Measles was eradicated in Canada in 1998—but measles outbreaks are popping up again in Canada and the US, usually as unvaccinated travellers bring the virus back from other countries and expose kids and adults here who haven’t been vaccinated. Because measles is extremely contagious and can even be life-threatening, parents naturally have lots of questions about whether their kids are at risk and how they can protect them. Here’s what you need to know.
Anyone who isn’t immunized, including infants under 12 months, are at the highest risk of contracting measles, as well as people with a lowered immune system, even if they’ve received the vaccine, says Michelle Ponti, a paediatrician in London, Ont.
If there’s a measles outbreak in your area, make sure all family members who can be vaccinated have been. The Public Health Agency of Canada says babies as young as 6 months can get the MMR vaccine if there’s an outbreak, so talk to your doctor if this is something you’d like your baby to have. (She’ll still need her regular two doses of the vaccine later.) Hand hygiene is also super important to reduce the spread of germs, so make sure you’re all washing your hands well with soap and water, especially before preparing or eating food.
Paul Roumeliotis, an Ottawa paediatrician and medical officer of health for the Eastern Ontario Health Unit, says families with an unvaccinated infant should avoid public, confined places with lots of people like indoor playgrounds, restaurants and malls. “Measles is quite contagious. One individual can infect 18 people. If an infected person sneezes, the droplets can stay in the air for two hours, and the way you get infected is breathing the virus in, or touching an infected surface and then scratching your nose.” If you have a doctor’s appointment, call ahead to see if they recommend you come in or stay home.
You may have passed along your measles immunity to your baby when you were pregnant, but that “passive immunity” only lasts a month or so after birth, says Roumeliotis. Breastfeeding does pass certain antibodies (which are proteins that your body produces to neutralize harmful bacteria and viruses) to your baby. However, they’re mostly the kind of antibodies that help protect against intestinal problems like diarrhea, not the measles.
Within two weeks of the first vaccine, your child’s immunity is 85 to 95 percent. The second booster shot, which happens at 18 months of age in some provinces and territories and between the ages of 4 and 6 in other areas, increases immunity to about 98 or 99 percent.
“If you have the first dose, the chances of getting measles is very low,” says Roumeliotis. The first measles shot also means that if you do get the virus, the disease should be milder, you’re less likely to spread it to other people and the risk of complications like pneumonia is lower.
However, if there’s an outbreak in your area and you live in a province where the booster is at age 4 to 6, Ponti recommends talking to your doctor about getting the booster sooner.
You’re good to go—no need to avoid public places, says Roumeliotis. Be sure to continue regular hygiene habits, like frequent handwashing. If you’re really concerned, you could ask your doctor to do a blood test that confirms that measles antibodies are at the right levels to create immunity.
People born before 1970 are considered to have immunity because they have likely been exposed to measles at some point in their childhood. If you were born after 1970, you would have had one shot but may not have had your booster shot. “If you’re not sure, vaccinate. A second dose will not harm you,” says Roumeliotis. Note, however, that pregnant women or women who plan to become pregnant in the following four weeks should not get the measles vaccine. It’s safe to get the vaccine if you’re breastfeeding. You can also get a blood test that shows your antibodies levels. If you’ve recently been pregnant you would have screened for immunity to rubella (also known as German measles) but not measles.
“If all of your routine immunizations are up to date, then routine practices, like thorough and frequent hand-washing, using hand sanitizer, not sharing utensils, are our best advice. If there is an active outbreak and you are not immunized, then I would absolutely recommend not travelling if it’s not essential,” says Ponti. She suggests checking the federal government travel health and safety website to read any travel health notices for your destination. If you must travel with a child under 1 to an area where there’s a measles outbreak, the Public Health Agency of Canada recommends the MMR vaccine for children six months and older (and they will still need two additional shots after the age of 12 months).
Experts don’t recommend travelling to an area with an active outbreak with an infant who isn’t immunized.
This one comes down to a personal comfort level. “You’re contagious a day or two before you show symptoms, so a person can go on the plane and spread it to people around him, and a plane is essentially a closed tube. I can’t say there’s no risk,” says Roumeliotis. Ponti agrees. “I would think twice about going on a plane with an unimmunized infant or child.”
If your baby is over 6 months old, talk to your doctor about the possibility of getting the shot early. (Again, your baby will still need two more doses of the vaccine.)
In general, measles symptoms start out like a cold: runny nose, bit of a fever and a bit of a cough, says Roumeliotis. Clustered white spots (called Koplik spots) around the molars, as well as red eyes (conjunctivitis) are also an early sign of measles. “Then, during the fever, the rash comes out all over the body.” (In contrast, a common and benign virus like roseola starts with a high fever and no other symptoms, and then the rash comes out after the fever has ended.) Call your doctor to see if your child needs to be assessed, and be especially vigilant with a child under the age of one. “Tell your doctor or tell the ER before you come, because you don’t want to go in the waiting room and infect others if it is actually measles.”
Check in with your doctor, because there are options. If your child if over 6 months old, he could potentially get the vaccine—if it’s given within 72 hours of exposure, it will give some protection against the disease, and if measles does develop, it usually has milder symptoms and lasts a shorter time. There’s also immune globulin treatment, where you can get a shot containing antibodies to lower the risk of getting sick if you’ve been exposed to measles. This procedure can be done at any age, including under 6 months. It needs to be done within six days of exposure to the virus and is usually performed in a hospital.