Multiple measles cases have been confirmed in Maryland. Here's what you need to know about the contagious disease.
What are the symptoms of measles, and when do they appear?
Initial measles symptoms typically appear 10 to 14 days after infection. They include a high fever, cough, runny nose and red watery eyes. Two to three days after the first symptoms begin, patients might also notice small while bumps (Koplik spots) inside the mouth. A rash on the skin consisting of flat red spots and small raised bumps often appears three to five days after a person is infected.
How does it spread?
Measles is an airborne virus that spreads through coughing and sneezing. The virus is very contagious and can live in the air an infected person has contacted for up to two hours after the person has left.
Infected people are contagious four days before their rash appears to four days after, according to the U.S. Centers for Disease Control and Prevention.
Why is measles worrisome?
Some measles complication can lead to hospitalization or death. Ear infections and diarrhea are common complications, but one in 20 children contract pneumonia — the No. 1 killer of children with measles — and one in 1,000 kids develop brain swelling (encephalitis), which can leave them with intellectual disabilities, according to the U.S. Centers for Disease Control and Prevention.
One or two of every thousand children who get measles will die from it, the CDC says.
"This isn't always a very minor, mild disease," said Dr. Christina Johns, an Annapolis-based pediatrician and senior medical adviser for PM Pediatrics.
Who is most vulnerable to the disease?
People who are not vaccinated, people whose immune systems are compromised and pregnant women are most at risk for contracting measles. Children under age 5 and adults over age 20 are more likely to suffer complications from the disease.
When are children eligible for the measles-mumps-rubella (MMR) vaccine?
Doctors recommend children receive their first MMR shot between 12 and 15 months, and a booster between ages 4 and 6. But children can receive their first vaccination as early as 6 months, with the second as soon as age 1, Johns said. Children who receive two shots before age 1 often receive a third booster at age 4, Johns said.
When should I consider vaccinating my child earlier than the standard recommendations?
People who are traveling to areas with active measles infections should consider vaccinating their children early, Johns said. Domestically, other outbreaks — which the CDC defines as a cluster of three or more cases — are ongoing in New York, New Jersey, Washington, California and Michigan. Many of the U.S. cases originated from travelers who visited foreign countries with large outbreaks, including Israel, Ukraine, and the Philippines.
How much of a problem is measles nationwide?
As of April 11, the CDC had confirmed 555 measles cases in 20 states. That's the second-highest number of cases since measles was effectively eradicated in the U.S. in 2000.
How much of the Maryland population is unvaccinated?
Among all states, Maryland had the 12th-lowest percentage of kindergartners who were unvaccinated for at least one condition during the 2017-2018 school year, the most recent year for which data were available. At that time, 1.5 percent of children enrolled in kindergarten were not vaccinated for at least one condition. Among Maryland kindergartners, 0.9 percent were not vaccinated because of a non-medical exemption, and 0.6 percent of kindergarten students were medically exempt from vaccination.
Though the rate of unvaccinated children entering kindergarten in Maryland remains relatively low compared with other states, it has nearly doubled since 2009, when the rate of unvaccinated Maryland kindergartners was 0.8 percent, according to CDC data.
What exemptions does Maryland allow for vaccinations?
Like every other state, Maryland allows medical exemptions to standard vaccinations like MMR for people with conditions that compromise their immune systems. Maryland also allows parents to obtain religious exemptions to vaccinating their children.
How concerning are the three cases in Maryland?
"I'm very concerned about the few cases that we've seen honestly because this is how it starts," Johns said.
Most of Johns' patients are vaccinated, but she said the issue is still at the top of their parents' minds.
"Parents of my patients are in absolute disbelief," she said.
What reaction are Maryland families having to the local outbreak?
"There are lots of people who are vaccine-hesitant … a lot of them are starting to take note a little bit and wanting to dig deeper," Johns said. "It's very easy to not be worried about it when it's not in your backyard."
Where can I learn more?
State, county and city health departments often update their websites and social media pages with outbreak information. Johns also encouraged families to have one-on-one discussions with their pediatricians to discuss vaccines.