Can You Get the Measles Again if Youve Already Had Them
(CNN)Most two decades after measles was alleged eliminated in the U.s., the country and the globe take seen an upsurge of cases -- including adults who thought they were protected by the vaccine. Now, some are questioning whether they are properly vaccinated and whether they are still at hazard for getting measles.
In a video posted to YouTube last calendar week, a rabbi in Detroit who said he was "fully vaccinated" nonetheless came downwardly with measles -- "a barbarous 3 weeks," he said. In some other recent case, an Israeli flight attendant has been unable to breathe on her own after experiencing a dire complication of measles: inflammation and swelling of the brain, called encephalitis. Health authorities believe she also received a vaccine.
"It's just and so darn contagious. And the mode that people travel nowadays, it just doesn't actually take much for it to spread," said Dr. John Cullen, the electric current president of the American Academy of Family Physicians and a family unit doctor in Valdez, Alaska.
"I accept never seen a case of measles," he added. "Just it's just a matter of time."
Adding to the uncertainty, some adults simply don't know their vaccination status or have long lost their documentation, Cullen said. The history of the measles vaccine has also prompted questions about how people of different ages have been vaccinated: Non but has the recommended number of doses changed over the years, but so has the vaccine itself.
Several years ago, he recalled, a case of measles popped up in Fairbanks, Alaska -- the state's get-go example in years. Worried about having been exposed and uncertain near whether they were properly vaccinated, patients of his who had traveled at that place asked for a dose of the vaccine, just in case. (When given within three days of exposure to the virus, the vaccine may offer some protection or make the illness milder, according to health officials.)
Although Alaska hasn't seen any cases this year, health officials issued an warning following a declaration of emergency in nearby Washington state, which has confirmed dozens of cases in 2019.
"If we encounter a substantial increase in the number of infections of measles, then there's going to be a whole lot more people who are going to be wondering what their vaccine status is," he said.
What are the current measles vaccine recommendations?
Doctors recommend 2 doses of the MMR vaccine, so called considering information technology covers measles, mumps and rubella. Doctors give the start dose between 12 and 15 months, the 2nd between 4 to 6 years.
The current recommendation was issued in 1989 by the US Centers for Illness Control and Prevention. Prior to that, a unmarried-dose recommendation had been in identify from 1963.
Earlier we had a vaccine, the agency says 3 million to 4 million Americans were infected yearly, including 48,000 hospitalizations and 400 to 500 deaths.
In some contempo years, there have been fewer than 100 cases nationwide. But the virus has made a comeback in other years, including 2019 -- largely due to anti-vaxers, experts say.
"The reason why we take vaccine hesitancy in this country is because people don't recollect how bad it was," Cullen said.
One vs. ii vaccine doses: What'south the difference?
If yous were vaccinated with two doses, in line with the latest guidelines from 1989, the CDC says you have a 97% risk at existence protected against measles. And if that last few percent happen to come into contact with the virus, they're less probable to spread it to others, and their illness is often milder.
One dose is notwithstanding near 93% effective at preventing the affliction.
"Near virologists just dream of a solution as successful" every bit today'due south measles vaccine, CDC'due south principal deputy director, Dr. Anne Schuchat, wrote in 2015. "Success can breed self-approbation, skepticism or even attack," she added.
The second dose, however, is not a booster per se. In enquiry studies, nearly everyone adult signs of immunity to measles with a single dose -- and the vast majority of the time, this immunity is lifelong, experts say.
"That was in the clinical trials where everything was managed very, very tightly," said Dr. William Schaffner, an infectious affliction specialist at the Vanderbilt University School of Medicine and an adviser to the CDC on vaccines.
But out in the existent world, despite major gains against the virus, wellness experts were still finding measles outbreaks among kids and adolescents who had supposedly been vaccinated with one dose.
A 2d dose seemed to do the trick, just the question remained: Why had the vaccine failed the first time around?
"When that was examined further, it was discovered that, in the hurly burly of busy [medical] practice, the vaccine was not always handled optimally," Schaffner said.
For example, if a doctor or nurse were vaccinating multiple children in a row, they may have kept the vaccine out of the refrigerator too long, causing information technology to deteriorate. Even placing it in the door of a fridge, which is slightly warmer than the inside, may in some cases be enough to degrade the temperature-sensitive vaccine, he added.
That's less of a threat now that wellness care providers are more than educated nearly how to handle the vaccine. In addition, nosotros have shifted to single-dose bottles from multidose ones that might take been left out between shots, Schaffner said.
Even so, giving ii doses has allowed health systems to "fill in" a small per centum of kids for whom the vaccine didn't have the first fourth dimension around.
"That is a wonderfully American solution: Nosotros'll double the price of the vaccine program in social club to protect this minor group of children from getting measles and its complications," Schaffner said. "That strategy worked brilliantly and has been adopted in the developing earth.
"And the only way it's been undermined is when children are withheld from vaccination."
Which vaccine did I get?
If you were built-in before the 1960s, you may take never been vaccinated confronting measles considering information technology was causeless you'd been exposed to the virus. In fact, the CDC says that most people born before 1957 don't need the vaccine because "before vaccines were available, well-nigh everyone was infected with measles, mumps, and rubella viruses during childhood."
Then, in 1963, two types of measles vaccines were introduced: One was "killed" and some other "live attenuated." The difference is that the first inactivates the measles virus, whereas the other has a weakened class of it.
The killed vaccine, which was given to an estimated 600,000 to 900,000 people, was itself killed off in 1967 "because information technology did not protect confronting measles virus infection," the CDC says. The agency likewise recommended that people who got that vaccine, or aren't sure of which one they got during those years, should go vaccinated anew.
The following twelvemonth, in 1968, a new version of the live vaccine striking the market place. It was only as effective every bit its live-attenuated predecessor and even safer than the offset, as information technology had been further weakened. It'due south withal used today, and has been available in combination with the mumps and rubella vaccines since 1971.
Experts say many middle-aged adults who were vaccinated in the early days won't know which ane they got. Whether one received the "live" or "killed" vaccine was not always documented, Schaffner said -- and these days, those decades-one-time records might exist nowhere to be found.
"Dorsum then, the entire profession was non every bit nuanced about giving vaccines," he said.
What'south more, neither the CDC nor any national organization has kept vaccination records. Private states have immunization registries, only those didn't come along until later. For many Americans, "the records that be are the ones you or your parents were given when the vaccines were administered and the ones in the medical record of the physician or clinic where the vaccines were given," co-ordinate to the CDC, which recommends that people search amidst baby books, school records and previous employers that may have collected this information, such as the military.
But many adults will be out of luck.
Older records "but don't exist anymore because the doctors closed their practice, they retired, they moved away," Schaffner said. "Information technology would be well-nigh on impossible to actually resurrect those records."
What do the experts recommend?
If you've received two doses of MMR or have had lab results showing immunity or previous measles infection, the CDC says you're all set.
If you lot've had one documented dose of the live vaccine and aren't at high risk of exposure, the bureau says that's also adequate.
Those at higher risk -- whom the agency advises to get 2 doses for proficient mensurate -- might work in health care, travel internationally or be more likely to be affected past an outbreak.
Some people can't get vaccinated at all or need to wait: for example, people with weakened allowed systems and babies who are too young to reply to the vaccine.
Born before 1957 and don't work in health intendance? The CDC considers that "presumptive prove" that y'all're immune from having been exposed to the virus in a pre-vaccine era.
Just what if you don't have written documentation of the right vaccine? For anyone who's unsure, the CDC says you tin can simply roll up your sleeve for another dose or 2.
"The MMR vaccine is safe, and in that location is no impairment in getting another dose," the agency says.
Cullen, notwithstanding, acknowledged that the number of people uncertain about their vaccination status could be very high.
"If we were to have an epidemic in our area, would we take enough MMR to go effectually for the people who are concerned?" he wondered. "Probably not, nether those circumstances. Unfortunately, this is kind of the new reality that we're dealing with."
There is a claret test doctors can employ to check immunity every bit well, but it may have some time to get results dorsum, he added.
For the general population, Schaffner said that blood examination is "expensive, impractical, and it only rarely produces an actionable result."
"The juice own't worth the squeeze," he said. "The way to prevent those older people from getting measles is to brand sure all the kids are vaccinated."
Source: https://www.cnn.com/2019/04/19/health/measles-vaccine-protection-age/index.html
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