02/03/2025
I haven’t used this page in a long time as I’ve been focusing on HIV/STIs, but since we have measles and rubella in our midst, it’s time to revive.
Sources linked in comments.
The vaccine is MMR, first licensed in the US in 1971.
M - Measles
M - Mumps
R - Rubella
Lots of confusion out there, and the powers that be that named viruses a century ago are partly to blame.
Measles is also known as Rubeola. Not to be confused with Rubella, sometimes known as the German Measles, which aren’t measles at all.
See table photo
Many infections cause a rash and fever and general crud. You might say, they’re both rashes, they both cause illness, we have vaccines for both, why does it matter?
Once upon a time, pre-vaccine, measles mostly affected kids, because if you made it to adulthood, you likely had it and were now immune or somehow escaped it entirely. Not everyone made it to adulthood.
1 in 5 infections in unvaxxed people are hospitalized
1 in 20 infections lead to pneumonia
1-3 in 1,000 develop encephalitis
1-3 in 1,000 die
It can cause premature delivery for pregnant women, or low birth weight babies
A long term complication, Subacute sclerosing panencephalitis is rare (7-11 out of 100,000), thanks to high vaccination rates, but is fatal, typically developing 7-10 years after measles.
Measles causes “immune amnesia” – it suppresses the immune system, making the person already sick with measles more susceptible to other infections.
Rubella is also a disease of childhood. It has similar symptoms, and most people who get it have a mild, self-resolving illness.
The bad news is that Rubella can cause severe complications when a pregnant person becomes infected. The fetus can develop serious birth defects and the likelihood of miscarriage or stillbirth is high.
Rubella is pretty contagious, like measles, and we want to avoid both. It matters that they’re different because it impacts the public health response. Pregnant people in general will want to avoid anyone with either measles or rubella.
But when we’re looking at an outbreak response, factual information is important. When a case of “measles” was announced in Cibolo, just outside San Antonio, a week after a known measles exposure in the area, there was panic. It turned out to be rubella, which is important, but does not indicate the spread of the outbreak to the San Antonio area and had nothing to do with the measles exposure. How a virus is spreading is important in monitoring and intervening in the outbreak.
The Rubella case in Cibolo was an “imported” case. This happens often enough, where someone travels and brings back an infection. When everyone around them is vaccinated, there aren’t many susceptible people and it doesn’t spread. The measles outbreak in Gaines County spread because many people were susceptible.
So the Good News, we have vaccines.
There was an early measles vaccine licensed in the US in 1963. In 1968, a new vaccine was licensed, which includes the “A” strain of Measles. In 1971, that was joined with the mumps and rubella vaccines to create the MMR vaccine. Most of us born after 1968 in the US have been vaccinated with the *current* MMR vaccine unless our parents chose not to, which happened but wasn’t that common prior to 2000.
One dose of MMR is 93% effective against measles. In the late 80s and early 90s, there was an outbreak in school aged kids and later college students. The college kids were among the first cohort to be vaccinated 20 years prior. We learned that one dose of protection waned over time, and a second dose was recommended, bringing the efficacy to 97%. Pretty damn good.
If we were born between 1968-1989, we may not have had a booster, though if you were in school after 1989, you probably have.
The measles vaccine is a “live” vaccine. Because it’s live, you can have a minor immune response to the vaccine. This means the vaccine is working. It is also why a pregnant person or an immunocompromised person shouldn’t get it. And why everyone else *should.*
Anti-vaxxers like to say because it’s live, there is “shedding.” Because it’s a live *attenuated* virus, scientists have found vaccine RNA for a few weeks in nasal passages. Yes. Measles vaccine (and a few others) *can* “shed.” But here’s why it isn’t a problem for non-immunocompromised people: “If vaccination causes shedding, it typically results in significantly lower quantities of virus being shed, and the shed virus particles are less likely to cause disease because they are the weakened form used to make the vaccine.”
Remember that the vaccine includes strain A. ALL of the recent outbreaks have been from different strains, most notably D8. But the vaccine still works, because the antigenic properties of the strains don’t vary much. So the vaccine is still protective, but we also know that the vaccine is NOT responsible for any of the outbreaks.
Treatment with Vitamin A
A study found that in populations with Vitamin A deficiency, controlled treatment with Vit A helped kids with measles survive, kids who were malnourished. Your average unvaxxed person in the US comes from an upper middle-class household and is unlikely to be malnourished (and if they are, it’s another problem). Please don’t go dosing your kid with Vitamin A, which can be toxic in large doses.
Side note about Rubella vaccine. In the US, it was first given to women of childbearing age who were not pregnant AND children. In the UK, it was given to women of childbearing age because they were most at risk. But the UK found it didn’t decrease the incidence of rubella, whereas in the US, it did. Giving the vaccine to the ones who spread it (kids) helped protect the ones most affected, pregnant people. The UK began giving it to kids, and the incidence went down.
The HPV vaccine has the same story, but more on that later.
Finally, HUGE shout out to all the DSHS epidemiologists and public health workers, and all the PH folks in the impacted counties and across the state, and SAMHD, who are no doubt working tirelessly trying to make sure this outbreak doens't become even worse.
