Myths and Facts: Measles and Mumps

No one thinks much about measles and mumps anymore. This is because it is believed that these diseases have been all but eradicated. Unfortunately, that couldn’t be further from the truth. Measles is very rare in regions of the world and in countries, such as the U.S., that are able to keep vaccination coverage high. But, worldwide, there are estimated to be 10 million cases of measles and more than 197,000 deaths from the disease each year, more than half of which occur in India.¹ And, while most people in the U.S. have now been vaccinated against mumps, making it a rare disease, mumps has started to reappear; a mumps outbreak occurred in 2006 in the U.S., which marked a 20-fold increase in the number of cases.^2,3

Measles and mumps were most prevalent in the 18th and 19th centuries. While the first known report of measles was from an Arab physician writing in his medical notes in the 9th century about the differences between measles and smallpox, it wasn’t until 1757 that Francis Home, a Scottish physician, first demonstrated that measles was caused by an infectious agent present in the blood of patients. In 1954, the virus that causes measles was isolated in Boston by John F. Enders and Thomas C. Peebles. Before the first measles vaccine was developed in 1963, each year in the U.S. about 450 people died, 48,000 were hospitalized, 7,000 had seizures and about 1,000 suffered permanent brain damage or deafness from the disease. Today, there are about 50 reported cases each year, most of which originate out of the country.¹

Mumps was first described by a Greek physician and philosopher named Hippocrates in the 5th century. But, it became a plague in the 18th and 19th centuries when an epidemic broke out all around the world, including in military barracks, prisons, boarding schools and ships at sea. Drs. Claude D. Johnson and Ernest William Goodpasture were the first to prove that a virus caused mumps in 1934. Prior to the introduction of the first mumps vaccine in 1967, the disease became nationally reportable in the U.S., with an estimated 212,000 cases in 1964. Since 2001, there have been, on average, 200 to 300 cases per year reported in the U.S.⁴

Comparing the prevalence back then to now can lead many to believe that these diseases are no longer a threat, particularly in the U.S. But, the seriousness of them, especially measles, makes that belief a myth. Indeed, the only way to continue a decreased incidence is to separate the myths from the facts.

Separating Myth from Fact

Myth: Measles and mumps are no longer common diseases.

Fact: Measles remains a common disease in many parts of the world, and outbreaks are common. While rare in the U.S., the risk for exposure to measles can be high for many U.S. travelers and citizens living in other countries. Unvaccinated U.S. travelers returning to the U.S. and visitors to the U.S. can unknowingly bring measles into the country, causing outbreaks or epidemics among unvaccinated people and undervaccinated communities.⁵

The most recent mumps outbreak that occurred in 2006 in the Midwest sickened 6,600 individuals, a jump from the 314 cases reported in the U.S. in 2005. This outbreak prompted a study by researchers at the Centers for Disease Control and Prevention (CDC) to gauge the prevalence of mumps antibodies among Americans of different age groups in the years before the 2006 outbreak. Using data from a U.S. national health study conducted between 1999 and 2004, they found that 90 percent of 6- to 49-year-olds had antibodies to mumps in their blood, a level that is at the low end of what is needed to prevent significant outbreaks of the infection. The hardest hit population during the 2006 outbreak was non-Hispanic whites born between 1977 and 1986; only 87 percent of them had mumps antibodies, compared to 90 percent of other racial groups. The CDC estimates that between 90 percent and 92 percent of the population must be immunized against mumps to provide so-called “herd immunity.”³

Myth: Measles and mumps are not life-threatening diseases.

Fact: While serious problems resulting from measles and mumps are rare, they do occur. Measles begins with a fever that lasts for a couple of days, followed by a cough, runny nose and conjunctivitis (pink eye). A rash also occurs, starting on the face and upper neck, spreading down the back and trunk, and then extending to the arms and hands, as well as the legs and feet. The rash lasts about five days and fades in the same order it appeared. Between 6 percent and 20 percent of people who get measles will get an ear infection, diarrhea or even pneumonia. One out of 1,000 will develop inflammation of the brain (encephalitis/meningitis), and about one out of 1,000 will die.⁶

Mumps begins with a fever, headache, muscle aches, tiredness and loss of appetite, followed by parotitis (swelling of the salivary glands near the jaw line below the ears), which gives the appearance of “chipmunk cheeks.”⁷ The most common complication is inflammation of the testicles (orchitis) in males who have reached puberty. Other rare complications include encephalitis/meningitis, inflammation of the ovaries (oophoritis) and/or breasts (mastitis) in females who have reached puberty, and spontaneous abortion, particularly in early pregnancy.²

Myth: Measles and mumps are not that contagious.

Fact: Both measles and mumps are respiratory diseases caused by a virus that normally grows in cells that line the back of the throat and lungs. The viruses, spread through droplets sprayed in the air by breathing, coughing or sneezing, remain active and contagious on infected surfaces for up to two hours. Both are so contagious that any individual who is not immune will probably get the disease if exposed to one of the viruses. Measles is contagious from about four days before the rash starts to about four days after. Mumps is contagious approximately seven days before the onset of parotitis until eight days after. The CDC recommends isolation of measles patients for four days after the onset of the rash, and isolation of mumps patients for five days after the onset of parotitis.^1,2,6

Myth: A vaccine is not needed to prevent measles and mumps, since these diseases can be easily treated.

Fact: Both measles and mumps are vaccine-preventable diseases. The measles-mumps-rubella (MMR) vaccine was invented in 1971 and came into public use in 1977. American schools made the MMR vaccine compulsory in 1990.⁴ However, there is no treatment for either disease once it is contracted. The only “treatment” is supportive care, which involves providing relief of symptoms as the body fights the virus. Supportive care can include intravenous (IV) fluids, medications to control fever or pain, antibiotics to treat secondary infections from bacteria, and good nursing care. Clearly, the best option is to prevent the disease with the MMR vaccine.^2,8

Four vaccines are FDA-approved in the U.S., all of which are manufactured by Merck & Co. Inc. The most commonly administered vaccine is the M-M-R II vaccine, a combined measles-mumps-rubella vaccine. Another vaccine, ProQuad, is a combined measles-mumps-rubella-varicella vaccine. (Rubella is a milder form of measles, and varicella is another term for chickenpox.) Over the years, more and more vaccines have been combined to reduce the number of vaccinations administered to a child in one visit. The M-MR II and ProQuad vaccinations are examples of this. Merck & Co. also markets two other vaccines, Attenuvax to prevent only measles and Mumpsvax to treat only mumps. But, in October 2009, the company announced that, based on input from the Advisory Committee on Immunization Practices (ACIP), professional societies, scientific leaders and customers, it is not going to resume production of these vaccines.⁹

Myth: Only children need to be vaccinated against measles and mumps.

Fact: All children and most adults need to receive the MMR vaccine. The ACIP recommends routine vaccination for all children, beginning at age 12 to 15 months, with a second dose given between ages 4 and 6. Further, the ACIP recommends that adults born in 1957 or later receive the second dose (the booster) if they lack documentation of vaccination, are a healthcare worker, plan to travel internationally, are exposed to measles in an outbreak setting, were previously vaccinated with a killed measles or mumps vaccine (introduced in the 1960s), or were vaccinated with an unknown type of measles vaccine during the years 1963 through 1967.¹⁰ Complete prescribing information for both the MMR and MMRV vaccines can be found on the packaging instructions at www.fda.gov/Biologics BloodVaccines/Vaccines/ApprovedProducts/ucm093830.htm.

Myth: The MMR vaccine is not effective in preventing the disease.

Fact: More than 95 percent of individuals who receive a single dose of MMR vaccine will develop immunity to all three viruses. A second vaccine dose gives immunity to almost all of those who did not respond to the first dose.⁶

Myth: The vaccine to prevent measles and mumps causes autism.

Fact: The link between autism and the MMR vaccine has been studied extensively. Concerns were first raised just more than a decade ago by British physician Andrew Wakefield, who, based on a study of 12 children, proposed that there was a link between the vaccine and bowel disease and autism. That research, published in an article in The Lancet in 1998, has since been widely discredited, and in 2004, The Lancet published a retraction submitted by 10 of the 13 original authors of the article, which stated that there was no connection between the MMR vaccine and the bowel disease/autism syndrome. Numerous other national and international studies also have failed to find a connection between MMR vaccination and autism. In 2004, the independent Institute of Medicine (IOM) issued a report that concluded there is no evidence to support an association between the MMR vaccine or thimerosal-containing vaccines and the development of autism. In 2008, there were more than 20 peer-reviewed medical journal articles that refute the connection, and only three that suggest a connection.^{10, 11}

The most recent study concerning the MMR vaccine and the increased risk of autism included 96 Polish children ages 2 to 15 who had been diagnosed with autism. Researchers compared each child with two healthy children the same age and sex who had been treated by the same doctor. Some of the children had received the MMR vaccine, while others had not been vaccinated at all or had received a vaccine against measles only. Overall, the study found, children who had received the MMR vaccine actually had a lower risk of autism than their unvaccinated peers. Nor was there any evidence of an increased autism risk with the measles-only vaccine.¹²

Myth: The MMR vaccine is too risky because it is associated with increased risk of febrile seizures in children.

Fact: The risk of a febrile seizure (a brief, fever-related convulsion that does not lead to epilepsy or seizure disorders) after any measles-containing vaccine is low: less than one febrile seizure per 1,000 injections. However, a recent CDCfunded study that analyzed 459,000 children aged 12 to 23 months from health systems across the U.S. has shown that there is double the risk of a febrile seizure for 1- to 2-year-old children when receiving the four-in-one measles-mumpsrubella-varicella (MMRV) vaccine compared with same-day administration of the separate MMR and varicella (chickenpox) vaccines. The CDC recommends that either vaccine be used for the first dose in 1- to 2-year-olds; however, families with a strong preference should receive separate MMR and varicella vaccines.¹³

Dispelling the Myths Now

Preventive vaccines that substantially reduce the incidence of contagious diseases such as measles and mumps have been introduced with great success over the past several decades. But, even in countries where vaccination coverage is high, the risk of contracting these diseases is still present. The only way to eradicate them is to have a complete understanding of their seriousness and press for universal vaccination.