Amid the measles outbreak affecting nearly half of the country and reaching areas as near as East Tennessee, Virginia has, so far, dodged the bullet.

Compared to other states, Virginia has a relatively high vaccination rate, but Mount Rogers Health District Director Karen Shelton said there’s still room for caution.

“Measles is something that is very highly contagious,” she said.

Those who are not vaccinated are almost guaranteed to contract the virus just by coming into contact with an infected person.

“More than 90 percent will become infected if they are in a room with someone with measles,” Shelton said.

That’s because the virus can be transmitted by direct contact with infectious droplets or by simply breathing the same air as an infected person, according to the Centers for Disease Control. The virus becomes airborne when someone with the illness coughs, sneezes or just breathes the air, and the virus can stick around in the air for up to two hours after an infected person leaves the area.

Shelton said people can take what healthcare workers call droplet precautions—like wearing masks that cover the nose and mouth—if they know they will come in contact with an infected person. But because the virus is contagious up to four days before symptoms develop, most people won’t know such precautions are needed.

“The best prevention is to vaccinate,” Shelton said.

The MMR, or measles, mumps and rubella, vaccine is given in two doses and is typically administered at 12 months and 4 years of age. Shelton said those who received the first dose are 93 percent protected from the measles virus and those who have received both doses are 97 percent protected.

According to CDC data, Virginia generally maintains a high vaccination rate. Compared to other states, vaccination exemptions are harder to get approved.  Medical exemptions must be approved by a physician and religious exemptions must be notarized. Virginia does not allow philosophical exemptions from vaccinations.

The Mount Rogers Health District hasn’t seen a measles case in at least 13 years. The high rate of vaccination lessens the risk of the illness taking hold of the community, Shelton said.

According to Virginia Department of Health data, the vaccination rate among students entering kindergarten in Smyth County public schools in the fall of 2018 was at 98.7 percent. Smyth County reported only one religious exemption from vaccines and no medical exemptions.

For those who are either too young or who can’t get the vaccine for medical reasons, Shelton said herd immunity is the best line of defense.

“The best precaution is for those around them to make sure they’re vaccinated,” she said.

According to a National Public Radio report, those vaccinated with the killed measles virus, which was available between 1963 and 1967, should be revaccinated since that version of the vaccine was ineffective.

Shelton said most of the measles cases during the recent outbreak are a result of travelers who are either visiting or returning to the United States.

“They bring it back to this country and if they’re in an area where there’s a high non-vaccination rate,” it spreads.

Symptoms of the measles include fever, runny nose, cough, redness of the eyes. Two to three days after the initial symptoms present, tiny white spots may appear in the mouth and after three or four days, the blotchy rash will appear on the face and spread over the body. Symptoms can occur between seven and 21 days of exposure. A person with measles is contagious four days before initial symptoms begin and four days after the rash appears.

Out of every 1,000 cases, only one or two will result in death, Shelton said. That same rate applies to a complication called encephalitis, or swelling of the brain.

“The risk for complications is pretty small, but if you have enough people with it, there is reason for concern.”

To help keep the risks low and ensure herd immunity, Shelton said those who are unsure if they’ve received both MMR doses can check with their healthcare providers to see if they qualify for the vaccination. According to the CDC, an additional MMR vaccination will not harm a healthy person who may already have immunity.

Shelton also said anyone with plans to travel outside the country should make sure their vaccinations are up to date.

More information on the measles virus, vaccines and precautionary measures can be found on the Virginia Department of Health’s website at

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