The measly measles: what you need to know

You may have thought measles was a childhood illness of the past, but recent outbreaks in Quebec and across Canada have raised concerns among parents and health professionals.

Measles, also called rubeola, might seem fairly innocuous with its red rash, but it is considered one of the most serious contagious childhood diseases because of the dangerous complications that may be associated with it, which can include pneumonia, encephalitis and even meningitis. Complications are more common among people whose immune systems are weakened due to treatment or a serious illness (e.g. leukemia), and among babies under a year old, however, it is important to note that unvaccinated adults, especially those born after 1970, are vulnerable to catching the illness and developing complications too.

The Facts on Measles

Measles is spread by contact with mucus from the nose and mouth and by airborne droplets.
The classical symptoms of measles include a 3- to 4-day fever, accompanied by cough, runny nose and conjunctivitis (a swelling or infection of the membrane lining the eyelids), followed by a rash that appears 3 to 5 days afterwards.
Symptoms of the illness appear 8 to 12 days after the child has been exposed to the measles virus, and the illness usually lasts 10 to 14 days, from the beginning of the first symptoms to the time the rash fades.
Unfortunately, once a child contracts measles, doctors need to let the illness run its course, as there is no specific treatment for measles and management of the illness is limited to treating the symptoms. Sometimes antibiotics are given to manage bacterial complications such as pneumonia which can accompany measles.
Measles is an extremely contagious disease – 1 case of measles can infect up to 15 others who are not protected (those who have not received their 2-dose vaccine or have not had the disease).
The measles vaccine is highly effective: 99% of people who receive 2 doses of a measles-containing vaccine (MMR) will be protected against the disease.

According to Dr. Caroline Quach, infectious disease specialist at The Montreal Children’s Hospital of the McGill University Health Centre, the outbreaks we have seen recently in Quebec started in travelers returning from France, where outbreaks are currently reported, and have spread to non-protected (mostly non-vaccinated) teenagers. However, there have been additional cases of younger children contracting the illness, most of whom were not vaccinated.

The Importance of Vaccinating Against Measles

“If there is one thing that parents and caretakers should learn from this, it is to vaccinate their children,” says Dr. Quach. Two doses of the measles/mumps/rubella (MMR) vaccine are recommended for children. The first dose should be administered at the age of 12 months, and the second dose should be given at 18 months of age, according to the Protocole d’immunisation du Québec. However, if parents are planning a trip to a developing country, particularly in parts of Africa and Asia and some countries in Eastern and Western Europe, Dr. Quach recommends vaccinating children even earlier. “If the child is between 6 to 12 months old, parents should vaccinate them before a trip, and should remember that 2 additional doses will still be needed after the age of 12 months,” she adds.

While some parents may be weary of vaccinations, Dr. Quach insists that even when there are no vaccine-preventable diseases going around, the vaccination schedule should be respected so that children are properly protected when they are more vulnerable. “In order for a population to not have measles outbreaks, 94% of the population must be vaccinated,” affirms Dr. Quach. “By that same token, many individuals are mistaken if they believe that because much of the general population is immunized, their child will be protected.” Any child who is not vaccinated and is exposed to the disease will be vulnerable to contracting the illness, simply because it is one of the most contagious infectious diseases, she adds.

How do I know if I need to be vaccinated?

Measles was common before the 1970s when there was no measles vaccination program. It is likely that people born before 1970 had the disease even if they do not remember getting it, and they probably do not need to be vaccinated.

People born between 1970 and 1979 should have gotten one dose of vaccine. One dose is enough since these people are considered to have had natural boosters when they were exposed to measles, as it was still endemic (i.e. everywhere) in the 70s. However, some people born during this period (1970 to 1979) should get 2 doses; they include individuals at greater risk of transmitting the disease because of their work to vulnerable individuals (health care workers) or because they travel to countries where measles circulates widely (travelers or military personnel).

When in doubt, contact Info Santé [1] (by dialing 8-1-1 on your phone), your doctor or the CLSC that is part of the Health and Social Services Centre (CSSS) in your region [2].

Is the vaccine free in Québec?

Yes. You can get the vaccine free of charge at the CLSC that is part of the CSSS in your region [2], or from a vaccinating physician.

Is the vaccine safe?

Yes. The vaccine has been available and in use for about 30 years. It has proven to prevent and control measles, mumps and rubella. It is very safe. Most people have no reaction to the vaccine. Local reactions at the injection site can occur but are not long-lasting. Sometimes a person can develop fever and a temporary non-contagious rash 5 to 12 days after vaccination. Encephalitis, or the swelling of the brain due to infection, may occur in 1 in 1,000,000 persons vaccinated but is as high as 1 in 1,000 with naturally occurring measles. Other side effects can also occur.

Autism is not caused by the MMR vaccine. For more details about the vaccine, the Public Health Agency of Canada [3] can answer many of your questions.

References

Public Health Agency of Canada: Vaccine-Preventable Diseases Measles [4]

Santé et services sociaux du Québec: Measles outbreaks [5]