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Infectious Disease Expert Answers Questions about Measles and the Measles Vaccine

Measles is often initially mistaken for other respiratory illnesses, but can have serious complications for some patients.
Measles is the most contagious virus circulating today in the United States, according to PediatricInfectious Disease Physician Mark Schleiss, MD.

Measles is the most contagious virus circulating today in the United States, according to Pediatric Infectious Disease Physician Mark Schleiss, MD.

Schleiss, an expert on infectious diseases and immunology, has been on the forefront of the national discussion regarding the recent measles cases discovered in California and other states—and the declining vaccination rates that helped fuel the outbreak.

Schleiss, who sees patients at University of Minnesota Masonic Children’s Hospital, took a few minutes to answer some common questions about measles symptoms, treatment and prevention and the measles vaccine.

What are the most common symptoms of measles?
The most common measles symptoms are similar to the symptoms of a severe respiratory tract infection. You may have a profusely runny nose, a severe cough and red eyes. Those kinds of symptoms precede the onset of the rash by several days, and because they are non-descript and are similar to other, less-serious illnesses, measles can be overlooked initially. Unfortunately, people with measles are extremely contagious prior to the onset of the rash. The rash usually occurs on the fourth or fifth day of the illness, and typically begins on the head and neck, then spreads to the rest of the body. You can also look for white spots that appear in the mouth on the inner surface of the cheek. The rash peaks during days 4-7 and gradually begins to fade around days 8, 9 or 10 of the illness. The cough can persist throughout the full 10-day to two-week course of the disease.

What possible complications can occur if the disease is allowed to progress unchecked?
It’s important to be aware of some of the complications from measles. The most feared complication is encephalitis, which occurs in roughly one case in 1,000. When it occurs, it can cause permanent brain damage and hearing loss. Another common complication is pneumonia, which occurs in roughly 6-10 percent of cases overall. Other common complications include ear infections, mastoid infections, or a croup-like illness with a barking cough and risk of airway obstruction. Very rarely, a patient may contract another form of encephalitis, Subacute sclerosing panencephalitis (SSPE). In these cases, it seems the measles virus hides in the brain, only to come out long after the disease initially occurs to produce an unusual version of encephalitis later in life. The chances of this occurring are roughly one in 100,000 cases.

How is measles spread? I’ve heard it’s a highly contagious disease. Is this true?
Part of the reason measles is so effective at spreading is that it actually doesn’t require direct contact. A person infected with measles can saturate the air and surfaces of a room with the measles virus, and leave the room. Those droplets or the virus can persist for several hours, so others can become infected indirectly by airborne spread or by contact with those contaminated droplets. The virus can also be spread by direct person-to-person contact.

The multiple modes of transmission help explain the severe communicability of measles. I think it’s probably the most contagious and infectious agent we encounter today in the United States, which is why high levels of vaccine coverage are needed. For other, less contagious diseases, you might be able to achieve herd immunity with 70-80 percent of the population vaccinated. But with measles, you really need to have 95-99 percent of the population immunized because of its incredible communicability. That’s why, when the vaccination rate drops down into the low 90s or 80s or less, you set the stage for a really big outbreak.

What should I do if I believe one of my family members has contracted measles? When should I consider taking my family member in to see a doctor?
Measles has a disproportionately high risk of mortality and severe complications in very young children, so children under a year in age are at highest risk. If you have a young child in the household that’s not immune and has contracted measles, or if you have a family member with measles who has a compromised immune system because of chemotherapy, transplantation or other conditions, these are high-risk scenarios. Pregnancy is another high-risk situation. Any individual with difficulty breathing should also be evaluated, given the risk of pneumonia with measles.

With measles and suspected measles, it’s always a good idea to call your providers in advance of bringing a patient in for evaluation. It allows medical providers on the other end to prepare for triage. I encourage having a robust dialogue with your primary care doctor, if you’re concerned. I also recommend a post-exposure vaccination if it’s given within 72 hours of initial measles exposure; it can help reduce the severity of the illness.

How effective is the measles vaccine at preventing measles? Why is it important to get two doses of the vaccine?
The measles vaccine is highly effective. A single dose of the vaccine will confer immunity on about 95 percent of vaccine recipients. Since the 1990s, there’s been a recommendation for a second dose. This isn’t really a booster dose. The second dose is to capture the 4-5 percent who didn’t respond the first time. If someone receives both doses of vaccine, the degree of protection is 99 percent.

Why should someone who hasn’t received the vaccine consider vaccination for this?
Ultimately, getting your children vaccinated is an act of love and an act of good parenting. You vaccinate your children to try and save their lives. We also have a collective responsibility to each other. What gives one parent the right to put other parents’ children at risk, especially if a child is recovering from leukemia, a tumor or a transplant—medical conditions that prevent children from receiving vaccinations?

I think parents should be able to make choices in how they raise their children and how they want to live their lives, but in a civilized society, we also say there are limits. Sometimes, it’s not simply a matter of personal choice when our decisions put other people at risk. The measles vaccine is highly effective, extremely safe and protects not only your child, but other children

Anything else you’d like to add?
The University of Minnesota Medical School’s Division of Pediatric Infectious Disease and Immunology is available for phone calls if you have questions or concerns about measles. Our information line is: 612-624-1112.