Protecting Children With Weakened Immune Systems From Measles

February 17, 2015
Hana Hakim, MD

In 2000, measles was declared an eliminated disease in the United States. This was a result of population immunity developed by high coverage of the measles, mumps, and rubella (MMR) vaccine. However, recent multi-state outbreaks of measles are a reminder that infectious diseases do not respect national boundaries and can easily spread worldwide.share on twitter

Measles is a highly contagious virus that causes fever, cough, runny nose, pink eye, and rash. It spreads through the air when an infected person coughs or sneezes. Patients with measles are contagious from 4 days before the start of a rash until 4 days after the rash appears. Measles may cause severe complications involving the lungs and brain, and it might lead to death in previously healthy children.

Having cancer is associated with an additional ongoing risk for acquiring infections and for more severe infections. Children with cancer struggle with a weakened immune system that cannot fight infections either due to the type of cancer or cancer treatments. Therefore, keeping these children protected from infections is of paramount importance.

Although the MMR vaccine is highly effective in building immunity in people with a healthy immune system, it is not an option for immunocompromised pediatric oncology patients. The MMR vaccine is a weakened live virus vaccine that, in general, cannot be given to children with cancer while they are immunosuppressed.  For this reason, it is important to provide immunocompromised children with a circle of protection. This circle may be achieved by encouraging close contacts of immunocompromised children, including their siblings, household members, and health care team members, to keep themselves protected against vaccine-preventable infections—such as measles—by getting vaccinated.share on twitter  

Since the declaration that measles was eradicated in the United States, the Centers for Disease Control and Prevention (CDC) reported in 2014 the first alarming increase in measles cases, reaching 667 cases. Measles cases are dramatically increasing again in 2019. From January 1 to August 15, the greatest number of cases in the United States since 1992 have been reported. Most of the cases occurred in people who were unvaccinated.

According to the CDC, children should receive 2 doses of the MMR vaccine or the measles, mumps, rubella, and varicella (MMRV) vaccine. The first dose is given at 12 to 15 months old, and the second dose is given at 4 to 6 years old. The MMR vaccine virus does not transmit to others.  

In addition to ensuring siblings and family members are vaccinated, avoiding exposures to sick people is a key precaution.  Children with cancer are instructed to avoid crowds and public events, if possible, and wear a face mask when they leave their houses while immunosuppressed.share on twitter

Last reviewed and updated August 2019.


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