As measles cases continue to rise in the United States, pediatricians are reporting an increased number of calls from families wondering if they can get their children vaccinated earlier than recommended by the Centers for Disease Control and Prevention.
While doctors said families sometimes request early vaccination when they are traveling to high-risk countries, the new uptick is likely driven by the domestic measles surge, which has infected more than 300 people and killed two. Most cases are concentrated in Texas and New Mexico, but on Tuesday officials in Vermont reported the state’s first case of measles this year. Rhode Island reported its first case in over a decade in January.
“When you hear stories about people getting measles, or unfortunately, school-aged children dying from measles, it brings up the question, ‘What can I do to protect my family?’” said Dr. Brenda Anders Pring, president of the Massachusetts Chapter of the American Academy of Pediatrics.
The CDC recommends children get the first dose of the MMR vaccine, which includes protection against measles, mumps, and rubella, when they are between 12 and 15 months old. The second dose is given when children are between the ages 4 and 6. Recently, parents have been asking if their kids can get the first shot before they turn 1 or the second shot before they’re 4, pediatricians said.
“Our nurses are being inundated with calls from families,” said Pring, who is also a pediatrician at a clinic in Boston and at Beth Israel Deaconess Medical Center.
Somerville resident and mom Emily Hwang got her 2-year-old daughter her first measles vaccine when she was 1, on the recommended schedule. But the recent outbreak of measles led Hwang to get her daughter the second dose two years early.
“I contacted my pediatrician and asked, with the measles epidemic happening now, should I be doing something?” Hwang said. She added, “The doctor said it was safe for her to get a second one, and she recommended it.”
Despite the surge in cases, experts said they still advise parents to vaccinate children on the CDC schedule unless they are traveling to areas with outbreaks. If parents do decide to give their kids the first vaccine dose before they turn 1, it would offer temporary protection but wouldn’t count toward the two-vaccine series.
That’s because before the age of one, a child’s immune system is still developing, and a shot given that early isn’t considered sufficient to provide long-term protection.
“A truly early dose is between 6 and 11 months, but we’re not recommending that unless someone is going to an area with an outbreak,” said Dr. Vandana Madhavan, a pediatric infectious disease specialist and primary care pediatrician at Mass General Hospital for Children.
Dr. Shirley Huang, chief of general pediatrics at Tufts Medical Center, said questions about early vaccination are increasingly coming from families who aren’t traveling but are still concerned about exposure at day care or from people coming to visit from other states.
“What we’re doing is asking for potential exposures if they are traveling, if they’re traveling to states within the US with higher risk,” Huang said. “We might recommend it at that point, but we’re not recommending it to everybody.”
Amy, a mom of two who lives outside Providence, R.I., is getting her 8-month-old daughter her first vaccine early, even though it won’t count toward the two-dose series. Amy asked that her last name not be used for privacy reasons.
“We travel a decent amount, and we weighed the costs and benefits, and it seemed like the right move to get it now and get that protection for our little one,” she said. Her 3-year-old got her first vaccine on schedule, and because it offers significant protection, Amy said the family isn’t as concerned about her getting her second shot early but still wants to ask her pediatrician about it.
The first dose provides 93 percent protection from measles; the second dose boosts measles protection to 97 percent, according to the CDC.
“It doesn’t feel super likely [that they’ll get measles], but it also feels like the risk and the potential downsides are just so high that it feels like an easy thing to do to reduce that risk from nothing to zero,” Amy said.
The second vaccine can be administered 28 days after the first dose, when the first dose is given after the age of 1. But the CDC recommends that it be given at 4 years old, because at that point, kids can receive a combined vaccine for MMR and varicella, or chicken pox.
“Historically, it’s been at age 4 just to capture multiple different vaccines so we’re not piecemeal giving, ‘Here’s this booster at 3, here’s a booster at 3 1/2, etc,’ and just doing a 4-year visit for a combination of vaccines,” Madhavan said, adding that that age also coincides with when a child is likely to need other vaccinations to start kindergarten.
The CDC recommends a child’s first MMR dose be given with a varicella vaccine, though separately and at different injection sites, Pring said. For the second dose, parents can choose between a child receiving one shot that protects against both MMR and varicella, or MMRV, or receiving the two vaccines separately.
“We typically don’t [give the combination vaccine] to infants and young toddlers because of a higher rate of fevers and seizures with the combination vaccine,” Madhavan said. Still, the risk of febrile seizure — a seizure caused by a high fever — is only 0.08 percent in children age 12-23 months old when they receive a combination vaccine. After a child turns 4, there is no difference in risk between the two options.
Madhavan said there is no downside to separately administering the second MMR dose 28 days from the first; it still offers generally life-long protection from measles.
“Certainly, if someone is traveling internationally or traveling to an area in the US with an outbreak and it’s been four weeks since the first dose, we certainly recommend giving the second dose early,” she added.
If a child does just get that first vaccine early out of precaution, experts said it’s likely to reduce the severity of illness.
“There’s significant protection, but this is why we need everybody to be vaccinated — so that if there is someone who is in that 5 percent that doesn’t respond [to the vaccine], that they’re not picking it up from someone else,” Pring said.
Emily Spatz can be reached at [email protected]. Follow her on X @emilymspatz.
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