When Measles Strike
05 Feb 2015
When Measles Strike, It's Not the Happiest Place on Earth for Pregnant Women
By Sonia Alvarado, Senior Teratogen Information Specialist, MotherToBaby CA
"Martha," a 27 year-old pregnant woman from Long Beach, anxiously cried out over the telephone, "What if I have measles?! I'll never live with myself if my baby suffers because I may not have gotten vaccinated?!" "Let's take a deep breath, Martha, and walk me through the last couple of weeks," I calmly replied. "When exactly did you visit Disneyland?"
Granted, this is not the typical conversation one would expect from someone in post-vacation mode, especially after her vacation was at the "happiest place on Earth." However, as a teratogen information specialist with expertise in preventable birth defects, this not-so-happy call through the MotherToBaby free counseling line didn¿t surprise me. Measles (rubeola) has been a popular topic in the news lately with students being kept from attending schools and questions about the safety of visiting the popular theme park where the most recent outbreak appears to have begun, Disneyland, California. So, what did this all mean to a pregnant woman and her developing baby?
It's odd the topic is alive and well, considering the disease was practically eradicated not so long ago. In the early 1960's, prior to the availability of the MMR (Measles, Mumps, and Rubella) vaccine, in the U.S. alone an average of 500 people died every year from measles, 48,000 people were hospitalized and 4,000 people suffered encephalitis (inflammation of the brain) from the infection, according to the U.S. Centers for Disease Control and Prevention (CDC). The MMR vaccine was introduced in 1964 and due to successful Federal and statewide vaccination campaigns, public education, and social awareness and acceptance of the benefits of vaccination, the numbers of measles infections began to drop - so much so that by 2004 only 37 measles cases were reported. However, since that historic low, reported measles cases have increased.
In December of 2014 an outbreak was sourced to the Disneyland theme park and initially reporters and the public alike seemed surprised that this had occurred. However, California had reported cases of measles earlier in 2014, and there had been larger outbreaks in other states, including 382 cases in Ohio.
If you are a woman of reproductive age, chances are that you have never seen measles in your lifetime. Measles is a respiratory disease caused by a virus; it spreads in droplets after coughing, much like a cold virus. Measles is very contagious: about 90% of exposed susceptible individuals get measles. If a person has measles, they are infectious four days prior to the rash showing up to a period of about four days after the rash has appeared.
Measles symptoms typically start after 10-14 days and include dry cough, runny nose, fever, red eyes, tiny spots on the inside of the cheek and a skin rash of large red spots that appear all over the body. Fever occurs along with the rash and can climb to 104 and 106 degrees Fahrenheit. Pneumonia and encephalitis can occur and pose a serious and life-threatening complication of the disease.
"Well, I was at Disneyland two weeks ago today. So, I guess I would have had symptoms by now if I was exposed to measles? That's a relief," said Martha. "If I had been exposed, would it have been as bad as I think it would have been for my baby? Or am I overreacting?" she asked.
Pregnant women who have exposure to measles and have not been vaccinated previously, or had a previous infection, can acquire the disease and develop all of the same symptoms reported for non-pregnant individuals. It is unknown at this time how the presence of other underlying diseases (such as diabetes, autoimmune disease, HIV infection, and others) may contribute to the severity of symptoms in the pregnant woman, or the risk of death for her or her developing baby. To date, studies have not identified an increased risk for birth defects when pregnant women get the measles during pregnancy. However, studies suggest that measles infection is associated with an increased risk for miscarriage, stillbirth, prematurity and the baby being born with a measles infection.
"In other words, Martha, when it comes to the MMR vaccine, you don't want to be pregnant and not know if you are protected against measles infection," I told her. "While the MMR vaccine is not recommended to be given during pregnancy because it's a live virus vaccine, look through your vaccination records to be sure that you have received the appropriate doses of MMR in the past. If not, talk to your doctor about the possibility of getting vaccinated after you give birth. The MMR can be given to breastfeeding women without concerns for the baby, according to the CDC."
Vaccination with two doses of the MMR provides almost 100% protection. There are individuals who have the MMR vaccine who do not respond as expected; however, the number of people that fall into this group is very small. Studies of outbreaks where there is documentation of vaccination in medical records find that by a large margin, individuals are more likely to become sick with the measles when they are either not previously vaccinated or under-vaccinated (i.e., they missed the second dose).
In the words of some famous singing dolls, it's a small world after all...and as we've seen during this measles outbreak, close contact with others could mean the quick spread of illness. Getting protected against measles, mumps and rubella is easily available through your doctor's office or local health department. If you are a planning pregnancy at any time in the future and have not had two doses of the MMR, or don't know if you have had measles in the past, you should talk to your doctor about getting tested for it or receiving the vaccine.
Sonia Alvarado is a bilingual (Spanish/English) Senior Teratogen Information Specialist with MotherToBaby's California affiliates. MotherToBaby aims to educate women about medications and more during pregnancy and breastfeeding. Along with answering women¿s and health professionals' questions regarding exposures during pregnancy/breastfeeding via MotherToBaby's toll-free hotline, email and private chat counseling service, Alvarado has provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.
MotherToBaby is a service of the international non-profit Organization of Teratology Information Specialists (OTIS), a suggested resource by many agencies including the Centers for Disease Control and Prevention (CDC). If you have questions about vaccines, medications or other exposures, call MotherToBaby toll-FREE at 866-626-6847 or visit MotherToBaby.org to browse a library of fact sheets and find your nearest affiliate.