Rubella (German Measles)

Contents
  1. Research Immunologist at Johns Hopkins University
  2. Rubella Virus Persists After Vaccination in Some Patients with Immunodeficiency Disorders
  3. Childhood Immunizations
  4. About guidelines for routine childhood immunizations
  5. Reactions to immunizations
  6. Aspirin and the risk for Reye's syndrome in children 
  7. Rubella (German Measles)
  8. What causes rubella?
  9. Who is at risk for rubella?
  10. What are the symptoms of rubella?
  11. How is rubella diagnosed?
  12. How is rubella treated?
  13. What are the complications of rubella?
  14. Can rubella be prevented?
  15. When should I call my healthcare provider?
  16. Key points about rubella
  17. Next steps
  18. Rubella
  19. There’s a measles outbreak. Do you need another shot?
  20. Who is most vulnerable during a measles outbreak?
  21. What if you’re a healthy but unvaccinated adult—should you be worried about catching the measles?
  22. That said, pregnant women should avoid getting the MMR vaccination for the same reason that measles infection is so dangerous for them: Their immune systems are compromised. Once their child is born, they can get vaccinated and do things breastfeed without any concerns. Should anyone else avoid taking the vaccine?
  23. If you think you have the measles, what’s the best course of action?
  24. We don’t typically give the MMR vaccine right at birth? How come?
  25. The practice of giving two doses of the MMR vaccine started in Sweden in 1982, but why?
  26. Right, and eventually the U.S. Centers for Disease Control and Prevention adopted the two-dose strategy in 1989, as the nation experienced a major resurgence of measles that lasted until 1991. But how old do kids need to be now for their MMR vaccines?
  27. Right, if one person gets measles, they will spread it to 18 others if those people are unvaccinated. So, because of that, herd immunity or community immunity for measles can only be maintained when 90 to 95% of a population is immune.
  28. But what if you’re an older adult and you had measles as a child? Do you still need to get a shot?
  29. But America has experienced recent bumps in, another disease, the mumps, which I heard was due to the immunization wearing off?
  30. Right. So to recap: If an adult catches the measles, it most ly means that they never had the disease as a child or they only received one dose of the vaccine in their life. That means if you were born between the late 1950s and 1989, then you might want to get another MMR shot?
  31. What do you do if you can’t remember if you were vaccinated or lost your documentation?
  32. If you get a second MMR shot after childhood or in adulthood, how long does it take to become effective?
  33. …right, one dose yields 95 to 98% effectiveness, while two doses leads to 99% protection…
  34. True, but that means some people can still get the measles even after two doses?
  35. Do these cases suggest that the measles virus has evolved over time, the seasonal flu virus but in slow motion, rendering vaccines received decades earlier less effective?
  36. Much of New York City’s outbreak centers around Orthodox Jewish communities. How come?

Research Immunologist at Johns Hopkins University

Rubella (German Measles) | Johns Hopkins Medicine

Date Posted Employment Type
May 14, 2020
Full-time

About the Elisseeff Lab :

The laboratory of Dr. Jennifer Elisseeff in the TranslationalTissue Engineering Center at the Johns Hopkins School of Medicinestudies the innate and adaptive immune responses to injury invarious tissue models and biomaterials. We are working to map theseimmune profiles locally and systemically and are developingtechnologies to manipulate the responses to promote regenerationand reduce fibrosis. The lab uses a variety of techniques includingsingle cell sequencing, multi parametric flow cytometry, andimaging.

Position Description :

The Elisseeff lab is seeking an enthusiastic and hardworkingindividual interested in conducting advanced-level research inimmune-focused biomedical engineering. The Research Immunologist will use cutting-edge technologies inprinciples of tissue engineering and translational regenerativetherapies, have access to state-of-the-art resources and equipment,and will contribute to high-impact research at the interface ofengineering and medicine. The candidate will work under thesupervision of the principal investigator and the TTEC labmanager. Primary duties and responsibilities of the job will include:

  • Independent planning, design, management, execution, andanalysis of experiments.
  • Supervising and training technical personnel, fellows, andstudents involved in experimental research.
  • Serving as a central manager for flow cytometry and a resourcefor projects across the lab.
  • Developing protocols for experimental procedures in thelab.
  • Organizing and presenting of data in laboratory meetings andconferences.
  • Identifying and troubleshooting of situations requiring specialattention.
  • Assists in the preparation of manuscripts, presentations, andgrant proposals.

Strong applicants will be well-versed in the following technicalskills:

  • Flow cytometry and cell sorting, panel design, and managingflow cytometry equipment
  • Mammalian cell culture and isolation
  • Functional analysis using animal models
  • Experience working with humanized mouse models
  • PCR/gene expression analysis
  • Histology/immunofluorescence
  • ELISA and Western Blotting
  • Microscope imaging

Minimum qualifications:

Master's degree in Biology, Immunology or a related science. 6 years related experience. Proven technical knowledge andlaboratory experience. The successful candidate will be proficient in best lab practices,exhibit strong communication and management skills, keep excellentrecords, and demonstrate the ability to work independently. Manydepartment laboratories operate 24/7 with schedules on day,evening, or night shift. Rotating schedules may include weekendwork and holiday assignment.

Preferred qualifications:

PhD in Immunology or closely related field Classified Title:Research ImmunologistWorking Title: Research Immunologist ​​​​​Role/Level/Range: ACRP/04/MFStarting Salary Range:$70,805-$97,435 (commensurate withexperience)Employee group: Full TimeSchedule: Mon-Fri 8:30-5Exempt Status: ExemptLocation: 04-MD:School of Medicine CampusDepartment name: 60002051-Oph Translational Tissue EngineeringCtrPersonnel area: School of Medicine The successful candidate(s) for this position will be subject to apre-employment background check. If you are interested in applying for employment with The JohnsHopkins University and require special assistance or accommodationduring any part of the pre-employment process, please contact theHR Business Services Office atjhurecruitment@jhu.edu . For TTYusers, call via Maryland Relay or dial 711.

The following additional provisions may apply depending on whichcampus you will work. Your recruiter will adviseaccordingly.

During the Influenza ('the flu') season, as a condition ofemployment, The Johns Hopkins Institutions require all employeeswho provide ongoing services to patients or work in patient care orclinical care areas to have an annual influenza vaccination orpossess an approved medical or religious exception. Failure to meetthis requirement may result in termination of employment. The pre-employment physical for positions in clinical areas,laboratories, working with research subjects, or involvingcommunity contact requires documentation of immune status againstRubella (German measles), Rubeola (Measles), Mumps, Varicella(chickenpox), Hepatitis B and documentation of having received theTdap (Tetanus, diphtheria, pertussis) vaccination. This may includedocumentation of having two (2) MMR vaccines; two (2) Varicellavaccines; or antibody status to these diseases from laboratorytesting. Blood tests for immunities to these diseases areordinarily included in the pre-employment physical exam except forthose employees who provide results of blood tests or immunizationdocumentation from their own health care providers. Anyvaccinations required for these diseases will be given at no costin our Occupational Health office.

Equal Opportunity Employer

Note: Job Postings are updated daily and remain online untilfilled.

EEO is the Law

Learn more:https://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf School of Medicine – East Baltimore Campus The successful candidate(s) for this position will be subject to apre-employment background check. If you are interested in applying for employment with The JohnsHopkins University and require special assistance or accommodationduring any part of the pre-employment process, please contact theHR Business Services Office at jhurecruitment@jhu.edu. For TTYusers, call via Maryland Relay or dial 711.

The following additional provisions may apply depending on whichcampus you will work. Your recruiter will adviseaccordingly.

During the Influenza (“the flu”) season, as a condition ofemployment, The Johns Hopkins Institutions require all employeeswho provide ongoing services to patients or work in patient care orclinical care areas to have an annual influenza vaccination orpossess an approved medical or religious exception. Failure to meetthis requirement may result in termination of employment. The pre-employment physical for positions in clinical areas,laboratories, working with research subjects, or involvingcommunity contact requires documentation of immune status againstRubella (German measles), Rubeola (Measles), Mumps, Varicella(chickenpox), Hepatitis B and documentation of having received theTdap (Tetanus, diphtheria, pertussis) vaccination. This may includedocumentation of having two (2) MMR vaccines; two (2) Varicellavaccines; or antibody status to these diseases from laboratorytesting. Blood tests for immunities to these diseases areordinarily included in the pre-employment physical exam except forthose employees who provide results of blood tests or immunizationdocumentation from their own health care providers. Anyvaccinations required for these diseases will be given at no costin our Occupational Health office.

Equal Opportunity Employer

Note: Job Postings are updated daily and remain online untilfilled.

EEO is the Law

Learn more:https://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf Important legal informationhttp://hrnt.jhu.edu/legal.cfm

Source: https://chroniclevitae.com/jobs/162928-PRO_57_649279800

Rubella Virus Persists After Vaccination in Some Patients with Immunodeficiency Disorders

Rubella (German Measles) | Johns Hopkins Medicine

Some patients with rare primary immunodeficiency disorders may be at risk for infection by rubella virus, and possibly serious skin inflammation, after receiving the rubella vaccine, usually administered as part of the measles-mumps-rubella (MMR) vaccine. Although the vaccine for rubella (German measles) has an established record of safety and effectiveness in the general population, patients with severe deficiencies in their immune defenses may be susceptible to side effects from the vaccine.

“Up to now, the risk of adverse effects from rubella vaccine has been a theoretical concern for many immune deficient patients,” said study leader Kathleen E.

Sullivan, MD, PhD, chief of the Division of Allergy and Immunology at The Children's Hospital of Philadelphia (CHOP). “The vaccine's package insert states that it shouldn't be given to immune-deficient individuals.

Our new study found genuine evidence of harm in a subset of patients with these rare disorders.”

Her study appears in the November 2016 issue of the Journal of Allergy and Clinical Immunology, where it is highlighted as an “Editor's Choice” article.

Primary immunodeficiency diseases (PIDD) are a diverse group of rare, chronic disorders with genetic origins, characterized by malfunctions in the body's immune system. Most patients have recurrent infections, along with other health problems. Some PIDD patients have cutaneous granulomas—inflammatory skin lesions that may progress to life-threatening ulcers.

In previous, smaller case reports, researchers had found vaccine-related rubella virus in granulomas of PIDD patients. In the current study, Sullivan and colleagues analyzed data from a larger group of 14 patients with different PIDDs who had cutaneous granulomas.

Twelve of those patients were from the USIDNET, a national registry of American PIDD patients, and two other patients were from European outreach. Four patients were adults, the others children. Three of the 11 children died from severe infections.

Of the 14 patients, seven had evidence of rubella virus antigen in their granulomas.

The team's findings suggest that because PIDDs compromise a patient's immune system, patients are unable to clear out the weakened rubella virus contained in the vaccine. That virus persists in their bodies, damaging skin cells and even leading to ulcers.

“This research reinforces the warning already found in rubella vaccine package inserts,” said Sullivan. “It gives additional guidance to physicians and families as to who should be restricted from the MMR vaccine. All of the patients with this complication had pretty severe immune compromise of their T cells—the cells responsible for clearing viral infections.”

The Centers for Disease Control and Prevention (CDC) and The Children's Hospital of Philadelphia supported this study.

“Rubella persistence in epidermal keratinocytes and granuloma M2 macrophages in patients with primary immunodeficiencies,” The Journal of Allergy and Clinical Immunology, published online Sept. 6, 2016, in print Nov. 2016.

Source: Children's Hospital of Philadelphia

Source: https://www.infectioncontroltoday.com/vaccines-vaccination/rubella-virus-persists-after-vaccination-some-patients-immunodeficiency

Childhood Immunizations

Rubella (German Measles) | Johns Hopkins Medicine

Linkedin Pinterest Infectious Diseases

Immunization is key to preventing disease.

Vaccines benefit both the people who get them, and the vulnerable, unvaccinated people around them because the infection can no longer spread through the community if most people are immunized.

In addition, immunizations reduce the number of deaths and disability from infections, such as measles, whooping cough, and chickenpox.

Although children get the majority of the vaccinations, adults also need to be sure they are already immune to certain infections and stay up-to-date on certain vaccinations, including varicella, tetanus, diphtheria, pertussis (whooping cough), measles, mumps, rubella, shingles, human papillomavirus (HPV), pneumococcal, hepatitis A and B, flu, and meningococcal. Childhood illnesses, such as mumps, measles, and chickenpox, can cause serious complications in adults. 

About guidelines for routine childhood immunizations

Many childhood diseases can now be prevented by following recommended guidelines for vaccinations:

  • Meningococcal vaccine (MCV4). A vaccine to protect against meningococcal disease.
  • Hep B. This protects against hepatitis B.
  • Inactivated polio vaccine (IPV). A vaccine to protect against polio.
  • DTaP. This protects against diphtheria, tetanus (lockjaw), and pertussis (whooping cough).
  • Hib vaccine. A vaccine to protect against Haemophilus influenzae type b (which causes spinal meningitis and other serious infections).
  • MMR. This protects against measles, mumps and rubella (German measles).
  • Pneumococcal vaccine/PCV13 (pneumococcal conjugate vaccine). A vaccine to protect against pneumonia, infection in the blood, and meningitis.
  • Varicella. This protects against chickenpox.
  • Rotavirus (RV). This vaccine protects against severe vomiting and diarrhea caused by rotavirus
  • Hep A. This protects against hepatitis A.
  • HPV. This protects from human papillomavirus, which is linked to cervical cancer and other cancers. 
  • Seasonal influenza. This protects against different flu viruses.

A child's first vaccination is given at birth. Immunizations are scheduled throughout childhood, with many beginning within the first few months of life. By following a regular schedule, and making sure a child is immunized at the right time, you are ensuring the best defense against dangerous childhood diseases.

Reactions to immunizations

As with any medicine, vaccinations may cause reactions, usually in the form of a sore arm or low-grade fever.

Although serious reactions are rare, they can happen, and your child's doctor or nurse may discuss these with you before giving the shots.

However, the risks for contracting the diseases the immunizations provide protection from are higher than the risks for having a reaction to the vaccine.

Treating mild reactions to immunizations in children:

  • Fussiness, fever, and pain. Children may need extra love and care after getting immunized. The shots that keep them from getting serious diseases can also cause discomfort for a while. Children may experience fussiness, fever, and pain at the immunization site, after they have been immunized.
  • Fever. DO NOT GIVE ASPIRIN. You may want to give your child acetaminophen or ibuprofen to reduce pain and fever, as directed by your child's healthcare provider:
    • Give your child plenty to drink.
    • Clothe your child lightly. Do not cover or wrap your child tightly.
    • Sponge your child in a few inches of lukewarm (not cold) bath water.
  • Swelling or pain. DO NOT GIVE ASPIRIN. You may want to give your child acetaminophen to reduce pain and fever, as directed by your child's healthcare provider.
    A clean, cool washcloth may be applied over the sore area as needed for comfort.

Aspirin and the risk for Reye's syndrome in children 

Aspirin should not be given to children or teenagers because of the risk for Reye's syndrome, a rare but potentially fatal disease. Therefore, pediatricians and other healthcare providers recommend that aspirin not be used to treat any fever in children.

If more serious symptoms occur, call your child's healthcare provider right away. These symptoms may include:

  • Large area of redness and swelling around the area where the injection was given. The skin area may be warm to touch and very tender. There may also be red streaks coming from the initial site of the injection.
  • High fever
  • Child is pale or limp
  • Child has been crying incessantly
  • Child has a strange cry that is not normal (a high-pitched cry)
  • Child's body is shaking, twitching, or jerking

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/childhood-immunizations

Rubella (German Measles)

Rubella (German Measles) | Johns Hopkins Medicine

Linkedin Pinterest Infectious Diseases

Rubella, sometimes called German measles, is a viral infection. It usually causes a mild illness in children. Adults have a slightly more severe illness.

The disease is spread person-to-person through droplets coughed or sneezed into the air by an infected person. It takes 2 to 3 weeks before symptoms to develop after exposure.

Although the illness is mostly mild, the virus can cause serious birth defects in pregnant women. The vaccine is effective in preventing rubella.

What causes rubella?

Rubella is caused by a virus and is spread from person-to-person through droplets coughed or sneezed into the air by an infected person. Most outbreaks of rubella happen among young adults and adults who have not been vaccinated or have not had the disease before.

Who is at risk for rubella?

If you have not had the vaccine or never had rubella, you are at risk for the disease.

What are the symptoms of rubella?

The following are the most common symptoms of rubella. However, each person may experience symptoms differently. Symptoms may include:

  • Rash (usually begins at the face and progresses to the trunk, arms and legs, and lasts about 3 days)
  • Slight fever
  • Enlarged lymph nodes
  • Headache

Rubella in pregnant women may cause serious complications in the fetus. This includes a range of severe birth defects.

The symptoms of rubella may look other medical conditions. Always talk with your healthcare provider for a diagnosis.

How is rubella diagnosed?

Along with a complete medical history and medical exam, diagnosis is often confirmed with a throat culture and blood testing.

How is rubella treated?

Your healthcare provider will figure out the best treatment for you:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • Your opinion or preference

Treatment for rubella is usually limited to acetaminophen for fever. There are no medicines to treat the virus infection itself.

What are the complications of rubella?

For most people, rubella is a mild disease and does not cause complications. If a woman is infected with the disease while pregnant, her unborn baby can develop defects. Possible birth defects caused by rubella include:

  • Deafness
  • Congenital cataracts
  • Heart defects
  • Intellectual disability
  • Liver and spleen damage

Can rubella be prevented?

Measles, mumps, and rubella (MMR) is a childhood vaccine that protects against these 3 viruses. MMR makes most people immune to rubella (in addition to measles and mumps). People who have had rubella are immune for life.

Usually, the first dose of the MMR vaccine is given when a child is 12 to 15 months old. A second dose is given at 4 to 6 years of age. However, if 28 days have passed since the first dose was given, a second dose may be given before the age of 4.

When should I call my healthcare provider?

Rubella usually resolves on its own. However, tell your healthcare provider if:

  • If your symptoms get worse or you have new symptoms
  • If you are pregnant and aren't sure if you have been vaccinated against rubella
  • If you get a severe headache, stiff neck, earache, or problems with your vision either during the measles or afterwards

Key points about rubella

  • Rubella is a viral infection. It causes a mild illness in children and slightly more severe illness in adults.
  • If a woman is infected with the disease while pregnant, her unborn baby can be born with severe birth defects.
  • Rubella can be prevented by the combination vaccine for measles, mumps, and rubella.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/rubella-german-measles

Rubella

Rubella (German Measles) | Johns Hopkins Medicine
Analgesics. NMIHI. Accessed at http://drugs.nmihi.com/analgesics.htm on August 3, 2018.

Anti-inflammatory drugs. NMIHI. Accessed at http://drugs.nmihi.com/anti-inflammatory.htm on August 3, 2018.

Advisory Committee on Immunization Practices (ACIP). Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps. MMWR Morb Mortal Wkly Rep. 1998;47(RR-8):4.

Afzal MA, Minor PD, Schild GC. Clinical safety issues of measles, mumps and rubella vaccines. Bull World Hlth Org. 2000;78(2):199-204.

American Academy of Pediatrics. Age for routine administration of the second dose of measles-mumps-rubella vaccine (RE9802). Pediatrics. 1998;101(1):129-133.

Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, Penn: W.B. Saunders; 2000.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines.Boston, Mass.: Integrative Medicine Communications; 1998:144.

Blumenthal M, Goldber A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass.: Integrative Medicine Communications; 2000:44-46; 408-412.

Centers for Disease Control and Prevention (CDC). Rubella. Available at www.cdc.gov.

Chen RT, DeStefano F. Vaccine adverse events: causal or coincidental [letter]. Lancet. 1998;351:611-612.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. New York: Tarcher/Putman; 1997:112-114.

Farooqi IS, Hopkin JM. Early childhood infection and atopic disorder. Thorax. 1998;53:927-932.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine.14th ed. New York: McGraw-Hill; 1998.

Galewski R. Electroacupuncture: an effective treatment of some visual disorders. Acupunture in Medicine. 1999;17(1):42-49.

Gershon A. Rubella (German measles). In Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine.14th ed. New York: McGraw-Hill; 1998:1125-1127.

Greene E. Massage therapy. In: Novey DW, ed. Clinician's Complete Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby; 2000:338-348.

Hurwitz E, Morgenstern H. Effects of diphtheria-tetanus-pertussis or tetanus vaccination on allergies and allergy-related respiratory symptoms among children and adolescents in the United States. J Manipulative Physiol Ther. 2000;23:81-90.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York: Warner Books; 1996:228-230, 166-169.

Maldonado Y. Rubella. In: Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, Penn: W.B. Saunders; 2000:951-953.

NIH Consensus Statement Online. Acupuncture. November 3–5, 1997;15(5):1-34. Accessed on July 11, 2000 at dowland.cit.nih.gov/odp/consensus/107/107intro.htm.

How common is rubella? Cleveland Clinic. Accessed at https://my.clevelandclinic.org/ on September 19, 2018.

Odent MR, Kimmel T. Pertussis vaccination and asthma: is there a link? JAMA. 1994;272:592-593.

Ouhilal S. Viral diseases in pregnancy: a review of rubella, chickenpox, measles, mumps and 5th disease. Prim Care Update Ob/Gyn. 2000;7:31-34.

Peter G. Immunization practices. In: Behrman RE, ed. Nelson Textbook of Pediatrics. Philadelphia, Penn: W.B. Saunders; 2000:1081-1089.

Reef S, et al. Rubella. Chapter 11 in VPD Surveillance Manual. Atlanta, Ga: Centers for Disease Control and Prevention; 1999:1-11.

Reef S, et al. Congenital Rubella Syndrome. Chapter 12 in VPD Surveillance Manual. Atlanta, Ga: Centers for Disease Control and Prevention; 1999:1-12.

Rubella and pregnancy. Ada Health. Accessed at https://ada.com/ on September 19, 2018.

Starr M. A rash of exanthems: how they affect children and pregnant women. Aus Fam Phys. 2000;29(7):631-637.

Sildenafil. NMIHI. Accessed at http://www.nmihi.com/s/sildenafil.html.

Tadalafil. NMIHI. Accessed at http://www.nmihi.com/t/tadalafil.html.

Taylor B, Miller E, Farrington CP, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet. 1999;353:2026-2029.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 86.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 176.

Vandenbosche RC, Kirchner JT. Intrauterine growth retardation. Am Fam Phys. 1998;58(6):1384-1390.

Vardenafil. NMIHI. Accessed at http://www.nmihi.com/u/vardenafil.html.

Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998;351:637-41.

West R, Roberts PM. Measles, mumps and rubella vaccine: current safety issues. BioDrugs. 1999;12(6):423-429.

Wood RA, Doran TF. Atopic disease, rhinitis and conjunctivitis, and upper respiratory infections. Curr Opin Pediatr. 1995;7:615-627.

Why is it important to avoid rubella, or German measles? MedicalNews. Accessed at https://www.medicalnewstoday.com/ on September 19, 2018.

Zeina B, Othman O, Al-Assad S. Effect of honey versus thyme on rubella virus survival in vitro. J Altern Complement Med. 1996;2(3):345-348.

Source: https://www.anticoagulationeurope.org/conditions/rubella/

There’s a measles outbreak. Do you need another shot?

Rubella (German Measles) | Johns Hopkins Medicine

The U.S. could be eight months or so away from losing its “measles-free” status.

The measles virus was eliminated from the U.S. in 2000, meaning there was no longer continuous transmission of the disease for more than 12 months anywhere in the country.

Since then, the disease has occasionally sprouted up due to travelers, mostly Americans, getting infected abroad and returning home.

Though those outbreaks create public health hazards, especially for children and pregnant women, the incidents tend to stick to single locations — Anaheim, California, in the winter of 2015 or Minnesota in 2017 — and then fizzle out.

That trend started to shift last October, when New York City — namely Brooklyn and Queens — began reporting continuous measles episodes. On Monday, as the epidemic in Washington State came to a conclusion, the Centers for Disease Control and Prevention announced new outbreaks in Los Angeles, Sacramento, Georgia and Maryland.

Outbreaks are now ongoing in nine counties in the country, and 2019’s case count of 704 is the nation’s highest since 1994’s tally of 963 cases. (Reminder: It’s only April.

) On Friday, two Los Angeles universities quarantined more than 1,000 students and staff members, meaning they were confined to quarters on campus or sent home— and President Donald Trump, who formerly spread misinformation about vaccination and its false connection to autism, encouraged unvaccinated children to get immunized.

If the U.S. loses its “measles elimination” status, it will join Venezuela as the only other country in North and South America with this distinction.

If the U.S. loses its “measles elimination” status, it will join Venezuela as the only other country in North and South America with this distinction. Measles was declared eliminated across the Americas in 2016, but within a year, an outbreak sparked in Venezuela that has persisted up to the current day.

For most Americans, these outbreaks are a bittersweet wake-up call about the importance of the measles-mumps-rubella (MMR) vaccine. Thanks to the success of vaccination programs, most people are unfamiliar with measles itself — which means they may be unsure about how to approach these outbreaks and protect themselves.

The PBS NewsHour posed these questions and concerns to two experts: Stephen Morse, director of the infectious disease epidemiology program at Columbia University’s Mailman School of Public Health and Dr. William Moss, a infectious disease epidemiologist and pediatrician at Johns Hopkins’ Bloomberg School of Public Health.

Who is most vulnerable during a measles outbreak?

Morse: Children are usually the major targets in part because the youngest children don’t have immunity at all.

Moss: Because the vaccine has been so effective in the United States and around the world, I think people have forgotten about measles and have underestimated the risk of measles. [Globally,] more than 100,000 children die each year, or about 300 children per day. Measles can also cause lifelong disability [such as deafness].

Morse: The virus can incubate slowly in the brain over years. Then suddenly, usually when the patient is much older [up to 10 years after a person has measles], the infection will reactivate and you get this very severe progressive inflammation in the brain called Subacute Sclerosing Panencephalitis (SSPE)

[SSPE has long been considered rare, but a 2017 study from the California Department of Health estimated 1 in 600 infants developed the condition after they caught measles.]

What if you’re a healthy but unvaccinated adult—should you be worried about catching the measles?

Morse: There are actually serious complications that occur in unvaccinated adults who catch measles, namely pneumonia.

Pregnant women are certainly at risk too. These issues may not be as well publicized as the Zika virus, but measles-related pregnancy complications exist [such as stillbirths, miscarriages and low-birth weight]. There were a lot of those going around in the old days.

[Pregnant women infected with measles are also more ly to be hospitalized, develop pneumonia, and die than nonpregnant women, according to the Centers of Disease Control and Prevention.]

That said, pregnant women should avoid getting the MMR vaccination for the same reason that measles infection is so dangerous for them: Their immune systems are compromised. Once their child is born, they can get vaccinated and do things breastfeed without any concerns. Should anyone else avoid taking the vaccine?

Morse: People who have immunosuppression or some immunodeficiency, which are considered rare exceptions.

If you think you have the measles, what’s the best course of action?

Morse: Stay home and call your doctor or your health care provider before you head to a medical office or emergency room. If you do visit a doctor’s office or ER, immediately notify the staff, so they can take the proper precautions.

We don’t typically give the MMR vaccine right at birth? How come?

Morse: In general, the MMR vaccination was not recommended before about [one] year of age because the feeling was children younger than that would not respond and develop protection from measles — their immune systems were not sufficiently mature.

In outbreaks, doctors can push the envelope a bit because of the heightened possibility of exposure. They can give the vaccine at six months when there is some risk of exposure, but this dose doesn’t count toward the child’s vaccine schedule. In other words, the child still needs to get the other two doses when they’re supposed to.

For kids younger than 6 months, the recommendation has been basically to keep them away from anyone who might have measles or from places where they might catch it.

A vial of the measles, mumps, and rubella (MMR) vaccine is pictured at the International Community Health Services clinic in Seattle, Washington, U.S., March 20, 2019. Photo by REUTERS/Lindsey Wasson

The practice of giving two doses of the MMR vaccine started in Sweden in 1982, but why?

Morse: They’d noticed for a number of years that children would come into school, and even though they’d had one vaccine shot, they might still catch measles if someone else came into the school with measles. It became evident that one dose simply wasn’t giving a high enough level of protection.

Right, and eventually the U.S. Centers for Disease Control and Prevention adopted the two-dose strategy in 1989, as the nation experienced a major resurgence of measles that lasted until 1991. But how old do kids need to be now for their MMR vaccines?

Moss: It was later that the World Health Organization recommended that all children in the world get two doses of measles vaccine. And the reason for the second dose is really because not all children who receive a single dose are protected.

In much of the world, the first dose is given at nine months of age, and we generally see that about 85% of children will be protected after that first dose. The second dose is, in large part, really to immunize the 15% that didn’t respond to the first dose.

Now, in the United States, we give the first dose at an older age — it’s usually between 12 and 15 months of age. There, a higher proportion of children will respond to the first measles vaccine, on the order of 90 to 95%. So the second dose is really to get that small proportion, maybe 5 to 10% of the children who don’t respond to the first dose.

Both inside and outside the U.S., that second dose is really critical for elimination, because measles is a very highly transmissible pathogen. We often say it’s the most contagious “directly-transmitted pathogen,” meaning it spreads from person to person.

Right, if one person gets measles, they will spread it to 18 others if those people are unvaccinated. So, because of that, herd immunity or community immunity for measles can only be maintained when 90 to 95% of a population is immune.

Moss: In order to actually stop transmission, to eliminate measles, we need very high levels of immunity in our communities. That is achieved with the two doses of measles vaccine.

But what if you’re an older adult and you had measles as a child? Do you still need to get a shot?

Moss: This is somewhat arbitrary, but we generally say that people born before 1957 are immune, because almost everyone got measles before then. The vaccine was introduced in the United States in 1963.

Morse: And we believe that if you actually had it and recovered, you have lifelong immunity, which is good.

Moss: So, there’s no good evidence that once a person has developed protective immunity to measles, either because they had the infection before or from the vaccine, that that protection wanes over time.

The principle of community immunity applies to control of a variety of contagious diseases, including influenza, measles, mumps, rotavirus, and pneumococcal disease. Infographic and caption by National Institute of Allergy and Infectious Diseases, National Institutes of Health

But America has experienced recent bumps in, another disease, the mumps, which I heard was due to the immunization wearing off?

Moss: That’s a great question, and you’re exactly right. What we’ve learned in the past couple of years because of large mumps outbreaks, particularly on college campuses, is that it does appear that immunity to mumps virus wanes. It’s recommended during mumps outbreaks that individuals who’ve had prior mumps vaccine get an additional dose if they’re at high risk for exposure.

There’s no evidence that the immunity to rubella wanes.

And if waning immunity was a real phenomenon with measles vaccine, we would be seeing these outbreaks spreading out into the general population and particularly affecting older adults, and we’re just not seeing that.

Right. So to recap: If an adult catches the measles, it most ly means that they never had the disease as a child or they only received one dose of the vaccine in their life. That means if you were born between the late 1950s and 1989, then you might want to get another MMR shot?

Morse: Yes. What we say to people is if you’re not sure about your vaccine status, especially if you’re traveling, take another MMR shot.

What do you do if you can’t remember if you were vaccinated or lost your documentation?

Moss: There is a blood test to check for measles immunity. It can measure if your body is making antibodies to the measles virus. Those antibodies have a pretty good correlation with protection. It is what we call a serological test.

It’s used, for example, to test health care workers. We want to ensure that the employees within hospitals — nurses, doctors, other employees — are immune from measles, to not only protect that individual but to prevent the spread of measles within a hospital.

At the moment, it’s not widely used during outbreaks or in the general population. But it is being increasingly used to identify susceptible clusters of individuals outside of the United States.

If you get a second MMR shot after childhood or in adulthood, how long does it take to become effective?

Moss: When we’re talking about vaccine effectiveness, what we’re talking about is its ability to prevent disease.

…right, one dose yields 95 to 98% effectiveness, while two doses leads to 99% protection…

Moss: And, it usually takes two to four weeks for a person to develop protective antibody levels.

True, but that means some people can still get the measles even after two doses?

Morse: Given the nature of both statistics and the variation in human immune responses, it’s possible.

Three percent of the measles cases in Rockland County [New York] have apparently had two immunizations and should therefore not have caught the measles. They should have been fully protected.

An unidentified boy receives an early version of a measles vaccination at the Fernbank School in Atlanta, Georgia in 1962. Photo by the CDC

Do these cases suggest that the measles virus has evolved over time, the seasonal flu virus but in slow motion, rendering vaccines received decades earlier less effective?

Moss: The short answer is that there’s no evidence that measles virus has evolved over time. The measles vaccines that are used in the United States and throughout the world were derived from measles virus isolates from the mid-1950s.

Now, people have looked to see whether there is has been evolution of the virus, which we see with some other viruses — influenza virus, which changes dramatically and we have to develop a new vaccine every year.

We don’t have to do that with measles and there’s no evidence to date that the virus has evolved away from its vaccine-induced protection.

Much of New York City’s outbreak centers around Orthodox Jewish communities. How come?

Morse: Virtually every religion, including Islam, almost all Protestant sects, Catholicism and even ultra-Orthodox Judaism allows immunization without religious or theological objections. It’s considered to be a good thing. It saves lives.

This year’s outbreak is associated quite a lot with a subgroup within this ultra-Orthodox Jewish community.

That’s reflecting an insularity of one particular group that doesn’t trust government — really for the same reasons that you get vaccine hesitancy or vaccine refusal in any other group.

They don’t think the risk [of contracting measles] is that great. They’re willing to take the chance. But it’s a big chance to take, as we can see.

Editor’s note: This story was updated April 29 to reflect the latest case numbers from the Centers for Disease Control and Prevention and to add advice on what people should do if they think they’ve contracted the measles.

Source: https://www.pbs.org/newshour/science/theres-a-measles-outbreak-do-you-need-another-shot