Measles and Down Syndrome

Key Points

• Measles is a highly contagious infection.

• It can have very serious complications.

• There has been a recent increase in measles infections. 

• Little is known about measles infection specifically in people with Down syndrome.

• The immunization recommendations for measles are the same for people with Down syndrome as the rest of the population.

 

Introduction

Measles is a viral infection that many individuals have never experienced or even seen in the United States and many other parts of the world. With the introduction of the measles vaccine in the early 1960s, measles infections have markedly reduced. More on the history of the measles vaccine is available from the World Health Organization .

Unfortunately, at various times and in various places, lower vaccination rates contribute to outbreaks of measles. In March 2024, the Centers for Disease Control and Prevention (CDC) issued a health alert about an increase in measles cases  in the U.S. and globally.

 

Symptoms

It is known that people with Down syndrome are generally more susceptible to infections and may have more severe courses of an infection due to differences in their immune system. However, we could not find information that specifically addresses differences in measles infections in people with Down syndrome.

Measles is a highly contagious illness. It can cause severe health complications including pneumonia, hearing impairment, encephalitis (inflammation/infection of the brain), and death, primarily in those who are not vaccinated.

The onset of the illness usually includes: 

• Fever

• Cough

• Runny nose

• Pink eye (conjunctivitis)

Two to three days after the above symptoms, tiny white spots called Koplik spots may appear inside the mouth. 

Three to five days after the initial symptoms, the rash associated with measles appears. It usually begins as flat, red spots that appear on the face at the hairline and spread downward to the neck, trunk, arms, legs, and feet. Small, raised bumps may appear on top of the flat spots. The spots may become joined together as the rash spreads.

 

How is measles spread?

The virus is transmitted through contact with infectious droplets or by airborne spread when an infected person breaths, coughs, or sneezes. The virus can remain in the air and on surfaces for 2 hours. People with measles are typically contagious from 4 days before the rash to 4 days after the rash starts. After being exposed to measles, it typically takes 7-12 days to develop a fever. The rash typically occurs 7-21 days after exposure. As the CDC website  states, if a person thinks they have been exposed to measles, they should call their healthcare provider immediately. 

 

Vaccines

Vaccine recommendations for measles for people with Down syndrome are the same as the rest of the population.

Measles is almost entirely preventable by getting vaccinated. The measles vaccine is a live virus vaccine and is typically grouped with mumps vaccine and rubella (German measles) vaccine into the Measles/Mumps/Rubella (MMR) vaccine or those three with varicella/chicken pox (MMRV). It is recommended as a 2-dose series in childhood (age 12-15 months and again between 4-6 years). 

Because it is so contagious (it is sometimes called the most contagious infection), it is important that a high rate of vaccination is done in the community. The recommendation is to have at least 85% of the population vaccinated to prevent outbreaks. 

Should adults get vaccinated?

Adults are presumed to be immune if:

• They received one or more doses of measles-containing vaccine on or after their first birthday and they are not at high risk.

• They received two doses of measles-containing vaccine and are at high risk. High risk includes:

  • College studies

  • Healthcare personnel

  • International travelers

• A blood test is done that demonstrates immunity.

• They had measles infection that was confirmed by lab testing at the time of the infection.

• They were born before 1957.

There are a few conditions or situations for which it may be recommended to delay or avoid measles vaccine. Additional information, including information about potential side effects, is available on the CDC's Measles, Mumps, and Rubella (MMR) Vaccination  page.

MMR and autism

In the late 1990s, a paper was published in a medical journal called The Lancet that linked the MMR vaccine to the development of autism. This was found to be false. It was discovered that the researcher engaged in misconduct. The researcher lost his medical license and was prevented from practicing the medicine. The paper was also retracted from The Lancet.