Myths About Measles Vaccines and Outbreaks

Get Educated. Get Vaccinated. Stop the Outbreaks.

Misinformation often drives people to choose to intentionally not vaccinate their children.

And now, we are seeing one of the consequences, more and more outbreaks of vaccine-preventable diseases. Not surprisingly, we are also seeing more and more misinformation about these very same vaccine-preventable diseases.

Another record year for measles (644 cases in 2014) in the United States and now a large outbreak that started at Disneyland continues to spread, getting many people sick, exposing many more, and putting many unvaccinated people into quarantine, has people pushing more myths about measles.

The MMR Vaccine isn't Working

Two doses of the MMR vaccine can protect you against measles
Two doses of the MMR vaccine can protect you against measles. Photo by Getty Images

I was actually there at the birth for this conspiracy theory.

Of course the MMR vaccine is working. That's why most people who get sick in the measles outbreaks are unvaccinated.

This myth started in a message board of Age of Autism, in an article asking if there "been any laboratory confirmation of even one case of the supposed measles related to Disneyland," and if so, was it "wild-type measles or vaccine-strain measles."

Since there had been, in a report that was easily available from the CDC, I informed them that:

Measles genotype information was available from 9 measles cases; all were genotype B3 and all sequences linked to this outbreak are identical. The sequences are also identical to the genotype B3 virus that caused a large outbreak in the Philippines in 2014.

So that should have put to rest the idea that the Disneyland outbreak was cause by the vaccine-strain of measles and that this is just a regular outbreak triggered by folks not getting vaccinated. Instead, it morphed into a whole other conspiracy theory.

Wait, they mused. If the MMR vaccine contains an attenuated form of the genotype A Edmonston strain of measles, then how could it possibly protect anyone from the B3 strain of measles at Disneyland?

Well, it turns out that there are 24 different strains of measles, at least 19 of which have been circulating around the world since 1990. Like the flu virus, wild-type measles viruses can have variable hemagglutinin (H) and nucleoprotein (N) genes, which is how these different genotypes are classified.

Knowing the measles genotype can be helpful in measles outbreak investigations.

Fortunately, "the immune response generated through vaccination protects against all strains." (Source: Vaccines; Sixth Edition)

Measles Deaths in Canada

Dr. Jay Gordon on measles
Dr. Jay explaining on Twitter how he thinks measles isn't risky.

When was the last time someone died from measles in Canada?

In a reply to one of Dr. Bob Sears' infamous rants, one woman claimed that there had been no deaths from measles in Canada since 1990, even though they have had over 16,000 cases.

While that would be great, as historically, about 0.2% of people with measles die, many people do like to push the idea that measles isn't deadly in the age of modern medicine.

Tragically, it isn't true and at least 5 people in Canada have died with measles since 2000 among only 1,326 cases (source: Statistics Canada which only went back to 2000). That is a 0.33% rate of death for measles.

  • 2000 - 207 cases - 1 death
  • 2001 - 38 cases
  • 2002 - 9 cases - 1 death (measles encephalitis)
  • 2003 - 17 cases
  • 2004 - 9 cases
  • 2005 - 8 cases
  • 2006 - 13 cases - 1 death (measles encephalitis)
  • 2007 - 101 cases - 1 death (measles encephalitis)
  • 2008 - 61 cases
  • 2009 - 14 cases
  • 2010 - 97 cases
  • 2011 - 752 cases - 1 death (measles encephalitis)

While that will surprise many people, it is not as high as what we have seen in the United States during that same time period - 994 cases and 8 deaths (0.8% rate of death).

When was the last measles death in the US? In 2012, despite the fact that many anti-vaccine folks like to claim that no one has died from measles in the United States in over 10 years.

And it is not like you hit a certain number of measles cases and the next person dies. We had 963 cases of measles in the United States in 1994 and no deaths, while in 2003, there were only 56 cases and 1 death.

Still, this doesn't mean that anyone is saying that there is "death around every corner" because of these outbreaks. We just don't want any more deaths.

Oh, in addition to the 5 measles deaths in Canada since 2000, there have been 7 deaths from subacute sclerosing panencephalitis (SSPE) a late complication of measles.

Quarantines Aren't Fair

The Today Show has featured a mother and her unvaccinated teen who are upset that she is being quarantined and can't go to school for up to 21 days because of the measles outbreaks in California.

She isn't the first person to be upset about the measles quarantines in California. Many people will recall the story of the woman in Pasadena who said that she would refuse to be quarantined after getting exposed to her sister with measles.

Unlike many other intentionally unvaccinated people, like the woman in Pasadena, this child wasn't vaccinated because her older brother "had suffered a severe, allergic reaction when he got his first measles vaccination."

The teen has had all of her other vaccines and her mother is "not opposed to having her vaccinated, if I know she safely can have it."

Can she?

It is important to note that according to the CDC in their "Quick Guide to Conditions Commonly Misperceived as Contraindications to Vaccination," vaccination may be administered if you have a relative with allergies.

While it doesn't specifically mention a vaccine allergy, if you are still concerned enough to skip the vaccine and leave a child unprotected, the CDC can help doctors with these types of vaccine safety questions.

Parents should also note that having a sibling with a vaccine allergy is not listed among the contraindications or precautions for getting the MMR vaccine.

There is also an "An Algorithm for Treatment of Patients With Hypersensitivity Reactions After Vaccines" that was published in Pediatrics in 2008, which advises that skin testing can be done to see if a person is really allergic to a vaccine. And then, even if they are allergic and vaccination is considered necessary, they can be vaccinated "under controlled conditions."

Still, that someone with a potential medical contraindication to getting vaccinated should have to be excluded from school during a measles outbreak just goes to show some of the consequences when others intentionally skip vaccines.

If they are going to be upset, it should be at the folks who start and keep these outbreaks of vaccine-preventable diseases going. They should be upset at the people who intentionally skip vaccines.

Measles Panic

A measles alert posted on a home of a child with measles by the health department.
A warning notice put on homes of children with measles to show that they were quarantined because of a measles infection. Photo by Buyenlarge/Getty Images

Whenever there is a large measles outbreak, especially if it is in California, you can be sure to hear the words "Don't Panic!"

Should you panic about a measles outbreak?

Of course not. But if you notice, it isn't the CDC, AAP, or your local health department mentioning the word panic. It is typically Dr. Bob Sears, who does a very good job in getting parents scared and panicked about vaccines, and other anti-vaccine advocates who are talking about panic.

And in telling you to not panic about measles outbreaks, they are  implying that everyone else is trying to get you to panic.

Should you be concerned about the fact that we have had more measles cases in the United States last year (at least 644) than we have had since 1994?

With more cases comes more risk that someone who isn't vaccinated might get measles, including those who are intentionally not vaccinated,  infants who are too young to be vaccinated, and children and adults with a weakened immune system.

Still, it is unlikely that we will ever get to "panic level" measles outbreak numbers in the United States. Most people are vaccinated and the outbreaks are contained fairly quickly, although the Ohio outbreak last year showed that outbreaks aren't always that easy to contain - 377 people got measles before it was over.

But even if vaccination rates drop further and we start to see more measles cases and more of the complications of measles, such as measles encephalitis and death, vaccination rates will likely just go up again.

High numbers of measles cases in Europe which began in 2010, continued in 2011, with more than 30,000 cases in each of those years. That caused more people to get vaccinated in many countries. According to the World Health Organization, in their vaccine-preventable disease 2014 monitoring system report. In the UK, immunizations rates rose dramatically after these outbreaks:

  • immunization rates for having received one measles containing vaccine jumped from 86% (2009) to 90% (2011) and then to 95% (2013)
  • immunization rates for having received two measles containing vaccine also increased, from just 79% (2009) to 88% (2011) and then to 91% (2013)

No one wants people to panic.

Although the target date keeps getting pushed back, like small pox, measles will one day be eliminated. Worldwide, the number of people getting vaccinated and protected against measles grows every day. Which means that fewer kids are getting and dying of measles every day.

In 2013, about 145,000 people died of measles, which is far fewer than the 544,000 that died in 2000. That still makes measles one of the leading causes of death of children though.

No one is yelling panic though. We just understand that it will be a rocky road to measles elimination, with unnecessary suffering and deaths if these measles outbreaks are allowed to continue.

Marvelous Measles

Materials that helped promote measles vaccination in the 1960s.
Measles cases and deaths greatly declined with the introduction of the measles vaccine in the 1960s. Photo courtesy of the CDC

Measles is hardly marvelous or mild as some would have parents believe.

When was the last measles death in the United States? You have to go all the way back to 2012. Actually that's not that long ago.

A pregnant women who was hospitalized during the 2013 measles outbreak in Brooklyn did have a miscarriage.

Since 1995, there have been 16 deaths in the United States among just over 3,000 cases. Six of those deaths have happened just since 2005. There were 2 measles deaths in 2009 and another 2 in 2010 and 1 death in 2012.

And you just have to look at what happened in Europe a few years ago to know that low vaccination rates will lead to big outbreaks of measles and high numbers of measles complications though, just like in the pre-vaccine era.

  • 2010 outbreaks in Europe - just over 30,000 cases and 21 deaths
  • 2011 outbreaks in Europe - just over 30,000 cases, 7 deaths, 27 cases of measles encephalitis, and 1,482 cases of pneumonia

Do many people recover from having measles symptoms without any problems?

Of course. With historical rates of serious complications, like acute measles encephalitis and death at 1 to 2 per 1,000 people with measles, that means that most people with measles recover without serious complications. That's likely why many older people don't recall measles being deadly. Does the average person know 500 or 1000 people?

People say the same things about polio, another vaccine-preventable disease, but I personally know they are wrong. My uncle had polio just before the first vaccines came out and nearly died. He was in the hospital for nearly six months and was lucky to survive, developing the classic limb deformities of the disease.

Tragically, the ones who didn't survive these vaccine-preventable diseases aren't around to tell their story.

But even for those without serious complications, their measles' symptoms will likely include seven days of high fever and irritability. That's why so many of these patients end up in emergency rooms. And even one death or one case of measles encephalitis is one too many when talking about a vaccine-preventable disease.

Is it possible to find situations where there were 1000s of cases and no deaths? Sure. It is not like someone is sitting around with a counter and once we get to a 1000 cases or 3000 cases, someone dies.

To figure out the complication rates, they simply looked at how many people died over a period of time and how many people had measles at that same time. Many factors will affect that though, even in industrial countries, including the ages of people affected by the outbreaks and how many are partially vaccinated.

Dr. Bob Sears, when talking about measles and the current Disneyland measles outbreaks states that "we are at it's mercy" and that tragically, yes someone will "pass away in the U.S. from measles one of these years."

I think he forgets that measles is a vaccine-preventable disease.

Have mercy for those who are too young to be vaccinated or who have problems with their immune system and can't be vaccinated. Get educated and get vaccinated and you can stop the outbreaks so that no one has to die.

Contribute to the global fight so that measles can be eliminated so that we can one day live in a world without measles.

Vitamin A and Measles

Some people wonder why we need to be concerned about measles when it can be treated with vitamin A. The World Health Organization does recommend that "all children in developing countries diagnosed with measles should receive two doses of vitamin A supplements, given 24 hours apart."

How effective is Vitamin A for measles?

The WHO states that "Vitamin A supplements have been shown to reduce the number of deaths from measles by 50%." That's important, as the WHO also warns that in many developing countries, where children have high levels of malnutrition, "up to 10% of measles cases result in death."

What about in an industrial country, like the United States? Would vitamin A make a big difference when used as treatment for measles?

While vitamin A is typically given to children with measles no matter where they are being treated, the effect is likely not going to be as dramatic as that seen in developing countries. One study done during the large measles outbreaks in New York City in the early 1990s found that only about 20% of kids with measles had low vitamin A levels.

A Cochrane Database review article, "Vitamin A for treating measles in children," while concluding that "two doses reduced overall and pneumonia-specific mortality in children aged less than two years," also emphasized that "the evidence from these studies can only be generalized in relation to low-income countries."


Dr. Andrew Wakefield
Dr. Andrew Wakefield was one of the first to suggest a link between the MMR vaccine and autism. Photo by Getty Images

The MMR vaccine is a safe and effective way to prevent measles.

The MMR vaccine does not cause autism, shaken baby syndrome, SIDS, peanut allergies, or whatever other vaccine induced disease or vaccine injury some will try and make you believe. Not getting the MMR vaccine will put your child at risk of getting measles, mumps, and rubella.

The first dose is given when children are 12 to 15 months old, with a second dose when they are four to six years old.

A few things to keep in mind about the MMR vaccine:

  • the first dose of MMR can be given as early as age six months if you will be traveling out of the United States, although it should be repeated when your child is 12 months old. The second dose can be given as early as 4 weeks after the first dose and should be given before your child turns 4 years old if you will be traveling out of the country. Getting an early dose that has to be repeated is the only situation where your child would have to get three doses of MMR.
  • giving a second dose of MMR (the MMR ‘booster’) didn’t become routine until 1990, which means that many adults who were vaccinated between 1967 and 1990 may have only gotten one dose of a measles containing vaccine. While they may not be fully protected against measles, there is no formal recommendation for them to get a second dose unless they are a student in a postsecondary educational institution, work in a health care facility, or plan to travel out of the United States.
  • the original measles vaccine used between 1963 and 1967 didn’t provide as much protection as the live measles vaccine that replaced it. Adults who received this inactivated or killed measles vaccine should be revaccinated with two doses of the MMR vaccine.

Are you up-to-date on your measles vaccines? While most people caught up in measles outbreaks are intentionally unvaccinated, there are some who are partially unvaccinated or unvaccinated because of missed opportunities to get protected.

Especially if you are going to be traveling out of the country, make sure you have all of your necessary vaccines to help you avoid measles.

Dr. Jay Gordon, like Dr. Bob Sears, a California pediatrician who advocates for alternative vaccine schedules and panders to parents who don't want to vaccine their children, recently tweeted that 'I will give MMRs to kids 3yrs+ if parents are worried' in response to the Disneyland outbreaks.

Like the alternative schedule that Dr. Bob pushes in his "vaccine" book, there is no science behind Dr. Jay's recommendation. It is not safe and only helps to keep these outbreaks going.

Measles Outbreaks

A photo of a child with measles.
In addition to a high fever, cough, runny nose, kids with measles can get pink eye without eye discharge. Photo by Barbara Rice/CDC

What myths and conspiracy theories have you heard about measles outbreaks?

The easiest to debunk are that measles outbreaks are all started by vaccinated children. They aren't.

  • 2010 outbreaks in Europe - almost all were unvaccinated and only 2% had more than one dose of a measles vaccine
  • 2011 outbreaks in Europe - almost all were unvaccinated and only 4% had more than one dose of a measles vaccine
  • 2011 outbreaks in United States - through May, of 118 cases, at least 89% were unvaccinated
  • 2013 outbreaks in United States - through August, of 159 cases, only 3 people were known to be fully vaccinated
  • 2014 outbreaks in United States - through May, of 288 cases, only 10% were known to be vaccinated with at least one dose of a measles vaccine

How about the idea that measles outbreaks are usually small, so we shouldn't worry about them? While many measles outbreaks are small, it is only because most people are vaccinated and local health departments work very hard to contain them. That didn’t stop the 2014 Ohio measles outbreak from growing to at least 377 people though.

And containing measles outbreaks is expensive too. There were 220 cases of measles in the United States in 2011. To contain just 107 of those cases in 16 outbreaks, "the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars."

How much do you think it cost to contain the 644 measles cases in 2014?

More importantly, should the CDC and our local and state health departments be putting so many resources into containing a vaccine-preventable disease when we have much bigger things to be concerned about, such as Ebola and outbreaks of other emerging infections?

Third Dose of MMR

The MMR vaccine provides protection against measles
Two doses of MMR provide great protection against measles. Photo by Joe Raedle/Getty Images News/Getty Images

I first heard the myth about adults needing a third dose of MMR from a notorious mommy blogger named Jessica Gianelloni. In a blog (Life As We Know It: The Gianelloni 7) that she has since taken down, she posted the article "Measles Shmeasles Goes to Disneyland."

There was a lot of vaccine misinformation in her post, but the one that was easiest to correct was her assertion that the CDC was recommending that folks get a third dose of MMR.

While in some outbreak situations, it is possible that experts will recommend that some high risk people get an extra vaccine, that certainly hasn't been the case for measles. Sometimes it is for mumps, which is why she could have gotten confused with third dose of MMR, but even then, it wouldn't be a routine recommendation.

Unfortunately, even with Mrs. Gianelloni's blog was still up, she didn't allow my comments that would have corrected her reporting about a third dose of MMR.

Not surprisingly, that is standard on many of the mommy blogger sites. From Living Whole Megan to Kate, the Modern Alternative Mama, these mommy bloggers typically ban any people who disagree with what they are saying. That's why all of their comments are favorable. It certainly isn't because every one in the world agrees with them!

While it seems like Jessica Gianelloni has stopped blogging, the myth of the third MMR shot certainly hasn't gone away.

Instead of a third dose of MMR, when people talk about additional doses of MMR for adults, they are usually talking about a second dose. While the measles vaccine has been around since 1963, getting a second dose didn't become routine until about 1990.

So many adults born before the recommendation for a second dose may have had just one dose of MMR and may be just partially protected against measles.

These are the adults who are most in need of 'additional doses' when people talk about vaccinating adults.

Measles Outbreaks are Caused by Immigrants

We have seen a lot of people trying to explain the reasons for the rise in measles outbreaks over the last few years.

While we know the true reason is almost certainly the increase in the number of unvaccinated children, some have proposed that the real reasons are:

  • the Amish, as they "turned an otherwise unremarkable year for this virus into one of the worst in recent history." The story in Vox failed to mention that even without the Ohio measles outbreak among the Amish, 2014 would hardly have been unremarkable. It still have been the biggest for measles in the United States since 1996 - 277 cases.
  • "public health measures that targeted only children to lack of access to medical care," with the anti-vaccination movement compounding the problem. What this article in US News & World Report fails to mention is that while lack of access to care and vaccines may have triggered the measles outbreaks in the late 1980s, that doesn't seem to be what is happening now.

Perhaps the worst among the bunch in trying to shift the focus away from intentionally unvaccinated children and adults is those who are quick to blame 'illegal aliens.'

While it is true that most outbreaks of measles have been imported into the United States since 2000, when the endemic spread of measles was stopped, it is not undocumented immigrants who are doing the importing of measles or other diseases. It is typically foreign visitors or unvaccinated citizens of the United States traveling out of the country and returning with measles, such as when:

  • a 2008 outbreak in California started when an unvaccinated boy traveled from San Diego to Sweden, and returned with measles, getting 11 other people sick. Of the measles cases through the first half of 2008, "89% were imported from or associated with importations from other countries, particularly countries in Europe."
  • Again in 2011, 89% of measles cases were import-associated from at least 15 countries and at 74% of the cases started in "U.S. residents traveling abroad."
  • A 2013 report from the CDC found an even higher number of import associated measles cases - "among the 159 cases, 157 (99%) were import-associated."
  • In the first half of 2014, the CDC reported that of 288 cases, 97% "were associated with importations from at least 18 countries." Of 45 direct importations of measles, there were  "40 U.S. residents returning from abroad and five foreign visitors."

So despite what folks like to say in message boards, the measles outbreaks in the United States are not caused by anything other than mostly unvaccinated children and adults who are linked to foreign travel.

Vaccines Work

Get Educated. Get Vaccinated. Stop the Outbreaks.