Top-Line Questions From Moms About MMR
By Vice Admiral Vivek H. Murthy, M.D., M.B.A.,
U.S. Surgeon General
The Huffington Post
February 28, 2015
We all want our children to be safe and healthy. Measles is a serious and highly contagious disease, but, fortunately, we can prevent it with immunizations. The measles, mumps, and rubella (MMR) vaccine is safe and the best way to protect your child against measles and other diseases.
I understand that some parents are concerned about vaccines. The evidence about the vaccine's safety and benefits is strong and consistent. There is a lot of inaccurate information circulating about the measles vaccine, so let's make sure we separate the facts from the myths. If you have any concerns or questions, talk to your child's health care provider.
In the meantime, here are some answers to the most commonly asked questions I get:
How easy is it to get measles if you aren't vaccinated?
If you aren't vaccinated and you are exposed to measles, you have a 90 percent chance of getting measles.
We know that measles is extremely contagious. It spreads when an infected person breathes, coughs or sneezes. It spreads so easily that if one person has it, nine out of 10 of the people close to that person who are not immune will also become infected. You can get measles just by being in a room where a person with measles has been, even several hours after that person has left. A person is infectious from four days prior to rash onset through four days after rash onset.
Unvaccinated people put themselves and others at risk for measles and its complications.
If a person hasn't been vaccinated or isn't protected by virtue of having previously had a case of measles, they can get measles anywhere (school, work, gyms, etc.) and at any time of year because they can be exposed to the disease by unvaccinated and contagious people who may have entered or returned to the U.S. from another country. That's why vaccination is so important.
Should parents ever be worried about the vaccine? If so, which parents should be worried?
The measles-mumps-rubella (MMR) vaccine is very safe, and it is effective at preventing measles (as well as mumps and rubella). Vaccines, like any medicine, can have side effects. But most children who get the MMR shot have no side effects.
Many parents have some anxiety when it comes to health care visits, including those involving vaccines. However, parents can be reassured by the safety record of vaccines and the fact that they provide excellent protection. We take vaccine safety seriously. We have strong systems that monitor vaccines before they are licensed and after they go into widespread use.
In addition, it's important to remember that vaccines can provide parents with peace of mind when it comes to a number of diseases. Most parents choose the safe, proven protection of vaccines and are vaccinating their children according to the recommended immunization schedule. Thanks to vaccines, very few children now contract what used to be common diseases of childhood.
I encourage parents to talk to their health care professionals about their vaccine-related questions and concerns. There is a great deal of conflicting and often inaccurate information circulating about vaccines, so it is understandable that parents will have concerns. Parents may also have questions about which vaccines are being administered at a specific visit and how to recognize and manage any potential side effects. I always encourage parents to raise these kinds of questions with their children's health care providers.
What percentage of kids who get the MMR vaccine have a reaction?
Most children have no side effects from the MMR vaccine. The side effects that do occur are usually very mild and temporary, such as a fever or rash. More serious side effects are rare. These may include high fever that could cause a seizure (in about one person out of every 3,000 who get the shot) and temporary pain and stiffness in joints (mostly in teens and adults).
As America's doctor, I want our children to be safe and healthy. Nothing is more important than that. So I can understand why parents want to be sure that vaccines are safe for their kids. The evidence about the MMR vaccine's safety and benefits is strong and consistent. Many sources, like the independent Institute of Medicine report, have confirmed that the MMR vaccine is safe.
The measles vaccine has been used in the United States for more than 50 years and is 93-97 percent effective at preventing measles with long lasting protection. Because of measles vaccination, we have prevented more than 15.6 million deaths globally since 2000.
How would a parent know if they need to ask about their child getting a medical exemption?
I encourage all parents to talk to their doctor or health care provider about vaccinating their children for measles. There are cases in which some children should delay or should not get the MMR or MMRV (Measles, Mumps, Rubella and Varicella) vaccines and your doctor will be able to help guide you.
You should talk to your child's doctor if your child:
- Has ever had a life-threatening allergic reaction to the antibiotic neomycin, or any other component of MMR vaccine
- Has had a life-threatening allergic reaction to a previous dose of MMR or MMRV vaccine.
- Has HIV/AIDS, or another disease that affects the immune system, or has a parent, brother or sister with a history of immune system problems
- Is being treated with drugs that affect the immune system, such as steroids
- Has cancer or is being treated for cancer with radiation or drugs
- Has ever had a low platelet count, or another blood disorder, or has recently had a transfusion or received other blood products
- Has a history of seizures, or has a parent, brother or sister with a history of seizures
- Has received another vaccine within the past four weeks
The bottom line: Talk to your child's health care provider if you have any questions or concerns about vaccinations for your child.
When are kids supposed to get their vaccines?
Different vaccines are recommended at different ages. The recommended immunization schedule is designed to protect infants and children early in life, when they are most vulnerable and before they are exposed to potentially life-threatening diseases. CDC recommends the first dose of the MMR vaccine at 12 through 15 months of age, and the second dose at 4 through 6 years of age.
Check schedules on when to get your child vaccinated. Talk with your health care provider about what is best for your child, including how to schedule any missed vaccinations.
My kids aren't vaccinated, and now I'm worried that they are at risk. What do I do if my kids are late on their vaccines?
If your child isn't vaccinated, work with your child's health care provider to determine vaccination dates for the missed or skipped vaccines. Although it is advised to follow the recommended vaccine schedule so that you don't leave your child vulnerable to disease, there are catch-up schedules for many vaccines, including MMR. School-aged children and adolescents are recommended to have had two doses of MMR vaccine, with at least 28 days between the two doses.
Does it make a difference, medically speaking, if the vaccines are all given on the same day or are spread out over time?
CDC recommends the first dose of the MMR vaccine at 12 through 15 months of age, and the second dose at 4 through 6 years of age, or at least 28 days following the first dose.
MMR vaccine combines protection against measles, mumps and rubella in one vaccine.
However, your child may also need additional vaccines to protect against other diseases, such as Hepatitis A, on the same day that he/she receives the MMR vaccine. Your children can safely receive other recommended vaccines at the same visit that they receive the MMR vaccine.
Giving a child several vaccinations during the same visit offers two practical advantages:
- It provides protection as soon as possible to children during the vulnerable early period of their lives. It is important to help build and strengthen children's immune systems as early as possible because vaccine-preventable diseases can cause severe illness in infants and toddlers.
- It reduces the number of office visits, saving parents both time and money, and may be less traumatic for the child.
If a child doesn't have health insurance, how do I get them the vaccine?
If you don't have insurance, the Vaccines for Children (VFC) program may be able to help. This program provides vaccines at no cost to doctors who serve eligible children. Children younger than 19 years of age are eligible for VFC vaccines if they are Medicaid-eligible, American Indian or Alaska Native or have no health insurance. "Underinsured" children who have health insurance that does not cover vaccination can receive VFC vaccines through Federally Qualified Health Centers or Rural Health Centers. Nationally, there are nearly 44,000 healthcare providers enrolled in the VFC Program.
There is no charge for any vaccines given by a VFC provider to eligible children, but there may be other costs such as a fee for the office visit or non-vaccine services (like a blood test). If your child is VFC-eligible, he or she cannot be refused a vaccination if you cannot pay the fee for administering the shot. For more information, visit this website.
Additionally, your child or teen may qualify for free or low-cost health insurance coverage through Medicaid and the Children's Health Insurance Program (CHIP). Many parents may be eligible for Medicaid, too. If you or someone in your family needs health coverage, you should apply. Enrollment is open year-round. Visit here or call toll-free: 1-877-KIDS-NOW (877-543-7669). Under the Affordable Care Act, all children and adults enrolled in new group or individual private health plans will be eligible to receive the MMR vaccine without any cost-sharing requirements when provided by an in-network provider.
How long does the immunity from the mom last in an infant?
Most infants born in the United States will receive passive protection against measles, mumps, and rubella in the form of antibodies from their mothers if their mother has had measles or the MMR vaccine. By 12 months of age, almost all infants have lost this passive protection. While immunity from the mom can last for up to 12 months, this varies from child to child. All infants (of any age) are considered to be at risk for getting measles if they are exposed to the virus.
Should I be worried about measles when I bring my infant out in public, to events or to day care?
Most infants born in the United States will receive passive protection against measles, mumps and rubella in the form of antibodies from their mothers - though by age 12 months almost all infants will have lost this passive protection.
Overall the U.S. has high national vaccination coverage of roughly 92%, meaning that the risk of measles transmission is low. However, there are pockets of people within communities where vaccination rates are lower than the national average, making the risk of measles spreading in these communities higher.
Because risk of exposure to measles depends on whether it is circulating in your community, in places where measles is not currently circulating and vaccination rates are high, we'd generally state that it is safe for your child to go to day care. Day care facilities are required to report vaccination records to the state health department each year. Talk with your child's day care provider, or check with your state health department, to obtain these records. I also encourage you to consult with your doctor or local health department to get their advice on the risk of measles in your community.
The best way to protect infants before they are able to get the vaccine is to make sure people around them are vaccinated. The bottom line: talk to your doctor, talk to your day care, and make sure your kids get vaccinated on time.
What percentage of the population needs the measles vaccine in order to make everyone safe?
Preventing measles cases and outbreaks requires having as many people vaccinated as possible. Generally, about 92 percent to 94 percent of people need to be immune to measles to protect others who cannot get vaccinated. In 2013, the overall national coverage for measles-mumps-rubella (MMR) vaccine among children aged 19--35 months was 91.9 percent. However, even with very high national vaccination coverage, there can be subsets of the population that have much lower rates of vaccination. Rapid and early public heath responses to limit transmission, particularly in communities that may have groups of people who are not vaccinated, are equally critical to maintaining measles elimination.
The more people who are vaccinated or otherwise immune to measles, the more we decrease everyone's risk for getting measles. However, this "community immunity" cannot provide 100 percent protection, so we recommend that everyone who can, get vaccinated.
If a child is medically at risk and has been advised by their health care provider not to get the vaccine, then how many people around them need to be vaccinated in order to keep them safe?
Generally, about 92 percent to 94 percent of people need to be immune to measles to protect others who cannot get vaccinated. However, the concern is that some individuals in the community are opting out of vaccination, and these individuals tend to cluster in groups. These groups of susceptible individuals then accumulate and age over time. This, in turn, makes them susceptible to outbreaks when someone brings the virus into the group from abroad.
In 2013, the overall national coverage for measles-mumps-rubella (MMR) vaccine among children aged 19--35 months was 91.9 percent. But pockets of unvaccinated people can exist in states with high vaccination coverage, underscoring considerable measles susceptibility at some local levels.
The best thing families can do to protect children who can't get vaccinated because they are too young or have a medical condition is to make sure their own vaccines are up to date.
"What's the contagion level from kids who have recently been vaccinated? I heard they shed the live virus for a while after receiving the vaccine."
People who receive an MMR vaccine do not shed the live measles virus. Measles, mumps and rubella vaccine viruses are not transmitted from a vaccinated person.
It takes about 10-14 days for your immune system to fully respond to the MMR vaccine and protect you against measles.
As an adult, should I get another MMR vaccine?
People who received two doses of measles vaccine as children according to the U.S. vaccination schedule, have had measles, or are born before 1957 are considered protected for life and do not need a booster dose. If you're not sure whether you were vaccinated, talk with your health care provider.
When my child goes on a playdate, how should I ask the parents about whether their kids are vaccinated?
Parents generally understand and empathize with each other's concern for the safety and well-being of their children. However, we must also respect people's privacy when it comes to health issues.
Vaccinating your child is the best way to ensure that your own child does not get the measles. After receiving the recommended two-doses of the MMR vaccine, it is 97 percent effective at preventing measles. Your child is also at lower risk if there are no active measles cases in the community and vaccination rates are higher than 90 percent.
If your child cannot get vaccinated for medical reasons, you may consider sharing that information with the parents of your child's playdate. You can let them know that you are concerned about the risk of your child getting measles.
If I know parents who are not vaccinating their kids, what should I say to them?
Parents have an important role in making decisions about their children's health. You can help provide accurate scientific and public health information by referring peers to sources such as this or www.vaccines.gov. Additionally, the CDC has an excellent brief video of mothers talking with a pediatrician about vaccinations here. You should also encourage them to talk to their own pediatrician or health care provider to answer questions they may have about vaccines.
How can I help increase the vaccination rates in my community?
The best way to help increase vaccinations rates in your community is to ensure that you and your family are vaccinated. You can also support activities, such as National Infant Immunization Week (NIIW), to help recognize the critical role vaccination plays in protecting our children, communities, and public health. To learn more about NIIW, which is being held this year April 18-25, 2015, visit here.
Follow Vivek H. Murthy, M.D., M.B.A on Twitter: www.twitter.com/Surgeon_General