Measles outbreak may pose special threat to cancer patients

Once thought to be all but eliminated in the United States, measles is once again spreading in certain areas of the country. The disease may cause challenging complications in many patients, especially cancer patients and others with compromised immune systems.

Once thought to be all but eliminated in the United States, measles is once again spreading in certain areas of the country. As of mid-June, more than 1,000 cases of measles were reported in 28 states, according to the Centers for Disease Control and Prevention (CDC). And while some dismiss measles as a minor childhood illness, doctors and scientists warn that the condition can be very serious. Measles may cause challenging complications in very young patients, adults, pregnant women and especially cancer patients and others with compromised immune systems.

Measles complications can happen in immune-compromised hosts,” says Dr. Mashiul Chowdhury, Chief of the Division of Infectious Disease at Cancer Treatment Centers of America® (CTCA). “And almost all cancer patients are immune-compromised.” Fevers that last longer than their typical duration of two or three days point to a complication from measles, he says. Patients may also develop pneumonia, or a brain infection called encephalitis. The most common complication is diarrhea.

A rash of new cases

  Year   Measles 
2010 63
2011 220
2012 55
2013 187
2014 667
2015 188
2016 86
2017 120
2018 372
2019* 1077

Measles was once a common disease in the United States. Prior to the development of the measles vaccine in the early 1960s, more than 500,000 cases of measles and about 500 deaths were reported every year. According to the CDC, millions more cases went unreported. By 2000, thanks to the widespread use of vaccinations, the disease was declared eliminated in the United States, meaning that, while occasional outbreaks occurred, no concentrated populations were infected. According to the World Health Organization, the vaccine reduced the number of measles deaths worldwide by 80 percent.

Still, measles is common in other countries. Nearly 90,000 people die from measles worldwide. Fueled by unfounded claims about the dangers of vaccines, the number of children vaccinated for measles and other diseases has declined in recent years, according to the National Institutes of Health, which describes the rise in measles and the decline in vaccinations as “alarming.”

“This virus is very contagious,” Dr. Chowdhury says. “If 10 people get exposed to the virus, nine will get the measles. It’s an extremely contagious disease. We wouldn’t have these cases if people were following vaccination recommendations.”

Facts about measles

According to the CDC:

  • 20 percent of unvaccinated measles victims are hospitalized.
  • 5 percent of children with measles develop pneumonia, the leading cause of death from measles.
  • Unvaccinated pregnant women have an increased risk of delivering prematurely or having a baby with a low birth weight.
  • Measles cases have been reported in 28 states, including Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Virginia and Washington.

Measles and cancer

Cancer patients may be more susceptible to measles and other viruses while undergoing treatment, especially while taking chemotherapy drugs that often cause immunosuppression. Patients already are urged to be vigilant if they, their family members or caregivers develop signs of an infection or severe or unusual symptoms. Signs and symptoms specific to measles include:

  • High fever
  • Cough and/or runny nose
  • Conjunctivitis (puffy, red and watery eyes)
  • White spots inside the mouth
  • Rash (usually starting on the face and head and moving down the body)

Cancer patients should also be aware of the potential exposure to measles if they, their family members or caregivers travel. “When patients complain of a fever or rash, doctors need to ask questions about travel,” Dr. Chowdhury says. “Travel history is very, very important—especially travel to an area that has experienced a pocket of measles infection.”

Dr. Chowdhury recommends cancer patients make sure their family members and caregivers have received the MMR vaccine (for measles, mumps and rubella). But cancer patients themselves cannot receive the vaccine because it contains a live virus, which can cause the disease rather than prevent it in patients with a compromised immune system.

Cancer patients should talk to their doctor about receiving immunoglobulins if they are exposed to measles, which may prevent them from getting the disease. One important step in prevention, Dr. Chowdhury says, is to take steps to avoid exposure. “What can we do? It’s avoidance, avoidance, avoidance,” he says. “Patients really need to be educated. Be aware of where outbreaks are happening and avoid those locations.”

Tips for preventing infection

To help prevent infection during cancer treatment:

  • Watch out for signs of infection, such as fever, fatigue or diarrhea.
  • Wash your hands frequently with warm water and soap.
  • Avoid traveling to areas known to have an outbreak of disease or illness.
  • Avoid people you suspect may be sick.
  • Talk to your doctor about which immunizations you can receive during treatment.
  • Do not share food, drinks or utensils with others. Avoid raw or undercooked foods.

Learn more about preventing infections during cancer treatment.