Measles, Mumps and Rubella

For a variety of reasons, the measles, mumps and rubella vaccine (MMR) has become the epicenter of the vaccine debate. Reasons include the controversy around the discredited 1998 Wakefield paper, the ongoing autism epidemic debate, and the increasingly accepted belief that measles is not a dangerous disease. These are all good points to discuss. However, what is almost always missing from the conversation is the global picture. Measles elimination and even eradication is achievable, if not in our lifetime then certainly in our children’s. This disease provides us an excellent opportunity to “think globally, and act locally.”  

Key Facts

  • Measles is one of the most contagious diseases on earth.
  • In 2011 there were 158,000 measles deaths globally. That’s about 430 deaths every day or 18 deaths every hour.
  • Measles cases are on the rise in Europe and the US.
  • Vaccination rates in Ashland are not sufficient to prevent an outbreak.

What is Measles?

Measles is a highly contagious viral disease mostly affecting children. It is spread via droplets from the nose, mouth or throat of infected persons. So, coughing, sneezing or touching an infected surface are all ways in which the disease is spread. The initial symptoms of measles are similar to a cold, usually appear 10–12 days after infection, and include fever, runny nose, bloodshot eyes, and tiny white spots on the inside of the mouth. Several days later, a rash develops, starting on the face and upper neck and gradually spreading downwards. Measles infections can range from being a minor yet uncomfortable disease, to a very serious one that can result in death.

Measles deaths in the US are rare but not unheard of. There is no specific treatment for measles and most people recover within 2–3 weeks. However, in those with reduced immunity and in malnourished children, measles can cause serious complications such as blindness, severe diarrhea, ear infections and pneumonia. The most severe complication is encephalitis which can lead to death.

How contagious is measles? Have we mentioned that measles is one of the most contagious diseases on earth? It can be spread to others from 4 days before to 4 days after the rash appears. “Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected with the measles virus.” –CDC

The virus remains active and contagious in the air or on infected surfaces for up to two hours. It can be transmitted by an infected person from 4 days prior to the onset of the rash to 4 days after the rash erupts. That means a child can be spreading the virus with no obvious measles symptoms. Read here about an outbreak of measles in San Diego.

Measles in the US. In 2011 there were 222 measles cases in 31 states. The average number of yearly cases in the US from 2001 until 2010 was 51.

 

Did You Know?

Measles vaccination resulted in a 71% drop in measles deaths between 2000–2011 worldwide. Hygiene and nutrition conditions have not changed significantly during this time period and so they cannot account for this success.

 

What is Mumps?

Mumps is a viral disease that spreads via droplets in the air when an infected person coughs or sneezes. Children can sometimes become infected through contact with a contaminated object. Spread of the disease can occur before symptoms are present. The virus affects the saliva glands, located between the ear and jaw, and may cause puffy cheeks and swollen glands. Click here for more information on mumps.

What is Rubella (German Measles)?

Rubella is often a mild viral disease but can have serious consequences for pregnant women and their infants. If infected with rubella in the first trimester, women have a very high risk of giving birth to a child with Congenital Rubella Syndrome (CRS). CRS can cause multiple birth defects including heart problems, deafness and blindness. More than 100,000 children are born with CRS each year. The lifelong complications and disabilities can have an immeasurable emotional, social and financial cost for families.  –The Measles Rubella Initiative

 

Get the Global Picture?

Rubella cases are increasing in Europe and Japan. About 99% of the cases were reported being unvaccinated.

 

The Vaccine

Despite all the bad press the MMR gets, it is actually a very safe vaccine. The MMR is a live attenuated vaccine that protects against all three diseases: measles, mumps and rubella. Below we have listed the risks of each disease and the risks associated with the vaccine. Immunity from the vaccine is lifelong.

What are the side effects of the measles vaccine?

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of the MMR vaccine causing serious harm, or death, is extremely small. Getting the MMR vaccine is much safer than getting the diseases. Adverse reactions to the vaccine include:

  • Fever up to 12 days post vaccination, 1 in 3,000
  • Mild rash 7 to 12 days post-vaccination, 1 in 25
  • Tempory thrombocytopenia (low platelet count), 1 in 30,000
  • Encephalitis or severe allergic reaction, 1 in 1,000,000

Serious side effects of the MMR vaccine, including death, are so rare that they can’t be statistically quantified.

Common Misconceptions

Like chickenpox, measles isn’t a very serious disease.

Many parents have the misconception that measles isn’t a serious illness because like chickenpox it was very common. But because something was once common doesn’t make it something we want to keep around. Smallpox was common but nobody seems to miss it. Many people remember having measles as a child and making a full recovery. In reality, 1 to 3 in 1,000 children who contract measles will die. Because measles is so very contagious it doesn’t take long to infect 1000 people especially in a country (or city) where measles immunity is not at 95% or greater. England and France can testify to this. And even if a death should not occur, there are other serious risks associated with measles.

When we consider the risk of a disease or a vaccination we often think about mortality (death) and not morbidity (illness). But, measles also carries a serious risk of complications, about 1 in 15, pneumonia, encephalitis, with no guarantee that a child will make a full recovery. Thirty two percent of individuals who contracted measles in the U.S. in 2011 had to be hospitalized for complications. On average 1 in 4 people with measles will be hospitalized.

The MMR vaccine causes autism.

No, the MMR does not cause autism and multiple studies have confirmed this. Check out our page on autism here.

The MMR doesn’t really work. Vaccinated kids get measles, too.

Yes, that can happen with any vaccine but not likely in the case of measles. No vaccine is 100% effective, but the measles vaccine is actually better than some other vaccines. That is what is called efficacy. Here is an example: if 1,000 people were to get the 2 recommended doses of the vaccines, about 997 of them will be protected. After the first dose 95% are immune but 2–5 out of 100 will not be protected. Here is a bigger model of how that works.

You can get the MMR in separate components.

Single antigen shots (one for measles, one for mumps, etc.) are no longer available in the US. Parents who started their children on split or single antigen shots will now need to get the full MMR. The good news is that there is no known harm in getting an extra dose. Even Dr. Sears will attest to this. “If a child already has some immunity to one of the diseases from a previous vaccine, I’ve never seen any research that shows a child is any more likely to react to a second dose compared to anyone just getting their first dose… I’ve seen no evidence that getting an extra dose is dangerous. I know it’s very small consolation, but I just mention this so that parents aren’t afraid to get any extra components of the MMR if they decide to.” –Dr. Robert Sears.

Show Me the Numbers

Risk of Disease

Risk of the MMR Vaccine

Measles

  • Pneumonia: 6 in 100
  • Encephalitis: 1 in 1,000
  • Thrombocytopenia: 1 in 30,000
  • Death: 1 or 2 in 1,000
  • Fever: 1 in 3,000
  • Mild, measles-like rash in 5%
  • Encephalitis or severe allergic reaction: 1 in 1,000,000
Rubella

  • Congenital Rubella Syndrome: 1 in 4 (if woman becomes infected early in pregnancy)
Mumps

  • Deafness: 1 in 20,000
  • Serious complications are rare

Bringing It Home

There is a rapidly increasing number of kids who grew up in Ashland and remain unimmunized as teenagers and college students. Given that so many of us are blessed with the financial resources and opportunities to travel, we must be vigilant in the protection of our community. And, as we see repeatedly in the US, measles is only a plane ride away. As part of a project with the CDC, the Ashland School District and Jackson County Health and Human Services, experts put together a measles worst-case scenario outbreak model for Ashland School District. This was done to address the ever increasing threat of an outbreak here. This graph represents the Epidemic Curve of the “Worst-Case” scenario. It shows the number of infections at any one time in students if public health takes no intervening action. (Of course they would, but this gives you an idea.) The longest outbreak duration is at ~153 days at Walker Elementary, which means unvaccinated children could be kept out of school for that period. Using this 2012 data, Jackson County Health and Human Services ran a tabletop exercise simulating an outbreak of measles in an Ashland school. The number one problem identified was a rapid diagnosis by doctors and alternative health care providers, since measles is much less common and younger providers are no longer familiar with it. This delay in diagnosis can result in many more infants and unvaccinated children being exposed. Studies have repeatedly shown that unvaccinated children tend to live in clusters. Ashland is one such cluster, putting us at a much higher than average risk for an outbreak. (Measles Transmission in Immunized Communities) Several factors contribute to Ashland being at high risk for a measles outbreak.  

  • Low vaccination rates.
  • High number of tourists and students from other countries.
  • A collective perspective that measles is not a dangerous disease, which is perpetuated by a small but vocal group of vaccine critics.

 

 

My Town

A few years ago, an Ashland mother went on national television and stated, “Give me measles, give me chickenpox. My children can handle it.” She is probably right about her kids, but how many people would be exposed before she even realized they had a serious illness? And what about the boy with leukemia who lived up the street, just a few houses away? What about the infant who can’t be vaccinated in the doctor’s office who is sitting next to her child? Is this really who we are as a community?

Sources:

History of Vaccines

The Children’s Hospital of Philadelphia

The Red Book