The measles outbreak and immunosuppressed children

There is a measles outbreak in the U.S., with more than 1,000 cases already reported in 2019. If you’re the parent of an immunosuppressed child, you probably have many questions and concerns. The infectious diseases team shares some key facts about the situation and answers some frequently asked questions.

Why are measles cases on the rise?

Although the MMR vaccine (a live viral vaccine that is very effective at protecting people from measles), introduced back in 1963, successfully eliminated measles in the United States by 2000, the percentage of people who have been vaccinated since then has decreased. As a result, an increasing the number of measles infections are being reported across the country.

How is measles spread?

The measles virus is spread through the air when an infected person coughs or sneezes. It can remain in the air for up to two hours even after an infected person leaves the area. It is possible to be exposed to measles without ever knowing the source of the infection. Measles generally begins as a cold-like illness, about one to two weeks after exposure to the infection. It is characterized by a fever and the Three C’s: cough, coryza (runny nose), and conjunctivitis (red eyes). This is followed by the development of a red rash from head to toe.

The MMR vaccine is a two-dose series given beginning at age 1. For someone that was transplanted as a baby, or has a health condition that affects their immune system, it is possible that they were not able to receive this vaccine or did not receive a full vaccine series. This makes them vulnerable to getting the measles infection.

Are there treatments for measles?

There are no specific medications to treat measles once someone is infected. For people with healthy immune systems, the MMR vaccine can be given as an effective preventive measure if they have been exposed to measles. For someone whose immune system is suppressed either due to illness or medical treatments, including the medications needed after transplant, this may not be an option.

There is a supportive treatment that may be offered to help someone with a suppressed immune system to fight off measles more effectively if they have been exposed. It is important they contact their physician or transplant team as soon as they are aware that they have been exposed to measles, or have symptoms that are concerning for the development of measles. Their medical providers will work closely with the infectious diseases team to determine the right option and care needed.

Should parents of a transplant recipient or immunosuppressed child get an MMR booster?

People who have had measles in the past or have been appropriately vaccinated with the MMR vaccine should have adequate immunity to measles. If parents have concerns about their immunity, they should see their primary care doctor to discuss evaluating their current measles immune status. If they are not immune, it would be very helpful for them to receive the MMR vaccine.

Is it safe for parents of an immunosuppressed child to get an MMR vaccine?

It is very safe, and recommended, that all household members of an immunosuppressed person receive the MMR vaccine. There are no restrictions for a person who has a suppressed immune system to be around someone who has had this vaccine.

If an immunosuppressed patient is exposed to measles, what is the treatment?

While there are no specific medications to treat measles, there is a supportive treatment that can be offered within a few days of a known exposure. If there is a concern of exposure, the patient should contact their transplant/medical team as soon as possible, as they will likely need to be evaluated here at the hospital. They should not come directly to the hospital if they are worried they have been exposed. They should call their team first. 

Is it safe to give the MMR vaccine to someone with a suppressed immune system who has been exposed to measles?

MMR is a live viral vaccine. This vaccine is not typically recommended for patients who have received a transplant, or have a health condition that affects their immune system, because there is a very small risk that the immunization can cause illness. However, we may consider giving the MMR vaccine as a preventive measure to certain immunosuppressed patients who have had a direct measles exposure. This might include an exposure to a household member, another student at school, or being in a public place where someone who is known to have measles has also been. Because measles is an infection that is reported to the Department of Public Health, the locations of those diagnosed with measles is made available to the public.

In these cases, the decision about whether to give the child the MMR vaccine is decided by the transplant or medical team after discussion with the infectious diseases team. If you are concerned that your immunosuppressed child has been exposed to measles, please contact their transplant/medical team right away for further guidance.

Should families with immunosuppressed children travel to places with active measles cases?

Because measles is spread through the air and is very contagious, it is possible to be exposed at any time or place in areas where there are active cases of measles. If you are going to be traveling, it would be very helpful to know if your immunosuppressed child has received the MMR vaccine prior to their transplant and if they have immunity to measles. It is possible to check measles immunity with a routine lab draw. If your child is not immune to measles, it is important to be aware of the early symptoms of measles (fever, cough, runny nose, red eyes), and contact their transplant /medical team as soon as possible if any of these symptoms occur. 

Are there ways to reduce an immunosuppressed child’s risk of exposure to measles?

Proper hand washing is always a good idea, but it is important to remember that measles is contracted through the air. Wearing certain kinds of masks may be helpful if you are traveling, but may not offer full protection against measles.

If your family plans to travel to an area where measles cases have been reported, you can discuss the need for an evaluation by your child’s infectious diseases team before your trip to provide specific recommendations and advice. 

About our blogger: Kate Miller, MSN, RN, CPNP, is a nurse practitioner with Boston Children’s Division of Infectious Diseases. She works with our immunosuppressed and transplant patient populations.