Last week, employees at one Google’s Mountain View campus buildings received an unsettling memo from a company physician: a Googler who visited that office earlier this month had been diagnosed with the measles, it announced. Details were scant, but employees were urged to read an advisory from the local health authorities.
Days before that, headlines reported that a flight attendant for Israel’s El Al airline had slipped into a coma after developing measles-related encephalitis. That company began vaccinating its crews immediately, setting up a clinic at the Ben Gurion airport. Now, Israel’s Health Ministry is urging all of the country’s airlines to do the same.
Both cases illustrate an alarming fact: The measles, a highly contagious viral infection that was all but eradicated in much of the world decades ago, has once again become a concern for all workplaces—not only schools and hospitals, where there’s a higher risk of exposure from infected children. For those who are not vaccinated, the danger is everywhere, says Stephen Morse, an epidemiologist at Columbia University.
Morse argues that employers should start treating the measles like it’s their problem, too. Companies ought to make it easy for workers who know or suspect they need to get vaccinated to visit a doctor’s office and still be compensated. Even better, they could hold on-site vaccination clinics, as many companies do for the flu, he suggests, eliminating the inconvenience factor as an excuse for not getting jabbed.
It’s not such a stretch to imagine. Employers already put subtle pressure on staff to stay healthy, by stocking healthy foods in their cafeteria, banning smoking, and subsidizing gym memberships, and “this is an easier decision than exercising,” Morse says.
Awareness alone is a step in the right direction, Morse adds. Indeed, many of us have not given much thought to what measles means to adults in an office setting, even though the measles outbreak in the US is now the second largest since the disease was declared eliminated (no longer endemic) in the US nearly 20 years ago. Since January 1, there have been 626 cases of measles reported in 22 states, the CDC reported this week.
So Quartz at Work has gathered some answers to the most pressing questions you might have on this topic. (Note: This article is for informational purposes only, and should not be taken as medical advice. If you think you’re at risk of contracting measles, speak to a health professional.)
Does an adult really need to worry about the measles?
Yes, if that adult did not have measles as a child and has never been vaccinated.
In that case, a person would not be immune to measles, which is “right up there at the top” of the world’s most easily transmitted infections, says Morse. The measles virus is literally 10 times as transmissible as the flu, he explains. So, if a person has the flu, the number of additional cases that first case will give rise to is just under two, on average. “That’s assuming everyone around that person is susceptible, i.e., not immune to that flu virus,” says Morse. “But with measles, that number rises to about 15 to 20 people” (again, assuming those people are not immune).
For two hours after someone sick with measles has left a room, measles can lurk, “waiting to infect,” writes the Los Angeles Times . And you might not know that you just shared a conference room with the measles: The disease has an incubation period of 10 to 14 days before any symptoms appear. Someone is contagious the four days before and four days after a rash appears.
Children under five years old and adults over age 30 have a higher risk of developing serious, sometimes life-threatening complications from measles, according to the World Health Organization. We tend not to take measles seriously because it hasn’t been a menace for decades, says Morse, but we should. Measles is fatal in three out of every 1,000 cases.
Why do we need to worry about the workplace?
A better question may be “Why not?”
Whether or not you travel for work, Morse says, there’s a chance you’ll cross paths with someone who has been in a country where the measles is “smouldering.” So far in 2019, measles has been reported in 170 nations. And the number of cases globally has quadrupled compared to the same period last year.
Next, consider that kids visit their parents’ workplaces for all sorts of reasons, and some of those kids may be carrying the virus. Perhaps they’re too young to have been vaccinated, or maybe their parents refused immunizations, taking an anti-vaccination stance, or believing, sometimes mistakenly, that vaccinations are prohibited by their religion.
Basically, he says, in any job where you work around people, there are risks. Again, if you’ve been vaccinated, however, you’ll be fine.
So how do I know if I’m protected?
The answer may depend on your age.
In the US and other wealthy countries, if you were born before 1957, it’s almost a given that you developed lifetime immunity naturally because your body has already beaten the infection. “If you weren’t a hermit, or if you didn’t grow up in some place so far away that you never came in contact with any other human being, you’ve probably had it,” says Morse. The CDC estimates that before the vaccine was introduced in 1963, three to four million Americans, mostly children, developed measles annually.
People currently in their 40s and early 50s have likely received at least a single dose of measles-mumps-rubella (MMR) vaccine, and younger adults may have received two doses. (The CDC revised its guidance to recommend two doses for children beginning in 1989, and two doses are now advised for anyone working in high-risk environments and international travelers.) Still, a single dose of the vaccination should provide immunity for life.
But there’s an important caveat here for people who were inoculated between 1963 and 1967: They should find out whether they were given an inactivated vaccine (as opposed to a live virus vaccine) that was circulating at that time and found to be ineffective. If so, they will need to get a second shot.
Finally, if you grew up in a country with a weak public health system, or spotty record for immunizations, and you didn’t get the mandatory measles-mumps-rubella (MMR) vaccine as part of a green card process in the US, for instance, you may also need to do your research to confirm your status.
Should I get vaccinated if I have doubts about my immunization history?
Yes. “When in doubt, I’d get the MMR,” says Morse. The chance of suffering serious adverse effects are already low with the first and second doses, he says, but even if it’s your third dose, for more than 99.9% of people “nothing bad is going to happen.”
“Yes, some people do get sick and die after taking the vaccine,” Mores allows, but “it’s extremely rare. We’re talking one in a million.” (Scientists hope to one day be able to predict who those people are, he adds.)
There are also blood tests available that check for signs of antibodies in your system, indicating that your body already has immunity, either from an infection or vaccination. But the CDC notes that these tests are typically more expensive and time-consuming than just getting another MMR.
Can I get the measles even though I’ve been vaccinated?
Yes, like other vaccines, this one is doesn’t work for a tiny percentage of people. The good news: In most countries, more than 99% of those who have been fully vaccinated develop immunity. In these rare cases when the vaccine fails, having been vaccinated makes it likely that the illness will be mild.
The vaccine’s success rates drop in some low-income countries, Morse notes, including in parts of Africa. Scientists are still testing theories as to why that is.
Can I be a carrier and unwittingly take the measles home from work, even if I’ve been vaccinated?
It’s extremely unlikely. The same is true for children who are exposed at school.
If I hear someone at work has the measles, what’s the first thing I should do?
The CDC recommends checking your immunization records, which may mean immediately contacting your doctor’s office to determine whether you’re at risk of developing the disease. If so, you may be able to bolster your defenses against the virus by getting an MMR shot, or with an immune booster known as immune globulin.
Can employers mandate vaccinations?
Generally speaking, in the US, no. Though employment laws vary somewhat by state, the Americans with Disabilities Act prohibits employers from making vaccinations a condition of employment. Places like hospitals and child care organizations, where employees are far more likely to be exposed to infectious diseases, are exempt from this law, because they also have an obligation to protect their staff from health threats.
However, when a jurisdiction is under mandatory vaccination orders from a health authority, as is currently the case in the Williamsburg section of Brooklyn, New York, an employer could make the case for requesting proof of immunization.
Employees who refuse vaccines on religious grounds, or because a vaccine could compromise their health (proof of this risk may be required), usually need to be accommodated in either situation, says the Society for Human Resource Management (SHRM). That applies whether they work in a high-risk setting or in a district where vaccinations are mandatory.
What are the symptoms of measles in adults?
Many of the symptoms are similar to the flu: high fever, dry cough, runny nose, and sore throat. But the measles can also cause conjunctivitis, “koplik’s spots” inside the mouth, and, eventually, the telltale rash, described as “large, flat blotches that often flow into one another,” by the Mayo Clinic.
If you suspect you have the measles, or you know you’ve been exposed to the virus and have never been inoculated, do your community a favor: Avoid carrying the virus into the wild. Contact your doctor by phone, not in person. And don’t even consider showing up at work.
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