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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• Measles Mythbusting with Laura Romano, D.O.

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.

Lubbock hospitals have reported some measles patients showing signs of Vitamin A toxicity. Here is what you need to know about Vitamin A and measles.

What is Vitamin A?

We all have Vitamin A in our bodies. It helps with our vision, bone growth, cell development and immune system. This vitamin is naturally found in a lot of our food. Vitamin A deficiency is very rare. Most people have one to two years’ worth of Vitamin A stored in our livers!

Less than 1% of people in the United States have a Vitamin A deficiency.

Putting too much Vitamin A into our bodies at once, like with a supplement, can be harmful.

Taking Vitamin A supplements, especially at the dosages some people are recommending on social media, will likely cause Vitamin A toxicity.

A deeper look

Vitamin A is stored in the liver. The liver releases the right amount of Vitamin A into the rest of our bodies as needed. But when there’s too much Vitamin A, our bodies cannot process or store all of it. This can throw many of the body’s systems off. Too much Vitamin A flooding the body can cause vomiting, dizziness, blood clotting issues and liver damage.

For more detailed information about how this works, check out this article.

Toxic doses

Some social media posts recommend doses of Vitamin A that are dangerous.  Even a one-time high dose can be toxic. Our bodies can only handle so much Vitamin A at once.

Main takeaway: You and your child do not need to take Vitamin A, and taking it can cause harm.

Symptoms of Vitamin A toxicity

Acute toxicity happens when someone takes a toxic amount of Vitamin A.

• After 12 to 24 hours of toxic dose: headache, nausea, vomiting, lethargy, blurry vision, muscle and joint aches, dizziness.
• Chronic toxicity happens when someone takes too much Vitamin A over a period of time. These symptoms include:
• Skin lesions, skin lesions, dry and cracked lips, painful joints and muscles, fatigue, depression, anorexia, poor muscle control, alopecia (hair loss), visual impairment, blood clotting issues and liver damage

A deeper look

Where did this misinformation come from?

When someone has measles, their Vitamin A levels decrease. Because of this, people with the measles are sometimes given Vitamin A to make sure they do not develop deficiency.

But taking Vitamin A does not prevent measles. It should not be taken without a doctor’s recommendation.

Main takeaway:

Vitamin A supplements can cause toxicity in people, especially children. Some people urging people to take Vitamin A on social media are recommending doses that are far too high to be safe for children.

Vitamin A should only be taken at your doctor’s recommendation. The most effective and safest prevention against measles is the MMR vaccine. The MMR vaccine has helped keep us safe from measles for decades.

If you have questions about measles, the MMR vaccine or Vitamin A, talk to your doctor.

The measles outbreak that started in west Texas continues to spread, with cases occurring in 21 counties. The

Health officials have confirmed two measles cases in Tarrant County, the first cases reported in the county this year. The two patients are “household members,” according to the announcement, and both are unvaccinated. One is a child and one is an adult.

Health officials have not yet determined where the two county residents caught the illness.

No cases have been reported at Cook Children’s Medical Centers in Fort Worth or Prosper. If you are worried your child has been exposed to measles, please read this article for guidance.

We know there is a lot of misinformation out there about measles and vaccines. We asked Laura Romano, D.O. a Cook Children’s hospitalist, to give us the facts.  

Dr. Romano’s answers have been lightly edited for clarity and length.

Is it better to get measles and have natural immunity?

Dr. Romano: Absolutely not.

Measles can cause serious complications, even years after recovery. Kids can have brain damage, hearing loss and seizures. One out of every 1,000 kids with measles develops encephalitis, or brain swelling. Others can have seizures years down the road.

Measles can have devastating consequences for unvaccinated. As we’ve seen, it can cause death in unvaccinated people.

More info: For every 10,000 children who get measles, typically 2,000 will be hospitalized, 500 will get pneumonia, 10 will get encephalitis and 10 to 30 will die.

What about people who say measles is not that big of a deal?

Dr. Romano: Measles can be “not a big deal” for some people, but it is unnecessarily risky to not get vaccinated.

One in five children who get measles can get pneumonia. There’s a risk of encephalitis (brain swelling), seizures and brain damage.

Do you really want to take the risk that your child will be fine when we know that the vaccine is 97% effective at preventing those symptoms?

Recently, a second unvaccinated child passed away from measles pulmonary failure. This is a second preventable death.

More info:

Two children have died from measles in Texas as of April 30.

In the decade before the creation of the measles vaccine in 1963, measles killed 400 to 500 people. An additional 48,000 were hospitalized and 1,000 had encephalitis (swelling of the brain), according to the CDC. Across the globe, an estimated 107,500 people died from measles in 2023 alone, according to the World Health Organization. Most of the deaths were in unvaccinated or under vaccinated children under the age of 5.

Does measles only infect kids?

Dr. Romano: No.

What we’re seeing is that anyone who is unvaxxed is susceptible. It is more common in children, but that doesn't mean adults can’t get it. There was an adult who died in New Mexico after he had measles. (Health officials have yet to officially confirmed whether or not measles was the direct cause of death).

It is called a “child’s disease” because kids are most susceptible. But young adults or adults might be more at risk to measles now than in the last few decades. That’s because herd immunity is gone. There’s a chance we might see more cases in adults and young adults who are not vaccinated.

More info: As of April 4, the CDC reported 26% of measles cases in 2025 were among people over 20 years old.

Do you only need the first shot to be protected against measles?

Dr. Romano: No; you need both.

The first shot is 93% effective at preventing complications from measles and secondary infections. But the second dose bumps that prevention up to 97%. That second shot really is what makes sure you don't have symptoms of it.

Does the vaccine fully prevent people from getting the measles?

Dr. Romano: No, but it prevents it 97% of the time.

If you’re had both vaccine doses, it is highly unlikely you will get the measles. However, just like vaccinations against COVID, there is a small chance you could still get measles, but it will be extremely mild. More importantly, you are less likely to spread it.

The measles virus is extremely smart. And it spreads before most people know they have it or are symptomatic. If you are vaxxed, you might spread to one other person. If you are unvaxxed, you’ll probably spread it to 15 to 20 people.

Does the MMR vaccine make children sick?

Dr. Romano: No, the vaccine does not make children sick.

The most common side effects of getting the shot are arm soreness and a mild fever, like many vaccines. The vaccine can also give a mild fever and rash.  This is the body’s natural response to developing immunity and is not contagious.

Does the MMR vaccine, or other vaccines, cause autism?

Dr. Romano: No; there is no link between autism and the MMR vaccine or any vaccine.

There have been multiple credible studies that have shown there is absolutely no link between autism and any vaccine.

If you have questions about vaccines, you should talk to your child’s doctor. There is nothing wrong with parents who have questions and are willing to have a conversation with their providers about vaccinations.

More info: In 1998, a British Gastroenterologist published a paper claiming MMR vaccines cause autism. That paper has been retracted due to fraudulent methods and findings.

Countless studies have proved that there is no link between autism and vaccines.

Can Vitamin A prevent measles?

Dr. Romano: No.

While some people and even some members of the federal government have suggested that Vitamin A could be protective against measles, this is simply not true. Now kids are being hospitalized showing signs of too much Vitamin A. It is just giving frontline doctors another problem to address. Please do not take Vitamin A to prevent measles. It does not do anything.

Can vaccines hurt us because they contain dangerous chemicals and materials?

Dr. Romano: No.

Vaccines contain some materials that you probably would not want to eat in large quantities by themselves, like formaldehyde and aluminum. Some of these elements, like aluminum, are found in fruits and vegetables and are natural.

These elements are important to how the vaccine works: aluminum triggers the body’s immune response, and formaldehyde prevents bacteria from getting into the vaccine.

It’s like baking cookies. If you are baking cookies, you need things like baking soda and baking powder for them to turn out okay. If you ate an entire bag of baking powder, it would not be good for you. But you just need a tiny bit to make those cookies turn out okay. Vaccines are just like that. You need just a tiny amount to make the vaccine safe and effective.  

More info: We consume aluminum all the time.

Aluminum is the third most abundant element on earth and is naturally found in fruits, vegetables, flour, dairy, nuts, honey and other food. We all typically eat about 7 to 9 milligrams of aluminum per day.

Babies consume aluminum in formula and breast milk. In their first six months of life, babies typically get 7 to 38 milligrams of aluminum through formula or breast milk. In comparison, during the first six months, infants typically get about 4 milligrams of aluminum from vaccines. That amount is safe.

Similarly, the amount of formaldehyde in a vaccine is not harmful. Our bodies naturally produce formaldehyde to help with metabolism. There is about ten times more formaldehyde naturally occurring in a baby’s body than the amount found in any vaccine.

Doesn’t getting vaccinated only impact my children and I?

Dr. Romano: No; vaccinations protect everyone.

You need to get your kids vaccinated because it's not just for your kid. It's for your neighbor who is on chemotherapy and is now immunocompromised (meaning their immune system does not work). It's for your kids’ classmate who has a baby sibling who can’t be vaccinated yet.

Or for people like my dad, who is on immunomodulators (a type of medicine) for rheumatoid arthritis. The medicine weakens his immune system.

That is who my kids and I get vaccinated for; for my neighbors, for my kids’ classmates, for my patients. We get vaccinated because we care about others and we care about our community.

I vaccinate my children because I care about the health of my community. I encourage vaccines not because of my potential political, religious, ethical, or moral beliefs; I encourage vaccines because I care about the safety of my community.

Main takeaway from Dr. Romano: If you have questions about vaccines, don’t go to your favorite social media wellness influencer. Please come to us - your pediatrician or your family physician. We want to have that conversation with you. Even if you disagree with us at the end of the day, that is ok.

As a pediatrician, we want what’s best for you and your family and sometimes that’s not what can be found on social media.

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. 

Suzanne Whitworth, M.D., division chief of Pediatric Infectious Diseases at Cook Children’s, joined WFAA's Midday newscast to talk about the recent measles exposure in Collin County. She discussed what parents should know, how to prevent it, and more.

Watch the live interview here

An extended version of the interview can also be seen on WFAA+. 

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.

 Measles symptoms typically appear seven to 14 days after infection. 

They can include:

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

How do we stay safe?

The most effective prevention against measles is vaccination. The size of the virus makes it more contagious. Measles can live in the air in a room where an infected patient has been for two hours after that patient leaves.

This means that if ten unvaccinated children are in a room and one of them has measles, nine out of ten of them will likely catch 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 about other illnesses?

While Cook Children’s Medical Centers in Fort Worth and Prosper are not seeing an abnormal number of cases for RSV, COVID, and Flu, these illnesses can be prevented with proper hygiene as well.

It is important to speak to your primary care physician if you have any questions or concerns about vaccines. There are now vaccines to help prevent the severity of RSV, COVID, and Flu.

Where can you get immunized?
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. 
   

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.

As of Tuesday, April 8, the Texas Department of State Health Services (DSHS) reports 505 cases and 57 patients hospitalized. Of the 505 confirmed cases, 495 are either unvaccinated or their vaccination status is unknown. No cases have been reported at Cook Children’s Medical Centers in Fort Worth or Prosper.

Cook Children’s Health Care System, through Marc Mazade, M.D., medical director of infection prevention and control, and Alice Philips, M.D., director of ambulatory quality and safety, explained what this means and what families should know.

The measles virus is highly contagious and can remain in the air for up to two hours.

“If the children at Great Wolf Lodge (during the exposure dates) were vaccinated then only observation is needed,” Dr. Phillips said. “Vaccination provides excellent protection and these kids have little risk to develop measles.”

Dr. Mazade explained that if a child visited either of these locations during the exposure period and was not vaccinated, they should watch for symptoms related to measles.

“Parents should watch for fever, congestion, cough, and red eyes and development of a rash,” Dr. Mazade said.

There is a 21-day incubation period, which means a child could develop the measles during that time. Children who develop any symptoms during that period should contact their doctor.

Dr. Mazade explained if symptoms develop, the family should keep the child at home and call their primary care physician.

Cook Children’s primary care clinics and neighborhood health centers can do testing on site for existing patients. 

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.

“Parents should not hesitate to call their primary care physician for any questions,” Dr. Phillips said. “We are here to answer them.” 

Cook Children’s Health Care System continues to work with county health departments where clinics, medical centers and urgent cares are located.

DSHS recommendations

DSHS released new guidelines Monday now recommending children living in Cochran, Dallam, Dawson, Gaines, Garza, Lynn, Lamar, Lubbock, Terry, and Yoakum.

Infants
Immediately administer an early dose of measles, mumps, and rubella (MMR) vaccine for infants aged 6-11 months.

Children
Administer a second dose of MMR vaccine for preschool-aged children aged 1 to 4 years who received one prior dose.

Children at least one year of age with no documentation of vaccination history should receive two doses at least 28 days apart.

Adults
Administer a second dose of MMR vaccine for adults who received one prior dose.

Adults with no documentation of vaccination history should receive two doses at least 28 days apart.

Dr. Phillips advised parents that while this does not include Tarrant County, families should watch for any updates to this recommendation and discuss any questions or concerns with their doctor.

Where can you get immunized?

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. 
   

What are symptoms of measles?

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.

Related Stories

What Parents Need to Know About the Measles Vaccine
Proactive Protection: Cook Children's Measles Response Plan
Cook Children's Addresses Rising Measles Concerns
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Measles and Community Health 

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. 
   

Cook Children’s has six negative-pressure rooms to care for children with the virus. Rooms have space for family members and specialized air ventilation systems that pull air inward, preventing recirculation.

Dr. Whitworth hopes the rooms will not be needed.

“If everyone gets vaccinated, we won’t have this crisis,” Dr. Whitworth said. “This is preventable.”

Read the full story here.

Watch Dr. Whitworth's interview here.

“It takes planning,” explained Suzanne Whitworth, M.D., Division Chief of Pediatric Infectious Diseases.

The unit has six beds and dedicated areas for visitors and staff to put on and take off personal protective equipment (PPE). The rooms also provide a bed for family members and have specialized air ventilation systems. In the negative-air-pressure rooms, air is pulled inward, preventing recirculation.

“We are so grateful to have this unit here primarily because these children will be able to stay with their parents and keep our staff safe,” Dr. Whitworth said.

The unit focuses on keeping children with their parents and avoiding exposure to others. The rooms provide space for two parents or guardians to sleep and a bathroom with a shower.

Dr. Whitworth adds that any medical personnel in the unit will don PPE similar to that used during the pandemic.

“They would wear a gown with long sleeves, gloves, an N95 mask, and eye protections,” said Dr. Whitworth.

Currently, Cook Children’s Medical Centers in Fort Worth and Prosper have not had a measles case.

Dr. Whitworth explains the unit is not new. In 2022, the unit opened although Cook Children’s had discussed the need long before, and the need became more pronounced during the COVID-19 pandemic.

“This unit allows us to have a space where we are always ready for the next thing that comes along,” said Dr. Whitworth.

The unit provides staff with an area for them to shower and change before going home.

System-Wide Solutions

Dr. Whitworth said a meeting was held with Cook Children’s Health Care system stakeholders to ensure a synchronized response in case of a measles outbreak. This includes the medical center in Prosper, primary care and urgent care offices.

The medical center in Prosper also has negative-pressure rooms, which would be used if a child were diagnosed with measles.

Clinics have adopted updated policies for testing, identifying people with measles, and caring for those patients.

“Everything is really full-court press right now for preparation in case we have to do that here, and hopefully we won’t,” Dr. Whitworth said. 

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. 
   

Related Stories

Cook Children's Addresses Rising Measles Concerns
Measles FAQs: What Parents Need to Know
Measles and Community Health

Alice Phillips, M.D., medical director for Abulatory Quality at Cook Children’s, said families can protect their babies by making sure everyone else is up to date on their immunizations.

“It’s very similar to advice we give them for other vaccine-preventable diseases. We want to cocoon that baby in protection,” Dr. Phillips said. “That’s what’s so critical for families and for the community to understand about vaccines: What we all do protects those infants who can’t get vaccinated yet.”

Read the full story here.

 Julee Morrow, M.D., a pediatrician at Cook Children’s Harris Parkway, is one of the few current doctors at Cook Children’s who treated patients during that time.

“A majority of the kids that I took care of had to get admitted to the hospital,” Dr. Morrow recalls. “We needed a way to keep them hydrated. We needed a way to keep their oxygen levels up.”

More than 30 years later, Dr. Morrow did not expect to see another outbreak, especially with the availability of the measles, mumps, and rubella (MMR) vaccine.

Cook Children’s has tested patients for the measles; there have been no confirmed cases at its  Fort Worth and Prosper medical centers.

“We are in such a good place from a standpoint of the science and the technology we have now, it can be prevented, ” Dr. Morrow said.

According to the Center for Disease Control and Prevention (CDC), measles was declared eradicated in the United States in 2000.

“We were the only country that didn't have a travel advisory for measles, because our rates were so low, because we had such good vaccination rates,” said Alice Phillips, M.D., Director of Ambulatory Quality and Safety.

The Texas Health and Human Services reported the first measles death on Feb. 26, A school-aged child who was not vaccinated died. The child had been hospitalized in Lubbock and tested positive for measles.

“I feel sad because measles is so easily prevented,” Dr. Morrow explained. “One dose of measles vaccine gives 93%. Two doses give people 97 to 99% immunity.”

As of Feb. 28, the state reported 146 measles cases, mostly in children. Rockwall County reported its first measles case on Feb. 25. Cook Children’s Medical Centers in Fort Worth and Prosper are prepared to treat patients.

Cook Children’s Health Care System is prepared

To prevent potential spread, Cook Children’s Medical Centers, primary care, and urgent care offices ask families to call ahead and inform staff if they believe their child may have measles.

“We will likely be donning all of our personal protective equipment (PPE) to go to the family’s car to screen children before bringing them into the waiting room, so as not to expose any other susceptible patients,” said Dr. Morrow.

If the child is taken into an exam room, the room will be closed for two hours afterward. Families will be provided with a handout on quarantine and measles information. 

Cook Children’s continues to monitor the cases in the state and will revise protocols as necessary.

Thirty-eight years ago, there was no rapid test. Doctors diagnosed patients based on symptoms.

“We now have better testing,” explained Dr. Morrow.

Now, patients are given a nasal or throat swab, similar to the tests used during the COVID-19 pandemic. The sample is sent to a lab. While patients await results, Dr. Morrow said families must quarantine.

“Measles virus is one of the most contagious germs on the planet,” said Dr. Morrow. “It would be very easy to spread it to someone whose immune system is not very strong, like a person who has finished chemotherapy, or has heart or lung problems. It would be very dangerous for a premature baby.”

Dr. Phillips understands that parents may have concerns about the science of vaccines and encourages them to discuss these concerns with their pediatricians.

The CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 - 15 months of age, and the second dose at 4 through 6 years of age.

“We are here to help them, for them to understand the science and to give them the vaccines that their children need,” Dr. Phillips said.

A native Texan, Dr. Morrow urges people to care for one another. The MMR vaccine provides 93% to 95% protection with one dose and 97% effectiveness with two doses.

She encourages families to have a plan in place if they are unable or reluctant to get the vaccine.

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. 
   

This is an ever-evolving situation. As information changes, we will update you here and on our website at cookchildrens.org.

For a downloadable flyer, click here. 

The measles outbreak in Texas has reached nearly 150 cases, according to the state health department. Twenty of those patients have been hospitalized, and one school-aged child has died. 

There have been no confirmed cases across Cook Children’s Medical Centers in Fort Worth and Prosper. 

We know questions about measles are at the top of every parent’s mind. To provide the most up-to-date information, we’ve compiled and answered some of our most frequently asked questions (FAQs). 

1. What is measles? 
Measles is a viral infection caused by rubeola virus (which is not the same as rubella), that causes a fever, rash, cough, runny nose, and red eyes. Ear infection, diarrhea, pneumonia and—in rare cases—brain damage, and even death can occur.

The virus is very small, which makes it more contagious. It is in the air in a room with an infected patient and remains in the air for another two hours after that patient leaves.

2. How contagious is it? 
Measles has a contagiousness rate of 90%, making it one of the world’s most contagious diseases for the unvaccinated. This means that if ten unvaccinated children are in a room and one of them has measles, nine out of ten of them will likely catch the virus. 

3. How long after exposure will someone get sick if they have measles? 
Measles has an incubation period (the amount of time between exposure and symptoms) of seven to 21 days.

4. When can a person spread the measles virus? 
A person with measles can spread the virus to others for nine days, starting four days before the rash appears, the day the rash appears and ending after the rash has been present for four days.

5. What are the symptoms? 
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

Typically, ten days after exposure is when a person will develop a fever, cough and runny nose. Some people may have conjunctivitis (eye infection) that looks like pink eye and develop a sensitivity to light. Tiny white spots known as Koplik spots may appear inside the mouth two to three days after symptoms begin. After about four days, the fever may go down, but the second phase of measles will likely begin.

The red rash is the most well-known sign of measles. A measles rash typically starts three to five days after symptoms first begin. It usually begins on the scalp behind the ears or at the hairline. The rash can spread down the face, body and all the way to the feet. It is not itchy but is uncomfortable and painful. Once the rash sets in, the fever might come back.

Gastrointestinal symptoms, vomiting, diarrhea and severe abdominal pain are also possible.

While rare, internal issues can start at this point. As coughing and respiratory symptoms pick up, about 1 in 20 children with measles may develop pneumonia. This can lead to inflammation in the lungs that can only be treated with oxygen.

6. What do I do if I think my child has measles? 
Call your child's pediatrician or your primary care physician or medical provider if you or your child have been exposed to measles or are showing symptoms. Follow your providers’ instructions.

Consider making an appointment instead of seeking emergency care unless your child is in respiratory distress (wheezing, severe breathing problems), is unresponsive or showing other acute signs of distress.

Parents or guardians should call the primary care doctor before arriving at a doctor’s office so arrangements can be made to minimize potential exposure in the waiting room.

If you make an appointment at a Cook Children’s facility, do not come into the waiting room. A medical provider will meet you to take you to a room. This is to mitigate the spread of the virus. The facility will do a nasal or throat swab test. They may also do a blood test.

7. Where have people tested positive for measles? 
As of Feb. 28, the Texas Department of State Health Services said cases have been confirmed in the South Plains and Panhandles regions of Texas in the following counties: Dallam, Dawson, Ector, Gaines, Lubbock, Lynn, Terry, Martin and Yoakum. On Feb. 26, Rockwall County officials said they also had a confirmed measles case. 

As of Feb. 28, 146 cases have been identified since late January. Forty-six cases are in children zero to four years old, 70 are in children five to seventeen and 25 cases are in people over the age of 18. Five cases do not have the age confirmed yet. Five of the cases are vaccinated. The rest are unvaccinated, or their vaccination status is unknown. 

Twenty of the patients have been hospitalized. One child has died from measles in Lubbock. 

8. Am I and my child safe from measles if we have been vaccinated? 
You are very likely protected.

Vaccinations provide the strongest available protection against measles. The first MMR vaccine is typically given to kids at 12 months, with a booster at 4 years old. People who receive MMR vaccination according to the U.S. vaccination schedule are usually considered protected for life against measles and rubella with 97% immunity, according to the Centers for Disease Control and Prevention (CDC).

However, if you were vaccinated before 1968, you may need a booster because vaccines during that time period were less effective, according to the CDC. A small number of vaccinated people can occasionally develop measles. In these cases, the symptoms are generally milder, and they are less likely to spread the disease to other people.

9. Can my child receive the vaccine early? 
The first MMR vaccine is typically given to kids at 12 months, with a booster at 4 years old. Reach out to your doctor with questions about early vaccination. Children traveling outside the country may be able to receive the vaccine earlier than 12 months.

10. If I or my child hasn’t been vaccinated, can we still get the vaccination? 
Yes. Children over the age of 12 months can receive their first vaccination. People who were not vaccinated as children can be vaccinated any time unless you are pregnant.

11. How long does the vaccine take to be effective? 
Detectable antibodies generally appear within just a few days after vaccination. People are usually fully protected after about two or three weeks.

12. Should I also have my child tested, or should I get tested?
Contact your child's pediatrician or your primary care physician to determine if you need testing. 

13. Can I order a test myself? 
Tests have to be ordered from the Texas Department of Health and Human Services. Go to the website for more information or contact their lab via email at labinfo@dshs.texas.gov or Phone at 512-776-7318. 

We anticipate updates regarding community testing options from our local public health departments in the near future. Stay tuned.

14. What is the test? 
Tests come in various forms; nasopharyngeal swabs, throat swabs and oral swabs. There are also blood tests for some patients. 

15. How long do test results take? 
Test results typically take anywhere from two to seven days. 

16. What is the treatment for measles? 
There is no specific treatment for measles, just like most other viruses. Supportive care and close observation is very important including: 

• Making sure your child is drinking plenty of water to stay hydrated 
• Controlling fever with Tylenol or Motrin (Do not use Motrin in children less than 6 months of age).
   

17. Should we quarantine while awaiting test results? 
Yes. All exposed members of the household should stay home and away from others while waiting for the results of the measles test. If your child tests positive, they should stay home and have no outside contact. If you have been fully vaccinated, your likelihood of spreading measles is low, but consider limiting your exposure to others as well. If you are not vaccinated, you should stay away from settings where there are susceptible people (such as schools, hospitals, or childcare) until your healthcare provider says it's okay to return. This will help ensure that you do not spread it to others.

18. What do I do if I or my child tests positive for measles? 
Continue isolation at home for four days after the rash appears or until directed by your physician.

If you think your child needs to be seen, please call ahead so we can prepare and see your child safely.

19. What are possible complications from measles? 
Measles can be serious in all age groups. However, there are several groups that are more likely to suffer from measles complications: 

• Children younger than 5 years of age 
• Adults older than 20 years of age 
• Pregnant women 
• People with weakened immune systems, such as from leukemia or HIV infection 
   

Ear infections: 1 out of every 10 kids develops an ear infection. Call your doctor if your child complains of ear pain 

Diarrhea: 1 out of every 10 has diarrhea. Make sure your child is getting plenty of fluids. 

Pneumonia: 1 out of every 20 will develop pneumonia. Watch for cough or rapid breathing 

Brain swelling: Very rarely children with measles can develop acute disseminated encephalitis, where the virus gets into the brain tissue and spinal fluid and causes brain swelling. This can cause seizures, paralysis, hearing damage, comas or death. 

20. How does measles spread? 
Measles lives in the nose and throat mucus of an infected person. It can spread to other through coughing and sneezing.

Measles can be spread through air droplets when an infected person coughs or sneezes. You can get measles just by being in a room where a person with measles has been for up to 2 hours after that person has left.

Measles can also spread through infected surfaces.

21. What can we do to prevent the spread of measles? 
The most effective prevention against measles is vaccination.

Aside from getting vaccinated, the spread of measles can be mitigated by proper handwashing, covering your mouth and nose when you cough or sneeze, avoid sharing drinks or eating utensils and disinfect frequently touched surfaces.

22. Why is a measles outbreak happening? 
Measles was declared eliminated from the United States in 2000. However, measles immunization has been on the decline in recent years due to several factors like missed doctor visits during the pandemic, parental concerns about vaccines and vaccine misinformation. 

Measles is also still common in many parts of the world. Most recent cases of measles in the United States stemmed from travelers who are not vaccinated bringing measles back to the U.S. This, combined with a decline in immunization, can cause a disease resurgence. 
 

"There's really no reason why we should have to go through this again," said Dr. Morrow. “We're all really sad about it, we're really, really concerned because we've done this already."

She's been with the health care system for 38 years and was around in 1989 when a measles outbreak impacted the entire state.

"I ended up with about about 9 or 10 children with measles," recalled Dr. Morrow. "Every child that I diagnosed was admitted to the hospital."

The current outbreak and the news of a school-age child dying from measles in West Texas has many parents calling Dr. Morrow's clinic to check their kid's vaccination status, she said.

"Get vaccinated. The vaccine is extremely effective. It's one of the most effective vaccines that we have in our armamentarium of protected kids," said Dr. Morrow.

Read the full story here.

Measles is "probably the most infectious contagious disease on the planet," said Dr. Whitworth.

"We know that about 40% of kids under the age of five who get measles are gonna wind up in the hospital, and nobody wants that," Dr. Whitworth said.

Read the full story here.

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.

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)

A case of measles was confirmed in a pediatric patient last week in Texas, according to Texas Health and Human Services. The last confirmed measles case in Texas was in 2019. Cook Children’s is sharing what parents and caregivers should know.

Measles is highly contagious. It causes severe pneumonia and can cause a progressive form of encephalitis or inflammation of the brain.

Measles spreads through the air when an infected person coughs or sneezes. You can get measles by being in a room where a person with measles has been, even up to two hours after the person has left. An infected person can spread measles to others even before knowing he/she has the disease.

Some of the more common measles symptoms include:

• high fever (may spike to more than 104° F),
• cough
• runny nose
• red, watery eyes (conjunctivitis)
• rash (3-5 days after symptoms begin)

If you think you have measles or may have been exposed, isolate yourself and immediately call your health care provider and your county health department. It is recommended to wear a face mask.

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.

Two doses of MMR vaccine provide the best protection against measles for your child. The Centers for Disease Control and Prevention recommends that all children receive two doses of the measles-mumps-rubella (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.

People at high risk for severe illness and complications from measles include:

• Infants and children aged <5 years
• Adults aged >20 years
• Pregnant women
• People with compromised immune systems, such as from leukemia and HIV infection

According to the Centers for Disease Control and Prevention, 16 cases of measles have been reported this year as of June 8, 2023. The CDC warned in November 2022 that a record of nearly 40 million children missed a measles vaccine dose, leaving them susceptible to infection.

Protection

The best protection against measles is MMR vaccine. MMR vaccine provides long-lasting protection against all strains of measles.

Here at Cook Children's, we follow the same guidelines that we recommend to our patients and their families.

• Vaccines save lives
• Vaccines are safe
• Vaccines protect those that cannot be vaccinated
• We vaccinate our own children

Nicholas Rister, M.D., of the Cook Children's Infectious Disease team, answers questions about measles and shares what parents and caregivers need to know.

What should I do if my child has only received one dose of the MMR vaccine so far?

If your child has received only a single dose of the MMR vaccine and is >4 years of age, then they are due for a second dose which can help boost their immunity.

In the meantime, the single dose they have gotten should provide substantial protection from severe disease. This is great for their safety but can make how they may present more subtle. While they may still have a fever, cough, red eyes, and a rash, these may be much more subtle or absent. However, they will still be contagious and can infect other children and adults who are non-immune.

If your child is only partially immunized and has some of these symptoms, especially a red rash that starts on the head and spreads downwards, be sure to ask your pediatrician about measles to review if testing is indicated.

How do I know if my child has been exposed to measles?

In many cases, you will not unless you are contacted by the health department. Sometimes an outbreak will occur through schools or daycares, and you will be alerted through these contacts as well. However, if your child or close contacts develop the constellation of symptoms above, be sure to discuss with your physician about the need for monitoring and testing.

How does measles transmission occur?

Measles transmission occurs via person-to-person contact as well as airborne spread. Infectious droplets from the respiratory secretions of a patient with measles can remain airborne for up to two hours. Therefore, the illness may be transmitted in public spaces, even in the absence of person-to-person contact.

Additionally, if someone is exposed to measles and is not immunized, they have a 90% chance of contracting the disease. It is highly contagious without vaccination.

What are the physical signs of measles in children?

The classic findings of measles in addition to fever and rash are cough, pink eye, and a runny nose. These are often prominent. The rash is also unique in that it starts on the head and spreads downward over the body. While other viruses can cause some or all of these symptoms, the constellation should raise the question of measles if there has been a known exposure or if a patient is unimmunized.

Where do measles come from?

Humans are the only natural source of the measles virus. While it could be spread in a laboratory setting, virtually all disease we see is from natural infection between person-to-person and airborne contact.

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.

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

More than 500 people spanning 20 states have been diagnosed with measles this year already. According to the Texas Department of State Health Services, 15 of those cases were in Texas.

For the rare remaining physicians who have treated measles, the news is like déjà vu.

“We learned a lot from the 1989 measles epidemic,” said Deborah Susan Hucaby, M.D., an emergency room physician at Cook Children’s Medical Center. “We got to a point where anyone who came into the pediatric emergency room or clinics with a fever was presumed to have measles until proven otherwise.”

Dr. Hucaby was a resident at Ben Taub Hospital in Houston in 1989 when the worst measles outbreak in recent history occurred. That year, 17,850 measles cases were reported in 47 states with 3,201 of those in Texas.

“At the time, the MMR vaccine was recommended for children at 15 months,” Dr. Hucaby explained. “Due to the high number of unprotected children we were seeing with measles, that recommendation was lowered to 12 months of age. We also started giving the single measles vaccine at 6 months of age.”

For this reason, Dr. Hucaby says a doorbell was installed outside of the pediatric clinic where she worked during the outbreak.

“Parents were asked to ring the bell if their child had a fever, with or without other symptoms,” she said. “A nurse would go out into the hallway to look at the patient. If they appeared to have a risk factor for measles, we would take them straight into an exam room. We didn’t sit them in the waiting room.”

In Houston alone that year, 1,434 children under the age of 5 were diagnosed with measles. Dr. Hucaby says it’s frustrating to interact with parents today who refuse to vaccinate their children against diseases such as measles, mumps and rubella.

“So many of these parents have never seen these diseases. I’m 40 years older than most of them and I have. I have seen kids die from them,” she exclaimed.

Dr. Hucaby says there’s one child she will never forget. The little girl was only 6 months old when she arrived at the hospital with measles and pneumonia. She was too young to have been immunized and died as a result.

“Parents who decide they are OK with their children becoming infected with diseases probably frustrate me the most,” added Dr. Hucaby. “We didn’t see that during the Houston epidemic. Truly, people were willing to vaccinate their children. I don’t remember a single parent saying ‘no’ to a vaccine.”

She said in the 1980s, children often weren’t up to date on their immunizations mostly because parents didn’t see the importance or they had difficulties with transportation or finances. Today, vaccines are more accessible than ever in the U.S. with programs providing low-cost vaccines in every state.

“Every place I worked before Cook Children’s had an infectious disease ward where patients could be isolated,” said Dr. Nelson. “But as infectious diseases became better controlled, particularly the ones that are so contagious like chicken pox and measles, we didn’t need to have a special ward anymore.”

The reason for the decline in such quarantined areas is simply vaccines.

“I have lived through the era where I’ve seen vaccines come and save children’s lives. I have stood in line to get the polio vaccine,” Dr. Nelson explained. “I grew up with a great deal of anxiety about all of these diseases. That’s the piece that is missing in our society now, no one is anxious about these diseases.”

Dr. Nelson had good reason to be anxious. Not only did he know people who fell ill with polio, he himself lived through infections of measles, mumps and chicken pox.

“I had measles when I was a little boy, before I even started school. I remember having to stay in a dark room for four days because they thought light might increase your chances of losing your vision, which was not true, but that was the belief back then,” he said. “I didn’t want to eat. I didn’t want to do anything. I just wanted to die. It was that horrible.”

“As a physician, I’ve seen a ton of children die when there was nothing I could do about it. There was nothing anyone could do about it. So it does make me incensed that a parent would put a child at risk for a disease that could kill them based on emotion,” he said. “A parent that has never lost a child doesn’t understand the emotion that they are going to feel if they do.”

Read More About Measles and Vaccines

Resources Available at Cook Children's

There's so much misinformation on the Internet and television about the dangers and risks of immunizations, that it can be hard for a parent to separate the facts from the fears. Visit our website to learn more about our recommmendations regarding vaccines and how to make the best decision for your family. 

This is the fourth case of measles confirmed in North Texas this year and the fourteenth in the state. Health officials say the patient recently traveled internationally to an area that has seen an uptick in measles and this case is not related to any previous infections reported in North Texas. 

“This is an important case to take note of because we already know that Tarrant County is a hot spot for potential outbreaks of diseases like the measles,” said Jason Terk, M.D, a Cook Children’s pediatrician and a nationally known advocate for vaccines. “Even though this is an imported case, we are more likely to have a wider outbreak of measles in our area because of the number of unvaccinated people and especially the people who are unvaccinated and live in unvaccinated clusters.”

Currently, there are no recommendations for early vaccination for babies who are not traveling to other countries.

"The scale of the problem is vastly different in other countries than these scattered cases here," Dr. Terk said. "Right now, and always, people need to make decisions based upon a thoughtful conversation with their doctor. We are seeing a signal of the problem we have been warning about. Even in the larger outbreaks in places like Washington, there are no recommendations for early vaccination for babies under 12 months of age. The health department follows this closely and will make formal recommendations if needed for any changes in vaccine schedule."

Peter Hotez, M.D., who is director of the Texas Children’s Hospital Center for Vaccine Development, co-authored a study in 2018 on vaccine exemptions published by the Public Library of Science Journal of Medicine.

Texas is one of 18 states that allows non-medical exemptions for vaccines and the report named Tarrant County and Fort Worth specifically as national “hot spots” for a potential outbreak.

In an editorial in the Star-Telegram, Dr. Hotez urged parents to provide immunization for their children, warning that “we are extremely vulnerable to a measles outbreak in Texas.”

Measles was declared eliminated from the United States in 2000 by the Centers for Disease Control and Prevention thanks to a highly effective vaccination program.

But as more parents are refusing vaccines for their children, despite scientific proof that they are safe and effective, measles has made a comeback. The CDC reports that there are more than 260 measles cases in 12 states with exemption rates continuing to rise.

Earlier this week, Collin County confirmed its second case of measles and Denton County confirmed a case in February.

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.

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 healthcare provider. Residents considering foreign travel should always check their health status beforehand.

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

But it also raises important questions that need to be addressed.

Last week after the article 12 Facts About Measles You Need To Know ran, we received questions from concerned parents of more vulnerable kids, including immune suppressed children and newborn babies.

We were able to talk to Jason Terk, M.D., a Cook Children’s pediatrician in Keller and a nationally known advocate for vaccines, to answer a few of the questions we received last week.

1. How could the measles virus impact immune suppressed individuals?

Dr. Terk: People who are immune suppressed have a higher risk for the deadlier complications of measles infection such as encephalitis and pneumonia.

2. Even if your child is up to date on their vaccinations, if they have a low immune system due to organ transplant/cancer/other health incident, how at risk are they? Is the vaccine still effective?

Dr. Terk: Each circumstance is unique so a general answer that applies to every one of them is not possible. For people who are on immune suppressing drugs following organ transplantation, risk from infection is higher because of the higher risk of complications from measles infection. People who are significantly immune suppressed cannot get the measles vaccine either because the vaccine would present a risk to them or because they would not be able to mount an effective immune response to the vaccine which would protect them from infection.

3. What are the risks and best course of action for newborns/babies that are not old enough to receive the first MMR vaccine?

Dr. Terk: The best course of action is to make sure that all persons in close contact with babies less than 6 months of age are properly vaccinated against measles and to avoid situations where larger groups of unvaccinated people are likely to be. The CDC now recommends that babies between 6-12 month who will be traveling to countries with measles outbreaks receive an MMR vaccine to provide short-term protection. This does not count toward the recommended two dose series that starts at 12 months of age. So far, the recommendation has not been extended to the circumstances that are occurring in certain parts of the US.

4. The vaccine is 97 percent effective after two doses, but is that true for someone who is immune suppressed?

Dr. Terk: No. Depending on the severity, a person who is immune suppressed may not be able to mount a good response to the measles vaccine and be protected from measles infection.

5. Could the measles virus mess up a transplanted organ in any way?

Dr. Terk: There are reports in the medical literature of rejection of transplanted organs (specifically livers) following measles infection. In addition, there have been complications of measles infection seen in stem cell transplants.

6. Some people wrote in with the claim that boosting your Vitamin A levels and watching your sugar intake will prevent and/or treat measles. What are your thoughts on this claim?

Dr. Terk: Vitamin A is a treatment given during measles infection because it is known that Vitamin A deficiency increases the risk of severe complications for measles infections. But, this treatment does not actually fight the infection itself and treatment with Vitamin A does not eliminate the risk of complications arising from measles infection.

7. Important work is being performed at the Mayo Clinic where oncologists are treating cancer with the measles. But some have used the work at Mayo and a study from the NCBI as showing that vaccines aren't the way to treat a child with measles, but instead it can be handled by diet, such as skipping sugar. Is this the case?

Dr. Terk: The use of the measles virus to target cancers is one of the exciting new things about cancer treatment these days. However, the measles viruses being used are genetically altered in such a way that they cannot cause general infection. These altered viruses are tailor-made to attack a specific individual’s cancer. I do however recommend skipping sugar as a means to fight the epidemic of obesity.

For More Information On This Topic:

• Why Your Choice Not To Vaccinate Impacts My Child Too
• Measles: How To Protect Your Child
• Measles, Mumpes and Rubella (MMR) Vaccination: What Everyone Should Know
• Frequently Asked Questions about Measles in the U.S.
• Infant Immunization FAQs
• Understanding MMR Vaccine Safety
• MMR Vaccine: What You Need to Know (VIS)

DCPH says no further information will be released to protect private patient confidentiality.

“Vaccination is the most effective way to prevent measles,” stated Dr. Matt Richardson, Director of Public Health in Denton. “Unfortunately, people think that measles is just a rash and fever but measles can cause serious health concerns, especially in young children, and is highly contagious. Vaccination is incredibly effective at protecting those we love from this infection."

This information comes only days after a national study published in the Public Library of Science, names Fort Worth as a hot spot for the anti-vaccine movement. Texas is one of 18 states that allows kids to opt out of vaccines as a philosophical exemption.

In the year 2000, the CDC declared that measles had been eliminated in North America and we thought we were well on our way to relegating measles to the trash heap of history. Now, thanks to declining vaccination rates, measles is making a comeback. Along with the cases in Texas, 55 people in Washington and neighboring Oregon have gotten sick with the virus.

So, since we are starting to see measles again, we thought it would be important for people to know a few things about this incredibly contagious disease from Jason Terk, M.D., a Cook Children's pediatrician in Keller and a nationally known advocate for vaccines:

1. Measles starts out looking like a bad cold with runny nose, cough, red and watery eyes, and high fever.
2. Two or three days after the initial symptoms begin, tiny white spots may appear in the mouth that are only seen with measles called Koplik spots.
3. Three to five days after the initial symptoms begin, a rash will appear as flat red spots on the face at the hairline and spread downward to the neck, torso, arms, legs and then feet. Small raised bumps may appear on top of the flat red spots.
4. The spots may become so numerous that they combine to create an overall red appearance to the entire body.
5. Fevers as high as 104° F will be present when the rash appears.
6. Measles is the most contagious infectious disease known and is spread by coughing and sneezing. The virus particles are suspended in the air for up to two hours where an infected person has coughed or sneezed.
7. If you are exposed to the measles and have not been vaccinated, you have a 90% chance of getting the measles.
8. A person with measles is contagious from 4 days before through 4 days after the rash appears.
9. One out of every 4 people with measles will be hospitalized.
10. One out of every 1000 people with the measles will develop swelling of the brain which can lead to brain damage and death.
11. One out of every 20 children with measles gets pneumonia which is the most common cause of death from measles in children.
12. For every 1000 children who get measles, one to two will die from it.

So, if you don’t want any of the above, get yourself and your child vaccinated! Tarrant County has been identified as a location where a measles outbreak is considered likely. Only we can change that!

Learn more on this topic:

• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles
• Vaccines and Immunizations
• Frequently Asked Questions About Immunizations
• Immunization Schedule
• Information for parents
• Talking to your child about immunizations
• What teens should know about immunizations

According to The Washington Post, the number of confirmed cases have been steadily rising from a handful last week to 23 cases on Tuesday, Jan. 22.

“The vast majority of those who had have fallen ill had not been immunized,” the Washington Post wrote.

While this news is alarming to health care officials, it does not come as a surprise. The World Health Organization (WHO) says the number of measles cases has grown 30 percent worldwide and that “vaccine hesitancy” is one of the top 10 threats to global health in 2019.

The WHO defines vaccine hesitancy as “the reluctance or refusal to vaccinate despite the availability of vaccines.”

The organization says vaccine hesitancy threatens to reverse progress made in tackling vaccine-preventable diseases that currently prevents 2-3 million deaths a year. But the WHO states a further 1.5 million could be avoided if global coverage of vaccines improved.

In New York, NBC News reports that an outbreak among Orthodox Jews has led to 177 cases. The Centers for Disease Control and Prevention states that 349 cases of measles were confirmed in 26 states in 2018, making last year the second-worst year for measles since 2000.

“Almost none of the cases had been vaccinated against measles,” NBC reports.

Measles is one of the most infectious viruses known to man and will infect 90 percent of unimmunized people who breathe it in. What frustrates health care providers is that the spread of this highly contagious disease can be contained.

And while the vaccine has been found to provide about 95 percent protection, a recent poll of Texas parents found 13 percent say they believe the risks of vaccines outweigh the benefits and 16 percent say they should be able to opt out of vaccinating their children.

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 medical reasons or conscientious and religious beliefs.

In an editorial in the Fort Worth Star-Telegram, Peter Hotez, M.D., director of the Texas Children’s Hospital Center for Vaccine Development, urged parents to provide immunization for their children, Dr. Hotez warned that “we are extremely vulnerable to a measles outbreak in Texas.”

Dr. Hotez identified Tarrant County and Fort Worth as national “hot spots” for a potential outbreak. A study co-authored by Dr. Hotez found that parents of at least 518 kindergartners in Tarrant County schools last year opted to not get preventive shots for their children.

“This news is frustrating to physicians and other health care providers because measles is a disease once thought to be all but gone from the planet. 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. In 2000, the United States declared that measles was eliminated from this country. Now, more and more kids aren’t getting immunized and diseases like measles have returned. Measles is very serious and can cause pneumonia. Children under the age of 5 have a higher risk of hospitalization.”

Keeping vaccination rates relatively high (somewhere around 90 percent) helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

"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," Jason Terk, M.D., a Cook Children's pediatrician.

Learn more:

Measles

Vaccines and Immunizations

Frequently Asked Questions About Immunizations

Immunization Schedule

The Star-Telegram reports that Tarrant County Public Health officials are working to identify any Texas Christian University students who may have been exposed to the mumps. Currently, no other cases have been reported, but symptoms can take as long as 25 days to develop after exposure.

This is another reminder about the value of vaccination in preventing what can be serious illness. Mumps cases decreased 99 percent after the introduction of a successful strategy for vaccination.

Mumps can be prevented with the MMR vaccine (measles, mumps and rubella). The Centers for Disease Control and Prevention (CDC) recommends children 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.

Health officials hope that no other cases will occur because of the TCU campus' high vaccination rate.

The CDC states that a "mumps outbreak can occur any time of year. A major factor contributing to outbreaks is being in a crowded environment, such as attending the same class, playing on the same sports team, or living in a dormitory with a person who has the mumps. Also, certain behaviors that result in exchanging saliva, such as kissing or sharing utensils, cups, lips balm or cigarettes, migh increase spread of the virus. in some years, there are more cases of mumps that usual because of outbreaks."

Here's a quick look at mumps cases over the years according to the CDC:

*Case count is preliminary and subject to change

** Cases as of Jan. 27, 2018 Case count is preliminary and subject to change

For More Information:

• Tarrant County Public Health Department
• CDC Mumps Cases and Outbreaks
• About Mumps (CDC)
• Mumps Vaccination

According to the National Conference of State Legislatures, Texas is among 18 states that allow families to opt out of vaccines for personal or moral beliefs. The Morning News reports that Plano, Fort Worth, Austin and Houston all ranked among the 15 U.S. metro areas with the most such conscientious exemptions for kindergartners. Each had more than 400 kindergartners exempted from vaccines.

Fifteen years ago, about 2,300 students opted out of at least one vaccine. Today, that number has grown to 56,737 kindergarten through 12th grade students.

This has many doctors, including myself, worried about more measles outbreaks in Texas.

"Populations who choose to not follow the recommended vaccine schedule for themselves and for their children 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," Jason Terk, M.D., a Cook Children's pediatrician in Keller.

News about vaccine preventable diseases is important for us to share, but it brings up many strong opinions.

Here’s how the debate usually goes:

“Please vaccinate your children.”

“If your child is vaccinated and vaccines are such a good thing, why do you care if my child gets vaccinated?”

Most people don’t have a good answer for it so it tends to be a good trump card.

So why do I care?

There are two reasons.

1. I care about your child. I firmly believe that vaccination is the right thing to do. I vaccinate my children on time and on purpose. I would not want any child to receive less care than I would provide my own children.

2. Vaccines sometimes do not provide complete protection. Most provide protection in the 90-percent plus area (some nearly 100, some lower). Because of this, even a vaccinated child can contract the disease. I will go into this in more detail below, but the more children who are vaccinated for a disease the less likely it is that any child will contract that disease. This occurs through a process known as community, or herd, immunity.

Many people will stop reading right here because they have already decided or have read somewhere that herd immunity is not a real thing. Here are some of the arguments against herd immunity I come across from time to time:

• It’s not based on a science, but on epidemiology. Epidemiology is the study of the way diseases spread. It is a very complicated field, involves tons of statistics and research and IS science. To say that it is not science is a false comparison.
• We still have outbreaks even in areas where there are high vaccination rates. This is most definitely true, but does not prove that herd immunity is not real.

How does it work?

Since it's most timely, let’s use measles as an example. First, you need to know some things about measles…

Measles has an attack rate of a susceptible individual at 75 percent. This means that 75 percent of people exposed to measles who are not protected will contract the disease. I’ll use 70 percent to keep my numbers round and err on the side of people who would disagree with me.

Measles vaccination has a 95-100 percent protection rate. Again, I will use 95 percent so that I am not cherry picking the best results to prove my point.

There are two scenarios below. The first scenario has a case of measles in a classroom where everyone else is vaccinated. The second scenario is a case of measles in a class with one child who is not vaccinated.

Scenario No.1:

Scenario No. 2:

In scenario No. 1, all the children are vaccinated which means they have a 5 percent chance of catching measles. If that child goes to another class or event where all children are vaccinated, each of those children have much less than a 5 percent chance because the child doesn’t likely have the disease and they only have a 5 percent chance of catching the disease even if he did.

In scenario No. 2, one child in the classroom is unvaccinated. He thus has a 75 percent chance of catching the disease. He’s going to go to other locations with other children, even if those children are all vaccinated, we have potentially opened up a whole second circle of exposed children. Not to mention that the children in the first class have now potentially been exposed twice.

So, in scenario No. 2:

• If I gave you a choice, would you want your child in group A or B?

• Does it matter if your child is vaccinated or not?

• What if you also have a baby in your house who cannot be vaccinated?

• What if you child is in class B, but has a disease for which they cannot receive the MMR vaccine?

The answer is no, none of these things matter. Logically, we should all want our child in room A because it decreases the odds of our child being exposed. Is it 100 percent? No, but it doesn’t matter. Are you more likely to be angry about a measles outbreak if your child cannot be vaccinated? Yes, and I understand that.

For one last thought, consider this … a  study in Pediatrics described geographic clusters of people who choose not to vaccinate at all or to under-vaccinate their children. I suspect that is true across our area as well, but I also suspect that there is clustering according to other factors as well: socioeconomic status, church/religious affiliation, etc. Populations where there are multiple families who choose not to vaccinate would be particularly susceptible in an outbreak situation. Let’s pray we don’t get there.

This is herd immunity and why the question, “If your child is vaccinated and they are such a good thing, why do you care if my child gets vaccinated?” doesn’t end the conversation.

That’s the concern of many of the state’s physicians based on new numbers from the Texas Health and Human Services department.

In its Annual Report of Immunization Status, 56,738 kindergarten through 12^th grade students were reported as having a conscientious exemption on file at the school. This number represents 1.07 percent of the number of students reported enrolled by schools in the survey.

This is on top of a recent report by the Centers for Disease Control and Prevention that states that Texas is one of 21 states that is currently being monitored for the spread of measles. The CDC says there has been 107 cases reported this year and that the majority of those cases weren’t vaccinated.

The amount of children who aren’t receiving at least one vaccination for a nonmedical reasons has been steadily on the rise since Texas lawmakers passed what’s known as conscientious exemption in 2003. Parents and legal guardians can choose for their child not to receive an otherwise required immunization for their child because of reasons of conscience, including religious beliefs.

Fifteen years ago, about 2,300 students opted out of at least one vaccine.

In an editorial in the Star-Telegram that urged parents to provide immunization for their children, Dr. Peter Hotez warned that “we are extremely vulnerable to a measles outbreak in Texas.”

Dr. Hotez, who is director of the Texas Children’s Hospital Center for Vaccine Development, recently co-authored a study on vaccine exemptions published by the Public Library of Science Journal of Medicine.

Texas was named one of 18 states that allows non-medical exemptions, and identified Tarrant County and Fort Worth as national “hot spots” for a potential outbreak. The study found that parents of at least 518 kindergartners in Tarrant County schools last year opted to not get preventive shots for their children.

“These numbers are very concerning,” said Justin Smith, M.D., a pediatrician and Medical Advisor for Digital Health at Cook Children’s. “In 2000, the United States declared that measles was eliminated from this country. Now, more and more kids aren’t getting immunized and diseases like measles has returned to this country. I don’t think that’s a coincidence. Measles is very serious. Measles can cause pneumonia and children under the age of 5 have a higher risk of hospitalization.”

Dr. Hotez’s study found that children not given the measles, mumps and rubella vaccine are 35 times more likely to contract measles than a vaccinated child.

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

"Populations who choose to not follow the recommended vaccine schedule for themselves and for their children 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," Jason Terk, M.D., a Cook Children's pediatrician.

The Dallas Morning News reports that person from another state who had mumps traveled to Dallas for the National Cheerleaders Association All-Star National Championship, which took place Feb. 23-25 at the Kay Bailey Hutchison Convention Center. 

At this point no Texas residents have developed mumps in connection with the case, but people are urged to watch for symptoms. 

This is another reminder about the value of vaccination in preventing what can be serious illness. Mumps cases decreased 99 percent after the introduction of a successful strategy for vaccination.

Here's a quick look at mumps cases over the years according to the CDC:

*Case count is preliminary and subject to change

** Cases as of Jan. 27, 2018 Case count is preliminary and subject to change

Just in time for the holidays a reader wrote in with this question:

“My friend...was told by her grandson’s pediatrician that her grandchildren who are vaccinated should never be around any unvaccinated children. Well, the parents of her other grandchildren do not want to vaccinate their small children…As a result there are no more family gathering with all grandchildren. They have to spend holidays on separate days. My question is: Why would the pediatrician say this? If the children who are vaccinated and the children are not showing symptoms what’s the problem?”

This is definitely a sad and tricky situation and one that we should use extreme care when discussing.

One thing I will say is that no matter what one’s choice about vaccinating is, parents believe they are making the choice in the best interest of their child. Of course, I have strong opinions about how important it is, but this discussion is not for the faint of heart.

There are probably some doctors that would tell you it’s no big deal and you shouldn’t worry about it (I would disagree with them). There are other doctors that would say you should never have your child around children who are unvaccinated regardless of your child’s health (I recognize this is not reasonable in many situations).

Here are the questions to consider:

1. How old is the child? The younger the child, the more vulnerable they will be to infection. They cannot receive protection for chicken pox or measles before 1 year. Older children who are fully vaccinated have a significant amount of protection and they likely encounter an unvaccinated child at school every day.
2. Who isn’t vaccinated? This question is about family members which makes transmission of infectious diseases more likely than if you just walked by someone on the street and were not interacting with for longer periods of time.
3. Can you have an open conversation with those involved? The discussion is clearly more complicated than simple medical advice as it broaches on several tricky areas including family dynamics and vaccination.

The easy (get out of having to make a committed answer) is that there is no one answer to the question. The family should talk with their doctor about their specific concerns and make a decision with their counsel.

Should I stop the blog post there? Not so fast.

Instead, I want to give you a framework for having that discussion with your doctor.

What diseases should I be worried about?

I believe that all vaccines are important, period. But there are 3 diseases that jump to the top of my list when considering this issue:

1. Flu

Flu season is predictable in that it comes every single year at roughly the same time. It is unpredictable in that we never know how widespread it will be and how severe the cases will be when it does come around. Flu is particularly dangerous in babies and they cannot be vaccinated until they are 6 months old. Remember that the flu vaccine isn’t perfect, so I’m not saying that everything’s cool if we all have flu vaccines but it would seem logical to get as much protection surrounding the baby as possible.

2. Pertussis

Pertussis, or whooping cough, is still common and is a very serious disease for anyone who gets it. In children, teenagers and adults it tends to cause a very rough and painful cough that lasts for weeks to months. I know of adults who have had broken ribs because the coughing is so hard. The real danger for pertussis comes in small babies (less than 3-4 months). These babies commonly have spells of coughing that cause them to stop breathing; leading to ICU stays for intubation and unfortunately, death. Babies are vaccinated against pertussis at 2, 4 and 6 months which increases the number of children who are protected with each shot but they go on to get another vaccine at 4 and 11 years as well. So, when are they fully protected? It’s impossible to say. In addition, vaccines are not perfect so even vaccinated infants who are exposed could develop pertussis. Pertussis still occurs commonly in the United States and is generally carried by older children and adults who are coughing but do not know that they have pertussis. Just like flu, having the vaccine does not prevent disease 100% and I still feel that we need to do something better with the pertussis vaccine but again, it would seem logical to increase protection as much as possible.

3. Measles

Measles is another disease that still occurs in the United States. In 2014, there was a record number of 667 confirmed measles cases reported to the Center for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases (NCIRD). That’s the highest number of cases since measles elimination was documented in the U.S. in 2000. Measles can cause pneumonia and have a higher risk of hospitalization in children under 5. Children receive their first measles vaccine at 1 year of age, but they have no protection from measles until then.

What criteria should I use for being around others?

1. If your baby is under 6 months, use extreme caution. Many babies do not have full protection until after the 6 months shots. In addition, they cannot receive a flu vaccine until 6 months.
2. If your baby is under 1 year, I would also use caution. Your baby cannot be vaccinated against measles or chicken pox until 1 year.
3. After your child is vaccinated at 4 years, they have much of the protection that they need to protect themselves against the vaccine preventable diseases.
4. Babies or children who may not have a normal immune system-such as those with chronic illness or who were born premature deserve extra caution.
5. Anyone with symptoms of illness, especially fever, cough, congestion or rash, should not be around your baby or child regardless of your contacts’ vaccination status.

Can you get a definitive answer about when your baby can be around unvaccinated children? No, but you at least have some information to make an informed decision.

After you’ve discussed your plan with your pediatrician how do you handle the conversation with friends and family?

Here are some thoughts about some things you might say:

1. Our baby/child doesn’t have protection against many very dangerous diseases and we do not feel comfortable having her around people who could spread them to her.
2. Our baby/child has already been through so much, we can’t risk putting her through another medical problem. Especially something that we could have avoided.​
3. The doctor was emphatic that we cannot be out around anyone (especially someone who is not vaccinated or you could leave that out) until __________. (I’m fine with a family placing the “blame” completely on me.)

We have said this before (many times), but a new study shows just how true this statement is.

A recent study published in the Journal of the American Medical Association (JAMA) looked at the combined data of 18 published measles studies on several measles and pertussis outbreaks.

Reviewing a total of 1,416 measles cases, 56 percent had no history of measles vaccination. This is way higher than you might expect given that most still choose to have their child vaccinated.

Still the study states that “a substantial proportion of the US measles cases in the era after elimination were intentionally unvaccinated.”

Intentionally unvaccinated?

As a pediatrician this concerns me. As a dad, it terrifies me.

In one outbreak the risk of contracting measles was 35 times more likely when parents had skipped the shots. A child who isn’t vaccinated is much more likely to spread measles than a vaccinated child.

We know that the pertussis vaccine is not working as well as we would like. The protection from the vaccine is falling off quickly. However, this study showed that despite this, vaccine exemptions continue to be a factor in the spread of pertussis outbreaks. Somewhere around 1 out of 3 kids who got pertussis during these outbreaks was unvaccinated.

Why are children not getting the vaccines? Not all studies had the information necessary to say. But, for those that did, most families skipped the vaccines for personal or religious reasons (70 percent for measles, 60-90 percent for pertussis).

This is further proof to something we’ve suspected for some time. Having even small pockets of unvaccinated children increases the risk to the whole community.

Each of these families who chose not to vaccinate gamble on 3 issues:

1.Their child would not be exposed to the disease (banking on herd immunity whether they know it or not).

2.If their child was exposed, that they would not contract the disease.

3.If their child contracted the disease, they would not suffer serious consequences.

These are consequences I’m not willing to gamble on.

In the case of measles, consequences could mean pneumonia, hospitalization and, later in life, neurologic complications.

In the case of pertussis, consequences could mean painful coughing, broken ribs and, in the very young, death.

This is further proof to something we’ve suspected for some time. Having even small pockets of unvaccinated children increases the risk to the whole community.

A letter published by the department reports that they are “reviewing individual exposure status, although anyone at the school on January 5, 2016 could have had exposure.” Those who have come into contact with the virus will need to be observed for up to three weeks as symptoms may not develop until later.

Measles is an airborne disease and is highly contagious. Measles can easily spread through 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. Notify your provider of your concern prior to the visit so that appropriate precautions can be taken.

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.

It is important to remember that measles is a vaccine-preventable disease. Children receive the vaccine at one and four years of age. 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.

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 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.

You can find more information about Measles by clicking HERE.

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

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?

Articles and news reports about infectious diseases and their impact on our children keep me up at night. Tonight, it’s not an article about an outbreak of disease that has me up typing away at 11:30 on the night before I come home from vacation.

Tonight, at least in the United States, there’s no large ongoing outbreak.

Tonight, my concern isn’t so much about those parents who choose not to vaccinate. I’ve been down that road before.

Tonight, I’m concerned about parents who are choosing to vaccinate their child, but then also choose (often unknowingly) to send them to a school where the low vaccination rates put even their fully vaccinated child at risk.

We know that families who choose not to vaccinate tend to cluster in geographic regions because studies have shown this. I have proposed the theory before that perhaps clusters of unvaccinated children in our area might be more based on ideology (faith-based or otherwise).

Why does this matter?

Herd immunity.

Keeping vaccination rates relatively high (somewhere around 90 percent) actually helps protect all children (vaccinated or not) from diseases. In addition, when outbreaks occur (which is much more likely when herd immunity breaks down), even children who are vaccinated become at risk for contracting disease due to the number of possible exposures. (If you are about to say, “If your child is vaccinated, why do you care if mine is?” read the post above.)

NBC 5 Investigates released a really enlightening (frightening) report this week on vaccination rates in local school districts. They highlighted the growing number of vaccine exemptions in three public school districts (Frisco, Plano and Lewisville).

At first glance it may not seem that concerning. If you look at an individual school or district, the percentage of vaccinated children in those districts is still really high.

My bigger concern, and what keeps me up at night, is in the schools where unvaccinated children, for some reason, are clustered together.

Take a look at what’s happening in our area:

• 30 schools in the DFW area have vaccination rates below 96 percent.
• 5 schools in the DFW area have vaccination rates below 90 percent.
• The highest unvaccinated rate in our area is around 13 percent. The highest in the state is near 50 percent.

Why does it matter?

If you read the names of the schools that fall into the categories above, you’ll see a trend. They are private schools. They are schools that have a high likelihood of having people go overseas for mission trips or other opportunities.

Traveling to countries where diseases are more common increases the likelihood of bringing a disease back to school. Waiting at school are their unvaccinated friends and their vaccinated friends who could even be at risk as the number of cases rise. Outbreaks are possible.

Do you think this is far-fetched?

The Tarrant County measles outbreak from 2013 basically had all the characteristics that I am describing. A large group of unvaccinated people, grouped together based on their faith that contracted measles from a visitor who brought measles into the United States after traveling overseas.

What can you do?

• Get the best start to protection by vaccinating your child.
• Be aware of the vaccination percentages of your child’s school, your church and your social community.
• Be especially cautious when your child’s unvaccinated contacts return from overseas travel. If they are sick, stay away.

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.

We’ve spent a lot of time recently talking to you grownups out there about all of these conditions in an effort to inform you, but also hopefully to calm your nerves.

But what about your kids? It’s easy to understand why they would panic, especially if they hear of school-aged children being kept home or other kids simply afraid to go to school in fear of Ebola. And it’s all happening in Dallas, so close to where many of them live.

So, what do you say to them?

A lot of it has to do with their age and how much they can comprehend, according to two of our licensed child psychologists at Cook Children’s.

Joy Crabtree, a licensed psychologist for Cook Children’s Behavioral Health in Southlake, said the most important thing parents can do is be there for their children. If your children come to you with questions about anything scary in the news, reassure them that you love them and are there for them. Tell them the chances of them getting a disease such as the Ebola virus is rare. For example, one of the main symptoms of Ebola is fever yet, reassure your child that unless they or someone in their family has travelled to West Africa, or come in contact with anyone from that region, their fever is no more dangerous than any other time they had a fever. We get fever from a lot of things and recover. Answer the questions they ask you, but don’t go off on tangents that will increase their fear. Make sure you know the facts and check them with a reputable source. Don’t drift into other areas that may cause your children discomfort.

Your older children may not want to talk to you about the issues of the day, try to put up a brave front or be blissfully unaware. You know your children better than anyone. If you feel your children are old enough and/or mature enough, and you feel they have heard about it anyway, you might consider bringing up recent events from the news to get their opinion, and to offer reassurance and support.

“For older children, they may have a few initial questions based on what they’ve heard on the news or from friends at school,” Crabtree said. “Make sure that you are giving them accurate information. Make sure to reassure your child, but also let them know that bad things do happen in life. We have to be careful and cautious, but we also can’t live in fear of the unknown. We have to live life to the fullest. You might also let them know that just like there are people (doctors, nurses, etc.) whose job it is to take care of kids, there are people, such as the public health department, whose job it is to take care of communities. They let us know when there is danger and what to do.

Lisa Elliott, a licensed psychologist and clinic manager at the Cook Children’s Psychology clinic in Denton said to keep younger children, elementary age, away from the news and don’t talk to them about something like Ebola unless they ask you. There’s no need to bring up a fearful topic to children, unless it’s for their own good.

For older children, Elliott said ,“There has to be limits to the news and it has to be age appropriate. The older kids can become fixated on bad news sometimes. Help your older children process what they are hearing and make sense of the news. But at the same time, limit them on the amount of news they are watching or reading about. They don’t need to dwell on the issue.”

As for your kids or yourself, Elliott adds it’s a good idea for the entire family to get away from the news and spend some family time together.

After all, the most important thing is to be there for your children.

Related links:

• Ebola in Dallas
• Are you concerned about Ebola?
• 4 reasons not to fear Ebola
• Enterovirus: What we know now
• The flu season
• Whooping cough makes a comeback
• Breaking news: Chikungunya case confirmed in Tarrant County
• Breaking Tarrant County news: Measles alert

For more information

Cook Children's Behavioral Health services provides a broad range of care that focuses on children from 3 years through 17, and their families. We also have some limited services available for children age 2. As part of family-centered care all of our professionals are qualified both through education and experience to work with children who have behavioral and emotional challenges. Our psychiatrists are board certified in child and adolescent psychiatry and our psychologists and therapists are all licensed independently in Texas.

The

I understand the fear. Ebola is a terrifying disease. Symptoms start off similar to flu and progress to liver and kidney failure, followed by internal and external bleeding and then often times by death (about 60 percent of the cases).

So, I get it, it’s scary. The way people die from Ebola is very unpleasant which makes it even scarier. But it shouldn’t be the scariest infectious disease to us. Here are three reasons why:

Reason No. 1 – It’s actually not that contagious.

Ebola is transmitted via blood and body fluids. Contrast that with measles and flu, which are spread via droplets. Obviously, doctors are using extreme caution when treating patients with Ebola and I agree with that. However, the likelihood of catching Ebola from being in the same room with a person with it is not that high. If someone with measles or flu coughs or sneezes near you, it’s very possible that you will contract the disease.

Hepatitis A is another virus that can spread quickly because it is spread via a pathway called the fecal-oral route (yes, it’s as gross as it sounds). It causes vomiting and in severe cases, liver failure. Outbreaks of Hepatitis A often occur when a food worker unknowingly spreads the disease by handling the food with contaminated hands.

Meningococcal meningitis is another illness that commonly spreads quickly and anyone who has been in the room with an infected person is at risk. Outbreaks used to occur commonly on college campuses prior to the introduction of universal vaccination. Health care workers who are exposed to a patient with meningitis have to undergo treatment to try to prevent contracting the disease. So remember that when the person next to you in a room looks sick; it’s probably not Ebola, but it could be any of these other scary things.

Reason No. 2 - People with Ebola are not contagious until the affected person is sick.

Because patients with Ebola are very sick, they are unlikely to be walking around infecting everyone in their path. There will not be people walking around looking fine, unknowingly spreading the disease to everyone they meet. This is not the case for many other infections. See my example for Hepatitis A above.

Pertussis, or whooping cough, is another disease where many infected people (usually adults) can walk around contagious for weeks at a time coughing the bacteria on everyone they meet. Pertussis is not that serious in adults (aside from an occasional broken rib here and there), but it can be deadly in small babies. Despite being sick, many people with flu suck it up and trudge into work or school because they think flu isn’t that big of a deal. The problem is that while one person may not have trouble with flu, they may have contact with small infants, pregnant women or older adults who can have significant complications from it.

Another disease that affects 1/3 of sexually active teenagers and adults is human papilloma virus (HPV). Most often boys and girls who carry HPV do not know they are infected and thus spread it to their sexual partners. HPV by itself is a troubling problem, but even more troubling is the fact that HPV is the leading cause of cervical cancer (about 99.7 percent of cases).

Reason No. 3 - Ebola is not that common and has not been transmitted in the United States.

The world-wide, all-time death total from Ebola sits in the thousands … the world-wide death toll from measles was 122,000 in 2012 alone. Ebola has a very high rate of death and severe illness, much more so than measles, but because measles is much more common it affects many, many more people. There has never been a case of Ebola transmitted from person to person in the United States. There have been over 600 cases of measles in the United States thus far in 2014. What about deaths? Fortunately, there were no deaths from measles, but in 2012 there were 52 deaths from the flu just in pediatric patients. It’s a simple reminder that we sometimes forget how dangerous things are when we have not heard about them for a while.

Now what?

If you aren’t convinced that many of these other infectious diseases are a more immediate concern for you than Ebola, I understand. When things are new and sound scary they tend to take over your mind. But after reading all the points I’ve made above, know there is something you can do to protect your child from the other diseases I’ve mentioned …

Every single bolded disease has a vaccine! While vaccines are not perfect and getting a vaccine in some cases does not protect you 100 percent, they significantly decrease your chances of contracting any of these diseases. In many cases, if vaccines don’t completely prevent the disease, they make the case milder and less serious. If you agree with my concerns about these other diseases, give your child the best chance by having them vaccinated.

I hope I’ve addressed all of your questions or concerns. Maybe, you still have questions about the diseases mentioned here or the vaccines to fight them? If so, please talk to your pediatrician.  

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.”