Original Post by Jennifer Berkowski, MD at Emmaus Health

Measles in Michigan

For months, we have been nervously watching the measles outbreaks around our country, wondering how long it would take for Ann Arbor to be affected. On March 13th, a case of measles was reported in Oakland County, which has since spread to 38 cases in Oakland and Wayne Counties. Because measles complications and deaths are more common in infants and pregnant women, it’s important for parents to be aware of these outbreaks and know what to watch for.

Why are these outbreaks happening?

The short answer: we’re losing herd immunity, which is the protection you enjoy when almost all of the people around you are immune to a specific illness. The idea is that if they have been vaccinated, they can’t catch the illness. And in turn, they can’t pass it to you.

We rely on herd immunity to protect people that can’t be vaccinated, such as infants or pregnant women. However, as more families – for a variety of reasons – choose not to give their children the MMR vaccine, herd immunity begins to fail.

What to watch for:

Measles is VERY contagious and 9 out of 10 people who haven’t been vaccinated will develop measles if exposed. The most commonly recognizable symptom of measles is a rash. This rash typically develops first on the face and then spreads down the body.

However, a person with measles is usually contagious 4 days before this rash breaks out. During those 4 days, they will likely exhibit these symptoms:

• Fever
• Cough
• Runny Nose
• Fatigue
• White spots inside the cheeks

Measles Prevention & Pregnancy

Pregnant women cannot get the MMR (measles-mumps-rubella) vaccine because it is a “live” virus vaccine and could theoretically create an infection and harm the mother and baby. However, most women had 1-2 doses of MMR vaccine as a child and are probably protected against measles. (I say probably because the vaccine is not perfect.) For those who were not vaccinated or who are not immune, there is something called immunoglobulin, which is given as a shot, that can provide temporary protection to pregnant women who are exposed to the measles.

To reduce risk of exposure, consider these suggestions:

1. Watch for symptoms in friends/family members, and avoid contact with people who have been exposed to the measles virus.
2. Watch county websites for instances of exposure and outbreak (e.g. Washtenaw County and Oakland County).
3. Wear an N95 mask in public in areas with widespread outbreak.
   1. Can be easily purchased online. Ensure mask is NIOSH approved.

Measles Prevention & Infants

0-5 Months:

These babies are too young to get the MMR vaccine, but during pregnancy, some immunity is passed from mom to baby. This may provide a small amount of protection during these months.

Also consider these protective measures:

1. Breastfeed: measles antibodies (which is what protects us) can be passed to the baby in breast milk. This will help, but not provide complete protection.
   1. Be cautious if using another mother’s breast milk, as this can also create exposure to viruses.
2. Make sure everyone around the baby gets the MMR vaccine. This will make them less likely to catch the measles and pass it to the baby.
3. Before going on playdates, ask parents if their children are vaccinated.
4. Avoid taking the baby to public places until 21 days after the last case of measles is reported in your area (found on county websites).
5. Place a light blanket over car seat or stroller.
   1. Be cautious against overheating or restriction of airflow.

If you think your baby has been exposed to measles, call your pediatrician or primary care doctor immediately. Temporary protection can be given to a child this young by giving them an immunoglobulin shot.

6-11 Months:

These babies are old enough to get the MMR vaccine, but it’s an “extra dose.” Because there can still be some remnants of mom’s immune system in the baby’s blood, the shot may not work as well or last as long. It will help protect the baby from the measles but they still have to get their regular doses of MMR starting at 12 months of age. Otherwise, the same protective factors as mentioned for younger babies apply.

12 Months:

Hurray! The baby is finally old enough to get their routine MMR vaccine and their immune system should respond to it appropriately. Typically, the second & final dose of the MMR vaccine is not given until 4 years of age but if there is a high risk of exposure, it can be given as early as 4 weeks after the first dose to help boost the child’s immunity.

What If I don’t have a Primary Care Doctor for my baby or myself?

A primary care provider is a doctor, nurse practitioner, or physician assistant who checks on your health every year, and keeps track of all of the specialists you have seen and tests you have had done to try to keep you healthy as long as possible. They are also the provider you see when you get sick. Ideally, every person would have a primary care provider. Primary care doctors can have different types of training: family medicine doctors see adults and children, internal medicine doctors just see adults, and pediatricians just see kids.

If you are already at ArborWoman, Emmaus Health is right across the hall from the new ArborWoman location at Domino’s Farms and is always accepting new patients, both children and adults. They have doctors and nurse practitioners trained in family medicine, internal medicine, and pediatrics who would be happy to be your primary care provider. They also offer nurse visits if you just need a vaccine and don’t need don’t need to see a doctor. Other nearby clinics include a University of Michigan Family Medicine Clinic at Domino Farms, Pediatrics and Internal Medicine at IHA across the street, and the University of Michigan Pediatrics and Internal Medicine clinics kitty corner at UM East Ann Arbor.