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 first outbreak-related cases were reported on May 13 in Collin and Rockwall counties. Alice Phillips, M.D., director of ambulatory quality and safety, advises parents to be aware but not alarmed.

“These cases remain small in our region. If your children are vaccinated, nothing about activities needs to change,” Dr. Phillips said.

Cook Children’s Health Care System continues to work with local public health departments on any report of measles cases. The Texas Department of State Health Services in April recommended that children between 6 months to 11 months traveling to or living in an area with an active measles outbreak receive a vaccination.

Dr. Phillips explained that the best way to protect a child from measles is the MMR vaccine. One dose offers 93% protection, and two doses provide 97% protection against the virus.

DSHS has designated these counties as outbreak areas: Cochran, Dawson, Gaines, Lamar, Lubbock, Terry, and Yoakum.

Currently, the Tarrant and Denton County health departments, where Cook Children’s Medical Center – Fort Worth and Prosper are located, have not issued this recommendation.

“If that changes due to a rise in cases, we will update,” said Dr. Phillips.

However, Dr. Phillips noted that families planning to travel outside of the United States, should be aware of regions where the MMR and/or Hepatitis A, vaccine is recommended for infants between 6 and 12 months.  She encourages parents to check with their pediatrician.

“If your kids are vaccinated, they are safe and protected,” said Dr. Phillips.

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. 
   

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.

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.