We have understandably been receiving many questions and concerns about the current measles outbreak that originated in Vancouver. While the outbreak has continued to spread to some degree, recommendations have not changed at this time. The short answer is that no further action is needed if your child is following the recommended vaccination schedule unless they have had direct contact with a measles case within the past 72 hours or have classic symptoms. If so, please call our office to confirm if any management might be needed. As of now the cases have been almost exclusively among unvaccinated individuals, but sometimes outbreaks can extend into vaccinated communities especially when herd immunity is not high enough. We will be watching this closely, and are anxiously waiting for this outbreak to blow over and hope that no further children are harmed.
Here are our recommendations and answers to common questions, based on age range of the child:
Infants 0 - 6 months: no change to vaccine schedule recommended; first MMR at 12 months. Maternal antibody is still present and offers good protection, but reasonable precautions* won’t hurt.
Infants 6 - 12 months: no change to vaccine schedule is recommended; first MMR at 12 months (but there could be some exceptions in specific cases). Maternal antibody is fading, but may still be present in variable amounts. It is ideal to wait until 12 months for the first MMR to prevent maternal antibody from interfering with the long term effectiveness of the vaccine. You can actually do the MMR early (between 6-12 months), and it can offer some additional short term protection, however it won’t count towards your vaccine schedule because of the maternal antibody. As of now public health officials are NOT recommending families get this additional dose of MMR unless the outbreak worsens substantially, and we agree with this recommendation. We prefer to do the vaccine at the age we know it works best unless we are starting to see measles cases and complications in infants while waiting until 12 months to get this dose, and as of this writing we have not. However, if you live in or frequently visit a community with many developing cases or unusually low vaccination rates, this is an optional measure that may be reasonable - just call our office to schedule and let us know that you are aware of these recommendations but wish to proceed with early MMR anyway as a special case scenario. Otherwise, for routine exposures here in Portland, reasonable precautions* are what we recommend.
Children 1 - 3 years old: If your child has not yet had their first MMR (normally given at the 12 month well check), call our office right away to schedule. Otherwise, no change to vaccine schedule is recommended, with first MMR at 12 months and second MMR at 4 years. While it is acceptable to do the second MMR early (as early as 28 days after the first MMR), and it would actually count towards completing your child’s immunization status, as of now public health officials are NOT routinely recommending families get this dose of MMR early unless the outbreak worsens substantially, and we agree with this recommendation. Here’s why: the first dose provides excellent protection for most kids, and the second (“booster”) dose makes sure they have lasting immunity. That long term protection is believed to be better when the booster is received at age four than if given early, so we prefer to stick to that schedule for best long term immunity unless the short term risks are exceedingly high. As of this writing there has only been one case of measles among those with a single MMR dose. I don’t at this time have further details about that case (age, severity of disease, etc), but typically if cases do occur they are substantially more mild and without complication. So as of yet there has not been any urgency to go out and change the schedule for all these children to something that might benefit them less. With that said, if you live in or frequently visit a community with many developing cases or unusually low vaccination rates, this is an optional measure that you may choose to do - just call our office to schedule and let us know that you are aware of these recommendations but wish to proceed with early MMR booster anyway as a special case scenario. Otherwise, for routine exposures here in Portland, reasonable precautions* are advised, with second MMR booster at age 4.
Children ages 4 and up: If your child has not yet had their second MMR (normally given at the 4 or sometimes 5 year well check), call our office right away to schedule. Otherwise, if your child has had both MMR doses, no further action is needed - your child is fully protected.
*Reasonable precautions = over the next ~ 4 weeks while this is expected to be going on, it is reasonable to avoid places that have higher risk for transmitting measles to your child if they have not yet had their first or second MMR dose. The age of highest concern would be 6-12 months because they have the least protection. For example, avoiding crowded indoor public venues especially where higher percentages of unvaccinated children might be found. By “reasonable”, we mean as an example, if feasible, going shopping for example at less busy times of day, but if not feasible, don’t avoid shopping - your family needs groceries, etc., and we are not at a “stay home and lock your doors” kind of level at this time. Don’t keep your child out of all activities, but consider prioritizing activities where fewer children at a time are playing together, playing with other kids who you know/know their vaccination status, and/or at venues that tend to have pretty standard vaccination rates and keep their area and toys clean. Measles can be airborne, so there is not foolproof way to prevent it in these settings, but it can also be spread by contact so keeping surfaces clean and washing hands is also good practice.
For more questions about Measles and this current outbreak, please view this FAQ page maintained by the OHA.