Infants under six months can't be vaccinated against measles, but they're not entirely without protection | License: CC0
For families with young children, New York City can feel like an obstacle course on the best of days. And in the midst of the recent measles outbreak, the reality can feel increasingly terrifying for those of us with infants too young to be vaccinated. But the good news is that young infants are not totally defenseless, and there are things you can do to mitigate the risks they face.
What is measles, and why is it spreading?
Measles, also known as rubeola, is a highly contagious viral infection most commonly contracted in childhood. Before a vaccine became available in 1963, nearly everyone caught measles at some point in their early life, according to the Centers for Disease Control and Prevention. Sufferers develop a fever and break out into a characteristic splotchy rash, and in severe cases can experience swelling in the brain, pneumonia, and even death. Infants under the age of five are at highest risk for complications and fatalities.
Though it’s still responsible for up to 100,000 deaths per year worldwide, the virus was eliminated in the U.S. in 2000 thanks to widespread administration of the measles, mumps and rubella (MMR) vaccine. The virus has since resurfaced, however, because of the increasing number of unvaccinated children in the country, and travelers contracting the virus abroad and bringing it home.
The current outbreak is the most severe since 1992, with a total of 1022 individual cases confirmed across 28 states. About 60% of these cases are in New York City, specifically Brooklyn and Queens, and most involve members of the Orthodox Jewish community, according to New York City’s Department of Health. Children under the age of five account for over 90% of all local cases since the outbreak began, but there have been no deaths as of June 2019.
So is there a link between the measles vaccine and autism?
In a nutshell, no.
Contrary to the claims of the ‘anti-vaxxer’ community, there is no scientific evidence linking the MMR vaccine to autism. The controversy dates back to 1998, when a scientific paper published in a prestigious journal claimed that the vaccine damaged the brain and caused autism in children. But the research was funded by lawyers working against vaccine manufacturers, and the findings could not be reproduced by any other scientists. The journal retracted the paper, declaring it fully invalid. Since then, multiple studies have confirmed that there is indeed no link. “You’re much more likely to get measles than to have dangerous side effects from the vaccine itself,” says Dr. Roberto Posada, pediatric infectious disease specialist at Mount Sinai in New York City.
Like others, the MMR vaccine works by introducing small amounts of the weakened virus into the body – enough that the immune system will recognize it and react, but not enough to make you seriously ill. When the immune system reacts, it produces antibodies: cells specifically designed to fight the invading virus. These antibodies remain in your bloodstream for years, and keep you from catching the same virus again. One dose of the measles vaccine is 93% effective at keeping measles at bay for life, and two doses are 97% effective. That’s why the CDC recommends all children get one dose at around 12 months, and another at around five years of age.
Is my unvaccinated baby completely helpless?
Luckily, your baby likely has some immunity against measles even before vaccination.
If a baby’s biological mother ever received the measles vaccine (or contracted measles herself,) then some of that immunity was shared in utero: “Before the age of six months most babies are fully protected,” says Dr. Posado. That’s because measles antibodies in the mother’s blood have been passed on to her baby. Somewhere between six and 12 months, however, infants lose this protection. That’s why the first dose of the measles vaccine is traditionally given at one year of age.
Given the current outbreak, however, New York City’s Department of Health has recommended moving the age of first vaccination to six months as an extra precaution. But there’s no guarantee the vaccine will be effective then: “If the baby still has maternal antibodies present in the blood, they’re going to prevent the vaccine from working,” says Dr. Posado. If given too early, the existing antibodies from the mother will attack the virus from the vaccine, preventing the body from mounting its own immune response and producing the antibodies that can last a lifetime. So to be safe, this early dose at six months does not count as one of the two recommended vaccines, and the usual regimen must still be administered. If your baby gets a shot at six months, they’ll still need to get their one and five year vaccines too.
There are, however, no guarantees, and even with residual immunity from mom and the early vaccine, “the protection is likely to be partial,” says Dr. William Schaffner, Professor of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville, Tennessee. But if the baby did contract measles, he says, it would be a milder case, with a reduced likelihood of complications.
Should adults get another dose of the vaccine, just to be safe?
It can’t hurt, but there’s no need to if you’re under 50 and are sure you’ve already had two doses.
Since 97% of Americans have received the MMR vaccine, there’s a good chance that you did too, in which case an extra dose, known as a booster, is not necessary. If you’re unsure whether you’ve been vaccinated and don’t have access to your records, a quick blood test through your primary care provider can give you the answer.
If your baby’s caregiver is a foreign national and their vaccination records are unavailable, it’s probably a good idea to ask them to get the MMR vaccine.
There is no harm in getting an extra dose, and there are certain cases in which you will want to consider doing so. If you’re over the age of 30, you likely only received one shot, since the two shot regimen wasn’t implemented until 1989. Additionally, the CDC recommends that people born in the 1960s get revaccinated, because the earliest versions of the vaccine were sometimes ineffective.
Finally, if you’re traveling to a country on the CDC’s travel notice list, it’s wise to take extra precautions and get a booster.
Can I take my baby to public places in Brooklyn and Queens?
If you need to spend time in Williamsburg, Crown Heights or Borough Park with your infant, try to stay outside when possible. If you can do that, says Dr. Posado, there’s not much of a risk. But the virus can remain suspended in the air for up to 2 hours, he clarifies, so it’s best to avoid crowded spaces. Dr. Schaffner agrees: “It depends on how risk averse you are,” he stresses, but open air spaces are relatively safe. Ultimately, he says, it’s always better to be safe than sorry: “Measles is a serious infection, there isn’t any doubt. We don’t take measles lightly.”
What you need to remember:
- Your infant probably has some immunity from mom, so don’t panic
- Vaccinate infants at six months, and again at 12 months and five years
- Make sure all caregivers have been vaccinated
- Consider a booster shot if you received the vaccine before 1989, or were born in the 1960s
- Stick to outdoor spaces in outbreak hot spots if you can