02/28/2025
With the recent outbreak of measles in West Texas, which has grown to 124 cases, and now the news of a case of measles here in Rockwall county, lots of people seem to be calling and having a lot of questions. Let's address some of the most common questions now.
What is Measles?
Measles is a highly contagious virus caused by the Rubeola virus. It is highly contagious and can potentially lead to serious complications.
How is it transmitted?
Measles lives in the throat and nose mucus of infected individuals. It is usually spread from one contact to another through airborne transmission such as talking, coughing and sneezing. However, it can also be transmitted through contact transmission on surfaces where it can live for hours.
Do I have to be in direct contact with a measles patient to contract measles?
No, unfortunately because measles is very contagious and transmitted through airborne transmission. Thus, when a patient with measles talks, coughs, or sneezes they release infectious respiratory droplets into the air. In addition the virus can live in the air for up to 2 hours after being released into the room.
How contagious is measles?
Extremely contagious since it is transmitted through both airborne and contact transmission! Approximately 90% of unvaccinated people who are exposed to the virus eventually become infected. Luckily it is very rare for vaccinated individuals to get measles and if contracted it is typically very mild.
Are they only contagious when they have the classic measles rash?
No, when a person has measles they become contagious up to 4 days prior to the formation of a rash.
What are the classic symptoms of measles and when do they appear?
The first signs of measles typically occur 1-2 WEEKS after exposure. The initial symptoms which usually last for 2-3 days are cold like symptoms such as cough, runny nose, conjunctivitis (red watery eyes), and sore throat. Many people will also get the classic Koplik’s spots which are small white dots with bluish-white centers inside their mouths usually on inner cheeks.
When does the rash appear?
Typically the rash occurs 3 to 5 days after the initial cold like symptoms. The rash usually begins on the face and behind the ears and spreads down to the neck, trunk, arms and legs. It appears as small raised bumps that tend to coalesse together to form larger spots. Once the rash occurs patients usually spike high fevers sometimes exceeding 104 degrees.
How long does the rash last?
Typically the rash will begin to fade in 4-5 days.
What are the worst possible complications of measles?
The two worst complications of measles are encephalitis and even death. Encephalitis is a swelling of the brain that can lead to convulsions (seizures). This unfortunately can cause serious long term complications leaving the child deaf or with serious intellectual disability.
Luckily encephalitis is very rare affecting approximately 1 out of about a thousand children. Death typically occurs from severe neurologic or respiratory complications and once again is very rare with a rate of 1-3 out of a thousand cases. Another very severe complication is called subacute sclerosing panencephalitis (SSPE). It once again is a very rare disease but this one occurs 7-10 YEARS after the infection. It is a fatal disease of the central nervous system. Luckily since the development of the vaccine this has rarely been reported. It is believed to be more common if measles is contracted prior to age 2.
What are other complications of measles?
Measles frequently causes otitis media which is an ear infection or diarrhea in up to 10% of the cases. It can also lead to hospitalizations and pneumonia in around 5% of the cases.
What if I am pregnant and get Measles?
If you are pregnant your Obstetrician likely ran a measles titer at one of your first visits. Measles can cause premature delivery and a possible low birth weight baby. So it is advisable to insure you are immune PRIOR to getting pregnant as you can not get a booster if you are already pregnant as the vaccine while attenuated (weakened) is still a live virus.
Who is at risk of contracting measles?
While measles can affect anyone it is very rare in vaccinated individuals. The main risk will be unvaccinated. Babies don’t get their first MMR until age 1 so under age 1 we need to take some extra precautions with who contacts them and using antiseptic on hands. People with weakened immune systems like cancer patients or patients on immunosuppressive medications. We mentioned pregnant women already.
How do I know if I am immune or not?
While most of us will be immune from our childhood vaccines, since those people are considered to have presumptive immunity. The only way to truly know is to get a Measles titer. It will measure the presence of measles IgG. A positive response means you are considered immune. A negative response would require a booster shot to develop immunity.
What if I don’t want to get a titer but was exposed to measles?
In this situation you may choose to just get a booster to insure immunity. However, most born after 1957 have had the measles vaccine. And those with two doses are considered to have presumptive immunity. Thus, no booster is needed.
Can I still get measles if fully vaccinated?
Yes about 2% of the population for unknown reasons still get measles even with two doses of the vaccine. But the good news is they tend to have much milder cases and are much less contagious than those who never received the vaccine.
Why is measles coming back now?
As the number of unvaccinated individuals increases the ability of the level of herd immunity decreases. Thus, the virus has more potential hosts to find.
What is herd immunity?
Herd immunity is the situation where let's say you have a hundred cows. You vaccinate 99 but choose to save money and not vaccinate the other one. Since you have a controlled environment this cow is protected by ‘herd immunity’. Unfortunately as the number of people choosing to not vaccinate their children rises the level of herd immunity for infants and the immunosuppressed goes down. Current data from the CDC shows the MMR (measles, mumps, rubella) vaccine down to 90.3%. It is believed to need a threshold of greater than 95% to achieve effective herd immunity. So herd immunity has dramatically decreased recently thus leading to more outbreaks.
This information is for education purposes only and you should never make changes to your health without consulting your own personal physician. Every person’s case can be a little different, so make a virtual appointment with your physician and discuss your personal risk factors and the best possible treatment plan for you.
