So much in the news lately about measles. A bit disappointing considering we sincerely thought it was “eliminated” in 2000. As you’ve heard, in the New York City area, there have been 285 confirmed cases since their outbreak began in the fall. Mayor Bill de Blasio declared a public health emergency that would require unvaccinated individuals living in Williamsburg, Brooklyn, to receive the measles vaccine. The mayor said the city would issue violations and possible fines of $1,000 for those who did not comply who lived in areas with dense outbreaks.
Under-vaccinated populations are at risk for outbreaks. Case in point in New York and Washington State. Public health officials are stepping in to stop the spread, the hospitalizations, and the absolutely unnecessary toll it’s taking on human health. Measles IS and remains a wildly contagious virus; measles IS and remains vaccine-preventable.
Across the country, there have been 465 measles cases since the start of 2019, with 78 new cases in the last week alone, the Centers for Disease Control and Prevention said on Monday (4.8.19). In Washington State, our outbreak led to 73 confirmed cases.
I don’t think I can be any more clear: the best way to protect yourself against measles is to get immunized (>98% effective vaccine for lifelong protection) or to not be exposed in the first place (live in an immunized, safe community). The healthiest place to live is where everyone is healthy and immunized. If you and your children are immunized with 2 doses of the MMR vaccines, you can feel very comfortable, even in the midst of an outbreak. The vaccine is that good — safe and just amazingly effective at creating immune protection that is iron-clad.
The 1st dose (and 2nd dose for those infants and children who didn’t respond to the first) of the MMR (measles, mumps, rubella) vaccine work to trigger lifelong immunity. Typically after the 1st dose (given here at 12 months of age), 95% of people immunized are protected for life. The 2nd dose (typically given at age 4 years) protects those not protected from the 1st dose and brings protection to 97-99%. If your child hasn’t had a 2nd dose of the MMR vaccine yet, and you live where widespread measles infections are being reported, you can get the 2nd dose of MMR now as long as it’s been 1 month since the 1st dose.
Infants, Antibodies, and Breastfeeding:
Under 6 months: Infants are a vulnerable population during a measles outbreak. We don’t recommend the MMR vaccine to infants under 6 months of age. The reason being, if the mom has had the MMR vaccine or had a measles infection, her maternal antibody protection is passed onto her baby while in utero. Those antibodies stay with the baby after birth and circulate in baby’s bloodstream — therefore those very maternal antibodies would prohibit the vaccine from working in the first place. If you administer a vaccine while maternal antibodies are still around, the vaccine won’t stimulate the baby’s own immune system to respond, the vaccine itself will just get soaked up by the maternal antibodies doing their job.
Over 6 months: After your baby is 6 months of age, if you live in an area of outbreak or if you’re ever traveling out of the country, you can consider early vaccination with MMR to protect your baby. If you’re planning to travel abroad with your infant and they are between 6-12 months of age, it’s recommended they get an MMR shot before travel to protect against measles at any time (even when no outbreaks here in US). Your baby will still need to repeat that MMR dose at 1 year of age, and get the last shot at age 4 years, but they will be better protected during travel to higher-risk areas while still an infant.
What about breastfeeding & measles protection? When it comes to breastfeeding and passive immunity coming from mom, the data is a little murky. The strongest point I can make is that stronger protection comes from vertical transmission (in-utero immunity passed on by mom through the placenta directly to baby) than from antibodies in breastmilk. We know there is likely some immune protection against measles in breastmilk, but its utility is not known or trusted. If you are breastfeeding, your baby is not receiving full protection against any infection from your breastmilk. Measles is no different – and I’d say even harder to protect against compared to other infections because it is so contagious and so serious. The best way to protect your baby from measles is to steer clear of the infection if known outbreaks, immunize your baby if over 6 months of age in an area of outbreak or if you’re leaving the country, and then make sure you immunize your baby at age 12 months. Breastmilk is triple great for you and for baby but is not singularly protective (or strongly protective at all) for fighting off or preventing, measles infections.