Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health Service Clinic.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Just weeks before students return to the classroom, the Texas Department of State Health Services (DSHS) issued a health alert following four reported cases of measles in July. According to DSHS, all four cases occurred within a single family after a family member traveled out of state.

With back-to-school season underway, pediatricians at Cook Children’s Health Care System are sharing key information about how measles moves through communities and how families can protect their children.

Measles is highly contagious. One infected person can potentially infect 12 to 18 unvaccinated individuals. The virus spreads through infectious respiratory droplets and airborne transmission (from coughing or sneezing), where tiny droplets can remain suspended in the air.

Cook Children’s experts say the best way to prevent getting and spreading the virus is to get the measles, mumps and rubella (MMR) vaccine.

The MMR vaccine is required by most school districts and Cook Children’s understands that navigating conflicting information about vaccines can feel overwhelming. Mary Suzanne Whitworth, M.D., medical director of Cook Children’s Infectious Diseases, explains the key facts about the measles and the MMR vaccine.

What is measles

Measles is a viral infection caused by the rubeola virus, which is not the same as rubella. The virus is very small, which makes it more contagious. It can remain in the air of a room for up to two hours after an infected patient leaves. Measles symptoms typically appear seven to 14 days after infection.

Symptoms include:

• Rash
• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

Complications can include ear infections, diarrhea, pneumonia and, in rare cases, brain damage or death.

How can measles be prevented?

Vaccination is the most effective way to prevent measles. The first dose of the MMR vaccine is typically given to children on their first birthday (12 months old), followed by a booster at age 4. Talk to your pediatrician about questions and concerns. Children traveling outside the United States may be able eligible to receive the vaccine before their first birthday.

Because measles remains airborne for up to two hours, if 10 unvaccinated children are in a room with one infected child, nine of them will likely contract the virus.

In addition to getting vaccinated, the spread of measles can be mitigated by proper hygiene. This includes:

• Handwashing
• Covering your mouth and nose when you cough or sneeze
• Avoid sharing drinks or eating utensils
• Disinfect frequently touched surfaces

What would you like families to know about measles and the MMR vaccine?

Measles was declared eliminated from the United States in 2000. However, measles immunization rates have declined in recent years due to missed checkups during the pandemic, parental concerns and vaccine misinformation.

Measles also remains common in many parts of the world. Most recent U.S. cases stemmed from unvaccinated travelers returning from abroad. This drop in vaccination coverage makes communities vulnerable to disease resurgence.

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The Texas Department of State Health Services [DSHS] reported a measles outbreak in Gaines County on Feb. 6.

Measles is a highly contagious upper respiratory virus that can cause serious health problems, especially for pregnant moms, infants, and young children. Last week, six school-aged children contracted measles, according to DSHS. On Feb. 11 the number increased to 24 cases, all residents of Gaines County.

Mary Suzanne Whitworth,M.D, medical director of Infectious Diseases at Cook Children’s, explained that DSHS puts out health alerts to notify physicians about disease outbreaks so they are aware of local patterns and can recognize cases.  

Cook Children’s Health Care System has not reported any measles cases.

Measles symptoms typically appear seven to 14 days after infection. They can include:

• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

Following the initial symptoms, a rash will develop that starts on the forehead and spreads down the body and out to the hands and feet.

Measles can make individuals more susceptible to ear infections, croup, and severe bronchopneumonia. Long-term complications, including debilitating neurological conditions like subacute sclerosing panencephalitis (SSPE), can also occur, said Marc Mazade, M.D., medical director of infection prevention and control.

Pregnant women are significantly more likely to be hospitalized, develop a secondary pneumonia, or even die, explained Alice Phillips, M.D., Director of Ambulatory Quality and Safety.  Equally at risk is their unborn child.  First, there is an increased risk of spontaneous loss of the pregnancy.  If born after exposure, the infants can suffer from heart problems, cataracts, developmental delays, deafness, or learning disabilities.  

Protect yourself

“The good news is that vaccination against measles virus induces strong protection from serious infection in as few as 3 days,” Dr. Mazade said.

The first MMR vaccine is typically given to kids at 12 months, with a booster at 4 years old.

The patients in Gaines County are unvaccinated, according to DSHS. Nine patients have been hospitalized.

“Face-to-face exposure is not required to transmit measles,” said Dr. Mazade.

The virus spreads through infectious respiratory droplets and airborne transmission (from coughing or sneezing), where tiny droplets can remain suspended in the air. Measles is highly contagious; one infected person can potentially infect 12 to 18 unvaccinated individuals.

Although there have been no measles cases reported at Cook Children’s Medical Centers in Fort Worth and Prosper, Dr. Phillips, noted a decrease in childhood immunization rates.

The decline in immunizations is attributed to several factors like missed doctor visits during the pandemic, parental concerns, misinformation, and other factors.

Dr. Phillips said parental concerns for the vaccine range from pain to questions surrounding the complex science of vaccines.

“Vaccines must traverse an intense approval process before going to market and ongoing safety monitoring occurs through four major vaccine safety surveillance systems,” said Dr. Phillips. She adds Cook Children’s doctors are willing to answer any questions.

Dr. Mazade encourages parents who have postponed the vaccination of their children to call their primary care doctor. Pregnant woman cannot receive the measles vaccine, if concerned they should reach out to their provider.

If a parent suspects their child may have measles, they should call the primary care doctor before arriving at the office so arrangements can be made for safety and to minimize potential exposure in the waiting room.

In the year 2000, measles were declared eliminated from the United States. This occurred because there was a 12-month period where no measles cases were contracted here, making the disease no longer native to the United States.

I hear this question often in my office and its logical based on the fact that measles was eliminated:

“We haven’t seen outbreaks of these diseases for years. Do we really need to continue vaccinating for them?”

The answer is yes and it's exactly because of what we've seen in the past two weeks. Measles are only a plane ride away. We live in a society with global mobility. People fly in and out of countries where measles continue to be a huge problem and then fly back to the United States. Measles are highly contagious via droplets from coughs and sneezes. In addition, people are contagious before they start to show symptoms. (Contrast that with another infectious disease we dealt with recently (Ebola) that requires blood or body fluid contact and is not contagious until there are significant symptoms.)

Continued vaccination programs protect our citizens when they travel abroad. It protects our citizens when travelers return to the United States. It helps to control outbreaks when they do occur.

Another common questions centers around the severity of these diseases.

I pulled this quote from an interview with The Today Show in Australia and Dr. Sherri Tenpenny:

“I don’t believe that measles, mumps, rubella or chicken pox are routinely fatal illnesses. If you ask any person over the age of 50…they had all those illnesses when they were children and growing up.”

There are so many false assumptions mixed in with this statement:

1. You cannot ask a person in their 50s that died from one of these diseases how serious it is.

2. Even if not fatal, the complications associated with these diseases can be very serious.

3. This completely discredits the suffering of any family member of someone who experienced complications from these diseases.

Just look at the stats. In the United States, prior to the introduction of measles vaccine in 1963:

• 3-4 million people had measles each year
• 400-500 died
• 48,000 were hospitalized
• 4000 developed encephalitis (brain swelling)

These complications don’t happen as much in the United States, but do continue to occur in areas where vaccination rates are not as high. There were 145,700 measles deaths worldwide last year. This is a 75-percent drop since 2000 due to efforts to make vaccinations available to children all over the world.

Continuing to vaccinate for measles is important because measles are serious and only a flight away ... and lately, even in our own backyard. 

This is part 2 of Dr. Smith’s series on measles. For more information about measles vaccination and herd immunity, click here.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . View more from The Doc Smitty at his Facebook page. He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.