The recent rise in cases of measles is especially frightening for parents of babies: While one dose of the MMR vaccine can provide 93 percent protection against measles, and two doses provides 97 percent protection, babies don’t typically receive their first vaccine until they’re 1 year old, with the second dose given between 4 and 6 years old.
If you have a child in your home who is too young to be vaccinated, what should you do? We asked UNC Health pediatric infectious diseases specialist Zachary Willis, MD.
What advice do you have for parents of infants?
The most important thing any family can do right now is make sure that every family member who is able and eligible gets the MMR vaccine.
Do babies have any protection against measles?
Babies who were born after 28 weeks of gestation likely do have some antibodies from their mother, if the mother was vaccinated. That protection wanes over time, and we don’t know when it fully goes away.
Does breastfeeding provide any protection against measles?
Most of the protection that babies can get from their mothers comes from the placenta when they’re still in the womb. There may be some antibodies against measles transferred through breast milk, but it’s not a significant benefit. There are still a lot of benefits to a baby’s immune development and protection from other common viruses from breastfeeding.
When is early vaccination recommended?
Early vaccination, or giving the vaccine between 6 months and 1 year old, is only recommended if you live in an area where there are high rates of person-to-person transmission. Right now, the only places in North Carolina that meet that criteria are Buncombe County, around Asheville, and several counties around the Charlotte metropolitan area. It’s not officially recommended to provide early vaccination in any other county right now. You can find out if there are changes to that by following updates from the North Carolina Department of Health and Human Services website or your local health department.
If you’re traveling to an area with outbreaks, it’s reasonable to discuss early vaccination with your child’s doctor if they’re between 6 and 12 months old. The good thing about an MMR vaccine is that it’s very quickly effective, so even if you’re traveling tomorrow, a vaccine today would help.
Should people who are around a baby get a booster MMR vaccine?
If you’ve had two doses of the MMR vaccine after your first birthday, you do not need a third vaccine. It will not significantly increase your antibody levels or level of protection. If there are older siblings who are eligible for their first dose and not yet had it, they should definitely get it. If there are older siblings who have had their first MMR but not their second dose, ask their primary care provider if they should get their second MMR now. Two doses of the MMR vaccine give you 97 percent coverage for a lifetime.
Is it safe for babies to go on airplanes right now? What about traveling by car through an area with a lot of cases?
There is always the risk of infection for an infant on an airplane; it’s a lot of people in a small space, breathing the same air. There are many respiratory viruses to consider, including RSV and influenza.
The risk of measles exposure on any individual plane trip is probably very low, even with this current situation. However, the risk is higher right now than it has been in the past.
On a plane, wiping down seats or handles is very helpful for viruses like RSV, which is commonly spread by droplets on surfaces, but measles is typically spread by airborne droplets, so disinfection won’t help much with measles. Keeping the overhead air vents turned on might help to keep airborne droplets away.
There’s no risk of measles when you’re traveling in a car. To be exposed to measles, you need to be in the same space as a person with measles who is currently contagious. You can safely stop to pump gas or get food from a drive-through, even if it’s an outbreak area. If you have a person who hasn’t been vaccinated, there is a small risk of taking them inside a gas station or a restaurant.
If you’re concerned, make sure everyone who can be vaccinated is, and if you’re going to a place where measles transmission is high, ask about a vaccine for the baby. If you have travel plans, talk to your primary care provider about how to make the trip as safe as possible.
What about taking a baby to the grocery store or a playground? Any activities to avoid?
I wouldn’t be concerned about almost anything taking place outdoors. That’s still a very low-risk activity, unless it’s a large gathering with restricted airflow, such as a large group underneath a tent.
We should always be taking steps to protect young infants from all the viral infections that are around. In public spaces, there may be lots of people in closed environments, so parents do need to consider that.
At this time, there’s no recommendation to avoid public places because of risk, especially in areas with few cases. If that changes, you’ll see it on the news or in communications from health departments. In an area where there are more cases, I’d exercise more caution going to a busy public space with someone who can’t be vaccinated.
If siblings or caregivers are vaccinated, could they still be carriers for measles, even if they’re not sick?
No. To be exposed to measles, you need to be in the same space as a person with measles who is currently contagious. If older kids have received their recommended MMR vaccines, it’s extremely unlikely they’ll catch measles, and measles is only spread by symptomatic people. Vaccinated siblings and caregivers can’t carry measles on their clothing or even on their hands.
What precautions should older siblings take around a baby?
If you have a newborn and older kids in school, measles is not your only concern. After school, make sure siblings wash their hands for 30 seconds in case a classmate was sick with something else, because that could be brought home on the child’s hands. And if your older child has any symptoms of illness, keep them separate from the baby. But for older kids who have received their MMR vaccines, their risk of spreading measles to the baby is very nearly zero.
What do I do if I think my baby has been exposed to measles?
If you see that your baby was in the same location as a known exposure—the state puts out notifications of where these exposures occurred—there are options for preventive medications if it has been fewer than six days since the exposure.
If the baby is older than 6 months, we can give them an MMR vaccine, because the MMR vaccine by itself is effective once there’s been an exposure. If they are younger than 6 months old, we can do antibody replacement through IV or shots. Time is tight, so at UNC, we’re working to quickly get people in.
If you’re the parent of someone who is susceptible, pay attention to the local news and state measles dashboards, because they will have the exposure locations all in one spot and instructions about what to do if you believe you’ve been exposed.
What if my baby has some symptoms of measles, but I’m not sure if they’ve been exposed?
The early stages of measles can be difficult to tell from more common viral infections because the symptoms are the same—fever, cough, runny nose, pink eye. A child will usually have those symptoms for three to four days before a rash appears. Parents should know that for the vast majority of these symptoms, like fever and cough, it’s almost certainly something more routine.
Watch for a rash that starts on the face and then goes down the body or a fever that is very high, like 103 or 104 degrees Fahrenheit. Any time a fever is that high, you should contact your baby’s primary care provider and be seen.
The MMR vaccine is so effective that if your child has had at least one dose, it’s likely not measles. But if your child has symptoms and you have been in places with a lot of people, get it checked out by your child’s doctor, an urgent care or the emergency department.
If you do, it’s really important to call ahead and tell them about your concern before walking in the building. Clinics have plans to safely get these patients to their own room without exposing anyone else.
Anything else parents should keep in mind right now?
It’s important to remember that the majority of cases of measles are happening in children and adults who have not received the recommended vaccinations. We can prevent outbreaks in our own communities by maintaining measles immunity through vaccination.
The MMR vaccine is effective for those who can get it. For those who can’t get it, like babies or people who are immunocompromised, we can build a ring of immunity around them by making sure that family and friends are vaccinated.
Questions about measles? Talk to your doctor or find one near you.