccines, he said.

I would also encourage health care workers to welcome people with open, non-judgmental arms, Barocas said.

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Measles in the US: Vaccines, treatment, and what to do to protect your family - Vox.com