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Are You Immune from Measles? Are You Sure?

Declared eliminated from the United States in 2000, measles has made a comeback. Between January 1 and May 17, 2019, 880 cases of measles were reported in the United States, the largest number of cases reported in the U.S. since 1994 (Centers for Disease Control and Prevention [CDC], 2019a). Most clinicians practicing in the U.S. today have never seen a case of measles (Pavia, 2019). Although the infection's clinical presentation is fairly typical and predictable, the virus can lead to serious complications.

Measles vaccine did not exist when I was a child, and just like everyone else of that era, I contracted the disease. Between measles and the other rampant contagious diseases of the time--chicken pox and mumps--elementary school classrooms stood half empty for several weeks during the school year until the disease had run its course through the student population.

I was elated when a vaccine was available when my children were born, one that would spare them the experience. Thus, I wasn't prepared for what happen in the late seventies. Quite suddenly, our oldest daughter Katy, who was about 11 years old at the time, had a runny nose, cough, sore throat, and a slight fever. Within about 24 hours, her temperature had climbed to 104 degrees. As I took the thermometer from her mouth, I saw something I couldn't quite believe: Koplik's spots, small red spots with blue-white centers. I thought to myself, if I didn't know better, I would swear she has measles. She was up to date on all her immunizations. How could this be?

I reported what I saw to our pediatrician. He asked me to bring her to his office. Yes, he confirmed, she does indeed have measles. Katy was born in 1968. At that time, the vaccine was given prior to 9 months of age, which we now know is too early. This was the explanation given for the vaccine failure.

Having measles is a miserable experience--the high fever, headache, rash, cough, sore throat, and painful conjunctivitis. Katy stayed in a darkened room for a couple of weeks until, finally, it was over. Fortunately, she had no complications, some of which can be very serious or even deadly: encephalitis, otitis media, laryngotracheobronchitis (croup), measles pneumonia, and bacterial pneumonia (Wendorf et al., 2017). One complication is especially frightening: subacute sclerosing panencephalitis. This delayed form of encephalitis may appear 3 to 30 years after the infection.

Thankfully, we have a measles vaccine. However, according to Pavia (2019), people who think they are immune from measles might not be. How about you? Are you immune? Are you sure? What about other adults in your life? What about the parents of the children you care for?

Having had the infection or two doses of the measles-mumps-rubell (MMR) vaccine provides durable and generally lifelong protection (Pavia, 2019). Although two doses of vaccine are 97% to 98% effective, one dose's effectiveness is only 90% to 93% (CDC, 2019a). In 1989, both the American Academy of Pediatrics (AAP) and the CDC's Advisory Committee on Immunization Practices (ACIP) issued a recommendation for two doses (AAP, 1989; CDC, 1989); therefore, most people born after 1988 received two doses of MMR vaccine and are immune (Goodson & Stewart, 2015).

Most, but not all, individuals born before 1957 had measles and are presumed protected. For people born between about 1957 and 1988, the situation may be more complex. It wasn't until the 1990s that most schools and many colleges, universities, and professional schools began to require a second dose of MMR for entry, so many people born in the late 1970s and 1980s have had two doses. From 1962 to 1967, a less effective vaccine was used. Some individuals who received this vaccine are still susceptible to measles, as are those who were vaccinated between 1962 and 1989, when only a single dose was given (Pavia, 2019).

The CDC (2019b) recommends that adults born in 1957 or later who do not have a medical contraindication should receive at least one dose of the MMR vaccine, unless they have documentation of vaccination with at least one dose of measles-containing vaccine or other acceptable evidence of immunity to the disease. Healthcare personnel, college and university students, and international travelers are at increased risk for the disease and should receive two doses of the MMR vaccine, separated by at least 28 days.

During outbreaks such as the one we are experiencing now, the CDC recommends that everyone without evidence of immunity should be brought up to date on the MMR vaccination (CDC, 2019a). The CDC adds that some people who are already up to date on their MMR vaccination may want to get an additional dose of MMR for added protection. As a healthcare professional, you should receive two.

The number of measles cases continues to climb. Keep in mind the risk of death from measles is higher for adults (and infants) than for children. Take advantage of the vaccine and protect yourself and those around you from this awful and potentially devastating disease.


American Academy of Pediatrics (AAP) Committee on Infectious Diseases. (1989). Measles: Reassessment of the current immunization policy. Pediatrics, 84(6), 1110-1113.

Centers for Disease Control and Prevention (CDC). (1989). Measles prevention. MMWR Morbidity and Mortality Weekly Report, 39(SS-9), 1-18.

Centers for Disease Control and Prevention (CDC). (2019a). Measles and outbreaks. Retrieved from

Centers for Disease Control and Prevention (CDC). (2019b). Measles, mumps, and rubella (MMR) vaccination: What everyone should know. Retrieved from

Goodson, J.L., & Seward, J.F. (2015). Measles 50 years after use of measles vaccine. Infectious Diseases in Clinical Practice, 29(4), 725-743.

Pavia, S. (2019). Never seen measles? 5 things to know. Retrieved from

Wendorf, K.A., Winter, K., Zipprich, J., Schechter, R., Hacker, J.K., Preas, C., ... Harriman, K. (2017). Subacute sclerosing panencephalitis: The devastating measles complication that might be more common than previously estimated. Clinical Infectious Diseases, 65(2), 226-232.

Judy A. Rollins, PhD, RN

Rollins, J.A. (2019). Are you immune from measles? Are you sure? Pediatric Nursing, 45(3), 106,114.
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Title Annotation:From the Editor
Author:Rollins, Judy A.
Publication:Pediatric Nursing
Date:May 1, 2019
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