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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Marc Mazade, M.D., Cook Children’s medical director of Infection Prevention and Control, encourages anyone who has not received the vaccine to do so. Vaccinations not only protect you, but also help limit the spread to others.

As of March 14, the Texas Department of State Health Services reported 259 cases of measles in Texas.

“I'm worried. It's a real dangerous situation right now,” Dr. Mazade said.  “There are lots of people who are eligible to receive the vaccine and haven't. There are areas where vaccine uptake has been really poor and it is likely to rip through these communities like wildfire, like it did in West Texas.”

The best way to prevent getting and spreading the virus is to get the measles, mumps and rubella (MMR) vaccine. We talked with Dr. Mazade about what makes this vaccine effective, who can get it and why vaccination is important.

Measles is one of the most contagious diseases humans have faced. Descriptions of the disease date back to at least the 9th century, according to the World Health Organization (WHO), and became more widespread in the 16th century. Prior to the vaccine, the Centers for Disease Control and Prevention (CDC) estimates three to four million people became infected per year, and 400 to 500 died.

Before the measles vaccine, which became available in its current form in 1968, most everyone got measles, Dr. Mazade said. While measles can be mild, it is “pretty miserable.” The virus can cause a fever from 104 to 106 degrees, congestion, cough and a red rash that spreads across the body. Complications from the measles are not uncommon, including ear infections and pneumonia. As of March 14, one child has died from the current measles outbreak.

“People don’t understand how dangerous it is and how dangerous vaccine preventable diseases are,” Dr. Mazade said. “It can be really serious for people who are pregnant, people with immunodeficiencies and people who are on immunosuppressants that would make them more susceptible.”

Herd Immunity

The current measles outbreak shows just how contagious it is.

In general, measles has not been transmitted within the U.S. for years due to herd immunity.

Herd immunity is the idea that when enough people are vaccinated against a disease, it is much harder for the disease to spread. Herd immunity for measles is reached when 90% of a population is vaccinated, Dr. Mazade said.

Imagine a group of 100 people spread out across a room. Ninety of them have been vaccinated and cannot get or give anyone else measles. One person in the room brings in the virus.

Perhaps the people nearby are all vaccinated; the virus will likely not spread or will only spread to a few people.  But if only half of the people are vaccinated, the infected person is likely standing near at least one other unvaccinated person. The disease can spread through the community, and can do so at an increasing rate.

With measles, face-to-face contact is not required to contract the disease, Dr. Mazade said. The infectious aerosol that is created when someone with measles coughs or sneezes fills the entire air space and even lingers in the air for up to two hours after a person with measles leaves the area. To go off of the room metaphor, measles can spread throughout a space quickly and endanger more people.

For years, the U.S. was like the first room. Sometimes, an unvaccinated person would travel abroad and bring back measles, but it was not able to spread due to herd immunity. In 2000, the U.S. documented zero cases of measles, and the virus was declared eliminated from the United States.

About 92 to 94% of a population needs to be vaccinated in order to achieve herd immunity for measles, according to the American Academy of Pediatrics. The current outbreak is due to that vaccination percentage dropping, Dr. Mazade said. Over the past few years, fewer and fewer people received the MMR vaccine.

Misinformation about vaccines has contributed to that decrease. Mazade encouraged people to seek direct sources for accurate vaccine information. The CDC, WHO and Cook Children’s vaccine resource page are good places to find accurate information.

Asking your doctor directly may be the best way to get information on your vaccine questions.

 “Trust your doctor,” Dr. Mazade said. “He or she is the best source of information about vaccines and vaccine safety.”

Getting Vaccinated

Fortunately, future measles outbreaks are preventable.

The MMR vaccine is safe and available for unvaccinated adults to receive -- and it is extremely effective. The first dose grants about 93% immunity and the second, and final, dose grants 97% immunity. This means that 97 out of 100 vaccinated people exposed to measles will not become sick.

The measles vaccine can be administered to children who are 12 months old and is part of the recommended vaccine schedule that the CDC recommends. If you did not get the vaccine as a child -- or are not sure if you did -- talk to your doctor.

Some people may want their children to get the vaccine early due to the outbreak. As of now, this is not recommended by our local health department. Babies who are younger than six months will likely not respond to the vaccine and not achieve immunity, Dr. Mazade said. Even if the baby has been exposed to measles, the vaccine is not recommended at this age. Dr. Mazade recommends talking to your doctor if you have concerns about measles exposure.

Even if this outbreak slows down, it is still important to get vaccinated.

“If people who are fully eligible are not fully vaccinated, we will be in the spot time and time again,” Dr. Mazade said. “Until we have a huge outbreak with lots of sick people."

Vaccinations and immunizations

Here are a few resources and tips for finding a place to take your child for immunizations. 

• Check with your child’s doctor. Ask which vaccines are due and make an appointment. If your child needs a doctor, see our locations or call 211 for help. 
• Visit a public health vaccine clinic. Anyone from any county can 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. 
• Enter your zip code at Vaccines.gov to find other options. 
   

National Infant Immunization Week (April 22-29) is a yearly observance highlighting the importance of protecting children 2 years and younger from vaccine-preventable diseases (VPDs). The Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP) recommend that children stay on track with their well-child appointments and routine vaccinations. On-time vaccination is critical to provide protection against potentially life-threatening diseases.

Measles is one of the most contagious infectious diseases on the planet. This year alone, there have been seven outbreaks across the United States, compared to four in 2023. An outbreak is defined as three or more related cases.

“If you’re in a room with someone who has measles and you’re not vaccinated or immune, there’s a 90-95% chance you now have the disease,” said Cook Children’s Infectious Diseases physician, Nicholas Rister, M.D. 

So far in 2024, there have been 121 cases of measles across 17 states, according to the Centers for Disease Control and Prevention. Ninety-five percent of these cases have occurred in unvaccinated or under-vaccinated populations. Fifty-six percent of cases, the majority of which have been in children under 5 years old, resulted in hospitalization due to severe complications. Though no cases have been reported in Texas, the virus is spreading rapidly and the Cook Children’s team is prepared. 

“Hopefully we won’t need it, but we are developing a workflow so that our clinics know exactly how to recognize, handle, test for, and guide our families through measles,” said Cook Children’s Medical Director for Ambulatory Quality, Alice Phillips, M.D.

Because cases have remained relatively contained over the last few decades, Julee Morrow, M.D. is one of the very few pediatricians at Cook Children’s who has cared for measles patients. She saw an influx of the disease during the last major outbreak from 1989-1991, during which cases in the U.S. spiked to roughly 55,000. 

“My partners and I diagnosed about 30 cases here in Fort Worth, and every single one of them had to be admitted to the hospital due to the severity of their infection,” Dr. Morrow said. “If another major outbreak happens, there’s a possibility we could run out of beds.”

Measles is not to be taken lightly—but it is easily preventable. Dr. Rister, Dr. Phillips, and Dr. Morrow shared vital information about the virus, its risks, and vaccination protocols to help families be proactive in protecting their children. 

What is measles? 

Measles is a highly contagious virus that spreads through the air via coughing and sneezing. It can even enter the body through the mucus membranes of the eyes. 

Common symptoms include:  

• Fever
• Cough
• Conjunctivitis (red eyes) 
• Coryza (runny nose)
• Sore throat
• Rash (after 3-4 days)

What are the risks of measles? 

While most people fully recover from measles, it can still pose life-threatening and potentially fatal risks. For every 1,000 children who get measles, one to three will die, even with the best care.

As many as one out of 20 children with measles will also develop pneumonia, which is the most common cause of death from the virus in infants.

One in 1,000 children with measles will develop encephalitis, or severe brain inflammation, which can lead to convulsions, deafness, disability, or death.

Though it is extremely rare, a fatal disease of the central nervous system, SSPE, can appear as late as seven to 10 years after a child is infected. 

Who is most at risk? 

Any unvaccinated or non-immune person of any age can contract measles, but it is most common in children. Unvaccinated children—particularly infants under 1 year of age—are at the highest risk of severe complications or death. 

“Who we need to worry about is not so much ourselves and our staff, but our tiny patients coming through the door,” Dr. Morrow said. “Measles is a disease of unvaccinated people, and our biggest concern is infants and immunocompromised kids.” 

Dr. Rister pointed out that unvaccinated pregnant women are also at high risk, as measles can have devastating effects on a developing fetus.

What is the MMR vaccine? 

The measles, mumps, and rubella vaccine is a safe, tried-and-true immunization that prevents people from contracting and spreading measles. It is 93% effective after one dose and 97% effective after the recommended two doses. 

“There is no reason a disease that is preventable with a safe and effective vaccine should harm one of our children,” Dr. Phillips said.

When should my child get vaccinated? 

The CDC recommends that children receive two doses of the MMR vaccine—the first between 12 and 15 months old, and the second between 4 and 6 years old.

If you’re an adult and you’re unsure if you’ve completed your vaccines—especially if you are pregnant—ask your doctor to check your vaccination records and make sure you are up to date. 

Can my child get vaccinated early for international travel?

If your child is at least 6 months old, they can get one dose of the MMR vaccine before traveling internationally. Plan to get your child fully vaccinated at least two weeks before your trip. Follow the below vaccination schedule from the CDC based on your child’s age:

Infants Under 12 Months Old: 

• Get an early dose at 6-11 months
• Follow the recommended schedule and get another dose at 12-15 months and a final dose at 4-6 years

Children Over 12 Months Old:

• Get first dose immediately
• Get second dose 28 days after first dose

Teens and Adults With No Evidence of Immunity*:

• Get first dose immediately
• Get second dose 28 days after first dose

*Evidence of immunity includes at least one of the following: Written documentation of adequate vaccination, laboratory evidence of immunity, laboratory confirmation of measles, or birth in the U.S. before 1957. 

What if my child is immunocompromised and can’t get vaccinated?

Dr. Rister said the best way to protect your immunocompromised child is to ensure everyone surrounding them is fully vaccinated—including family, friends, and classmates. 

If a case appears in your area and your child is in daycare or another environment around other children, consider keeping them home until the outbreak passes.

What should I do if my child is exposed to measles?

If you think your child has been exposed, call your pediatrician right away. It’s important to alert your doctor before bringing your child to the office. That way, staff can take precautionary measures to prevent further spread and ensure they have the necessary supplies to care for your child.

If your child has a confirmed case of measles, don’t panic—you will receive step-by-step guidance from your physician and the Texas Department of State Health Services. They will evaluate the individual risk of everyone in your household and tell you the exact steps to take to keep everyone safe.

Information from Cook Children’s and the Centers for Disease Control and Prevention:

• CDC: Top 4 Things Parents Need to Know About Measles
• CDC: Measles
• Go here to view photos of measles from the CDC.
• What to know about vaccines and immunizations | Vaccine fact and fiction | Cook Children’s

Related content on CheckupNewsroom.com:

• Infectious Diseases Doctor Shares Why Measles Vaccination is So Important (checkupnewsroom.com)
• Infant Immunization Week Encourages Babies' First Shots (checkupnewsroom.com)
• Get Immunized for a Healthy School Year (checkupnewsroom.com)

Editor's note: An earlier version of this story included information about deaths during the measles outbreak in Ohio which was incorrect. We regret the error.

By Heather Duge

During the recent measles outbreak in Ohio, the majority of children under 5 years old who were infected did not receive the measles, mumps and rubella (MMR) vaccine. Of the 85 children infected with measles, 25 of those children were hospitalized and several were treated in intensive care. Mary Suzanne Whitworth, M.D., Medical Director of Pediatric Infectious Diseases at Cook Children’s, said the under 5 age group is more at risk for severe cases of measles.

Not only that, but even children who recover from measles, especially those younger than 2 years old, are still at risk for developing SSPE – delayed brain inflammation – seven to 10 years later.

“Delaying the vaccines only leaves children vulnerable for longer than necessary,” said Dr. Whitworth, who never questioned vaccinating her children. “I could not sleep until my children were vaccinated.”

The Centers for Disease Control and Prevention recommends that all children receive two doses of the MMR vaccine – one at 12 to 15 months old and another at 4 to 6 years old. One dose is 95% effective against measles and two doses are 97% effective.

Some areas in the U.S. are more at risk for outbreaks – particularly communities with anti-vaccine sentiment. Age makes a big difference – being exposed in early infancy can be devastating which is why herd immunity is crucial to protect the vulnerable ones.

Herd immunity means enough people are immune through having the disease or vaccination so the disease does not have an easy place to land and cannot spread. If a person with measles coughs in a room with 10 people and everyone has been immunized, it will not spread. But if four of those people are not vaccinated, it will begin to spread.

Devastating Effects of Measles

Measles infections typically begin with high fever, congestion, cough and watery eyes. Three to five days later a rash may appear with flat red spots starting at the head/neck area and working its way down the body along with spots in the back of the throat. For some children, the infection worsens to measles pneumonia.

“One out of 1,000 children have brain inflammation and one to three children out of every 1,000 will die from respiratory or neurological complications,” Dr. Whitworth said. “These potentially tragic effects of measles are completely preventable.”

View CDC facts about measles.

Regardless of statistics, research or science, some parents will never change their minds.

But for the vaccine-hesitant parents who are truly trying to make the most informed decision for their child, let’s take a look at some of the most commonly asked questions and concerns we read on social.

The responses to these questions are based on extensive research conducted by the Cook Children’s Vaccine Clinical Guideline teams, comprised of primary care and specialists in their field. The team cited 99 different sources during their research and their work was approved by the Cook Children’s Medical Center’s Clinical Excellence Committee.

We hope this helps to answer some of your questions.

1. Do vaccines work?

Immunizations are considered to be one of the greatest accomplishments of modern medicine. Compared to pre-vaccine statistics, we’ve seen a reduction in the number of cases of measles by 99.9%, mumps by 95.9%, pertussis by 92.2% and rubella by 99.9%.

This is important because many vaccine-preventable diseases require high vaccination rates to maintain community immunity. For most of the vaccines that are currently available, there must be a population immunization rate for at least 90% to ensure consistent community immunity and some diseases that are highly contagious, such as pertussis or measles, require population immunization rates of at least 95%.

The maintenance of community immunity protects people who received the vaccine but were unable to generate a lasting immune response to the illness, as well as those individuals who are too young to receive a vaccine or have medical reasons that prevent them from receiving a vaccine.

2. Do vaccines cause autism?

This is a most difficult subject to approach because some parents make the direct link to their child’s autism to the vaccines they received.

Because MMR is one of the vaccines that is given to children between 12-18 months and signs of developmental conditions such as autism develop around the same time, it’s easy to see why families would perceive a cause and effect relationship between the two.

This argument was strengthened when Andrew Wakefield published an article in The Lancet in 1998 that claimed a link between the MMR vaccine and autism. Since his initial article was published, investigations have found that Wakefield’s study was flawed by research misconduct, conflicts of interest and lies. This ultimately led the Lancet to retract his original article. In 2010, Wakefield was barred from practicing medicine in Britain.

Dozens of studies have been conducted to look for any possible link between vaccines and autism and these studies continue to confirm no link exists, and that vaccines are safe and effective.

3. If children receive too many vaccines, can it overload their system?

While the number of vaccines that children are given has increased over time, children are actually being exposed to fewer antigens than they had been previously – thanks in large part to the increased purity of the pertussis vaccine.

Some parents may have concerns that vaccines can overwhelm a child’s immune system, but this simply isn’t true. When a child is born, they leave a relatively sterile environment and within hours their GI tract becomes heavily colonized with bacteria. They begin to produce what’s called a specific secretory IgA against these bacteria within the first weeks of life. A 2002 study, published in Pediatrics, states that an infant has a theoretical capacity for up to 10,000 vaccines at any one time.

Multiple studies have been done that show vaccines do not cause an increased risk of infection for children. One study even found that children who received vaccines had a lower rate of infections from vaccine-related and unrelated pathogens. There is also no evidence to support the idea that vaccines lead to increased risk of SIDS. Research has found that vaccines significantly reduced the risk of SIDS.

Children with severe immunodeficiencies who receive live viral vaccines may be at risk for developing an infection or disseminated disease. The biggest concern would be children with T-cell immune deficiencies receiving live virus vaccines. Fortunately these immune deficiencies are usually diagnosed around 6-8 months well before the first live virus vaccines are scheduled (12 months). 

With all that being said, many children with immunodeficiencies can receive vaccines safely, such as certain children with HIV or certain children with malignancies.

4. Is it really hygiene and better nutrition that caused disease reduction and not vaccines?

Statements like this are commonly found in anti-vaccination literature and it implies that vaccines are ineffective and unnecessary. While better hygiene and nutrition have certainly helped to improve the health of our population, it ignores the dramatic effects of vaccination.

If hygiene and nutrition were responsible for disease reduction, you would expect all disease incidence to decrease at around the same time, but this is not what we have seen. Instead, we have seen a recurrent pattern of disease reduction shortly after a vaccine against that disease has become available.

For example, while there was yearly variation in rates of measles, it wasn’t until a vaccine was released and widely distributed in 1963 that we saw a permanent drop in measles cases. Another example is Haemophilus influenza type b, which remained prevalent until the early 1990s when a vaccine that could be used in infants was developed.

Another way of debunking this myth can be to look at individual countries who saw a decrease in their immunization rates. Great Britain saw a dramatic drop in their immunization rates for pertussis in 1974, which was followed by a pertussis epidemic with more than 100,000 cases and 36 deaths by 1978.

In Japan, a drop in pertussis vaccine rates around that time from 70% to below 40% resulted in an increase of pertussis cases from 393 in 1974, to 13,000 in 1979.

5. If your child is vaccinated, why do you care if my child isn’t?

The increasing prevalence of vaccination acts to prevent the circulation of an infectious organism within the community provides benefit to everyone, even those who aren’t vaccinated. This is referred to as community immunity. Community immunity is an important means of protecting the elderly, the young and those with medical conditions that prevent them from receiving vaccines.

For most of the vaccines that are currently available, there must be a population immunization rate of at least 90% to ensure consistent community immunity and some diseases that are highly contagious, such as pertussis or measles, require population immunizations rates of at least 95%.

The maintenance of community immunity is important to protect those individuals who received the vaccine but were unable to generate a lasting immune response to the illness, as well as those individuals who are too young to receive a vaccine or have medical reasons that prevent them from receiving a vaccine.

More on This Topic:

• Vaccines for Your Children: 9 Facts Parents Need To Know
• Vaccines and Immunizations
• Information for Parents
• Immunization Collaboration of Tarrant County
• Childhood Vaccine Assessment Tool (CDC)
• American Cancer Society and HPV
• Centers for Disease Control and Prevention
• Vaccinate Your Family
• Voices for Vaccines
• Allied Vaccine Group
• Texas Department of State Health Services

It was also during this time that measles showed up in Texas and when I received my second MMR.

My sister had been in San Antonio with my mother for two months receiving care at a Bone Marrow Transplant center. While she had no memory of her twenty-third birthday, I saw pictures of the nurses and doctors surrounding her with a cake.

Later when she returned home, she commented on this nice shirt she had found in her suitcase as she had not seen it previously. I did not have the heart to tell her that it had been a gift from me for her birthday, she just had been so ill she did not remember.

As the number of measles cases in Texas were climbing, her doctors became fairly insistent that I receive a second MMR. They really didn’t want me to be around her without being protected.

Some may feel that wasn’t their decision to make. However, those doctors were not only scientifically correct but they cared deeply for my family. They knew me well enough to know that if I gave anything to my sister that would have hurt her, I likely would have never recovered from that guilt.

While measles can harm anyone, it likely would have been a death sentence for my sister. Initially, my mother was concerned about any possibility of me developing measles after the vaccine and giving it to my sister. The doctors reassured her and said the only way to protect her was to protect me. My mom had to make so many difficult decisions that year. Sometimes she did what the physicians recommended and sometimes not. Her goal everyday was to advocate and protect her daughter. So I was vaccinated based on the new two dose MMR policy.

Then I was able to be with my sister. I was with her when they told her that cancer returned. I was there to watch my platelets infuse into her weak body. I was there on the morning she died. Holding her hand. It would have been too risky during the measles outbreak for me to be around her that summer if I had not received that vaccine. While I grieve the loss of her beautiful mind and spirit still after almost 30 years, I realize that experience inspired me to enter medicine and advocate for children.

It is so unfortunate that the discussion around vaccination has become so volatile. Like my mom, parents are just trying to make the best and safest decisions for their children. They have to navigate a much more complex world of information available to them. At my clinic, we spend a good amount of time discussing questions and concerns regarding vaccines. While I try to work with families and guide them, in the final discussion, vaccinating children is the healthiest choice for them. Not just for their own disease prevention but for all of those who cannot receive certain vaccines through age or medical condition.

Honestly, I was a bit nervous writing this realizing potential backlash from those not agreeing with vaccinations. Yet as I was looking through my closet the other day, I saw that shirt I gave my sister. It made me smile remembering her wearing it and it reminded me of how all of us had to be brave in different ways that year. In her memory, I will continue to try and be brave.

Vaccinate. It saves lives.

Tarrant County Public Health has confirmed a traveler passing through DFW Airport on a May 15, 2019

TCPH wants the traveling public to be aware that exposures may have occurred at DFW Airport on May 15 in the following areas:

• Terminal D customs area from 5:15 to 7:45 p.m.
• The Skylink (i.e., tram between terminals) from 5:45 to 8 p.m.
• Terminal A in the area of gate 8 from 6 to 10:50 p.m.

People who were in the areas listed above are asked to watch for any symptoms until June 5, 2019. Measles is an airborne disease spread by coughing and sneezing. It causes a reddish rash, high fever, cough, runny nose and watery eyes. It usually lasts one to two weeks. The rash begins on the face and head and then proceeds downward and outward to the hands and feet. It fades in the same order it began, from head to feet.

Travelers who are flying internationally or to sites of active outbreaks are advised to follow these guidelines:

• Infants 6 months through 11 months of age should receive one dose of MMR vaccine.
• Children 12 months of age and older should receive two doses of MMR vaccine separated by at least 28 days.
• Adults should be sure they have had at least two doses of MMR vaccine.

Most people born in 1957 or after should have documentation of at least one dose of MMR (Measles, Mumps and Rubella) vaccine or other evidence of immunity to measles. The U.S. Centers for Disease Control and Prevention recommends two doses of the vaccine.

For children, the first dose should be given at 12 months of age and the second between the ages of 4 to 6 years.

“Vaccination is still the most important thing you can do to protect your child against measles. If you have concerns you, or your child, may have the measles or been exposed to the measles, please call your doctor immediately and try not to come in contact with others,” said Justin Smith, a Cook Children’s pediatrician. “The MMR vaccine is safe and very effective at preventing measles. If you or your child has not had the vaccination, please call your doctor to arrange this as soon as possible.”

Click here to read the release from Tarrant County Public Health.

More Resources:

• What Is Measles?
• Vaccines and Immunizations
• Common Questions About Immunizations
• MMR Vaccine
• When It Comes To Your Kids, It's Never Just a Virus

To identify the hot spots, researchers from the University of Texas at Austin and Johns Hopkins University looked at each area’s volume of international travel from foreign countries with large measles outbreaks and the prevalence of nonmedical exemptions from childhood vaccinations.

The same researchers previously predicted outbreaks in Washington, Oregon and New York which are all experiencing an influx of measles cases.

“For measles, most experts believe that there will be one to two deaths per 1,000 cases, most likely infants. We are set to see over 1,000 cases in the U.S. in 2019. So, for the first time since the 1980s, we may expect infant deaths from measles in the U.S.,” said the study’s lead author, Sahotra Sarkar, a philosophy and integrative biology professor at UT Austin and an expert on public health, in UT news. “We have long known that vaccine avoidance is a critical public health issue in the U.S. and Europe. Our results show how travel from regions elsewhere compounds this risk.”

The Texas Department of Public Safety has confirmed 15 measles cases in Texas this year, including one in each: Tarrant, Dallas and Denton counties and two in Collin County. Comparatively, Texas had nine measles cases in 2018 and only one in 2017.

Already this year, more than 760 cases of measles have been confirmed in the United States, the highest number in decades.

Physicians at Cook Children’s call this news frustrating because measles is a disease once thought to be all but gone from the planet. Texas has one of the highest rates of unvaccinated children in the U.S., partly due to a 2003 state law allowing parents to opt out of getting their children immunized for reasons of conscience.

“It’s not a coincidence that as we have seen more people hesitant to receive the vaccine, we have seen the number of measles cases increase nationwide,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “The numbers are very concerning.”

Measles is a highly contagious respiratory illness spread by contact with an infected person through coughing and sneezing. Measles is so contagious that if someone has it, 90 percent of the people around that person who are not immune will become infected.

The Centers for Disease Control and Prevention (CDC) recommends children who are older than 12 months get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

Two doses of the MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

"Populations who choose to not follow the recommended vaccine schedule are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," said Jason Terk, M.D., a Cook Children's pediatrician.

Other Texas counties to make the Top 25 were Harris at No. 9 and Travis at No. 22.

To learn more about where you can receive vaccines in the Tarrant County area, visit the Immunization Collaboration of Tarrant County website.

For More on This Topic:

• 25 U.S. Counties Identified as Most at Risk for Measles Outbreaks
• Vaccines and Immunizations
• Immunization Collaboration of Tarrant County
• Common Questions About Immunizations
• Why Children Like Olivia Need You to Immunize
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

Mercury (Thimerosal)

Thimerosal is a preservative that was used in vaccines starting from the 1940s. The preservative contains a small amount of mercury and chronic mercury toxicity has been shown to be related to psychiatric problems and other medical issues. Because of this, it was brought up as a concern around 1999 because the overall number of vaccinations was increasing that perhaps over time the exposure to mercury could be a cause of autism.

Studies started quickly to determine if this could be the case, but in the meantime, the vaccine companies, at the request of the American Academy of Pediatrics (AAP) and the Food and Drug Administration (FDA), began to take Thimerosal out of their vaccines. Thus, by 2001, Thimerosal (and mercury) were removed from vaccines except for one exception (see below). Fortunately, in 2004, further studies released by Institute of Medicine determined that mercury was not a cause of autism.

Currently, the only vaccines that contain mercury that I offer in my clinic are seasonal flu vaccines when they are given in a mutli-dose vial. I try to order as much “preservative free” flu vaccine as I can so that this is not even a concern for my patients. However, because studies have shown that mercury is not a cause of concern, I do not worry that receiving their flu vaccine from a multi-dose vial would harm my patients.

MMR Vaccine

Autism is generally diagnosed around 15-18 months, right after the time when children receive their measles, mumps and rubella (MMR) vaccinations. I believe that is because of this relationship in time that MMR was ever thought to be associated with autism.

The original paper that reportedly found a relationship between MMR and autism by Andrew Wakefield was published in The Lancet. The research has now been completely discredited after multiple other scientists were unable reproduce the results and significant problems with the methods he used for conducting his research. In addition, further information has come out regarding Dr. Wakefield’s conflicts of interest and his motivation for publishing the paper. Over time, ten of the twelve authors involved in the writing of the paper retracted their support of its conclusion.

Finally, after many years, The Lancet published the following statement, “We wish to make it clear that in this paper no causal link was established between (the) vaccine and autism, as the data were insufficient. However the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper.”

Despite this overwhelming criticism of his paper, the damage done by Dr. Wakefield and The Lancet still persists today. Parents continue to ask about and remain fearful of MMR and a possible (although incorrect) link to autism. His belief caused parents to fear the use of MMR vaccine and unfortunately, this often extends to all vaccinations.

“Too Much, Too Soon”

Are children getting too many shots too soon?

Will receiving all the scheduled shots, so many more than we got as kids, overload their immune systems?

This is a conversation I often have with parents of newborns. And despite the fact that I’m pro-vaccine, I am not afraid to have discussions with parents who have fears and simply want what is best for their child.

Because of that, I follow the evidence closely and love to see new studies that look at different angles of the vaccine discussion.

That’s why I was I excited to see a recent study in the Journal of the American Medical Association (JAMA) that analyzed children with infections not covered by vaccines to determine how many vaccines they had received and if that was a potential reason why they got the infection.

The research looked at around 200 children with diseases and compared them to 750 other children. Those who contracted the diseases had a total vaccine exposure of 240.6 antigens while those in the control (without the disease) group had 242.9.

So, it doesn’t appear that vaccine load on the immune system is a contributing factors towards children contracting other diseases.

This study is another perspective and further evidence that lends support to the idea that vaccines are one of the most successful, safest advancements in the history of medicine.

So why did the Tarrant County Health Department just announce that there is a case of rubella in a Texas Christian University student?

Unfortunately, the student returned from a part of the world where rubella continues to be an ongoing concern. The World Health Organization states that rubella continues to cause infection in Africa, the Eastern Mediterranean and Southeast Asia. Despite the fact that rubella is no longer transmitted in the United States, an average of 10 cases of rubella are diagnosed here each year from travelers who bring it back from affected areas.

Don’t get me wrong, rubella is a big deal. Prior to the vaccination, it used to cause millions of cases per year around the world. The most severe complication from rubella is congenital rubella syndrome (CRS) which can affect the babies of women who contract rubella during the first three months of their pregnancy. Children born with CRS are at risk for growth problems, developmental delays and other birth defects.

We should definitely be aware that there is a case of rubella in our area, but I’m advising parents not to panic about their children getting rubella.

Here are the 2 main reasons why I’m choosing not to panic:

1. Rubella is a mild illness in children. It can start with a mild fever (but often doesn’t) and then causes a rash that starts on the face and spreads downward. Other complications from rubella are very rare and are more likely to happen in teenagers and adults.

2. Rubella vaccine works very well. After the first dose of the rubella vaccine (given at 1 year), 90-95 percent of children are protected. After the 4-year booster dose, protection gets much closer to 100 percent. If your child is vaccinated, they are most likely protected. As with anything, the vaccination is not perfect so we are relying on each individual person getting vaccinated to help protect their neighbors from an outbreak. Despite the fact that cases of rubella have been imported into the United States, no outbreaks have occurred, thanks to our relatively high immunization levels.

Children (or adults) who are infected by rubella can spread the disease via droplets spread by sneezing or coughing. We recommend all children be vaccinated against rubella. The vaccination helps prevent children from getting the disease and it also helps protect anyone they may come in contact with, including pregnant women.

Pregnant women with rubella run the risk of potentially having a baby with congenital rubella syndrome.

As always, if you are pregnant (especially in the first three months), use caution around sick individuals especially those with a rash. If you already have a baby, you were likely checked for rubella immunity at the delivery and your doctor should have the results of that test. If you are thinking about becoming pregnant, a doctor can check your immunity level now so that you can be vaccinated prior to getting pregnant.

Let’s not panic about rubella at TCU. If your child is starting classes there, feel free to send them on (I’ll be on campus for a meeting today if that gives you any peace of mind). Let’s be aware. We’ll follow the story and notify you if there are any updates or new reasons to be concerned.

More resources:

• Rubella
• Frequently asked questions about immunization
• Measles: Just a plane ride away
• Should you immunize?

Measles is highly contagious and can easily spread by simply breathing, coughing, sneezing or coming in close contact with an infected person. If you or anyone you know develops symptoms of this disease, please contact your health care provider immediately.

Measles begins as a mild infection with fever, congestion, cough and some oral lesions. It then worsens to a severe respiratory infection, with very red eyes, lots of coughing and a rash all over the body with red, slightly raised, round spots. Measles can have complications such as pneumonia, dehydration and in rare occasions swelling of the brain (encephalitis). Measles is especially dangerous for people with weak immune systems.

Donald Murphey, M.D., medical director of Infectious Disease at Cook Children’s, and TCPH remind people that measles is a vaccine-preventable disease. Adults who have received a measles vaccine series are considered immune. Those who have not been immunized against measles, or have never had measles, should contact their health care provider to get vaccinated.

“If you think you, or your child, may have measles or have been exposed, call your doctor immediately and try not to come in contact with others,” Dr. Murphey said. “The measles, mumps and rubella (MMR) vaccine is safe and very effective at preventing measles.  If you are travelling with children, they can be immunized against measles to protect them as early as 6 months old. Children normally start the MMR vaccine at 1 year old. If you or your child has not had the vaccination, please call your doctor to arrange this ASAP.”

The Centers for Disease Control and Prevention recommends two doses of the vaccine. The first dose should be given at 12 months of age and the second between the ages of 4 to 6 years. But children can get the second dose at any age, as long as it is at least 28 days after the first dose.

You can find more information about Measles by clicking HERE.

The last recorded cases of Measles in Tarrant County were in 2013.

Click here to find a Cook Children's pediatrician in your area to get your child vaccinated.

Donald Murphey, M.D., medical director of Infectious Disease at Cook Children’s, worries over the fact that diseases like measles and pertussis are once again in the news.

“It’s alarming to see the rise in these diseases that were so common prior to the advent of effective vaccines, but largely disappeared with immunization,” Dr. Murphey said. “It’s frustrating too because we have safe vaccines that prevent these diseases. The solution is for kids, teens, and adults to get immunized.”

Measles is a highly, dangerous, but preventable disease with vaccinations.

The CDC report says that many of the cases are from people who visited other countries. Of the 129 cases reported by the CDC, 34 were “importations” from other countries. The Philippines has seen 20,000 confirmed or suspected cases of measles cases from Jan. 1 to Feb. 28 and 69 confirmed deaths.

But why is this happening? “The increase in importations from this outbreak and subsequent transmission in certain settings in the United States highlights the importance of ensuring age-appropriate vaccination for persons traveling to areas where measles is endemic and maintaining high vaccination coverage at the national and local level,” The CDC report states.

Parents can make an important step in preventing their children from catching measles through the use of two doses of the MMR vaccine.

“We thought we were on our way to eradicating these diseases,” Dr. Murphey said. “Our goal was that these diseases would be completely controlled by the year 2015. But misinformation and fear about immunization has prevented that from happening. It’s a very sad situation because children suffer, but it can be much worse if segments of the population refuse to receive their vaccines.

Measles is particularly contagious. Transmission is by coughing, sneezing or simply being next to someone laughing. It’s that easy.

Dr. Murphey said what’s particularly frustrating is that these diseases can be contained and even eliminated if we do our part. MMR vaccination remains the most effective way to prevent outbreaks. In children, the first MMR vaccine dose is usually administered at 12-15 months and the second at 4-6 years.  However, the MMR vaccine is recommended for children as young as 6 months old when they are traveling abroad. Children under 12 months of age and traveling internationally should receive 2 doses of MMR, separated by at least 28 days

All college students, international travelers, and health care personnel should receive two doses of MMR vaccine, unless they have other evidence of measles immunity.

“I can’t stress enough if you are traveling abroad, the importance of making sure you are updated on your immunization,” Dr. Murphey said. “This holds true for pregnant women, infants, kids, teens and adults. We all have to do our part and have our shots updated to keep each other healthy.”