Who needs to protect themselves from measles? Your questions answered.
Last week, I explained why it matters if the United States were to lose its status of having eliminated measles. That prompted many readers to ask what additional precautions they should take to protect themselves against the virus, which I wanted to answer here.
Several wanted to know if they should continue with planned trips. Mary from Maryland, who is 73 and has diabetes and asthma, told me she goes to a summer house on the New Jersey shore every year. 'My daughter warned me that there are cases in New Jersey,' she wrote. 'Should we rethink this trip? For your knowledge, I had measles as a child. I'm retired as a nurse, and my daughter and her kids are, of course, fully vaccinated.'
Travis, also from Maryland, has a new grandchild who is about to turn 3 months old. 'His parents had been planning to take [their baby] to Texas to meet the other set of grandparents,' he wrote. 'Where they live is in the 'hotzone,' with dozens of measles [cases] reported. Do you think they should cancel [the trip]?'
And Annie from California has been looking forward to a trip to Europe. 'I saw the new guidance from the [Centers for Disease Control and Prevention],' she wrote, referring to agency's recent shift from recommending two doses of the measles vaccine for travelers to certain countries to recommending it for all international travelers. 'Please tell me I can still go visit my sister in Spain. It's my first international trip since the pandemic.'
I believe there are two key questions to assess the risk of measles while traveling. First, are there active outbreaks in the area you are visiting? The New Jersey Department of Health reports known ongoing community transmission in the state. It's recorded four measles cases: three in a single household, and another that is under investigation. State health officials continue to recommend that all eligible people receive the measles, mumps and rubella (MMR) vaccine, but measles is not a high concern there.
This is a similar situation to Spain. While sporadic measles cases have been reported in Spain, and infections across Europe have increased overall, endemic measles transmission stopped in Spain in 2014. The country achieved measles elimination status in 2017.
On the other hand, Texas is still experiencing an active and large outbreak. Since the beginning of the year, 762 people have been diagnosed with measles, of which 99 required hospitalization and two have died. If Travis's other grandparents live in one of the hardest-hit counties and the virus is actively transmitting there, the area is significantly riskier than New Jersey or Spain.
Second, do you and the people you are inquiring about have optimal immunity against measles? Mary had measles before, which gives her strong lifelong protection. Two doses of the MMR vaccine are 97 percent protective against measles infection, so her daughter and grandchildren should have good immunity as well. Combined with the low risk in New Jersey, that means Mary has no reason to change her travel plans.
Likewise, if Annie is fully vaccinated or has had measles before, she should have no issues going through with her Spain trip. The CDC issued its new guidance for international travelers in light of several cases associated with travel settings (for instance, six cases in Colorado linked to an international flight). Importantly, though, the agency is not advising people to forgo travel altogether. Annie should proceed as planned.
My advice is different for Travis. His grandson is too young to be vaccinated, and since his family would be staying in the area of the ongoing outbreak, they should discuss delaying the trip. The first dose of the MMR vaccine is normally given to infants between their first and second birthdays, but it can be given as early as 6 months of age. One dose conveys 93 percent protection against measles. His grandson could get the vaccine when he turns 6 months old and then travel a few weeks after that. (Infants who receive the first dose early should receive two additional MMR shots during early childhood for full protection.)
What about people who cannot receive the MMR vaccine? Janet from New York wrote that her husband has a severe immunodeficiency and is unable to obtain live vaccines, including MMR. 'How should we protect against measles? Do masks work?' she asked.
Yes. Measles is a highly contagious respiratory illness that can be transmitted through droplets and aerosols. The same protections that guard against covid, flu and other respiratory illnesses will help reduce the risk of contracting measles.
Janet's husband should wear a well-fitting N95 or equivalent mask while traveling and when in crowded public places. His close contacts should be fully vaccinated against measles. His risk of contracting this virus is probably still quite low given the relatively few cases in his area, but masking and additional precautions will guard against other diseases.
'Your newsletter said that even vaccinated people can get measles because of 'breakthrough infections,'' wrote Arthur from Germany. 'Why are you giving fuel to the fire of anti-vaxxers? They are going to use your piece and say, 'what's the point of getting vaccinated if you're just going to get measles anyway?''
I'm glad that Arthur raised this point. Very few therapies in the world are 100 percent effective. A 97 percent effectiveness rate is remarkable. Imagine if there were a vaccine that is 97 percent effective against cancer or diabetes! Yes, some vaccinated people can contract measles, but that likelihood is far lower compared to someone who is unvaccinated. Moreover, vaccination reduces the risk of severe illness if someone is infected.
To me, these are compelling reasons to strongly support the MMR vaccine. Acknowledging that breakthrough infections can occur is crucial because good medicine requires honesty and transparency. Physicians and health officials must clearly communicate both the benefits and the limitations of their recommendations. Failing to do so would give anti-vaccine activists grounds to accuse public health authorities of misrepresentation and deception, which surely would have far worse consequences for public trust.
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