SINGAPORE: Can you get measles even if you have been vaccinated? And what should you do if you come into contact with someone who has the viral disease?

Amid a spike in cases around the world, Singaporeans have been urged to be vigilant as the country is likely to see more imported cases of measles, said the Ministry of Health (MOH) on Tuesday (Jul 23). 

So far this year, there have been 116 measles cases in Singapore, although MOH said there is currently no evidence of a community spread. 

Here is what you need to know about measles and how you can protect yourself.

HOW IS MEASLES SPREAD?

Measles is a highly contagious disease that affects a person’s respiratory system and often results in a skin rash.

The virus spreads easily through direct contact with the saliva or mucus of an infected person, whether through coughing, sneezing or contact with contaminated surfaces.  

While measles is more common among children, it can be contracted at any age if a person has not had the measles, mumps and rubella (MMR) vaccination. 

SYMPTOMS OF MEASLES

Symptoms of measles usually start to appear 10 to 12 days after you come into contact with a contagious person, said MOH on its health portal.

Patient receiving measles vaccination

A child receiving measles vaccination at a hospital. (Photo: AFP/Getty Images North America/Joe Raedle) 

Early symptoms include coughing, a runny or stuffy nose, malaise, red eyes, tearing and a fever.

Two to four days later, bluish-white spots called Koplik’s spots may start to appear on the inside of cheeks. At the same time, or slightly later, a skin rash would spread across the person’s face, neck, trunk, limbs, palms and soles of the feet.

Diarrhoea, vomiting and inflammation of the eyes are also associated symptoms of measles.

HOW DANGEROUS IS IT?

Children are at high risk of developing complications.

While most patients recover completely from measles, it can also lead to ear infection and pneumonia for older patients.

In rare cases, measles may cause encephalitis – an acute inflammation of the brain – and increase the risk of seizures, epilepsy, mental disability, coma or death.

WHY IS MEASLES VACCINATION COMPULSORY IN SINGAPORE?

Measles epidemics used to occur every one to three years in Singapore during the 1960s and 1970s, and most children developed measles after the age of one.

A measles vaccination was introduced in 1976, but the acceptance rate was poor because of “cultural beliefs that measles is an innocuous and inevitable childhood infection”, said MOH in a report.

Child with measles in the Philippines 2

A rash seen on a child infected with measles in the Philippines. (Photo: Jack Board) 

In 1984, there was a record of 2,417 cases, including seven deaths. 

The following year, measles vaccination, which consists of two doses, was made compulsory for all Singaporean children aged 12 to 24 months.

Earlier this year, it was made compulsory for foreign children applying for a long-term visit pass to be fully vaccinated against measles.

IS IT POSSIBLE TO GET MEASLES EVEN AFTER VACCINATION? 

Those who have had the two doses of MMR vaccines are usually considered protected for their entire lives, said Dr Yan Shiyuan, medical director at Edgedale Medical Clinic (Cambridge).

“The two doses of MMR vaccines are 97 per cent effective against measles,” he told CNA.

Dr Yan added that while some might still get measles despite being vaccinated, this may be due to a decrease of the immune system’s ability to fight the virus over time.

“There are also some people with immune systems that may not produce sufficient antibodies to fight the virus after being vaccinated,” he explained.

Measles outbreak in Ukraine

A nurse prepares a measles vaccine to vaccinate a girl in the school of Lapaivka village near the western Ukrainian city of Lviv. (Photo: AFP/ Yuri Dyachyshyn)

SHOULD TRAVELLERS GET VACCINATED?

If you are travelling to places with a high-risk of measles infection, Dr Yan’s advice is to take the necessary vaccinations beforehand. 

“Children (below the age of 12 months) and adults with no documented evidence of measles vaccination should receive two doses of MMR vaccine at least 28 days apart,” said Dr Yan. 

Infants between six to 11 months old travelling to high-risk countries should also receive one dose of vaccination, followed by another two doses at 12 months and 15 months. 

For adults, those who have evidence of only one dose of the vaccine should receive a booster shot before travelling.

“It is important to ensure good hygiene during travel such as frequent hand washing, wearing a face mask and avoiding close contact with sick people,” he added. 

WHAT TO DO IF EXPOSED TO A PERSON WITH MEASLES 

If a person has been exposed to measles, they should talk to their doctor about vaccination, said Dr Yan.

“It is not harmful to be vaccinated after being exposed to measles,” he said.

“If a person receives MMR vaccination within 72 hours after exposure, they may be able to get some protection against the disease or have milder symptoms.”

Children below the age of 11 months should especially avoid contact with an infected person. They should also be taken to the doctor for consultation on vaccination. 

Measles Philippines

Measles has resulted in hundreds of deaths this year in the Philippines. (Photo: Jack Board)

WHY THE INCREASE IN MEASLES CASES HERE AND AROUND THE WORLD?

If most Singaporeans have been vaccinated against the disease, then what are the possible reasons for the rise in measles cases?

In May, Minister of Health Gan Kim Yong said in Parliament that the global increase in measles outbreak was due to “declining vaccination coverage in many countries”.

“This has resulted in a significant increase of non-immune individuals in the community, making it easier for the disease to spread,” said Mr Gan.

“Being a travel hub, Singapore is also exposed to imported cases.”

READ: As a measles epidemic rolls through the Philippines, blame falls on bungled vaccination programme

READ: Measles threat looms in Philippines as trust in vaccines declines: Health officials

On Tuesday, MOH said that of the 116 measles cases confirmed this year, 88 were local and 28 were imported rom Bangladesh, Dubai, Malaysia, New Zealand, Philippines, Thailand and Vietnam.

Measles cases rose 300 per cent globally through the first three months of 2019 compared to the same period last year, according to the World Health Organization.

This has been attributed to slipping vaccination rates amid a so-called anti-vax movement. The movement has been driven by claims linking the MMR vaccine to the risk of autism in children.