Measles Q&A

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With measles cases on the rise, I know it’s easy to feel overwhelmed. There’s so much information coming at us—news headlines, social media debates, and differing opinions on vaccines and outbreaks. 

It can feel like too much.

If you’re feeling worried, you’re not alone. The goal isn’t to live in fear but to be aware and take informed steps to protect our families. Measles is highly contagious, but it’s also preventable. The key is focusing on what we can do rather than getting lost in the panic. That means leaning on trusted, evidence-based sources, understanding the risks, and making the best choices we can for our kids. Let’s break it all down together.

How to handle news articles related to this measles outbreak (or cases around the country):

• Stay informed without spiraling into fear. Look at credible sources like the CDC and AAP for updates. Here’s a link to check for current outbreaks. Or ME here :) 

• Have conversations with your pediatrician. Every child and family situation is unique. Pediatricians take general recommendations and apply them to your specific needs. A lot of my guidance is general and I may discuss how I would guide patients in my office, but discussing choices for early vaccination or checking titers for immunity is a conversation to be had with your child’s pediatrician. 

• Understand your options. If you’re traveling or in an outbreak area, an early vaccine dose may be recommended.

Now, let’s get into your biggest questions about measles– these are quick, clear answers with links included for more information.

Understanding Measles & Measles Outbreaks

An outbreak is typically defined as three or more linked cases in a community. Areas with low vaccination rates are more vulnerable to rapid spread.

Measles typically starts with fever, cough, runny nose, and red, watery eyes. A few days later, tiny white spots (called Koplik spots) may appear inside their mouth, followed by a characteristic rash–which starts on the face and spreads down the body. The illness can last 7-10 days.

Measles is especially concerning for infants and young children because it can lead to serious complications like pneumonia and brain swelling (encephalitis). Vaccination can greatly reduce these risks.

The rash looks like flat, red spots that spread from the face downward. It usually appears 3-5 days after symptoms start, and the fever can spike as high as 104 degrees Fahrenheit.

Measles is one of the most contagious viruses, which is why we are so grateful to have an effective vaccine. If someone is infected, 9 out of 10 unvaccinated people around them will catch it. It spreads through coughing, sneezing, or just being in the same room as someone who has it. The virus can linger in the air for up to two hours after an infected person leaves.

• If they’re fully vaccinated (2 doses of MMR): They have strong protection. Monitor for symptoms, but no action is needed.

• If they’ve had only 1 dose (under age 4): They have 93% protection, but in outbreak areas, an early second dose may be recommended– talk to your pediatrician.

• If they’re unvaccinated: Call your doctor right away. Depending on timing, the MMR vaccine or immunoglobulin may help reduce the risk or severity of infection.

• If they’re between 6-12 months and in an outbreak area (outbreak is defined as 3 or more cases linked together), an early vaccine will likely be recommended.

• 1 dose (given at 12 months): 93% effective against getting measles

• 2 doses (routine schedule): 97% effective against getting measles life-long as we know it currently.

• Immune Response Varies: A small percentage of people don’t develop full immunity after vaccination.

• Booster Strengthens Protection: The first dose (12 months) gives 93% protection; the second dose (4 years) boosts it to 97% by covering those who didn’t fully respond to the first.

• No Vaccine is 100% as long as the illness is not completely eradicated in the world: The MMR vaccine uses a weakened virus to build immunity, but effectiveness isn’t absolute.

• High Exposure Can Overwhelm: Measles is extremely contagious; in outbreak settings, even vaccinated individuals may rarely get infected—but cases are usually mild and short-lived.

Rarely, but if they do, symptoms are typically mild and far less contagious than in unvaccinated individuals. The key takeaway? The MMR vaccine dramatically reduces both infection risk and severity.

Yes– if you live in or are traveling to an outbreak area, an early dose is recommended between 6-12 months. Or, if you are internationally traveling. This helps provide short-term protection, but your baby will still need their routine doses at 1 and 4 years for full immunity. There is currently no need for early vaccination for routine domestic travel. 

Newborns are born with some temporary immunity (antibodies) from their mother during pregnancy, which can interfere with the vaccine’s effectiveness if given too early. By 6 months, this protection starts to wane, making early vaccination an option in outbreak situations. However, for long-term immunity, the routine doses at 1 and 4 years are essential.

No additional doses are needed for travel if they’ve already had their first routine dose at 12 months. If you’re traveling to a high-risk or outbreak area, you can talk with your pediatrician.

Yes– if measles cases are high in your area, an early second dose before age 4 is recommended. Your child will still need their routine 4-year dose for long-term protection.

If you're traveling within the U.S. but not to an outbreak area, routine MMR vaccination at 12 months is still the standard recommendation. An early dose (6-11 months) is not routinely needed unless you’re going to a high-risk location.

How to Think Through the Decision:

1️. Check if your destination has reported measles cases

• If no active outbreaks → No need for early vaccination.

• If cases are rising but not declared an outbreak → Still no routine need, but be mindful of exposure risks in crowded places (airports, theme parks, etc.).

• If you’re going to a declared outbreak area → Early vaccination at 6-11 months may be recommended (talk to your pediatrician).

2️. Consider your baby’s exposure risks

• Airports, public transportation, and crowded indoor spaces increase exposure risk, as measles spreads easily through the air.

• If you’re staying with family or in low-risk settings, the risk is lower.

3️. Know what early vaccination means

• If your baby gets an MMR dose at 6-11 months, they will still need two routine doses (one at 12 months, one at 4 years).

• The early dose is helpful if exposure is likely, but if your travel is low-risk, it may not be necessary.

Bottom Line: For domestic travel outside outbreak areas, the standard first MMR dose at 12 months is sufficient. If you have concerns about exposure—like traveling to a high-traffic tourist area or airport hubs—talk to your pediatrician about your baby’s specific risk and whether early vaccination is worth considering.

Babies under 1 year old are too young for routine MMR vaccination (albeit 6-12 months can receive it if internationally traveling, traveling to outbreak area, or living in an outbreak area), so their best protection comes from limiting exposure– especially in outbreak areas. For more on newborns and outings in general, watch this important video.

Here’s what helps: 

• Be mindful of your surroundings– avoid unnecessary travel to outbreak areas and limit close contact with known unvaccinated individuals.

• Check caregiver vaccination status– ensure family members and caregivers are up to date on their MMR vaccine. This is the concept of herd immunity– where people who are unable to be vaccinated are protected by those who are vaccinated.

• Consider early vaccination in outbreak areas– if you live in or are traveling to a high-risk area, your baby can get the MMR vaccine as early as 6 months old. This does not replace their routine doses at one and four years old.

Measles has an incubation period of 7-14 days after exposure. A person is contagious 4 days before and after the rash appears, making early identification crucial.

There is no specific antiviral treatment for measles. Care is supportive, focusing on hydration, fever management, and monitoring for complications. High-dose Vitamin A may be given in hospitalized cases, as it has been shown to reduce complications in children.

The World Health Organization (WHO) recommends high-dose Vitamin A for all children diagnosed with measles, especially those hospitalized or at high risk of complications. Measles depletes Vitamin A stores, weakening the immune system and increasing the risk of pneumonia, diarrhea, and blindness. Studies show that supplementation reduces severity, complications, and measles-related deaths, particularly in malnourished children. While Vitamin A is not a prevention tool, it is a key treatment given after diagnosis. WHO guidelines recommend 50,000–200,000 IU over two days, depending on age, to help restore immune function and lower mortality risk.

Yes, the MMR vaccine is safe, and the benefits far outweigh the risks. It protects against three serious diseases–measles, mumps, and rubella–and has been used safely for decades.

Like any vaccine, mild side effects include soreness and redness at the injection site, mild fever, a temporary rash, and some children may have swelling of their lymph nodes. 

Serious side effects are extremely rare. For a full breakdown of the MMR vaccine, check out the PedsDocTalk Vaccine Guide and the MMR Vaccine Information Sheet from the CDC.

The MMR vaccine does not cause autism– this claim has been thoroughly debunked by extensive research. The original study making this claim was retracted for falsified data, and multiple studies have confirmed no link between the MMR vaccine and autism.

Immunity starts about 2-3 weeks after vaccination, so if you’re considering early vaccination for travel or an outbreak, timing matters. After the vaccine, your immune system responds by creating antibodies that offer protection against measles (mumps and rubella).

First, what are titers?

A titer test checks for antibodies in the blood to determine if someone has immunity to a disease, like measles. It helps assess whether a person is still protected or may need a booster vaccine.

Do you or your child need a titer check?

Routine titer testing isn’t necessary for most people, but in high-risk situations, it can be useful to take extra precaution or decide if a booster is needed. You may consider checking titers if:

• You or your child are immunocompromised– If undergoing chemotherapy, on immune suppressants, or have a medical condition affecting immunity, titers can help confirm protection.

• A fully vaccinated child or adult is living with an immunocompromised individual– If someone in the household is highly vulnerable (e.g., undergoing cancer treatment or organ transplant), checking titers ensures they are surrounded by immune individuals.

• You’re an adult unsure of your vaccination status– If you don’t know whether you had two doses of MMR, a titer test can check your immunity. However, in most cases, getting a booster is safe, effective, and often easier than testing.

Bottom line? In an outbreak setting, knowing immunity status can be helpful for those with weakened immune systems or vulnerable household members—but for most, staying up to date with two doses of MMR is the best protection!

There’s no official recommendation for adults to routinely get a second MMR dose if they were vaccinated before 1989. Although rare, if you know you got the killed measles vaccine (given to less than 1 million people between 1963-1967) you should talk to your healthcare provider about getting vaccinated with the current MMR vaccine. 

If you’re unsure about your vaccination status, talk to your doctor. They may recommend checking titers or getting a booster, which is a safe and effective option. There is no harm in getting an additional dose of the MMR vaccine.

If they have both doses of MMR, they’re 97% protected. With one dose, they’re 93% protected. While no vaccine is 100%, breakthrough cases in vaccinated children are rare and usually mild compared to unvaccinated cases.

This is a personal decision that depends on your child's vaccine status and comfort level. If your child is fully vaccinated, their risk is low, but if they are under 1 year old or immunocompromised, limiting contact with unvaccinated individuals—especially during outbreaks—is a good precaution. I discuss my thought process on this more in my YouTube Live Q&A, as there is room for a lot of gray area for many families.

With both doses of the MMR, your child has strong protection. However, lower herd immunity increases overall exposure, which means a higher risk for vulnerable populations and those who can’t be vaccinated. This is why community vaccination matters– it helps protect everyone.

For fully vaccinated children (2 doses), there is no need to keep them at home, as they have strong protection (97%). However, if your child is too young to be vaccinated or immunocompromised, extra precautions may be necessary. Here’s how to approach the decision:

How to Assess the Risk in a Childcare or School Setting

• Ask if the facility has a measles vaccine policy. Do they require MMR vaccination for attendance? If they don’t, and there are unvaccinated children in the facility during an outbreak, your child’s risk of exposure is higher.

• Consider the child’s age and vaccine status. If your child is not yet eligible for MMR or has received only one dose, their level of protection will differ:

What to Do Based on Age & Vaccination Status

• If your child is under 6 months (not eligible for MMR) → Highest risk since they have no direct protection. If there’s an outbreak in the daycare, consider temporary removal to avoid exposure.

• If your child is 6-11 months and in an outbreak area → Early MMR vaccination is recommended. This early dose does not replace the routine doses at 1 & 4 years but provides temporary protection.

• If your child is 1-4 years old and has received only one dose → A second (early) dose may be recommended if at least one month has passed since the first dose.

• If your child is 4+ years old and fully vaccinated (2 doses) → No extra precautions needed. Their immunity is strong, and staying in school is safe.

Bottom line: If your child is fully vaccinated, the risk is low, but if they are too young to be vaccinated or only partially vaccinated, consider early vaccination or temporary removal in high-risk outbreak settings. Always consult with your pediatrician for personalized recommendations.

The MMR vaccine contains a weakened (live-attenuated) virus, which means it stimulates immunity without causing disease in healthy individuals. While the vaccine strain triggers an immune response similar to natural infection, it’s not contagious like wild measles and does not lead to outbreaks. Studies have found that in rare cases, the vaccine strain can be detected in bodily fluids, but there is no evidence that it spreads or causes infection in others. The MMR vaccine remains the safest and most effective way to prevent measles.

Maintaining high vaccination rates is crucial for preventing outbreaks and protecting those who can’t be vaccinated. The CDC’s latest shows that MMR coverage among kindergarteners is around 92.7%, which is below the 95% threshold for optimal herd immunity. Lower coverage increases the risk of outbreaks, especially in communities with declining vaccination rates. You can check vaccination rates in your area using the CDC’s GISVaxView tool.

Final Thoughts

Measles is preventable, and staying informed helps you take action without fear. The best way to protect your family is by keeping up with routine vaccinations, knowing your child’s risk, and talking to your pediatrician about any concerns.

Here’s what you can do:

• Check your child’s vaccine status—If they’re due for a dose, schedule it.

• Stay aware of outbreaks in your area—Knowing local case numbers helps you make informed decisions.

• Talk to your childcare provider—Ask about their vaccination policy and any outbreak precautions.

Have more questions? I cover more in the PedsDocTalk YouTube Live Q&A, including:

• Does hand sanitizer work against measles?

• Are symptoms different in vaccinated vs. unvaccinated kids?

• And more common parent concerns!

If you're unsure about your child’s vaccine status, your pediatrician is the best resource to guide you.

Stay updated: Check the CDC’s Measles Page for the latest information.

As a pediatrician and a mom, I know how much parents carry on their shoulders. It’s normal to feel concerned, but the good news is that we have tools to protect our kids and reduce risk. Making informed decisions for your family is what matters most, and you’re already doing that. You’re not alone in this, and I hope this helps you feel more prepared.

On The Podcast

No parent ever wants to end up in the Pediatric ICU; but we know it happens and we want you to be informed and know what to expect. I invited my social media friend and Pediatric Critical Care Doctor, Dr. Anita Patel on the show to chat about the Pediatric ICU and what to expect. We discuss: 

• The common reasons children end up in the Pediatric ICU and what to expect 

• The questions to ask your care team in the ICU

• How we manage health anxiety as a pediatric ICU doctor and general pediatrician 

On YouTube

Discover the truth about kids’ skincare! I debunk 7 common myths and share tips to keep your child’s skin healthy and protected in partnership with Aveeno Baby & Kids. The video covers:

• Do kids need a skincare routine?

• Are lotions, ointments, gels, and balms all the same?

• Does moisturizing make skin dependent?

• How often should I bathe my child?

• Can kids use adult skincare products?

• Do kids need hair care products?

• Is skincare only important in the winter?

Ask Dr. Mona

An opportunity for YOU to ask Dr. Mona your parenting questions!

Dr. Mona will answer these questions in a future Sunday Morning Q&A email. Chances are if you have a parenting concern or question, another parent can relate. So let's figure this out together!