Measles Cases Confirmed in Washtenaw and Monroe Counties

State health officials have temporarily revised their recommendations for measles vaccines for infants in Washtenaw and Monroe counties, Michigan's southeastern region. Some children as young as 6 months should now receive the MMR vaccine, which protects against measles, mumps, and rubella, at least six months earlier than previous guidance.

Facing a growing outbreak of measles in southeast Michigan, the Michigan Department of Health and Human Services announced the change Thursday evening. The recommendation applies to children who live in or travel to Washtenaw and Monroe counties.

Infants ages 6 to 11 months who receive this accelerated first dose will require two additional doses of the MMR vaccine after 12 months of age to complete the series.

Community Transmission Concerns

Monroe County, Michigan's most southeastern county, confirmed the state's eighth case of measles earlier in the day, following seven cases in Washtenaw County. Importantly, the Monroe County case could not be linked to the Washtenaw County cases or travel, raising concerns among officials that the previously connected cases have turned into "community transmission."

The measles virus is "incredibly transmissible," Dr. Natasha Bagdasarian, the state's chief medical executive, noted in a statement. She and other experts emphasize that two doses of the vaccine are 97% effective against measles.

Vaccination Rates Below Threshold

As of Thursday, the US Centers for Disease Control reported 1,671 confirmed measles cases in 33 states, putting the country on track to far surpass last year's cases of 2,286, which had been the highest number in a quarter-century.

Michigan's vaccination rates in the affected counties fall below the threshold needed to prevent widespread transmission. About 92% to 94% of a community's population must be immune to measles—either by vaccination or previous infection—to limit its spread, according to the American Academy of Pediatrics. Some experts place the threshold for "herd immunity" even higher.

In Washtenaw County, 81.3% of children aged 19 through 35 months had received at least one dose of MMR as of December 31. In Monroe County, 76.2% of children aged 35 months and under had received one dose of the MMR vaccine as of December 31.

Temporary Measure Until May 16

Michigan's adjusted vaccination recommendation for children in those two counties is in place until May 16—the length of two incubation periods after the infectious period of the last identified measles case.

The CDC and national pediatricians' group normally recommend the MMR vaccine at 12 to 15 months of age, with a second dose given a minimum of 28 days after the first dose. The state's change to lower the age recommendation is an emergency response to the outbreak.

What Adults Should Know

Vaccination recommendations for adults are less defined. Some adults who received vaccines between 1963 and 1967 may have received a less-effective version of the vaccine. Other adults vaccinated before 1989 may have only received one dose of the MMR vaccine and may be eligible for a second dose.

Those who fall into these categories or are unsure about their vaccination history should contact their local health care provider.

Understanding Measles Symptoms

Measles is highly contagious and spreads through direct person-to-person contact and through the air. Symptoms can take up to 21 days to appear after contact with the virus. During that time, the infected person can spread the virus to others.

Common symptoms include:

  • High fever that can spike to over 104 degrees
  • Cough
  • Runny nose
  • Red, watery eyes
  • Tiny, white spots in the mouth
  • A rash that typically starts as flat red spots on the face, then spreads to the trunk, arms and legs. Small, raised bumps may also appear on top of the flat red spots

What To Do If You Think You Have Been Exposed

Individuals who think they may have been exposed, or who develop symptoms, are urged to call their health care provider before seeking testing or treatment so steps can be taken to prevent exposure to other individuals.

Vaccines are widely available at no cost through most health insurance or at local health departments and pharmacies. Uninsured children are eligible for the Vaccines for Children program and can receive no-cost vaccination at a provider enrolled in that program.

National Context

Michigan's measles outbreak is among numerous outbreaks in the US as vaccine rates fall. The state's situation reflects a broader national trend where declining vaccination coverage has allowed measles to take root again in widespread outbreaks.

The American Academy of Pediatrics and CDC recommend the vaccine at 12 to 15 months of age with a second dose given a minimum of 28 days after the first dose. However, the CDC and national pediatricians' group do recommend that infants 6 to 11 months old receive an early dose of the MMR vaccine before international travel.