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Vincent Iannelli, M.D.

Measles in California - Vax or No Vax?

By March 21, 2011

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Did a 27-year-old California man who recently contracted measles while traveling to the Philippines and Thailand receive his routine MMR vaccines as a child?

It would seem like an easy question to answer, but unfortunately we don't know.

According to the County of San Diego Public Health Services Department, 'He recalls having vaccinations as a child without any exemptions for school entrance, but he has no available records and his family could also not produce any records.'

We often assume adults are immune to most vaccine-preventable infections, but unless they have documentation of getting vaccines or documentation of having the diseases, many adults should consider themselves susceptible.

MMR Vaccine History

Without vaccine records, we can try to reconstruct what you would have expected to have happened in regard to his vaccines.

He was born around 1984, which was well after the MMR vaccine began to be routinely used in 1971, so he likely got one dose of MMR before starting kindergarten.

It is important to keep in mind that kids didn't start to routinely get an MMR booster dose until 1994 (1989 in high risk areas) though. This booster dose of MMR was given when a child was either 4 to 6 years old (before entering kindergarten) or when they were 11 to 12 years old (before entering middle school).

And California didn't add a school requirement for a 2nd dose of MMR until July, 1999 for students entering 7th grade. At the time, he would have been about 15 years old and in the 9th or 10th grade, and so, could have bypassed the new MMR booster requirement.

MMR and Adult Vaccines

Why does it matter?

It is quite possible that there are many other adults in similar situations who are not fully vaccinated against MMR and put themselves at risk for infection, especially when they travel to high risk areas overseas, and can then spread measles to other adults and children.

This is especially true for people born before 1985, who would likely have gotten their 4 year checkup and possibly their last childhood vaccines before the booster dose of MMR was first recommended in 1989.

Everyone should keep in mind that in addition to the routine childhood immunization schedule, there is an adult vaccination schedule that recommends most adults born in 1957 or later should get one or more doses of MMR.

Specifically, unless they are immune to measles and mumps, they should:

  • get two doses of MMR if they have been exposed to measles or mumps, work in a healthcare facility, attend a postsecondary educational institution, or plan to travel internationally
  • consider being revaccinated with 2 doses of MMR if they were originally vaccinated with the original inactivated measles vaccines from 1963 to 1967
  • consider being revaccinated with 2 doses of MMR if they were originally vaccinated with the inactivated mumps vaccines before 1979 and are at high risk for mumps

Women of childbearing age should be tested for rubella immunity and get the MMR vaccine as appropriate if they are not immune to rubella.

Measles in California - Vax or No Vax?

Although we may never officially now if this man was fully vaccinated against measles, it is a good reminder for adults to check their vaccine status, especially before traveling.

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March 22, 2011 at 1:28 am
(1) Lisa R. says:

Could he be checked for rubella immunity? Seems like that would indicate at least 1 dose of MMR.

March 22, 2011 at 9:36 am
(2) Vincent Iannelli, MD says:

‘Could he be checked for rubella immunity? Seems like that would indicate at least 1 dose of MMR.’

Or natural exposure to rubella.

Since it wouldn’t change anything, I doubt anyone would advocate doing any additional testing in this case.

It’s not really about proving vaccine failure or not getting vaccinated, but simply that there are many adults who not have had the opportunity to get both MMR shots because of the timing of when these routine shots started to be given. Of course, those who went to a pediatrician regularly, would likely have had it sometime later, but even now, not everyone has their yearly checkups with their doctor as teenagers.

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