How worried should I be about measles?

A series of measles cases in the United States has led to fear and uncertainty in some communities, as well as...

Posted: May 2, 2019 3:13 PM

A series of measles cases in the United States has led to fear and uncertainty in some communities, as well as quarantines at sea and at universities. Some cases have even hit adults who thought they were protected by the vaccine.

Even the Avengers could hardly be prepared for the threat, with moviegoers in California facing possible exposure to the virus. Same for some travelers at multiple airports across the country.

In 2019, the US has seen the highest number of confirmed cases since disease was declared eliminated in 2000. Some officials across the country have declared states of emergency.

How contagious is it?

"Measles is one of the most highly contagious diseases known," said Dr. Julia S. Sammons, a pediatric infectious disease specialist and medical director of the Department of Infection Prevention and Control at the Children's Hospital of Philadelphia.

Once a person has measles, about 90% of close contacts who are susceptible to it will develop the disease, she added.

The measles virus spreads through coughing and sneezing. Afterward, it can linger in the air for up to two hours. If someone who is not immune to the virus breathes the air or touches an infected surface, they can become infected, according to the US Centers for Disease Control and Prevention.

How do I know if I have measles and not just a cold or the flu?

Early on, measles can be confused for other viral illnesses such as the flu. But the red blotchy rash that comes with it may help set it apart.

"Imagine that you have a bucket of rash. If you pour that bucket of rash over your head, the rash sort of cascades down," Sammons said. "So the rash starts over the head, typically over the scalp, and then it spreads down head to toe."

In addition, the virus often manifests as a combination of high fever -- as high as 105 degrees Fahrenheit -- along with cough, runny nose and pink eye, Sammons explained. Some people may develop blue-white spots on the insides of their mouths.

Anyone who's infected can still be contagious for four days before and after a rash appears, experts say.

Even after being exposed to the virus, the vaccine may offer some protection or make the illness milder when given within three days. Symptoms may not appear until one or two weeks following infection.

Another type of post-exposure prophylaxis, called immunoglobulin, is also sometimes given to folks who face an increased risk of serious illness or complications down the line, including babies under 12 months and pregnant women who aren't verifiably immune.

Before running to the doctor, however, you might want to call ahead.

"What you don't want to do is to go to a busy pediatric waiting room, for example, and potentially expose others," said Sammons, urging anyone who's concerned to speak with a care team for guidance before coming in.

I know I was vaccinated. Am I protected?

If you were vaccinated with two doses, the CDC says you have a 97% chance at being protected against measles. And if that last few percent happen to come into contact with the virus, they're less likely to spread it to others, and their illness is often milder. One dose is still about 93% effective at preventing the disease.

The current recommendation for two doses was issued in 1989 by the CDC. Doctors give the first dose of the MMR vaccine -- so called because it covers measles, mumps and rubella -- between 12 and 15 months of age. The second is given between 4 to 6 years.

Prior to 1989, a single-dose recommendation had been in place starting in 1963.

But there's a snag: From 1963 to 1967, doctors used different types of measles vaccines before discovering that one -- the "killed" version -- was ineffective. Folks who received that vaccine, or who were vaccinated during those years and aren't sure which one they got, should get vaccinated anew, the CDC says.

But if you've had one documented dose of the effective "live" vaccine and aren't at high risk of exposure, the agency says that's adequate.

Those at higher risk -- whom the agency advises to get two doses for good measure -- might work in health care, travel internationally or be more likely to be affected by an outbreak.

I'm not sure if I was vaccinated. What should I do?

Excepting people who work in health care, most people born before 1957 don't need the vaccine because "before vaccines were available, nearly everyone was infected with measles, mumps, and rubella viruses during childhood," the agency says, resulting in lifelong immunity.

Before we had a vaccine, the agency says 3 million to 4 million Americans were infected yearly, including 48,000 hospitalizations and 400 to 500 deaths.

But what if you don't have written documentation of the right vaccine? For anyone who's unsure, the CDC says you can simply roll up your sleeve for another dose or two.

"The MMR vaccine is safe, and there is no harm in getting another dose," the agency says.

There is also a blood test doctors can use to check immunity. Though some experts say it's impractical or expensive for the general population, versus simply getting another shot.

Some people can't get vaccinated at all or need to wait: for example, people with weakened immune systems and babies who are too young to respond to the vaccine.

Is it risky to travel overseas?

Most cases of measles in the United States stem from someone who isn't protected by the vaccine traveling abroad, according to the CDC. That person can then spread it to others when they get back. The virus is commonly found in various countries in Europe, Asia and Africa -- including large current outbreaks in Israel, Ukraine and the Philippines.

And even when traveling internationally with a young child is unavoidable, the agency recommends that infants between 6 and 11 months get one dose of the vaccine before hopping on a plane -- before the usual first dose at 12 to 15 months.

Like other enclosed and crowded spaces, planes can create opportunities for transmission, though the CDC says the overall "risk of getting a contagious disease on an airplane is low." Still, the risk surged to the forefront when one recent case left an Israeli flight attendant in a coma.

When the CDC and other public health authorities are called to investigate possible transmission on aircraft, they try to figure out who may have had contact with the infected person -- including people who may have been sitting nearby. In these cases, the flight manifest comes in handy, as does listing your up-to-date contact info when you book a flight.

The "contact zone" typically includes folks sitting in the same row as whoever was infected, plus two rows ahead and behind. One exception: It doesn't matter where a child under age 2 was sitting on the plane; they will be considered contacts no matter what.

What can I do to protect myself in public spaces?

First item on doctors' lists: Make sure you're vaccinated.

The CDC says you can take other steps, as well: wash hands often or using sanitizer, avoid touching your eyes and mouth, disinfect surfaces and toys with standard household products, and refrain from coming into close contact or sharing silverware with anyone who's sick.

And if you have to cough or sneeze, use your sleeve or a tissue -- but not your hands, the CDC says.

If you think you've been exposed to measles, the agency recommends calling your doctor.

For people in the midst of an outbreak who can't get vaccinated, are unsure about their status or think they might be infected, public health experts recommend limiting contact that could spread the virus -- including keeping unvaccinated kids home from school.

In some cases, officials may also issue a quarantine -- an effective, if sometimes controversial, measure to limit the spread of an infectious disease. Every state has laws in place that allow quarantines and other public health enforcement tools, and they differ based on the jurisdiction.

Such was the case with more than 1,000 students at two California universities last month as officials raced to contain a potential measles outbreak. Those who couldn't verify their immunization records were asked not to return to work or school. For some, this meant staying in quarantine for just a couple of hours; for others unable to get a hold on those records, the quarantine lasted much longer.

"Campuses really are hotbeds of infectious diseases," said Georgetown University's Lawrence Gostin, who directs the O'Neill Institute for National and Global Health Law. "Young people are in close contact, being intimate, eating food together, living together in dorms."

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 595436

Reported Deaths: 9466
CountyCasesDeaths
Marion822851311
Lake44626670
Allen32165543
Hamilton28684308
St. Joseph26917378
Elkhart24173343
Vanderburgh18856236
Tippecanoe17638125
Johnson14687289
Porter14513163
Hendricks14010242
Madison10715216
Vigo10540177
Clark10349135
Monroe9189108
Delaware8956134
LaPorte8867158
Howard7982140
Kosciusko791380
Warrick652994
Hancock646999
Bartholomew631096
Floyd6205107
Wayne5984159
Grant5874110
Dubois547175
Boone538867
Morgan524192
Henry497764
Marshall495384
Cass475362
Dearborn464545
Noble463157
Jackson417846
Shelby405680
Lawrence383876
Clinton367840
Gibson360058
DeKalb339163
Montgomery338152
Harrison333643
Knox329839
Miami312743
Steuben309343
Adams297435
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Scott218538
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Washington179321
Starke172743
Jay163922
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Owen161137
Carroll153915
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Rush151618
Perry149327
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Franklin144433
Tipton129232
Parke12918
Pike114326
Blackford109222
Pulaski95337
Newton89821
Brown85931
Benton85310
Crawford7719
Martin70713
Warren6637
Switzerland6235
Union6146
Ohio4727
Unassigned0374

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 836049

Reported Deaths: 10323
CountyCasesDeaths
Franklin98533705
Cuyahoga831801065
Hamilton61931441
Montgomery42028399
Summit33849736
Lucas30524605
Butler30003228
Stark25093419
Warren19083140
Lorain18418212
Mahoning16931337
Lake15592136
Clermont15335105
Delaware1403077
Licking12819132
Trumbull12515307
Fairfield1232480
Greene11729135
Medina11286165
Clark10672264
Wood10081156
Allen9639126
Portage9006107
Miami895273
Richland8910116
Marion7377113
Tuscarawas7177174
Columbiana7164124
Pickaway710350
Wayne6855165
Muskingum678241
Erie5976118
Hancock542990
Ross535287
Scioto527063
Geauga491755
Darke459489
Ashtabula443172
Lawrence439353
Union437028
Sandusky427462
Mercer427387
Seneca417357
Auglaize416259
Huron416138
Shelby413521
Jefferson409066
Belmont403740
Washington375940
Putnam367872
Athens36759
Madison343429
Knox340122
Ashland336838
Fulton328543
Defiance322578
Crawford316371
Preble313836
Brown298819
Logan296529
Ottawa283934
Clinton281243
Williams272866
Highland266018
Jackson259043
Guernsey245325
Champaign244427
Fayette229729
Morrow22574
Perry223318
Holmes220362
Henry213547
Hardin206433
Coshocton199620
Van Wert198744
Wyandot192549
Gallia192126
Adams167415
Pike167417
Hocking165523
Carroll151316
Paulding141121
Noble118740
Meigs105021
Monroe97229
Harrison8598
Morgan79728
Vinton67613
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