Should Adults Get the Measles Vaccine?

Now that more than 700 people have confirmed cases of the measles in the U.S., public health officials are concerned about the danger spreading, according to a story published on the NPR website.

Currently the highest risk is in unvaccinated children who live in areas that have seen high numbers of outbreaks, like Brooklyn, New York. But if the disease continues to spread, there is worry that others might be at risk.

And what about adults: Who should be concerned about getting the disease?

People born between 1957 and 1968 might not have been adequately immunized against the measles due to the fact that a live (and more durable) vaccine was not used prior to 1968, said Primary Care Physician Floyd McIntyre, MD, whose office is in South Dennis. Those born earlier than that shouldn’t worry.

“Before we started vaccinating, the people that had measles are generally thought to have lifetime immunity,” he said. “We are 98 percent sure that people born before 1957 are immune because measles was so widespread.”

There is another group that may also be slightly at risk, he said. They include those who were only given one live vaccine between 1968 and 1989. In 1989, a measles outbreak among vaccinated children prompted a policy change to two vaccines.

“The kids now get two doses; the first between 12 and 15 months, and they also get a second dose between the ages of four and six, because they found out that a single dose of the MMR didn’t really protect everybody,” he said. “There may be some people who didn’t get the second dose during those years who have waning immunity, but that’s potentially a lot of people. From a public health standpoint and a logistical standpoint, there is really no point in reaching out to all of those people. Your average person is at low-risk, despite all the noise about it.”

How Dangerous is it?

“Measles is a serious illness,” Dr. McIntyre said. “In the old days, probably one in 20 of the children that got measles would get pneumonia and have to be hospitalized with it. There were probably one or two deaths in a thousand from measles. If you have thousands of people with measles, that’s a lot of deaths. But the 700 cases of measles out of 330 million people who live in the United States – that is actually not very many.”

The biggest challenge with measles is that it is extremely contagious. Dr. McIntyre used the example of 100 people who do not have immunity sitting in a lecture hall at a college to illustrate this point. If one person in that lecture hall has measles, 90 of the unimmunized people would catch it after being exposed for an hour.

According to the Centers for Disease Control and Prevention, measles can be serious for people of all ages, but especially for those under five and over 20 years of age. The most serious complications include:

• Pneumonia, which is the most common cause of death from measles in young children.
• It can also cause encephalitis that can lead to convulsions and can leave some children with deafness or intellectual disability.
• There is also a rare, but fatal disease called subacute sclerosing panencephalitis that can occur seven to 10 years after the measles. This risk is most prevalent in children who get measles under the age of two.
• Dangers for pregnant women include premature birth, miscarriage or low birth-weight.
• Less serious complications include ear infections and diarrhea.

If You Want to be Immunized

One option to ensure protection for those unsure of their vaccination status is to have a blood test to gauge immunity. If a patient came into Dr. McIntyre’s office and wanted to be screened, he would screen them, despite the fact that the realistic risk is quite small. Over the past 10 years, he has tested a small number of patients, mostly nursing students who needed to know for sure they were immune because nursing school required it. Every single person he has tested has in fact been immune, so he believes that generally most people are immune.

Mothers with babies under the age of 12 months need not worry unnecessarily, either, Dr. McIntyre said. Its an issue to discuss with your pediatrician if you have concerns, but most babies are considered to be safe because they have passive immunity from their mother, especially if they are breastfed. Another reason babies younger than 12 months aren’t vaccinated is that they don’t respond very well to this particular vaccine.

“The measles, mumps and rubella vaccine is a live virus vaccine, which is one of the other logistical issues that you get into,” he said. “We generally depend on the herd immunity to protect the children that are less than a year old. So, depending on your community, that may or may not be enough. If there is clearly a fair number of people that are unvaccinated, then the herd immunity starts breaking down and it’s a challenge.”

While most doctors’ offices do not have adult MMR vaccines on hand there is an option for those who would like to get vaccinated.

The Barnstable Department of Health and Environment website says they are able to offer all immunizations, including measles (MMR), to county residents. They can bill most insurance companies and offer lower cost vaccines for those with insurances they do not currently bill. Uninsured residents, including children, can receive free vaccines. Appointments are available from 8:30 a.m. until 4 p.m. on Tuesdays and Thursdays. To schedule an appointment, call 508-375-6617.

“As far as vaccinating people, it is a live virus so people who are immune suppressed from disease or if they are taking one of the immune modulator medicines for psoriasis or rheumatoid arthritis, they are not eligible for the vaccine,” Dr. McIntyre said.

The same is true of pregnant women. Pregnant women and people with compromised immune systems should also avoid contact with children or adults who have been recently vaccinated.