Vaccine Smarts
By Dr. Richard Rupp and Bridget Hawkins, Ph.D.

Dear VaccineSmarts,
I keep hearing about measles outbreaks. What is the big deal in this day and age?
Clear Lake Shores

Dear Daren,

Most people do not know much about measles thanks to the success of vaccination. They only have the image from the cartoons of a comical sad person sporting red spots, droopy eyes and a thermometer in the mouth. Measles is anything but funny. It is a serious disease.

The measles virus is highly contagious and is spread by coughing and sneezing. A runny nose, cough, congestion, red eyes and high fever usually start seven to 14 days after exposure.

Diarrhea and ear infections are also common. A rash composed of little red spots breaks out over the entire body two to four days after the onset of symptoms.

Unfortunately, people are contagious before the rash appears and the diagnosis can be made. The entire illness usually lasts about two weeks.

Babies, young children and adults are most likely to suffer from measles complications. Pneumonia occurs in about 6 percent of cases.

About 1 in a 1,000 cases develops inflammation of the brain that can lead to seizures, mental retardation and deafness. There is no treatment other than taking care of the symptoms.

Death occurs in 2 to 3 out of every 1,000 cases of measles in the United States. This past year, there were 20 million cases of measles worldwide with 122,000 resulting in death.

This year has been the worst in the United States in the past two decades with 477 cases as of June 13.

Outbreaks have occurred in 20 states including Texas. About 1 out of every 7 cases required hospitalization. Thankfully, no one has died yet.

The original sources of almost all of the outbreaks were unvaccinated travelers. The traveler visits a foreign country, returns to the United States, and spreads the disease among groups of other unvaccinated people.

Ohio has suffered the largest outbreak in the nation. The outbreak resulted from unvaccinated Amish missionaries returning from the Philippines. During this past year, the Philippines experienced a massive epidemic with 32,000 cases and 41 deaths.

Ninety percent of the cases in the United States have been in unvaccinated people. Most chose not to be vaccinated because of religious or philosophical objections. About 5 percent of the cases have been in babies who were too young for routine vaccination.

The outbreak in Ohio demonstrates the power of herd immunity, also known as community immunity. These terms refer to the fact that communicable diseases have a hard time spreading within a population if the majority has immunity.

The majority of Ohio residents are vaccinated, but there is a much smaller unvaccinated Amish community within the state. The greater Ohio population has protected the Amish community from measles for years.

Measles entered the Amish community from a foreign unvaccinated population by way of the missionaries. The disease spread quickly in the Amish community while failing to spread among the greater Ohio population.

The current U.S. recommendations are that infants 6 months and older receive a measles, mumps and rubella vaccine (MMR) before foreign travel.

All infants should be vaccinated at 12-15 months of age and receive another dose at 4-6 years of age.

Before leaving the United States, adult travelers who have not had measles or been vaccinated should get two doses separated by at least 28 days.

A common misconception among those choosing not to be vaccinated or to vaccinate their children is that many vaccine preventable diseases are no longer a threat and can easily be cured by miracles of modern medicine.

While it’s true that current medications and ventilators and the like save lives, who wants to be that sick? Vaccination remains a much better option.

Dr. Richard Rupp is a pediatrician and member of UTMB’s Sealy Center for Vaccine Development. Bridget Hawkins, Ph.D., is the assistant director of the Sealy Center for Vaccine Development. This column is supported by a UTMB President’s Cabinet Award to provide information about vaccines. Visit for more information.