As if cancer patients don’t have enough they need to focus on during their health care journeys — do they now need to add measles, a disease we were supposed to have eradicated, to the list? Due to a recent outbreak of the age old virus, SurvivorNet’s network of expert doctors is urging cancer patients to be vigilant.
“Live vaccines like MMR can be dangerous for cancer patients, who may not be able to mount an immune response necessary for the vaccine to work,” said Dr. Heather Yeo, an advisor to SurvivorNet, Assistant Professor of Surgery and Healthcare Policy and Research at Weill Cornell Medical College, and assistant attending surgeon at NewYork-Presbyterian/Weill Cornell Medical Center says.READ MORE
The resurgence of measles, which had been largely eliminated in the U.S. due to vaccinations, has been enormously controversial as public health officials have harshly criticized some religious and ideological groups, including some Ultra-Orthodox Jews in the New York City area, for refusing to vaccinate their children and thereby putting babies who are too young to be vaccinated — as well as elderly adults — at risk of a potentially deadly measles infection.
But another at-risk group for measles has gotten less attention but may be facing a similar risk: adult cancer patients who were vaccinated as small children but whose immune systems have been compromised by aggressive cancer treatments such as chemotherapy.
So how does cancer affect measles risk? Can patients with cancer get measles, even if they were once vaccinated? How should patients with compromised immune systems following cancer treatment protect themselves from the virus? SurvivorNet turned to our expert advisors to unpack what the measles outbreak means for patients with cancer.
First, What is Measles, Exactly?
Measles is a respiratory virus with symptoms that include nasal congestion, coughing, inflamed eyes, a high fever (up to 105˚F), and a blotchy telltale rash that shows up on the chest, back, and face. Adult patients with healthy immune systems who contract measles can usually recover on their own, and antibiotics can treat bacterial infections such as pneumonia or ear infections that can come with the virus.
But for elderly adults, young children, and those with compromised immune systems, measles can be dangerous—and potentially fatal. This is especially problematic given the contagious nature of the virus.
“Measles is very contagious,” Dr. Yeo said. “It’s spread through respiratory droplets from saliva, which can continue to be contagious after they have been on surfaces for several hours.”
According to the U.S. Centers for Disease Control and Prevention (CDC), if someone has measles, up to 90 percent of the people close to that person who are not immune to the virus will contract measles, too.
Luckily, in the 1960s, the U.S. introduced a measles vaccine and recommended all children receive it twice—once at 12 to 15 months old, and again at 4 to 6 years old. Today’s measles vaccine is given in a single, combined shot called the MMR vaccine, which also protects against mumps and rubella.
The vaccine was—and still is—highly effective in preventing the spread of measles. In 2000, in fact, as a result of the vaccine, the U.S. announced that it had entirely eliminated the virus after a period of twelve months with no reported cases.
So Why is There an Outbreak Today?
The resurgence of measles probably started when someone unvaccinated traveled outside the country, picked up the virus, then brought it back to the U.S. Measles has since spread quickly and powerfully throughout communities of people who—be it for religious, personal or (unfounded) scientific reasons—have chosen not to vaccinate their children.
In some particularly affected areas, such as Brooklyn, N.Y., officials have proposed fines for failing to vaccinate children, although laws that actually force people to get the vaccine are controversial; some consider mandated vaccinations unethical.
Measles Risk for People with Cancer
For those living with leukemia, lymphoma, multiple myeloma, or other cancers that either originate in or have spread to the bone marrow (where the body produces the cells that fight off infection), the risks and complications of the measles virus can be especially dangerous.
Certain cancer treatments can also heighten measles risk. Chemotherapy can decrease white blood cell counts, and stem cell transplants, during which the bone marrow is essentially eliminated with a strong dose of chemotherapy then replaced either with a healthy donor’s marrow or the body’s own marrow, can leave the body’s immune system compromised.
Frequently, patients are given immunosuppressant drugs after a stem cell transplant to prevent the body from attacking the donor’s bone marrow, a condition called “graft-versus-host disease”. These drugs are effective in preventing and treating transplant complications, but they also make it so that the body cannot effectively fight off viruses like measles.
I Was Vaccinated Before I Got Cancer. Am I Safe from Measles?
Vaccines work by introducing the immune system to a small dose of a virus so that the body can build up immunity should it come in contact with that virus again in the future.
Unfortunately, wiping out the body’s immune system and replacing it to treat cancer can make the body “forget” what it learned from a past vaccine—that is, how to fight a specific virus. This is especially true after a stem cell transplant.
“The purpose of [the stem cell transplant] is the high-dose chemotherapy,” Dr. Caitlin Costello, hematologist-oncologist at UC San Diego Health, told SurvivorNet. “That chemotherapy is going to really kind of hit the reset button. It’s a way to start anew, start afresh.”
So even if you were vaccinated, your treatment may have erased your measles immunity.
Dr. Yeo suggests that patients who have received stem cell transplants should be tested to see if they still have antibodies after the procedure. Even if the antibodies are not completely gone, Dr. Yeo added that the immune system may need a vaccine booster.
And while some vaccines can be re-administered following cancer treatment, the measles vaccine usually can’t be given again until the immune system is functioning and strong enough to fight the small dose of virus that the vaccine introduces.
Dr. Yeo added that, “Also, the patient can get sick from the vaccine itself.”
The Advisory Committee on Immunization Practices (ACIP) recommends that patients should not be vaccinated while receiving cancer treatment, and that live vaccines should not be given within four weeks of treatment.
What Can I Do to Protect Myself from Measles During and After Cancer Treatment?
“Patients with compromised immune systems should be careful,” Dr. Yeo says. “Handwashing is important.”
Immunocompromised patients should do their best to steer clear of unvaccinated individuals (whenever they can, that is—we know it’s not always possible to know for sure). Dr. Yeo also recommends letting others know that you are at risk, too.
And if you think you have been exposed to measles during or after cancer treatment, tell your doctor right away. You will likely receive immune globulin, which can help fight the virus preemptively.
“It’s hard to say patients should never go out in public,” Dr. Yeo says. “But the outbreak is certainly very concerning, and anyone who can be vaccinated should be.”