Measles outbreaks have recently been reported across the U.S. I’m a doctor ＆ assistant health director with the Louisiana Department of Health. AMA about measles and vaccines!

What vaccines do adults (over 21) need to keep up with?

(Also in case it gets lost- /u/Molly-Millions asks, “Also, do adults ever need to re-up on MMR?”

Dr. Kanter: some vaccines are considered good-for-life in most people, some (like tetanus and of course the annual flu vaccine) need regular boosters. CDC has a nice chart that lets you toggle btwn looking at vaccines needed by age of the patient and by any special conditions the patient might have. Go here: https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#table-age

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I live in Houston and have an infant too young to be vaccinated (4 months)—am I paranoid if I keep her home from crowded places?

Dr. Kanter: I can absolutely understand your fear and concerns. Outbreaks can be scary, even if they are relatively small (as is the current measles outbreak in Houston- 4 cases in Harris County so far as reported by State of TX Health Dept). Most kids get their measles vac (part of the MMR, or measles mumps and rubella series) at 1 yr and again at 4-6 yrs, but there is some room to bump this up if extenuating circumstances. This is usually a conversation w/ your pediatrician. I don'think anyone would fault you for keeping your child away from crowds at least for a wk or two until (hopefully) there are no more new cases in your area. You can follow the case counts in TX here: https://www.dshs.texas.gov/news/updates.shtm#measles

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Hello!

I'm currently working on my PhD in Public Health at UNLV. My husband and I have been discussing this a lot lately, it's terrible to see this disease making a comeback.

My question is: what steps do you think we need to start taking to reverse the distrust in science and the medical field? Many people seem to be "doing their own research" but in the wrong direction (ie. following science deniers). How can we as public health professionals begin fixing this? I know this is an intense questions, but I look forward to your response!

Dr. Kanter: Great question!! This is a frustrating issue and I feel similar to you. First, I'll say that demonizing anti-vaxxer parents doesn't work. These parents want the best for their children and are trying to do what they think is right. Unfortunately there is a lot of incorrect or even deliberately misleading information out there. These parents are not bad people- just misinformed. We should keep that in mind when engaging them. Second, we has public health advocates can always do a better job with education and promotion- we can use social media better, we can expand the circle of influence and get into new rooms and audiences. And we can enlist new allies and community partners. Check out this story from South Carolina- I love what she is doing! https://www.wabe.org/a-parent-to-parent-campaign-to-get-vaccine-rates-up/

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Follow up! How can we, as NON medical/public health professionals, help ?

Dr. Kanter: Great question as well!! Non medical/pub health professionals can play a big part in this. Many people are intimidated by docs and might be afraid to ask questions. There are obviously a lot of questions out there on vaccines and lots of good reasonable answers. Some of my favorite sources are here:

http://www.immunize.org/catg.d/p2068.pdf

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and here:

https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-conditions/vaccines-autism

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and here:

http://www.immunize.org/catg.d/p4209.pdf

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Learn more on the topic and help educate those in your social circles- community groups, PTA, etc. Often times you'll be much more effective than docs and other 'professionals'. And don't demonize anti-vaxxer parents!! They like all parents are trying to do what they think is best- they're just misinformed. Bring them in close and counter the misinformation out there with legit data and explanations.

Maria here: As a journalist I have based my reporting on the outbreak on data from the Centers for Disease Control and Louisiana's Health Department. As often as I can I try to share information about where people can get vaccinated if they haven't, cost and information to our local health officials should they need more info. I believe staying informed and sharing useful information like that is key

Yes! I would like to know this as well. It is really challenging to have conversations about vaccines when many people do not ‘believe in’ science, or weigh all sources equally regardless of their validity.

Even if you present the many facts supporting vaccination and explain the fraudulent root origin of the anti-vax movement, they are just waved away as lies.

So what can you do? If you can’t discuss the facts, you have to take the argument to an emotional or personal level, which seems unproductive.

Maria: One of the most interesting interactions as a reporter is with people who strongly disagree with something I write. Like the reactions I've had when I would post updates for where to get flu shots in the middle of worst flu season last year. Like I said about the best way is to stay as informed as possible. The CDC has a great resource page for all the information you need on the Measles outbreak. https://www.cdc.gov/measles/index.html

Trust the experts, not the Facebook commenters, in my opinion

Is there any existing science behind "vaccine shedding" that anti-vaxxers often bring up?

Just curious as to what it even refers to

Dr. Kanter: Thanks for asking this! With regards to measles, or any other modern day vaccine for that matter- answer is NO!!! "Virus shedding" refers to how virus can "shed" or spread from someone in the midst of an infection to a healthy person (because the virus is replicating so quickly in the infected person's body and is "shed" in their saliva, cough droplets, and other bodily fluids). Modern day vaccines do not cause this. The myth may be related to a very old (1950's) version of the polio vaccine that in some few cases caused this- but no modern day vaccine (including measles vac) causes any appreciable shedding. The measles vac is a highly "attenuated" or weakened blueprint of the measles virus-- something that lets your body know what the real virus looks like so it can start building up immunity to it. The measles vac doesn't actually cause measles and is not transmissible in any way to other people.

I think there's like, one vaccine where it "sheds"....into the patients poop. So...ya know, don't go around eating other people's poop.

Maria here: A good idea in general, i'd think

My girlfriend is due with our baby in a week and a half. We were told we need to get measles shots because if they were given before 1989, then we need to be vaccinated again.

We live in Austin Texas and there has been an active outbreak in town our region.

With our newborn not being vaccinated for another year, what precautions do we need to take during this time to avoid any worries?

Dr. Kanter: Congratulations!! My wife and I are expecting as well :)

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It's possible you and your GF are still protected- if there is a question about this, labs can be drawn to confirm. But for any specific situations like this it's very difficult to give clinical advice in this forum- I recommend you and your GF schedule time to talk with your (future) pediatrician and go over the particulars.

What is the current mortality rate for children in the US who contract measles?

Dr. Kanter: Very low (1-2 in 1000 cases) particularly given advances in medical care. And of course the very small number of cases since we declared measles eliminated in the US 19 yrs ago. But the disease can still be quite severe and cause permanent disability. In general:

1 in 1,000 measles cases will develop encephalitis, or infection/inflammation of the brain. This often leads to permanent brain damage, or deafness, or both.

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Maria: That's a good question. We have been generally reporting on the number of people who are sick, which was up to 127 confirmed cases in 2019. From a 2018 CDC report, hospitalization occurs in 1 out of 4 cases, the death rate was 1 out of 1000 cases in the U.S.

This is a link to the report. It's about a year old, so the data may not be up to date https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf

its about 1 - 2 / 1000 per https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf
slide 7 (they dont break out the cohorts)

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Maria: I couldn't find anything more recent. But yes 1-2 out of 1000. 1-4 cases lead to hospitalizations according to that report

https://www.cdc.gov/measles/downloads/measlesdataandstatsslideset.pdf

I was never vaccinated (my mom didn’t think it was necessary). I’m almost 30 years old and now I’m scared. How soon after you get the vaccine does it become effective. Also, what other vaccines do I need to get and will a dr judge me for being so dumb? I’m kind of embarrassed at this point.

Maria: Hi! The CDC provides great information regarding Measles and the MMR vaccine. https://www.cdc.gov/measles/vaccination.html

It is 97 percent effective and provides protection anywhere between 10 days to 2 weeks.

This chart, also from the CDC, provides a schedule of recommended vaccinations for adults. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#table-age

Dr. Kanter: THANKS FOR ASKING THIS!!! Great question and I am sure other folks have the same question. Docs will not judge you- they will be happy and proud (as am I!) you are taking the initiative to do this. I wish all my patients had this type of initiative.

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The vac generally takes about 14 days to build up protection.

My sister follows the anti-vax beliefs. We have tried EVERYTHING to get her to vaccinate her son. She has refused completely, and it has become a sore subject. She believes that vaccines are dangerous, and could cause autism. Well, my nephew, unvaccinated, was recently diagnosed with autism...and she continues to refuse.

Is there any recommendations you could give on what we can do? I truly fear for my nephew, and what his life will be like without vaccines.

Dr. Kanter: Another great question. Tough, frustrating situation. I faced a similar situation with a close friend of mine. Best advice is not to demonize her- she is doing what she believes is best for her kids (like all parents!)- she just happens to have fallen victim to all misinformation out there. Keep her close, keep the lines of communication open, and keep trying to deliver new forms of accurate information. Someday, hopefully, it will stick. Let me link to a few of my favorite resources:

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http://www.immunize.org/catg.d/p2068.pdf

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http://www.immunize.org/catg.d/p2068.pdf

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http://www.immunize.org/catg.d/p4209.pdf

I am 45 do I need a MMR booster? I keep forgetting to ask my doctor.

Dr. Kanter: If you received your vaccine as a kid, likely not. CDC generally considers "evidence of immunity" as written documentation of previous vaccination. That said, if you are a healthcare worker or high-risk for other reasons (discuss with your doc), you might need to have labs drawn to check titters and determine if you still have immunity.

What percentage of the population has had negative reactions to vaccines?

Dr. Kanter: Very, very, very few people, and of those who do have reactions, the overwhelming majority are minor like a small rash, low-grade fever, or feeling achy for a day or two. FDA and CDC keep very close tabs on vaccine reactions- CDC has a nice page to learn more about how they track and monitor:

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https://www.cdc.gov/vaccinesafety/vaccines/mmr-vaccine.html

Do you believe that this is because of the more recent anti-vaxxers refusing to vaccinate their children and even themselves?

What can be done to better educate the public of vaccines?

Dr. Kanter: Almost all of the recent outbreaks follow the same pattern: someone infected with measles from another country travels to the US and happens to visit a community with a larger percentage of unvaccinated individuals- this gap in the community's "heard immunity" allows the disease to spread. For comparison, last year in New Orleans we had two separate cases of folks infected with measles traveling in from outside the country- but thankfully the virus did not spread from either of these two individuals to anyone else (Louisiana generally has good vaccination rates- measles vac coverage in LA is around 96%). But in pockets where the vac rate is lower (think Orange County California and the Disneyland outbreak a few yrs back) the disease can spread quite quickly.

How long will an MMR vaccine last? I believe many people are under the impression they are a one and done kind of vaccine. Is this true?

https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#table-age

Maria: Hey! This is an resource sheet from the CDC Dr. Kanter provided for a similar question.

Dr. Kanter: If you are an adult who received the full MMR vac as a kid (and have documentation of this!), the CDC doesn't recommend further action, unless you have extenuating circumstances. Most people don't but if you're particularly concerned, talk to your doc about.

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For adults who work in the healthcare field, most need to show documentation of their previous vaccine or have labs drawn to check their immunity.

Do you believe that the villainization and ridicule of parents who are vaccine hesitant is contributing to the current anti-vaccine movement in any way?

Dr. Kanter: Well- I don't think it caused the anti-vax movement, but it certainly is not going to help us solve it. These parents want to do the best for their children, just like all parents. They just unfortunately have been tragically misinformed. Vulcanization and ridicule tends to push people into a corner....I think we have better odds of convincing anti-vaxxers of the real data and science if we avoid demonization, keep them close and the lines of communication open.

I’m an adult who has had the MMR vaccine at least 3 times but can’t seem to pass a titer test to confirm effectiveness... should I get another vaccine if the outbreak spreads to my area, or am I just screwed?

Dr. Kanter: Talk to your doc about this. It would be incredibly rare to not have an appropriate response after 2 doses. It might even be worth making an apt with an immunologist.

I read reports from Foreign Governments that the measles vaccine only last a certain amount of time. The CDCs stance is that its a lifetime Vaccine in 96% of cases. Is there a way to test to see if you need a vaccine? Just make a Doctors appointment?

Dr. Kanter: For most patients, the CDC doesn't recommend any further action if you received (have have documentation!) of your measles vac as a kid. But there are always special circumstances. Make an apt with your doc and talk it over if you're concerned about it.

I am 59. When I was a child I had measles, chickenpox and mumps. Can I get them again? Should I be vaccinated?

Dr. Kanter: Many people of your age had these diseases. And in general, yes-- if you had these diseases as a kid then you would have developed immunity and are now protected from having them again. In fact, because measles was so prevalent yrs ago, the CDC considers you automatically protected if you were born before 1957. If you haven't had the vac and there is any question if you had the disease as a kid, a doc can always check titers (labs)- or they can just give a dose of the vaccine- there's no harm in doing so even if you do have immunity.

Im 20 years old and am not sure when I was vaccinated the last time

The only one I know for sure is rabies and that was 3/4 years ago. The rest I don’t really know...

What vaccines do I 100% need to get again ASAP?

Maria here: Talk to your doctor if you don't have an up to date vaccination record. We have been providing this link in response to similar questions: https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html#table-age

It's a schedule of vaccinations for adults over the age of 19 from the CDC.