- Rubeola, or “red” measles, is a highly contagious respiratory disease spread by coughing, sneezing, or simply being in close contact with someone who is infected with it, even when the rash is not visible. Measles tends to be more severe in adults than in children, with a higher fever, more prominent rash, and more complications.
- Symptoms start with a fever, cough, runny nose, red irritated eyes, sore throat with tiny white spots inside the mouth and last 2-4 days before the signature itchy red rash appears on the body around the fourth or fifth day, beginning on the head and moving down the body.
- After coming in contact with someone infected with measles, the incubation period from initial exposure to onset of the rash is between seven and 18 days, with an average of 14 days. The period leading up to the appearance of the rash is characterized by a rising fever that peaks at 103-105 degrees F.
- Complications of measles can include bronchitis, ear infections, pneumonia, encephalitis and death. Some studies have demonstrated that vitamin A reduces the risk of death and complications and that children with vitamin A deficiency, especially in underdeveloped countries, are at increased risk for measles complications. Receiving serum immune globulin 6 days after exposure to measles can mediate the severity of measles.
- In 1960, three years before the first measles vaccine was licensed in the U.S., there were 380 deaths from measles recorded. Today, deaths from measles are rare in the U.S. (an average of 1 per year). Globally 95 percent of deaths from measles occur in developing countries, where measles is one of the leading causes of death among young children.
- Currently there are two measles containing vaccines being used in the U.S - MMRII - a combination measles-mumps-rubella(MMR) live virus vaccine and ProQuad- a combination measles-mumps-rubella-varicella (MMR-V) live virus vaccine. Both products are produced and distributed by Merck. The CDC recommends children get an MMR shot between 12 and 15 months of age with a second dose given between 4 and 6 years old.
- Common side effects from the MMR vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Reported serious adverse reactions following MMR vaccination include seizures, brain inflammation and encephalopathy; thrombocytopenia; joint, muscle and nerve pain; gastrointestinal disorders; measles like rash; conjunctivitis and other serious health problems;
- As of September 1, 2015, there had been 1,167 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination, including 77 deaths and 1,090 serious injuries.
- Using the MedAlerts search engine, which facilitates an online search of the federal Vaccine Adverse Events Reporting System (VAERS) database, as of March 3rd, 2016 there have been 7692 serious adverse events Vaccine Adverse Events Reporting System (VAERS) in connection with measles vaccine since 1990, with over half of those occurring in children three years old and under. Of these events 397 were deaths with over half of the deaths occurring in children under three years of age.
- Evidence has been published in the medical literature that vaccinated persons can get measles because either they do not respond to the vaccine or the vaccine’s efficacy wanes over time and vaccinated mothers do not transfer long lasting maternal antibodies to their infants to protect them in the first few months of life;
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IMPORTANT NOTE:NVIC encourages you to become fully informed about Measles and the Measles vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
Table of Contents
What Is Measles?
Rubeola, or “red” measles, is a respiratory disease caused by a paramyxovirus, genus Morbillivirus with a core of single-stranded RNA. Measles is highly contagious and causes a systemic infection that begins in the nasopharynx. The virus is shed through respiratory secretions (nasal discharge, coughing sneezing) for four days before symptoms appear until three to four days after rash onset, when it is most easily transmitted.
Before the first measles vaccine was licensed in the U.S. in 1963, measles increases were seen generally in winter and spring every two to three years.
Rubeola (not to be confused with rubella, a less serious infection commonly known as “German measles”) symptoms begin 10-12 days after close contact with someone infected with measles. Symptoms and start with a fever, cough, runny nose, conjunctivitis, white spots in the mouth and progresses to a rash that starts on the face and spreads to the rest of the body and lasts for about a week. Complications include very high fever, diarrhea, otitis media, seizures, pneumonia, encephalitis (0.1% reported) and very rarely subacute sclerosing panencephalitis (SSPE - a progressive, debilitating and deadly brain disorder) and death.1, 2 ,3
Measles can also be mistaken for influenza before the signature measles rash appears around the fourth or fifth day after the fever begins. 4,5
Measles virus is easily destroyed by light, high temperatures, UV radiation or disinfectants.6
Although the measles virus is closely related to certain animal diseases such as canine (dog) and porcine (pig) distemper, it is a disease unique to humans, and is not found in animals. Measles is highly contagious and is seasonal, occurring in cyclical “waves” around the world.
Doctors diagnose measles by looking for the presence of tiny white specks surrounded by a red halo inside the cheeks of an infected person’s mouth. 7 As the fever progresses, cold symptoms develop, such as cough, runny eyes and nose. Conjunctivitis (inflammation or infection of the membranes of the eyes) can be a complication.
Sometimes persons with measles will not be able to tolerate bright lights. They also may have a sore, red mouth. While rubella and scarlet fever can also have a measles-like rash, usually there is no cough, runny nose and cold symptoms (coryza) or conjunctivitis. 8
Other occasional illnesses that may develop along with measles are croup, bronchiolitis and pneumonia. Persons who have had measles infection usually will acquire long-lasting immunity.9
Is Measles Contagious?
Measles is a highly contagious viral disease that is spread through the air by respiratory droplets, or by coming in contact with nasal discharge/mucous of an infected person. Measles is most contagious during the three days before the rash appears. The rash usually begins around the face and neck, and works its way down the body, with increasing lesions often seen on the face and trunk. The rash lasts 3-7 days and fades from the body in the order in which it appeared. The fever can linger two or three more days, and the cough as long as 10 days after the rash subsides. 10
This disease can be transmitted very easily in areas where people are together in close quarters, such as family members in a home, or students in schools or daycare centers, or among travelers on an airplane. Other high-risk settings for easy transmission of measles include public places where large numbers of people gather and have close contact. Measles transmission has been documented to have occurred even after the contagious person has left the room up to 2 hours before a susceptible person entered the room.11 ,12
According to the CDC, Americans born before 1957 have naturally acquired immunity to measles.13 Infants born to mothers, who have had measles and acquired natural antibodies, benefit from a passive maternal immunity passed on to them by their mothers to protect them as newborns. There also is evidence that unvaccinated mothers, who have recovered from measles, can pass short-term measles immunity to their infants when they breastfeed their babies.14 However, maternal immunity wanes when the baby is around 4 months old.
If the mother has not had wild type measles but has been vaccinated against measles, studies show that there are no or few maternal antibodies passed on to the baby. Most babies born to vaccinated mothers are susceptible to measles in the first year of life, which is before measles vaccination is recommended at no earlier than 12 months of age, preferably at 15 months of age.15
What is the history of Measles in America and other countries?
Measles outbreaks occur in cycles in the U.S. and globally, usually every two to three years. 16 , 17 , 18 Prior to 1912, measles was not a reportable disease in the U.S., so accurate numbers of cases are not available prior to that time. In 1941, there were 894,134 cases reported. 19 In 1920, the United States had 469,924 recorded cases of measles and 7,575 deaths associated with measles. From 1958 to 1962, the U.S. averaged 503,282 cases and 432 death associated with measles each year. 20
Before measles vaccine was licensed in 1963, the CDC admits there was massive underreporting of measles cases and that “because virtually all children acquired measles, the number of measles cases probably approached 3.5 million per year (.i.e., an entire birth cohort).” 21, 22 Other doctors say it was more like 5 million cases of measles occurring every year. In 1960, three years before the first measles vaccine was put on the market in the U.S., there were about 442,000 reported measles cases and 380 related deaths23, 24 among 3.5 to 5 million Americans.
There was a huge resurgence of measles in the U.S. between 1989 and 1991, when reported measles cases increased 6- to 9-fold over a previous period studied between 1985 and 1988. During the1989-91 time period, more than 53,000 cases occurred in 815 separate outbreaks.25 Also during that time period, 120 deaths were attributed to measles in the U.S. 26
In an eight-year period between 1993 and 2001, there were 1804 cases of measles reported in 120 outbreaks. After only 15 measles cases were reported between 1999 and 2001, public health officials declared that measles was no longer endemic in the United States. 27
In the years 2000-2007, the U.S. recorded an average of 63 cases of measles a year before an increase in measles cases was reported. 28
Increases in reported measles cases in the U.S. can be observed by looking at the CDC’s Notifiable Diseases and Mortality Tables: 29
- In 2007 there were 43 cases
- In 2008 there were 140 cases
- In 2009 there were 71 cases
- In 2010 there were 63 cases
- In 2011 there were 220 cases
- In 2012 there were 55 cases
- In 2013 there were 187 cases
- In 2014 there were 634 cases
- In 2015 through January 28 there were 68 cases
According to the CDC, most cases of measles in 2011 were among, or linked to, travelers returning from, or visiting, other countries, including those in Europe and Southeast Asia.30 The CDC has also stated that many cases in the 2014 outbreak were associated with cases brought from the Philippines31 The majority of measles cases in the ongoing outbreak of 2015 appear to have begun in a Disney theme park. The CDC issued a health advisory on Jan. 23, 2015 stating that of the 68 cases covering 11 states, 51 were associated with the exposure while visiting the theme park. Of the 68 cases for ages ranging from 10 to 57 years of age 8 patients were hospitalized, 23 were unvaccinated, 6 were vaccinated, 5 were too young to receive the vaccine and 17 had an unknown vaccination status. 32
On Sept. 12, 2013, public health officials at the U.S. Centers for Disease Control (CDC) called a press conference to announce that vaccination rates among pre-school children are “high and stable” and “less than 1% are unvaccinated.”33 More than 90 percent of American toddlers have gotten a measles containing MMR shot by age three, along with many doses of 10 other government recommended vaccines.
The CDC attributes the drop in reported measles cases and deaths in the U.S. to use of the measles vaccine beginning in the mid-1960’s 34 But, published measles morbidity and mortality data give evidence that death rates for measles had dropped significantly in the U.S. before the measles vaccine was introduced in 1963.35,36
“Modified” measles can also occur in persons with some degree of immunity, as well as in previously vaccinated persons, who get a milder form of measles. “Atypical” measles can occur in a person, who was previously vaccinated with a killed-virus vaccine used from 1963 to 1967, and who is exposed to wild-type measles. The course of atypical measles is generally longer than natural measles.37
Can Measles cause injury and/or death?
Worldwide, measles is one of the leading causes of death in children living in undeveloped countries. In 2008 there were 164,000 deaths attributed to measles globally, mostly children under the age of 5.38 In the U.S. in 2009, there were just two deaths attributed to measles; zero in 2008; zero in 2007 and 2006; and one in 2005.39
Complications from measles include pneumonia, croup, and encephalitis.40 According to the CDC, 1 out of 10 children with measles develop an ear infection; 1 in 20 get pneumonia and 1 in 1,000 may develop encephalitis. It also can cause diarrhea in about 8 percent of cases. Measles also can cause a miscarriage in a pregnant woman, or cause her to give birth prematurely, or have a low-birth-weight baby. 41, 42 Other complications include appendicitis, hepatitis, myocarditis (inflammation of the heart muscle), thrombocytopenia (blood disorder), and death. 43
In developing countries, where serious malnutrition and vitamin A deficiency are common, measles has been known to kill as many as 1 out of 4 people 44 and lead to long-term health problems such as blindness, chronic lung disease, failure to thrive and recurrent infections.45
A rare but fatal disease of the central nervous system, subacute sclerosing panencephalitis (SSPE - a progressive, debilitating and deadly brain disorder) also can develop later in life after a measles infection earlier in life.46 Signs of SSPE, according to CDC, are:
- Changes in personality
- Gradual onset of mental deterioration
- Myoclonia (muscle spasms or jerks)
- An elevated anti-measles antibody (IgGP in the serum and cerebrospinal fluid)
Who is at highest risk for getting Measles?
Those most at risk for getting measles are poorly nourished young children, especially those with insufficient vitamin A, or those whose immune systems have been weakened by HIV/AIDS or other diseases.47 Crowded living conditions can also put people at high risk of contracting measles, even in highly-vaccinated populations.48 , 49
Worldwide, measles outbreaks occur in several year cycles, often coinciding with the seasons, usually late winter and spring. In the U.S. during a reported increase in measles cases during 1989-91, it was found that school-age children accounted for the largest proportion of measles cases.
Overall measles incidence rates were highest in urban Hispanic and African American populations where, among children younger than 5 years old, the incidence was four to seven times higher than among Caucasians. Also, CDC measles statistics from 1989-91 show that infants younger than one year of age may have been more susceptible to getting measles because their mothers had not experienced measles but had been vaccinated as children and were unable to pass on naturally acquired maternal antibodies to their infants to protect them in the first year of life.50
Who is at highest risk for suffering complications from Measles?
Unvaccinated children under age 5 and adults over 20 are most at risk for complications from measles. Undernourished or vitamin A-deficient children are at highest risk of severe complications. Acute measles encephalitis is more common in adults than children, and subclinical hepatitis occurs in about 30 percent of adult measles patients.
Immunocompromised individuals are also at higher risk of complications from measles, including those with HIV infection, congenital immunodeficiencies, and those persons with disorders requiring chemotherapeutic and immunosuppressive therapy.51, 52
Studies also show that complication rates and deaths are significantly higher, and recovery times longer, in infants and children who acquire measles in healthcare settings such as hospitals.53
Can Measles be prevented and are there treatment options?
There is no cure for measles. Once a person is infected, treatment primarily involves alleviating the symptoms with fluids and fever-reducers, and observation for signs of encephalitis and other measles complications.
Many studies have also shown that immediate administration of high doses of vitamin A (50,0000-100,000 IUs) can help control the severity of the disease, particularly in children who are malnourished. In the U.S. vitamin A treatment is often recommended for children hospitalized for measles, and in immunocompromised individuals, as well as those who have clinical evidence of being vitamin A deficient. 54, 55
Antiviral agents such as ribavirin and interferon have also been used to treat measles in immunocompromised individuals, although there are outstanding questions about clinical efficacy.56, 57
What is Measles vaccine?
Measles vaccine is a weakened (attenuated) form of the live measles virus. Currently, there are 2 available vaccines for use in the U.S. Merck's MMRII, which contains Measles, Mumps and Rubella Vaccine, Live and Merck's Proquad, which contains Measles, Mumps, Rubella and Varicella, Live. (The third measles vaccine, Merck’s Attenuvax, contains measles only; however, Merck has discontinued production of this vaccine, so new batches of it will not be available, even though it’s approved.)58, 59
Merck’s MMRII , is licensed and recommended for individuals aged 12 months or older. It is a live attenuated virus vaccine propagated in chick embryo cells and cultured with Jeryl Lynn live attenuated virus mumps and Meruvax II, a live attenuated virus vaccine propagated in WI-38 human diploid lung fibroblasts. 60 The WI-38 human diploid cell line was derived from the lung tissue of a three month human female embryo. The growth medium used was salt solution and 10 percent calf (bovine) serum.61
Merck's ProQuad , is licensed and recommended for individuals aged 12 months to 12 years of age. ProQuad (Measles, Mumps, Rubella and Varicella Virus Vaccine Live) is a combined, attenuated, live virus vaccine containing measles, mumps, rubella, and varicella viruses. ProQuad is a sterile lyophilized preparation of the components of M-M-R II (Measles, Mumps, and Rubella Virus Vaccine Live): Measles Virus Vaccine Live, and Varicella Virus Vaccine Live (Oka/Merck), the Oka/Merck strain of varicella-zoster virus propagated in MRC-5 cells. MRC-5 cells are derived from a cell line that was developed in 1966 from lung tissue taken from a 14 week aborted fetus and contains viral antigens.62
The growth medium for measles and mumps for both MMRII and ProQuad are a buffered salt solution containing vitamins and amino acids and supplemented with fetal bovine serum containing sucrose, phosphate, glutamate, and recombinant human albumin, and neomycin. The growth medium for rubella is a buffered salt solution containing vitamins and amino acids and supplemented with fetal bovine serum containing recombinant human albumin and neomycin. Sorbitol and hydrolyzed gelatin stabilizer are added to the individual virus harvests. In the ProQuad Vaccine, the Oka/Merck strain of the live attenuated varicella virus, initially obtained from a child with wild-type varicella, then introduced into human embryonic lung cell cultures, adapted to and propagated in embryonic guinea pig cell cultures and finally propagated in human diploid cell cultures (WI-38) is added to the MMRII component.
According to Merck, both MMRII and ProQuad vaccines are screened for adventitious agents. Each dose of MMRII contains sorbitol, sodium phosphate, sucrose, sodium chloride, hydrolyzed gelatin, recombinant human albumin, fetal bovine serum, other buffer and media ingredients and neomycin. Each dose of ProQuad contains sucrose, hydrolyzed gelatin, sorbitol, MSG, sodium phosphate, human albumin, sodium bicarbonate, potassium phosphate and chloride, neomycin, bovine calf serum, chick embryo cell culture, WI-38 human diploid lung fibroblasts and MRC-5 cells.63, 64
The CDC recommends that children get two doses of the MMR vaccine with the first dose given between ages 12-15 months, and the second dose given between ages 4-6 years.65 CDC recommendations state that persons age 18 or older, who were born in 1957 or later, should get at least one dose of MMR if there is no laboratory evidence of naturally acquired measles immunity or documentation that a measles vaccine was given on or after the first birthday.
Healthcare workers and students entering college or other post-high school educational institutions, as well as international travelers, are told to get two doses of measles vaccine if they have not been vaccinated previously. According to the manufacturer, MMR should be given one month before or one month after any other live viral vaccines.66, 67
What is the history of Measles vaccine use in America?
Two measles vaccines were first licensed in 1963. One was a live attenuated vaccine and the other was an inactivated (killed) virus vaccine, which was withdrawn in 1967 due to lack of effectiveness and an increased risk for atypical measles. The other vaccine was withdrawn in 1975 because of a relatively high frequency of fever and rash reactions.
In 1973, Merck’s further attenuated combination measles-mumps-rubella vaccine was licensed and, as of July 2012, it is the only measles-containing vaccine available in the U.S.68
In August and September of 2013, the CDC published annual reports that confirming American children are among the most highly vaccinated in the world.69, 70, 71 In 2012, 95% of children entering kindergarten had gotten two MMR shots and so had more than 90% of high school students. About 1.8% of kindergarten children had a medical or personal belief exemption to vaccination on file with schools.
In short, 95% of the approximately 75 million children under age 1872 have gotten two doses of MMR vaccine and there is also a high measles vaccination rate among young adults in their 20’s and mid-30’s because, since 1981, 95% of all children entering kindergarten have received at least one dose of MMR vaccine and three or more doses of diphtheria, tetanus, pertussis and polio containing vaccines. 73
After 17 years of giving children measles vaccine, in 1980 there were only 13,500 reported measles cases and 11 related deaths.74 But in 1990, about 28,000 measles cases and 64 deaths were reported in a population in which 95% of children entering kindergarten had gotten one MMR shot that public health officials had promised parents would give their children life long immunity to measles.75
So the CDC added a second MMR shot to the child vaccine schedule and, by 2005, there were only 66 cases of measles reported. 76 However, in 2008 and 2011, there were a total of 362 reported measles cases, even as there were no deaths.77
How effective is Measles vaccine?
The CDC estimates that measles antibodies develop in approximately 98 percent of children vaccinated at 15 months or older. It is estimated that about 2-5 percent of children, who receive the vaccine at 12 months of age or younger or who only get one dose of MMR, fail to be protected. A second dose or MMR is thought to stimulate a protective immune response in about 99 percent of vaccine recipients.
The CDC says that vaccine-induced immunity “appears to be long-term and probably lifelong in most persons.” However, some studies show that vaccine failure due to waning immunity may occur.78 Recent news reports from India showed that only 1 child in 5 vaccinated for measles was actually protected from getting the disease, even after being fully vaccinated. 79
According to the Merck product information insert, there is some evidence that if infants born to mothers, who have experienced natural measles infection, are vaccinated at less than one year of age, they may not develop long lasting vaccine acquired antibodies because natural maternal antibodies interfere with vaccine induced antibodies.80
Measles vaccine acquired immunity is reported to wane in at least 5 percent of cases, within 10 to 15 years after vaccination.81,82, 83 A report published in 2012 by the Cochrane Collaboration reviewed 57 clinical trials and studies that involved about 14.7 million children vaccinated with the MMR vaccine.84 Cochrane found that:
"Based on the evidence provided by three cohort studies (3104 participants), vaccination with one dose of MMR vaccine is at least 95 percent effective in preventing clinical measles among preschool children; in schoolchildren and adolescents at least one dose of MMR vaccine was 98 percent effective in preventing laboratory-confirmed measles cases; one or two MMR doses were respectively 92 percent and 95 percent effective in preventing secondary measles cases."
There are studies showing that measles outbreaks can occur in fully vaccinated populations.85 ,86,87 For example, an outbreak of measles in the spring of 1985 in Corpus Christi, Texas, occurred in a school where more than 99 percent of the students were fully vaccinated. After examining serum samples from students for detectable measles antibodies, the study’s researchers concluded that “outbreaks of measles can occur in secondary schools, even when more than 99 percent of the students have been vaccinated…”88
In another outbreak in a school in Illinois in 1983-84, the Centers for Disease Control confirmed that the school had a “documented immunization level of 100 percent,"89 suggesting the possibility of certain amount of primary vaccine failure or waning immunity since it had been 10 or more years since the students, who got measles, had had their last measles shot.
Some research reveals that exposure to natural measles not only is actually necessary to maintain protective antibodies in vaccinated persons, but also may help prevent symptoms of allergic diseases.90,91 Still other research shows that measles vaccine acquired immunity wanes over time, providing an opportunity for subclinical (asymptomatic) measles infections to occur in fully vaccinated populations.92
Can Measles vaccine cause injury & death?
Common side effects from the MMR vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Serious adverse events following MMR vaccination include seizures, severe headaches, double vision, vomiting, joint pain, or pain in the digestive system. 93,94
Other more rare but serious complications reported by Merck in MMR vaccine post-marketing surveillance include: 95
- brain inflammation (encephalitis) and encephalopathy (chronic brain dysfunction);
- panniculitis (inflammation of the fat layer under the skin);
- atypical measles; syncope (sudden loss of consciousness, fainting);
- vasculitis (inflammation of the blood vessels);
- pancreatitis (inflammation of the pancreas);
- diabetes mellitus;
- thrombocytopenia purpura (blood disorder);
- leukocytosis (high white blood cell count);
- anaphylaxis (shock);
- bronchial spasms;
- arthritis and arthralgia (joint pain);
- myalgia (muscle pain);
- polyneuritis (inflammation of several nerves simultaneously).
Using the MedAlerts search engine, which facilitates an online search of the federal Vaccine Adverse Events Reporting System (VAERS) database, as of March 3rd, 2016 there have been 7692 serious adverse events Vaccine Adverse Events Reporting System (VAERS) in connection with measles vaccine since 1990, with over half of those occurring in children three years old and under. Of these events 397 were deaths with over half of the deaths occurring in children under three years of age. Adverse events following MMR vaccination reported to VAERS include:
- lupus (autoimmune connective tissue disorder);
- Guillain-Barre syndrome (inflammation of the nerves);
- aseptic meningitis (inflammation of the lining of the brain);
- cardiomyopathy (weakening of the heart muscle);
- hypotonic-hyporesponsive episodes (collapse/shock);
- subacute sclerosing panencephalitis (SSPE);
- ataxia (loss of ability to coordinate muscle movements);
- parathesia (numbness, burning, prickling, itching, tingling skins sensation indicating nerve irritation)
- Transverse Myelitis
- Acute disseminated encephalomyelitis (ADEM)
In both its MMRII and ProQuad product information inserts96, 97 Merck also notes that during MMR vaccine post-marketing surveillance, there have been post-vaccination reports of:
- erythema multiforme (skin disorder from an allergic reaction or infection);
- urticarial rash (hives, itching from an allergic reaction);
- measles-like rash;
- burning/stinging at the injection site;
- nerve deafness;
- otitis media (ear infection);
- retinitis (inflammation of the retina of the eye);
- optic neuritis (inflammation of the optic nerve);
Merck also gives the following warnings in their product insert about vaccine strain measles virus infection and shedding: 98
- “ Measles inclusion body encephalitis (MIBE), pneumonitis and death as a direct consequence of disseminated measles vaccine virus infection have been reported in immunocompromised individuals inadvertently vaccinated with measles-containing vaccine;” although Merck also states that “Children and young adults who are known to be infected with human immunodeficiency viruses and are not immunosuppressed may be vaccinated” and that “The ACIP has stated that "patients with leukemia in remission who have not received chemotherapy for at least 3 months may receive live virus vaccines. Short-term (<2 weeks), low- to moderate-dose systemic corticosteroid therapy, topical steroid therapy (e.g. nasal, skin), long-term alternate-day 6 treatment with low to moderate doses of short-acting systemic steroid, and intra-articular, bursal, or tendon injection of corticosteroids are not immunosuppressive in their usual doses and do not contraindicate the administration of measles, mumps, or rubella vaccine."
- Excretion of small amounts of the live attenuated rubella virus from the nose or throat has occurred in the majority of susceptible individuals 7 to 28 days after vaccination. There is no confirmed evidence to indicate that such virus is transmitted to susceptible persons who are in contact with the vaccinated individuals. Consequently, transmission through close personal contact, while accepted as a theoretical possibility, is not regarded as a significant risk. However, transmission of the rubella vaccine virus to infants via breast milk has been documented.”
- “There are no reports of transmission of live attenuated measles or mumps viruses from vaccinees to susceptible contacts.”
- “It is not known whether measles or mumps vaccine virus is secreted in human milk. Recent studies have shown that lactating postpartum women immunized with live attenuated rubella vaccine may secrete the virus in breast milk and transmit it to breast-fed infants. In the infants with serological evidence of rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of acquired rubella.”
- “There have been reports of subacute sclerosing panencephalitis (SSPE) in children who did not have a history of infection with wild-type measles but did receive measles vaccine. Some of these cases may have resulted from unrecognized measles in the first year of life or possibly from the measles vaccination .”
In November 2014, the National Vaccine Information Center published a special report The Emerging Risks of Live Virus and Virus Vectored Vaccines: Vaccine Strain Virus Infection, Shedding and Transmission. 99 This report reviewed the medical literature for evidence that live virus vaccine strain infection, shedding and potential for transmission occurs, including measles vaccine strain infection and shedding.
There have been published reports of vaccine strain measles infection with clinical symptoms that are indistinguishable from wild-type measles. 100 101 There are also a few reports of measles vaccine strain virus shedding and lab confirmed infection in children following MMR vaccination. In 2002, there was a published report by researchers in France of “a child presenting with fever 8 days after vaccination with a measles-mumps-rubella vaccine. Measles virus was isolated in a throat swab taken 4 days after fever onset. This virus was then further genetically characterized as a vaccine-type virus.” 102
In 2010, Eurosurveillance published a report about the shedding of vaccine strain measles virus in urine and throat secretions of a Croatian child with vaccine-associated rash illness.103 A healthy 14-month old child was given MMR vaccine and eight days later developed macular rash and fever. Lab testing of throat and urine samples between two and four weeks after vaccination tested positive for vaccine strain measles virus. Authors of the report pointed out that when children experience a fever and rash after MMR vaccination, only molecular lab testing can determine whether the symptoms are due to vaccine strain measles virus infection. They stated:
“According to WHO guidelines for measles and rubella elimination, routine discrimination between aetiologies of febrile rash disease is done by virus detection. However, in a patient recently MMR-vaccinated, only molecular techniques can differentiate between wild type measles or rubella infection or vaccine-associated disease. This case report demonstrates that excretion of Schwartz measles virus occurs in vaccinees.”
In 2012, a report was also published describing a healthy 15-month old child in Canada, who developed irritability, fever, cough, conjunctivitis and rash within seven days of an MMR shot. 104 Blood, urine and throat swab tests confirmed a vaccine strain measles virus infection 12 days after vaccination. Addressing the potential for measles vaccine strain virus transmission to others, the authors stated,
“While the attenuated virus can be detected in clinical specimens following immunization, it is understood that administration of the MMR vaccine to immunocompetent individuals does not carry the risk of secondary transmission to susceptible hosts.”
There have also been 397 deaths reported to VAERS in association with the MMR vaccine. However, the numbers of vaccine-related injuries and deaths reported to VAERS may not reflect the true number of serious health problems that occur develop after MMR vaccination.
Even though the National Childhood Vaccine Injury Act of 1986 legally required pediatricians and other vaccine providers to report serious health problems following vaccination to federal health agencies (VAERS), many doctors and other medical workers giving vaccines to children and adults fail to report vaccine-related health problem to VAERS. There is evidence that only between one and 10 percent of serious health problems that occur after use of prescription drugs or vaccines in the U.S. are ever reported to federal health officials, who are responsible for regulating the safety of drugs and vaccines and issue national vaccine policy recommendations.105,106,107, 108
As of March 1, 2016, there have been 972 claims filed so far in the federal Vaccine Injury Compensation Program (VICP) for 57 deaths and 915 injuries that occurred after MMR vaccination. There have been 35 claims filed with the VICP for 1 death and 34 injuries that occurred after MMR-V vaccination. Of that number, the U.S. Court of Claims administering the VICP has compensated 377 children and adults, who have filed MMR vaccine injury claims and 16 children and adults, who have filed MMR-V claims.109
One example of an MMR vaccine injury claim awarded compensation in the VICP is the case of Madyson Williams. Madyson was growing and developing normally until May 12, 2006, when she was given MMR, varicella zoster and Hib vaccines simultaneously during an office visit. Six days later, she developed seizures and died.
On Oct. 10, 2008, the Department of Health and Human Services conceded Madyson died from a reaction to MMR vaccine and her parents were awarded $250,000, the maximum amount allowed for an acknowledged vaccine-related death in the VICP.110, 111
IMPORTANT NOTE: Even though ACIP says it’s safe to give other viral and bacterial vaccines at the same time as MMR vaccine, Merck’s MMRII product information insert states that other live virus vaccines—such as varicella112 should NOT be given at the same time as MMR vaccine but rather should be administered one month prior or one month after MMR vaccination.113
In 1998, public health officials and attorneys associated with the federal Vaccine Injury Compensation Program published a review in Pediatrics of the medical records of 48 children ages 10 to 49 months, who received a measles vaccine or combination MMR vaccine between 1970 and 1993 and developed encephalopathy after vaccination. The children either died or were left with permanent brain dysfunction, including mental regression and retardation, chronic seizures, motor and sensory deficits and movement disorders. The study authors concluded that:
“The onset of neurologic signs or symptoms occurred with a nonrandom, statistically significant distribution of cases on days 8 and 9. No cases were identified after the administration of monovalent mumps or rubella vaccine. This clustering suggests that a causal relationship between measles vaccine and encephalopathy may exist as a rare complication of measles vaccination.” 114
Nearly two decades earlier, in 1981, a report of the National Childhood Encephalopthy Study was published in Britain that concluded:
“The risk of a serious neurological disorder within 14 days after measles vaccine in previously normal children irrespective of eventual clinical outcome is 1 in 87,000 immunizations.” 115
However, a 2007 study conducted in Britain concluded “We can estimate the vaccine-attributable risk of serious neurologic disease after the first dose of MMR vaccine as 1 in 365,000 doses.116
Some studies have shown that there is an elevated risk of aseptic meningitis connected with the MMR vaccine containing the urabe strain of mumps. 117 (Merck’s MMRII vaccine used in the U.S. contains the Jeryl Lynn strain of mumps). Other studies have shown that MMR vaccine components or excipients, particularly egg antigens and porcine or bovine gelatin, can trigger anaphylactic reactions, both immediate and delayed.118
A study published in 2012 by the Cochrane Collaborative examined 57 studies and clinical trials involving about 14.7 million children who had received the MMR vaccine.119 While the study authors said they were not able to detect a “significant” association between MMR vaccine and autism, asthma, leukemia, hay fever, type I diabetes, gait disturbance, Crohn’s disease, demyelinating diseases or bacterial or viral infections, they added that:
“The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.”
In Guinea-Bissau, Dr. Peter Aaby has studied and administered vaccines to thousands of children for more than three decades and has published research on vaccine safety and effectiveness, including research on measles and measles vaccine.120 He found that there can be marked differences in the way that boys and girls respond to vaccines. For example, he found there was an increased mortality risk for girls if they received the DTP and measles vaccines together.121 He also found that fatality rates were increased for children ages 6 months to 17 months old, if they had received the DTP vaccine simultaneously with or after receiving measles vaccine. 122
In 1995, a study was published giving the first evidence of persistent measles virus infection of the intestine after vaccination. 123 In 1998, an association between live virus measles vaccine, inflammatory bowel disease (IBD) and regressive autism was hypothesized by gastroenterologist Dr. Andrew Wakefield and other physicians at Royal Free Hospital after they detected the presence of measles virus in the intestines of children suffering with Crohn’s disease and autism. The paper they published in The Lancet, which suggested MMR vaccine may be associated with development of regressive autism in previously healthy children, was immediately met with intense anger and criticism from public health officials and medical trade associations, like the American Academy of Pediatrics.124
During the course of their investigation, Wakefield and his colleagues learned that Hans Asperger had observed a high rate of gastrointestinal (celiac) disease in children diagnosed with autism. After studying children suffering with inflammatory bowel disease being treated at Royal Free Hospital, they hypothesized that persistent viral infection, either from natural measles disease or live virus measles vaccine, could cause chronic inflammation in the bowel and damage to the central nervous system in some children. However, they emphasized in their paper that they had not proven a cause and effect relationship between autism, MMR vaccine and non-specific colitis, which they described as “autistic ileal-lymphoid-nodular hyperplasia,” and called for more studies to explore the potential relationship.
Today, the majority of doctors and health officials reject the suggestion that MMR vaccine is associated with the development of autism in children. However, privately funded research continues to investigate the potential association between vaccines, including MMR vaccine, and the development of autism, inflammatory bowel disease and other kinds of brain and immune system dysfunction in previously healthy children.
Other independent studies also have reported gastrointestinal problems, such as enterocolitis, after measles vaccination. 125 Although in 2004, an Institute of Medicine (IOM) Committee report stated that “the body of epidemiological evidence favors rejection of a causal relationship between the MMR vaccine and autism,” 126 a 2011 report published by an IOM Committee to Review Adverse Effects of Vaccines, found that
“The evidence convincingly supports a causal relationship between MMR vaccine and measles inclusion body encephalitis in individuals with demonstrated immunodeficiencies.” 127
The 2011 IOM committee also found with “a high degree of confidence” that “the evidence convincingly supports a causal relationship between MMR vaccine and febrile seizures.” The committee also found a causal relationship between MMR vaccine and anaphylaxis and transient arthralgia in women and children. 128
Who is at highest risk for complications from Measles Vaccine?
Measles vaccine complications appear to be more prevalent in children under age 5 and in adults over age 20 and in persons with immune deficiency disorders or those suffering from malnutrition or vitamin A deficiency.129 Also, according to the CDC, persons, who have a history of thrombocytopenia purpura (low platelet count), may be at increased risk for developing clinically significant thrombocytopenia after vaccination.130
The CDC and Merck publish measles vaccine contraindications, which list reasons why a person may be at increased risk for suffering a reaction to MMR vaccine.
Who should not get Measles vaccine?
Below are some of the documented contraindications for the MMR vaccine contained in the product insert from Merck: 131
- Persons who have experienced a severe allergic reaction or anaphylaxis to an MMR vaccine component, including gelatin and neomycin, should generally not be vaccinated with MMR.
- Pregnant women should not receive this vaccine, as well as women seeking to become pregnant should avoid become pregnant for 4 weeks subsequent to MMR vaccination.
- Because case reports have linked measles vaccine to deaths in severely immunocompromised individuals, these persons should not be given MMR either.
- Individuals with febrile respiratory illness or other active febrile infection should avoid MMR vaccine.
- In general, persons receiving large daily doses of corticosteroids for 14 days or more should not get MMR vaccine. MMR and other measles-containing vaccines are not recommended for HIV-infected persons with evidence of severe immunosuppression.
Additionally, Merck’s product insert does not recommend giving MMR at the same time as DTP (diphtheria, tetanus, pertussis) and/or OPV (oral poliovirus vaccine), even though the Advisory Committee on Immunization Practices (ACIP) has stated that simultaneous administration of the entire recommended vaccine series is acceptable.132
According to the CDC, persons with moderate or severe acute illness should not be vaccinated until the illness has improved. It is recommended that vaccination be delayed for 3 months following receipt of immune globulin for prophylaxis of hepatitis A; a 7 to 11 month delay is recommended following administration of intravenous immune globulin, depending on the dose. Also, delaying MMR vaccine may be called for if a previous episode of thrombocytopenia occurred within 6 weeks after the previous dose of vaccine.133
The National Institutes of Health has also stated persons with weakened immune systems due to certain cancers, HIV, chemotherapy, radiation therapy or other drugs that suppress the immune system should not get this vaccine. If you are planning on getting pregnant within the next 3 months, you should not get this vaccine.134
What questions should I ask my doctor about Measles vaccine?
NVIC’s If You Vaccinate, Ask 8! Webpage downloadable brochure suggests asking eight questions before you make a vaccination decision for yourself, or for your child. If you review these questions before your appointment, you will be better prepared to ask your doctor questions. Also make sure that the nurse or doctor gives you the relevant Vaccine Information Statement (VIS) for the vaccine or vaccines you are considering well ahead of time to allow you to review it before you or your child gets vaccinated. Copies of VIS for each vaccine are also available on the CDC's website and there is a link to the VIS for MMR vaccine on NVIC's “Quick Facts” at the top of this page.
It is also a good idea to read the vaccine manufacturer product insert (in this case, Merck’s MMR vaccine information insert) that can be obtained from your doctor or public health clinic because federal law requires drug companies marketing vaccines to include certain kinds of vaccine benefit, risk and use information in product information inserts that may not be available in other published information. A link to Merck’s MMR vaccine product insert is here.
Other questions that may be useful to discuss with your doctor before getting the measles (MMR) vaccine are:
- If other vaccines in addition to MMR vaccine are scheduled for my child at this office visit, am I allowed to modify the schedule so fewer vaccines are given at once?
- What should I do if my child has a high fever or appears very ill after vaccination?
- What other kinds of reaction symptoms should I call to report after MMR vaccination?
- If the MMR vaccine doesn’t protect my child, do I have any other options for preventing measles infection?
Under the National Childhood Vaccine Injury Act of 1986, doctors and all vaccine providers are legally required to give you vaccine benefit and risk information before vaccination; record serious health problems following vaccination in the permanent medical record; keep a permanent record of all vaccines given, including the manufacturer’s name and lot number; and report serious health problems, injuries and deaths that follow vaccination to VAERS.
Remember, if you choose to vaccinate, always keep a written record of exactly which shots/vaccines you or your child have received, including the manufacturer’s name and vaccine lot number. Write down and describe in detail any serious health problems that develop after vaccination, and keep vaccination records in a file you can access easily.
It also is important to be able to recognize a vaccine reaction and seek immediate medical attention if the reaction appears serious, as well as know how to make a vaccine reaction report to federal health officials at the Vaccine Adverse Reporting System (VAERS). NVIC’s Report Vaccine Reactions—It’s the Law webpage can help you file a vaccine reaction report yourself to VAERS if your doctor fails or refuses to make a report
NVIC Press Releases, Statements & Commentaries Related to Measles
Bibliography & Resource Links
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5 Grabenstein JD. ImmunoFacts: Vaccines and Immunologic Drugs 2011. Wolters & Kluwer. p 293.
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54 Kasper D, Fauci A, Longo D, et al. Measles. Harrison’s Principles of Internal Medicine 16th Edition. 2005.
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111 KansasCity-Law.com. Verdicts and Settlements . Williams, Minor. v. Secretary of HHS--$250,000 Settlement. Oct. 2008. Online. (Accessed March 2012)
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117 Dourado I, Cunha S, Teixeira MG, et al. Outbreak of Aseptic Meningitis Associated with Mass Vaccination with a Urabe-Containing Measles-Mumps-Rubella Vaccine: Implications for Immunization Programs. Am J Epidemiol. March 1, 2000; 151(5):524-30. Online. http://www.ncbi.nlm.nih.gov/pubmed/10707922. (Accessed March 2012)
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