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Measles and Mumps and Rubella–Oh, My! By Our February Student Pharmacist, Ashley Sullivan.


From January 1 to January 30 2015, 102 people from 14 states were reported to have measles. Most of these cases have been part of a large, ongoing multi-state outbreak linked to an amusement park in California. On January 23, 2015, the Centers for Disease Control and Prevention (CDC) issued a Health Advisory to notify public health departments and healthcare facilities about this multi-state outbreak.

The United States experienced a record number of measles cases during 2014, with 644 cases from 27 states reported to the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000.

What is measles?

Measles is an acute viral respiratory illness. It is characterized by fever (as high as 105°F), malaise (general aches and pains), cough, nasal discharge, and swelling of the eyelids. Measles also involves clustered white areas in the mouth followed by a skin rash of flat, red areas covered with small bumps. The rash usually appears about 14 days after a person is exposed to the virus. The rash spreads from the head to the trunk to the lower extremities. Patients are considered to be contagious from four days before to four days after the rash appears.

Measles is one of the most contagious infectious diseases. Approximately nine out of ten susceptible persons with close contact to a measles patient will develop measles. The virus is transmitted by direct contact with infectious droplets and is airborne when an infected person breathes, coughs, or sneezes. The measles virus can remain on surfaces and in the air for up to two hours after an infected person leaves an area.

What is causing this sudden surge in measles outbreaks?

The majority of the people who became infected with measles were unvaccinated. Measles is still common in many parts of the world, including some countries in Europe, Asia, the Pacific, and Africa. Travelers with measles continue to bring the disease into the U.S. Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated. In 2014, one of the outbreaks occurred in an unvaccinated Amish community.

What is the recommendation for vaccination?

Measles can be prevented with measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. The combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella, and varicella. Single-antigen measles vaccine is not available.

One dose of MMR vaccine is approximately 93% effective at preventing measles; two doses are approximately 97% effective. Almost everyone who does not respond to the measles component of the first dose of MMR vaccine at age 12 months or older will respond to the second dose. Therefore, the second dose of MMR is administered to address primary vaccine failure.

The CDC recommends routine childhood immunization for MMR vaccine starting with the first dose at 12 through 15 months of age and the second dose at four through six years of age or at least 28 days following the first dose.

Students at post-high school educational institutions without evidence of measles immunity need two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose.

Adults: People who are born during or after 1957 who do not have evidence of immunity against measles should get at least one dose of MMR vaccine.

International travelers:

  • People 6 months of age or older who will be traveling internationally should be protected against measles before travelling internationally.
  • Infants 6 through 11 months of age should receive one dose of MMR vaccine.
  • Children 12 months of age or older should have documentation of two doses of MMR vaccine (the first dose of MMR vaccine should be administered at age 12 months or older; the second dose no earlier than 28 days after the first dose).
  • Teenagers and adults born during or after 1957 without evidence of immunity against measles should have documentation of two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose.

Healthcare personnel should have documented evidence of immunity against measles.

Why aren’t people vaccinated?

There are several reasons children and adults aren’t getting vaccinated. These reasons include medical, religious, and personal beliefs. While it is a personal choice to receive vaccination or to have your children vaccinated, it’s a decision that doesn’t just affect one person. Unvaccinated people increase the risk of infection of themselves and everyone in which they come in contact.

There is currently a huge amount of publicity around the decision to vaccinate or not vaccinate. This is mostly due to a couple of celebrities claiming vaccination caused autism in their children. Since this media was released, these celebrities have revoked their claims, but the damage has already been done. It’s human nature to catch wind of something and run with it, and that’s exactly what we’ve seen happen during this “vaccine war”. There are thousands of claims every year trying to link autism to vaccines, none of which have held any evidence or reached a settlement. There is currently no scientific evidence that links autism to vaccinations. The accusations attempt to link autism to thimerosal, a preservative that used to be in vaccines. However, the only vaccine that currently contains thimerosal is the multi-dose flu vaccine. Most pharmacies use single dose flu vaccines which are preservative free. Removing the “cause” of the concern from vaccinations should relieve some people, but it seems there is a large population that is still concerned.

Furthermore, unvaccinated individuals are not only at risk for infectious diseases, but these diseases may be difficult to treat, life threatening, and involve expensive medications. All of this can be avoided often with one or a series of vaccinations once in a lifetime. Fortunately, we haven’t lived through things like the plague, polio, or smallpox in a very long time, which has decreased awareness of how deadly diseases can be. However, things like hepatitis, tetanus, and meningitis can be life threatening and difficult to treat and they are still prevalent in our society. These diseases are preventable with vaccination.

As a healthcare professional, I am fully vaccinated and recommend it to everyone. At the end of the day, I’d rather receive the vaccines and decrease my chance of getting a disease than end up sick and on expensive medications for something preventable! It is each individual’s choice, but they should make an educated decision and think about their individual impact on society instead of following the whims of mainstream media.

Do unvaccinated individuals put the vaccinated population at risk?

Yes! Vaccines work in what we like to call “herd immunity”. Therefore, if one person in a group is unvaccinated but the other 100 are vaccinated, the unvaccinated person will be unlikely to get an illness due to protection from everyone around them. However, not vaccinating is becoming a trend and we could see this phenomenon in reverse. If 80 people are not vaccinated and 20 people are vaccinated all 100 people may get ill due to the lack of protection from the majority of the group. While getting vaccinated is a personal choice, people that choose not to aren’t only putting their own health at risk, but also everyone around them.




To see photos of people with measles to show what the disease looks like, follow the links below. The images were too disturbing to post here.



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