As measles cases increase in Arizona, should you get a booster? This doctor weighs in

Measles, a once-eradicated disease, is back in a big way as vaccine skepticism soars. And, as we’re seeing new cases pop up in heavily populated areas across the country — like here in Maricopa County, where health authorities have warned people they could have been exposed to the ultra-contagious virus.

All of it has a lot of folks wondering if they’re protected against measles. Do they still have immunity from a vaccine they may have gotten as an infant? Do you need a booster? How long does that shot last?

Dr. Sarah Coles is a medical doctor based in Flagstaff and associate professor for family, community and preventive medicine at the University of Arizona’s medical school.

She told The Show it’s more complicated than it should be. But there are some things you should consider.

Full conversation

DR. SARAH COLES: So first is the year you were born. So if you were born before 1957, you are presumed to have immunity against measles because more than 98% of people born before that year caught the measles and are immune have lifelong immunity to it. So that one's very easy. Born 1957, you're good.

LAUREN GILGER: OK.

COLES: If you were born after 1957 and you got a live virus measles vaccine, you're also presumed to be good. The reason for that is the live virus vaccine — like the MMR — is very, very effective at conferring immunity for the people who get it. And so we presume that if you got the vaccine, you're doing great. You don't need an additional booster.

If you don't know if you got the live virus vaccine or if you ever had measles, then it gets a little bit more gray. So for folks who are uncertain, we can either take a lab test and get a test to see how many antibodies you have in your blood against measles. That's called a titer.

Or we can just revaccinate you and give you an updated MMR shot.

GILGER: So there's no, like, problem with getting another measles vaccine if you don't know. It doesn't hurt you in any way?

COLES: Not at all. It is safe to get, just as safe as getting the initial shot.

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GILGER: OK, so that's an option for folks, but there is a way also to test, like you said, for immunity levels. Are folks doing more of that right now?

COLES: Yes, definitely. We see a lot of folks coming in wanting to know what their immunity levels are and if they should get a shot. And so what I'm recommending to folks is if you're very curious, we can certainly get the lab. Your primary care doctor can order that for you. And that test will tell us if you have enough antibody to be able to fight measles if you were exposed to it.

But if you don't feel like getting an additional lab draw or a poke, you can always just get the shot.

GILGER: OK. The MMR vaccine that covers measles is supposed to be a lifelong vaccine, right? So presumably if you got it when you were a kid, like you said, you will be covered. Do you lose some of those antibodies over time? Is that a possibility?

COLES: Yeah, very good question. You absolutely do have what's called antibody waning. So the antibody numbers do get lower over time. But that doesn't mean necessarily that you are not immune to the measles because there is another type of immunity in your body called cell-mediated immunity.

So even though you don't have as many antibodies floating around in your blood ready to go, these cells are in your body hanging out, kind of sleeping and waiting to see if they see the measles. And if that happens, then they make new antibodies and you're able to fight the infection.

GILGER: OK, so as we're watching something like measles come back, which is so dangerous and so, so, so spreadable, who's most at risk even if they are vaccinated? Is it, I'm guessing, old folks and very young folks?

COLES: Yes, old folks and very young folks. Very young folks because they aren't able to get the vaccine, and then older folks because they have a higher risk of complications should they get measles.

And as you mentioned, measles is really very dangerous. About one in five people who catch the measles will be hospitalized. One out of 20 will get a pneumonia. One out of 1,000 will get brain swelling that can lead to long term problems like seizures or death. And about three out of 1,000 people will die.

GILGER: Wow. OK, so at this point, with what you're watching in terms of the spread of measles right now — we've seen like a case pop up in Maricopa County and people warned that if they were in this venue or this location at this time, they may have been around it and then could catch it because it's so easy to catch.

Do you think that everyone should be checking if they have the antibodies they need? Like, how dangerous is this right now?

COLES: I am definitely concerned because the measles outbreaks are spreading. We're seeing more and more of them and more and more people across the country getting it, and I expect that it will happen in Arizona at some point. As you said, we've already seen cases in Maricopa County.

I definitely would encourage everybody to speak with their primary care doctor to talk about their specific risks. The risks and benefits to getting the measles vaccine earlier for younger children or getting updated measles vaccines if needed for those folks who we don't have presumed immunity for.

Because we do want to make sure that we're protecting not only ourselves from this very scary disease, we're protecting those around us who can't get vaccinated, like very, very young kids or people who take immunosuppressing medications or have immunosuppressing conditions and might get very sick from the measles.

GILGER: Do you think it's just a matter of time at this point, that this gets bigger and bigger?

COLES: That is very much my concern, and I think a concern shared by a lot of us in primary care and in public health, that this is going to continue to grow.

GILGER: Wow. OK. And measles, of course, is not the only virus disease out there that we're seeing come back. We're also seeing whooping cough come back. I had a friend whose child contracted this at school. Is this something we've seen in a long time?

COLES: Yeah. Whooping cough was never eradicated in the way that measles was, but has been significantly suppressed due to a successful vaccination campaign. But, yes, we're starting to see diseases like whooping cough have a resurgence because of the low vaccination rates. People don't need to be suffering from these illnesses, and vaccines were developed against them because they are significant illnesses that have potentially very serious consequences for the folks that get them.

I think there is a lot of misinformation about vaccines, vaccine safety and the diseases themselves about how serious they are. I think a lot of it is also driven by fear. Parents and families and individuals want to do the right thing for their health and for their loved ones, but don't always understand what that means. They get a lot of information from the internet or unreliable sources that sound very frightening, and I can understand why they are making these choices.

So I'd encourage everybody to talk to your primary care doctor about what is really out there. What do these things mean? How are these vaccines monitored? Are they safe? When are they indicated? And why are these such a good idea?

I tell all of my patients the most important thing that we're going to talk about in any visit is your vaccines. By far saves the most lives out of any medical intervention we've had in the last 100 years.

GILGER: So when you have those conversations right now, Dr. Coles, like, are you being met with skepticism or people asking a lot of questions and saying, "I don't know, like, it doesn't sound to me like a good idea anymore"?

COLES: Absolutely. Every day, somebody has a question or a concern or hesitation about getting the vaccine. And it's important for me to listen to where they're coming from, why they have this fear or perception, and then to help share good information with them and why I believe so strongly in vaccinating them and their families.

GILGER: What do they say when you push them on that? Are you getting people to believe you? And there is so much skepticism, not just in like vaccines specifically, but there's so much skepticism just of experts in general, right?

COLES: Yeah. There's a lot of science skepticism and skepticism of the medical profession. And a fair amount of that is earned. We have not always been trustworthy as a profession, and I recognize that. I asked for permission to earn individuals' trust. "Let me tell you why I think this is important and why I think this is something that I really want you to do. I'm here to answer any questions that you might have."

Sometimes I'll joke with patients that I'm not going to break into your house and give you a vaccine because that would be assault. But I would if I could. I really think this is important.

GILGER: Are you changing minds?

COLES: Yeah, I think it's about building relationships with your primary care doctor and with me as a doctor with my patients, and recognizing that we all have the same goal, which is the health of our, of ourselves, our patients, our populations and our communities.

And it might take a little bit of time. I don't always change minds in the very first visit or the very first encounter we're talking about that, but it's worth having these repeated conversations because it is so important.

Full conversation