I recently asked for titers due to a close miss with a measles exposure in my local Costco and learned that while measles and rubella were still holding up great, my mumps immunity was at 0. I also learned I had no Hep B immunity so, presumably, I never got it. I missed the varicella vaccine due to its timing and my age, but figured that out in my mid-30s when my stepdaughter got shingles and gave me chickenpox. Fortunately, I knew what that was immediately and was able to get antivirals. I'm 48, to put that in age perspective. I have one Hep B remaining and then I will be all caught up.
I really feel that titers should be encouraged for everyone. No one wants to catch this stuff!
I mentioned it, the doctor questioned my reasoning because she didn't know of any measles outbreaks, and I was able to point to some incidents in recent news. She ordered it, and my insurance covered it fully. No questions even asked by insurance!
I taught a program that required healthcare providers to provide proof of immunity to all the usual diseases and was surprised at how many showed lapsed immunity to childhood diseases they’d had as kids. So had my titers drawn and - to my surprise - had no immunity to varicella! (I had chicken pox in 1962). So I stood in line at the health dept with all the school-age kids one August and got vaccinated. Never hurts to check!
We actually do have a lot of longitudinal studies on these things - the issue is a matter of probability. If we expect waning in 10% of people to a level that is below protection… that means 90% of people are still protected. We are still early in some vaccination programs (varicella for example) or have imperfect vaccines (mumps) but for a number of them, getting tigers on everyone is just… not worth the effort.
For those born before 1957, we assume they (we) all had measles as children. Did we all? Is there any evidence that people born before 1957 should be vaccinated or titers checked for previous disease?
I had both measles as a kid - the “hard” measles very badly, and the the “German” measles a few years later. The German measles were very mild, compared to the first bought. I felt fine - but my teacher saw me flushed and took me into the girls bathroom to check my torso, where I did have the rash. My immunity to both has held.
It’s based on the estimated immunity and circulation and infectivity of measles in the population. Measles is EXTREMELY infectious in a naive population so the odds of not having had it in the pre vaccine era are very slim.
I am curious about this too. I was born after 1957, but my husband's much older siblings who were not. They do not think they had measles. Are cases very mild in young kids?
This is very interesting because I was born in 1950 and remember very clearly getting measles at age 13. When I became pregnant at age 23 (50 years ago. ha-ha), my Dr. asked if I had had measles. When I said yes, he said he would do a measles titer to be sure I had immunity so I would not need to worry about that during my pregnancy, especially since I couldn't get vaccinated as I was already pregnant. The titer indicated I did have immunity and that was one thing I didn't worry about during the rest of my pregnancy. Fast forward to my late 40s when I went back to college and had to get the MMR to enroll. I knew I was most likely immune but went ahead and got the vaccine anyway because it was just quicker and easier than seeing if I could get another measles titer done. I think nowadays its just standard to take care of this and many other health concerns prior to even trying to get pregnant.
Great article. These are the facts I've dealt with for the last 20 years (as patients and grandparents became more skeptical about vaccines). I have always been worried about older parents and I now worry about vaccine deniers. We sent many grandparents for titers. The problem became that only the "old timers" could recognize measles and rubella creating problems in dealing with parents and even the state.
I was born in 1960 and believe I had the normal two vaccines. I also think I had a vaccine in the early 80's in college. However I had a titer done some years ago possibly 2013 and found that I didn't have any immunity and got a booster. I think my age group should check to see if their vaccine has worn out and get a booster particularly if going abroad or being near young children. I really don't think I was in the age cohort which ran into notably short lived vaccines.
I got the “killed” version of the measles vaccine in 1966 and a titer showed I had no immunity. Probably worth looking into to if one was vaccinated between 1963-1967.
I had measles, chicken pox and whooping cough over 60 years ago. I never had the mumps. Now I have grandchildren who seem to be petri dishes. Should I get the vaccination?
Just wondering, for those of us of a certain age that acquired immunity the old fashioned way, can it be assumed the waning of coverage will be similar to those vaccinated and age?
I had all three...measles, mumps and German measles, and chicken pox, too!!....as a kid. If someone we knew had one of them, all the kids would visit to get exposed....herd immunity the old fashioned way??
This is very confusing: "A breakthrough case is rare but possible (3 out of 100 fully vaccinated people will get infected). " That makes it sound like 3% of vaccinated adults in the US are going to get measles. I can't imagine this is true, as measles is still very rare. Do you mean that out of every 100 people who get measles, on average 97 are unvaccinated and 3 are vaccinated?
Glad you raised this question, Meg - statistics are so often stated ambiguously. Perhaps it means that if 100 fully vaccinated people are "exposed" to measles, 3 will become infected. But what counts as "exposed?" Hopefully the study this statement is based on clarifies that. Almost as bad is "X out of every 100 people," since it's NOT really *every* 100 people - the average conceals a range of susceptibilities and exposure intensities.
I am a HUGE fan of your work, and I thank you from the bottom of my heart. Not a week goes by that I don't say to a friend, " Well ,my favorite epidemiologist says." ... Small point about recent piece: you said "But nothing is perfect. A breakthrough case is rare but possible (3 out of 100 fully vaccinated people will get infected)." Might sound like 3% of the fully vaccinated population are going to get it. Don't you mean: "Of 100 cases that occur, 3 will be in fully vaccinated people"?
I am 73. I had measles when I was about four years old. I have never been vaccinated for measles (or mumps (which I never had) and rubella which I did.) Should I get vaccinated?
I was born in 1951, and thus resumed to be immune from measles. However, when i took a new job at a different hospital as a clinical pharmacist, proof of immunity was required. I was not, and had the vaccine. Good thing for a bad disease.
I recently asked for titers due to a close miss with a measles exposure in my local Costco and learned that while measles and rubella were still holding up great, my mumps immunity was at 0. I also learned I had no Hep B immunity so, presumably, I never got it. I missed the varicella vaccine due to its timing and my age, but figured that out in my mid-30s when my stepdaughter got shingles and gave me chickenpox. Fortunately, I knew what that was immediately and was able to get antivirals. I'm 48, to put that in age perspective. I have one Hep B remaining and then I will be all caught up.
I really feel that titers should be encouraged for everyone. No one wants to catch this stuff!
Yes, I have never had a medical professional mention titers to me. I am wondering about that.
I mentioned it, the doctor questioned my reasoning because she didn't know of any measles outbreaks, and I was able to point to some incidents in recent news. She ordered it, and my insurance covered it fully. No questions even asked by insurance!
I taught a program that required healthcare providers to provide proof of immunity to all the usual diseases and was surprised at how many showed lapsed immunity to childhood diseases they’d had as kids. So had my titers drawn and - to my surprise - had no immunity to varicella! (I had chicken pox in 1962). So I stood in line at the health dept with all the school-age kids one August and got vaccinated. Never hurts to check!
It sounds like maybe we should be checking every 10-15 years. I wonder why it's rarely suggested.
We actually do have a lot of longitudinal studies on these things - the issue is a matter of probability. If we expect waning in 10% of people to a level that is below protection… that means 90% of people are still protected. We are still early in some vaccination programs (varicella for example) or have imperfect vaccines (mumps) but for a number of them, getting tigers on everyone is just… not worth the effort.
For those born before 1957, we assume they (we) all had measles as children. Did we all? Is there any evidence that people born before 1957 should be vaccinated or titers checked for previous disease?
I had both measles as a kid - the “hard” measles very badly, and the the “German” measles a few years later. The German measles were very mild, compared to the first bought. I felt fine - but my teacher saw me flushed and took me into the girls bathroom to check my torso, where I did have the rash. My immunity to both has held.
It’s based on the estimated immunity and circulation and infectivity of measles in the population. Measles is EXTREMELY infectious in a naive population so the odds of not having had it in the pre vaccine era are very slim.
I discussed this with my PC doc a while back. I wasn't sure whether I'd ever had measles or not, so I got the MMR booster just in case.
I am curious about this too. I was born after 1957, but my husband's much older siblings who were not. They do not think they had measles. Are cases very mild in young kids?
Not shown in the image about measles risks is one more especially bad thing: that measles destroys a lot of existing immune memory:
https://news.harvard.edu/gazette/story/2019/10/how-measles-wipes-out-the-bodys-immune-memory/
https://www.bbc.com/future/article/20211112-the-people-with-immune-amnesia
This is very interesting because I was born in 1950 and remember very clearly getting measles at age 13. When I became pregnant at age 23 (50 years ago. ha-ha), my Dr. asked if I had had measles. When I said yes, he said he would do a measles titer to be sure I had immunity so I would not need to worry about that during my pregnancy, especially since I couldn't get vaccinated as I was already pregnant. The titer indicated I did have immunity and that was one thing I didn't worry about during the rest of my pregnancy. Fast forward to my late 40s when I went back to college and had to get the MMR to enroll. I knew I was most likely immune but went ahead and got the vaccine anyway because it was just quicker and easier than seeing if I could get another measles titer done. I think nowadays its just standard to take care of this and many other health concerns prior to even trying to get pregnant.
Great article. These are the facts I've dealt with for the last 20 years (as patients and grandparents became more skeptical about vaccines). I have always been worried about older parents and I now worry about vaccine deniers. We sent many grandparents for titers. The problem became that only the "old timers" could recognize measles and rubella creating problems in dealing with parents and even the state.
I'm 72 and I've had measles but not mumps. I don't know if I've had the MMR. Should I request a titer test to see, or just get the MMR?
I was born in 1960 and believe I had the normal two vaccines. I also think I had a vaccine in the early 80's in college. However I had a titer done some years ago possibly 2013 and found that I didn't have any immunity and got a booster. I think my age group should check to see if their vaccine has worn out and get a booster particularly if going abroad or being near young children. I really don't think I was in the age cohort which ran into notably short lived vaccines.
I got the “killed” version of the measles vaccine in 1966 and a titer showed I had no immunity. Probably worth looking into to if one was vaccinated between 1963-1967.
Thanks, it is about time that someone answered many of our questions. I will contact my doctor since I got the same vaccine you got.
I too would like to know if I should get an MMR now. Born in 1951, I had both measles and mumps.
I had measles, chicken pox and whooping cough over 60 years ago. I never had the mumps. Now I have grandchildren who seem to be petri dishes. Should I get the vaccination?
Just wondering, for those of us of a certain age that acquired immunity the old fashioned way, can it be assumed the waning of coverage will be similar to those vaccinated and age?
I had all three...measles, mumps and German measles, and chicken pox, too!!....as a kid. If someone we knew had one of them, all the kids would visit to get exposed....herd immunity the old fashioned way??
This is very confusing: "A breakthrough case is rare but possible (3 out of 100 fully vaccinated people will get infected). " That makes it sound like 3% of vaccinated adults in the US are going to get measles. I can't imagine this is true, as measles is still very rare. Do you mean that out of every 100 people who get measles, on average 97 are unvaccinated and 3 are vaccinated?
Glad you raised this question, Meg - statistics are so often stated ambiguously. Perhaps it means that if 100 fully vaccinated people are "exposed" to measles, 3 will become infected. But what counts as "exposed?" Hopefully the study this statement is based on clarifies that. Almost as bad is "X out of every 100 people," since it's NOT really *every* 100 people - the average conceals a range of susceptibilities and exposure intensities.
It also keep in mind that no vaccine is 100%
How can people tell whether they once had measles (rubeola) or German measles (rubella)? Does vaccination prevent one of these or both?
The MMR vaccine protects against both (plus mumps).
Thank you. I had that many years ago; just wondering which kind of measles I had as a child.
I am a HUGE fan of your work, and I thank you from the bottom of my heart. Not a week goes by that I don't say to a friend, " Well ,my favorite epidemiologist says." ... Small point about recent piece: you said "But nothing is perfect. A breakthrough case is rare but possible (3 out of 100 fully vaccinated people will get infected)." Might sound like 3% of the fully vaccinated population are going to get it. Don't you mean: "Of 100 cases that occur, 3 will be in fully vaccinated people"?
I am 73. I had measles when I was about four years old. I have never been vaccinated for measles (or mumps (which I never had) and rubella which I did.) Should I get vaccinated?
I was born in 1951, and thus resumed to be immune from measles. However, when i took a new job at a different hospital as a clinical pharmacist, proof of immunity was required. I was not, and had the vaccine. Good thing for a bad disease.