The current outbreak of measles in the United States continues to spread with the number of cases hitting 800 as of April 17. Although, the increase is concerning, as of the writing of this article, no Massachusetts cases have been reported.
So, as an older adult, vaccinated or not, do you need to be concerned? That’s the question Senior Scope asked the New Bedford Health Department in April. The city’s Director of Public Health Nursing Liza Rebello, DNP, RN, NE-BC, had a lot of information about measles, vaccines, and what older adults specifically should to be aware of. Most importantly, she said, measles will impact people differently so anyone concerned should ask their primary care physician for more personalized recommendations.
People born at different times also have different vaccination experiences and Rebello again stressed that people should check with their health providers, whenever possible, to learn their specific vaccination history.
“Because the guidance is nuanced and may be difficult for individuals to determine which category they fall into,” she said, “We strongly encourage individuals to discuss their vaccination status with their healthcare provider, if possible.”
Here are excerpts from an interview with Rebello via email. Responses have been edited for clarity and length.
Senior Scope: Are adults age 60 and older at higher risk of getting measles and, if so, why?
Liza Rebello: Anyone who is not vaccinated against measles is considered at risk for getting sick.
There are also several groups that may be more likely to suffer from complications from a measles infection. Those groups include:
•Children younger than 5 years of age;
•Adults older than 20 years of age;
•Pregnant women; and,
•People with weakened immune systems, such as from leukemia or HIV infection.
Senior Scope: Do adults age 60 and older need a measles booster?
Liza Rebello: Because the (MMR vaccination) guidance is nuanced and may be difficult for individuals to determine which category they fall into, we strongly encourage individuals to discuss their vaccination status with their healthcare provider, if possible.
According to the Massachusetts Public Health, whether you need an MMR vaccination “depends on multiple things including your age, health, vaccination status, and risk factors. It is a personal decision that should be made with the guidance of trusted healthcare professionals.”
Current MDPH guidance includes the following:
•If you were born prior to 1957, the measles rates were so high that it is presumed everyone either got the measles and is immune or was exposed to the measles and developed immunity without becoming symptomatic. Unless you work in healthcare, if born before 1957 you are considered to have presumptive immunity to measles even without vaccination.
•If you were born after 1957 and vaccinated prior to 1968, you may be recommended to get one dose of MMR vaccine. Between 1963 and 1967 an inactivated measles vaccine was sometimes used. It was found to induce a less robust immune response and was replaced in 1968 by the live attenuated version in use today. People who were vaccinated prior to 1968 with either inactivated measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of MMR vaccine. However, not many people fall into this group; the inactivated measles vaccine was given to fewer than 1 million people before being replaced by the currently used measles vaccine. If you’re unsure whether you fall into this group, you should first try to find your vaccination records or documentation of measles immunity. If you do not have written documentation of measles immunity, you should get vaccinated with MMR) vaccine. There is no harm in getting a dose of MMR vaccine if you may already be immune to measles (or mumps or rubella). Another option is to have a healthcare provider test your blood to determine whether you’re immune, but this is generally not recommended.
•If you were born after 1968 to the present, please follow the US Immunization Schedule.
If you cannot find your vaccine records, you should get vaccinated. The MMR vaccine is safe to receive even if you already have immunity to measles, mumps, or rubella.
Senior Scope: Are there risks for older adults in getting vaccinated?
Liza Rebello: Specifically, there is a section in the the CDC’s page on the MMR vaccination that lists topics to discuss with the healthcare provider prior to vaccination as well as risks of a vaccine reaction.
Of note, “in people with serious immune system problems, this vaccine may cause an infection that may be life-threatening. People with serious immune system problems should not get MMR vaccine.” If an individual is concerned that they may be at risk for an adverse reaction due to their health status, they should consult with their provider.
Senior Scope: Are there specific health conditions that might lead one to have a higher risk of getting measles and if so, is there a recommendation for this group?
Liza Rebello: Individuals with specific health conditions, including those who are immunocompromised, may be at greater risk for developing complications if infected with measles. In terms of vaccination recommendations, an individual with a specific health condition should consult their healthcare provider to determine if a booster is indicated for them based on their overall risk factors and current vaccination status.
Senior Scope: Any other recommendations for older populations?
Liza Rebello: The key message at this time is for individuals to be informed about their vaccination status. Anyone who is uncertain about their status should speak with their healthcare provider to determine the most appropriate plan moving forward.
Anyone planning to travel—either within the U.S. or internationally—to areas with higher measles activity should review their vaccination status. Individuals who are part of a high-risk group are encouraged to consult their healthcare provider before traveling.
Senior Scope: Is there anything else older people need to know about the outbreak of measles?
Liza Rebello: As of now, there are no known cases of measles in Massachusetts. Public health officials continue to monitor the ongoing outbreak in the U.S. and assess its potential impact on our state. If the situation changes and there is local transmission, additional guidance may be provided by state health authorities. Also, please see the recommendations above regarding travel.
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