Measles

As of late January 2025, measles cases have been reported in West Texas. With news and social media spreading information—both accurate and inaccurate—we want to reassure you that our providers are closely monitoring updates from the CDC, Texas Department of State Health Services, AAP, and our local Dell Children’s Hospital Infectious Disease Department. Our priority is to keep you informed with the most accurate, up-to-date guidance.

We understand that situations like this can be concerning, and our goal is to provide clear, reliable information to help ease any worries. As your pediatricians, we are committed to keeping your children and our community safe. We will continue to share updates here as they become available.

Our most recent newsletter from 2/24/25 provides many more details, please click here to read more. 

Please read below to find the most common measles questions and answers:

What is Measles?

Measles is a highly contagious disease caused by the measles virus. It was once a common childhood illness, but widespread vaccination led to its near elimination in the U.S. by the year 2000. However, cases have been increasing in recent years due to declining vaccination rates. Travelers from countries where measles is still widespread can bring the virus into the U.S., where it spreads among unvaccinated individuals.

Measles spreads easily and can lead to serious complications, especially in young children, pregnant women, and those with weakened immune systems. Fortunately, it is a vaccine-preventable illness. About 95% of people develop immunity after one dose of the MMR vaccine. After receiving two doses, the vaccine is 97% effective at protecting against measles.

Texas measles information can be found on the Texas Department of State Health Services page, here: DSHS Measles Updates

Measles Symptoms and Contagiousness

How Contagious is Measles?
Measles is one of the most contagious diseases in the world. If a person with measles enters a room, the virus can linger in the air for up to two hours. About 9 out of 10 unvaccinated people who are exposed will get infected.

How Long is Someone with Measles Contagious?
A person with measles can spread the virus 4 days before a rash appears and up to 4 days after.

How Long Does It Take to Get Measles After Being Exposed?
Symptoms usually start 8-12 days after exposure.

How Does Measles Spread?
The virus can linger in the air and on surfaces for up to 2 hours, making it easy to catch. You can contract measles by:

• Breathing the same air as an infected person, even if they have already left the room.
• Touching contaminated surfaces and then touching your face, mouth, or eyes.
• Being near someone infected up to four days before and four days after their rash appears.

Measles is so contagious that 90% of unvaccinated people exposed will become infected.

What are the Symptoms of Measles?

• High fever (over 101 degrees F)
• Cough, runny nose, and red, watery eyes
• Small white spots inside the mouth (Koplik spots) – 50-70% of cases
• Rash starts on the face and spreads down the body – 100% of cases

While the flu and other viruses can cause symptoms like fever, cough, and rash, measles is different because it has Koplik spots (small white spots inside the mouth) that other viruses don’t have. Also, with most viruses, the rash usually appears after the fever goes away. But with measles, the rash shows up while the fever is still high – often even at its highest, which is an important clue toward measles.  Though there are 3 other common childhood viral rashes that can occur when fever is still present, we can easily distinguish them from measles based on other features (chicken pox, hand foot and mouth disease, and roseola).

What are the Complications of Measles?

Measles can lead to serious complications, especially in young children, pregnant women, and people with weakened immune systems. Before you read further, REMEMBER, your child’s risk of measles is VERY LOW if up to date on the MMR vaccine. Measles complications include:

• Ear Infections (~1 in 10 cases)
• Diarrhea (~1 in 10 cases)

• Pneumonia (~1 in 20 cases)
• Encephalitis (Brain Swelling) (~1 in 1,000 cases)

• Subacute Sclerosing Panencephalitis (SSPE) (~1 in 10,000 cases): A rare but fatal brain disease that can develop years after measles infection & cause progressive neurological deterioration.

School Guidelines for Measles Exposure, Vaccination Status, and Symptoms

If Exposed to Measles, What Determines When a Child Can Return to School?
Children who are exposed and unvaccinated must stay home for 21 days from the last known exposure unless they receive a vaccine within 72 hours of exposure.

Children who are exposed and FULLY vaccinated typically do not need to stay home, as they are at low risk of infection. However, in certain outbreak situations, public health officials may recommend additional precautions. Parents should follow guidance from their school or local health department. We will update our guidance here as well, if it were to change.

A child infected with measles should stay home from school or childcare until at least 4 full days after the beginning of the rash, when they are no longer contagious.

Should Children Who Have Not Had a Measles Vaccine Go to School During an Outbreak?

• Children who have not received a measles vaccine (MMR or MMRV vaccine), and wish to remain unvaccinated from measles, should be excluded for 21 days after the onset of rash in the last case of measles in the school or community.
• Children who have not received a measles vaccine (MMR or MMRV vaccine), and wish to start the vaccine series, can return to school or childcare immediately as soon as they receive a dose of MMR or MMRV vaccine.
• Children who have not received a measles vaccine (MMR or MMRV vaccine) AND HAVE AN EXPOSURE, should receive a dose of MMR or MMRV vaccine within 72 hours of their first exposure, and then can return to school immediately.
• Children who have not received a measles vaccine (MMR or MMRV vaccine) AND HAVE AN EXPOSURE, and wish to remain unvaccinated from measles, should be excluded from school until the outbreak is over.
• Children who have not received a measles vaccine (MMR or MMRV vaccine)AND HAVE AN EXPOSURE but receive a dose of MMR or MMRV vaccine more than 72 hours after their first exposure, should be excluded from school for 21 days from the time of the last (most recent) exposure.

Measles Prevention

How Do You Prevent the Spread of Measles?

• Ensure Vaccination: The MMR vaccine is 97% effective after two doses.
• Practice Good Hygiene: Wash hands frequently and avoid touching your face.
• Avoid Exposure: Stay away from crowded places if possible if there are reported cases nearby.
• Boost Immunity for Infants: Please refer to the vaccine recommendation section.

What About Infants Under 6 Months Old?
Babies younger than 6 months of age are not able to be vaccinated. However, they are likely to have some protection from maternal antibodies passed to them during pregnancy. Other steps can be taken to help keep them safe including limiting exposure to crowds, avoiding locations where measles is circulating, ensuring caregivers and household members are fully vaccinated, and remaining vigilant with frequent handwashing and disinfecting of surfaces

Does Breastfeeding Provide Measles Protection?
Breastfeeding offers some immune support, but it does not provide full protection against measles. Though breastfeeding is protective, no matter whether feeding your baby exclusively from the breast or with formula, adequate nutrition of any combination is important for babies when it comes to fighting illness of any kind.

Should We Avoid Public Places if Our Child is Too Young to be Vaccinated?
Since the virus can linger in the air for 2 hours, during an outbreak, it is safest to avoid crowded places if your baby is too young for the MMR vaccine.

Measles Vaccination

How to Know If Your Vaccines Are Up to Date?

Check Your Records: Ensure your child has received the 2 MMR vaccines. To be fully vaccinated against measles, 2 vaccines must be received >12 months (and the 2 doses should be spaced apart at least 28 days/4 weeks apart)

Recommended Standard MMR Vaccine Schedule:

• 6-11 months old: A single early-dose MMR dose may be given if your child is traveling internationally.
• First dose counting toward full vaccination: 12-15 months of age
• Second dose counting toward full vaccination: 3-6 years old. (The second dose can be given as soon as 28 days after the first dose and still count as a full vaccination.)
• If there’s an outbreak or if traveling, babies 6-11 months old can get an early dose but will still need the two regular doses later. The second dose should be given no earlier than 12 months, and the third dose no sooner than 28 days after the second dose.

Recommended MMR Vaccine Schedule with Measles Cases in Texas (but NO outbreak yet in Austin):

• First dose counting toward full vaccination: 12-15 months old. However, if you prefer, it’s okay to get the first dose early (between 6-11 months). If your child gets it early, they will still need two more doses: one at 12 months or older and one at least 28 days after the first.
  • If you want to schedule the MMR vaccine for 6-11 months, please contact us for a telemedicine visit. You may need to pay for the vaccine upfront because insurance coverage for early doses can vary. You should check with your insurance provider to see if they will reimburse the cost.
• Second dose counting toward full vaccination: 3-6 years old. However, it’s okay to get this dose early if desired, but there must be at least 28 days between the first and second dose.
  • To schedule the second dose early, keep an eye out for the MMR vaccine clinic posted on our website.

Recommended MMR Vaccine Schedule with Measles Outbreak in Austin:

• Will update when/if outbreak is declared in Travis Co.

The Vaccine Education Center at the Children’s Hospital of Philadelphia (CHOP) is a great resource for parents looking for trustworthy, up-to-date information about vaccines. Their website (Children’s Hospital of Philadelphia Vaccine Education Center)  provides reliable facts about vaccines for people of all ages. CHOP’s Vaccine Education Center is also part of the World Health Organization’s (WHO) Vaccine Safety Net, which means it meets strict standards for accuracy and credibility. If you have questions about vaccines or want to make informed decisions for your child, this website can help.

International Travel Tips for Families with Young Children

Before traveling, check for health advisories on the Centers for Disease Control and Prevention Travel Health Notices webpage. Depending on your travel destination and the activities you have planned, other vaccines may also be recommended.

Measles vaccine specific recommendations:

• <6 months: Cannot be vaccinated yet but may have some protection from antibodies passed to them during pregnancy. Consider delaying travel to locations with measles outbreaks to avoid risks of severe illness.

• 6 -11 months: Receive their first MMR vaccine dose at least two weeks before traveling. They will still need the standard 2-dose series if they receive a dose before age 12 months.
• >12 months: Receive their first dose of MMR vaccine in addition to the other vaccines recommended at that age. Infants 12 months and older should also receive a second dose of the MMR vaccine 28 days after the first dose.

How We Will Handle Testing & Prevent Exposure in Our Office?

PAA is following an algorithm developed in partnership with the Dell Children’s Infectious Disease Department and Austin Public Health to guide our approach to testing and office visits (in-office, telemedicine, and in-car visits). This plan will be adjusted as the situation continues to evolve. We will keep you informed and provide the best plan at the time of appointment scheduling.

To protect the health of our patients and staff, patients with known exposure to measles who are not fully vaccinated (i.e., have not received two doses of the MMR vaccine starting at 12 months and older) will not be seen in the office. These visits will be conducted via telemedicine or in the car. We will continue to update you as our policies change.

PAA Parent Questions

1. Should my child get an MMR booster if they are immunocompromised and have already had two doses? If your child has a weakened immune system, they may not respond well to the MMR vaccine. Even if they’ve already had two doses, they might need extra protection. Schedule a telemedicine appointment to discuss with your child’s primary care provider.
2. How much protection is provided with one dose of MMR if my child is under 12 months? One dose of MMR is usually given at 12 months or older. If your child gets the MMR vaccine before 12 months, measles protection varies. One study found that when infants 6-8 months old received the MMR vaccine, the immediate effectiveness against measles was 73%, but 1 week later, effectiveness increased to 96%. (From Effectiveness of vaccination at 6 to 11 months of age during an outbreak of measles)
3. Should my fully vaccinated child (who has received 2 doses of MMR) receive a 3rd dose of MMR if/when measles is in Austin? For a child who is not immunocompromised (ex: cancer), we are not recommending a 3^rd dose of MMR as long as the first 2 doses were given on or after 12 months of age (and the 2^nd was at least 28 days after the 1^st).

We will update this section as new questions from parents come up that haven’t been addressed above, and if the answers to the above questions were to change.

Great Measles References

Healthy Children’s: Measles 101

Measles and breastfeeding

CDC vaccine guidance

TCH Measles 101

Children’s Hospital of Philadelphia Vaccine Education Center