Measles primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

Ever since the introduction of the measles vaccine, there has been a marked reduction of the incidence of this disease in the population. The widespread use of measles vaccine has led to a greater than 99% reduction in measles cases in the United States, when compared with the non vaccine era. Therefore the most effective way of preventing measles is with active immunization provided by this vaccine, which is often incorporated with the rubella and/or mumps vaccines, in the MMR vaccine, in countries where these illnesses represent a problem. Unfortunately, measles is still a common disease in developing countries, where the virus is highly contagious and is able to spread across large areas, where vaccination is not common.

Primary Prevention

The best approach to prevent measles is by active immunization. Ever since the introduction of the vaccine in the developed world, there has been a marked reduction in the incidence of measles, however, there are still some reported cases of the disease in low-incidence areas, usually imported from other countries by travelers. Because of this potential re-introduction of the virus, it is important to maintain a high level of immunity among the population in order to prevent outbreaks. The measles vaccine is recommended in all infants, as well as in all adolescents and adults of high-risk. When evaluating the need to administer the vaccine, important factors should be attended:

• Age
• Date of administration of first dose, in case of such existence.
• Local measles virus epidemiology, including:

• Risk of exposure
• Kind of measles vaccine previously administrated
• Existence of contraindications for vaccination
• History of prior measles infection
• Near-future travel plans

Type of vaccine

The measles vaccine (MMR vaccine) is an attenuated form, which contains an attenuated strain of the virus that distinguishes it from the wild-type strain and at the same time decreases its tropism for lymphocytes.

Currently in the US, the available vaccine is the Enders-Edmonston strain. This is a live attenuated vaccine, licensed in 1968. It has two formulations:

• MMR or Measles-Mumps-Rubella vaccine
• Quadrivalent MMRV vaccine with measles, mumps, rubella and varicella.

Vaccination guidelines

According to the CDC, every child should get 2 doses of the MMR vaccine:

• The first dose should be between the 12th and the 15th month of life
• The second dose can be given at any age, as long as there are at least 28 days after the administration of the first dose. However, common practice is to administer the second dose between the 4th and the 6th year of life.

It is important to notice that for any international travel, any children who is between ages of 6 and 11 months, should have at least one dose of the MMR vaccine. If the child is older than one year of age, then he/she should have the two doses of the MMR vaccine interspaced at least by 28 days. The two doses of the vaccine are required in order to develop the required immunity to avoid transmission.

During one visit to the health-care facility, it is safe to administer the following vaccines with MMR concomitantly:

• Haemophilus influenzae type b vaccine (Hib)
• DTP or DTaP
• Inactivated polio vaccine (IPV)
• Varicella vaccine
• Hepatitis B vaccine

According to the CDC, the following individuals do not need the MMR vaccine if:

• Presence of blood tests that show immunity to measles, mumps, and rubella.
• Person born before 1957.
• The individual is a a woman born before 1957 who is sure she is not having more children, has already had rubella vaccine, or has had a positive rubella test.
• History of two doses of MMR vaccine, or one dose of MMR plus a second dose of measles vaccine.
• History of one dose of MMR vaccine and a low risk of measles exposure.

According to the CDC, the following individuals should get the MMR vaccine if not included in the categories listen above, and:

• Is a college student, trade school student, or other student beyond high school.
• Works in a hospital, or other medical facility.
• Travels internationally, or is a passenger on a cruise ship.
• Is a woman of childbearing age.

Contraindications

There are however some contraindications to the administration of the vaccine, including:

• Pregnancy
• Allergy
• Immunosuppression

For the adverse reactions of measles vaccines, see MMR vaccine § Safety, and MMRV vaccine § Adverse events.

Evidence of Immunity

Healthcare providers should not accept verbal reports of vaccination without written documentation as presumptive evidence of immunity. Acceptable presumptive evidence of immunity against measles includes at least one of the following:

• Written documentation of adequate vaccination:
  • One or more doses of a measles-containing vaccine administered, or after the first birthday for preschool-age children and adults with low risk.
  • Two doses of measles-containing vaccine for school-age children and adults at high risk, including college students, healthcare personnel and international travelers.
• Laboratory evidence of immunity (measles-specific IgG positive antibody).
• Laboratory confirmation of measles.
• Birth in the United States before 1957.

Risk for travellers

For non-immune travellers coming from areas without indigenous transmission of measles virus, the risk of exposure to measles is increased in an environment of insufficient vaccination coverage (rate <90%).

Vaccine

Live attenuated vaccine, available in 2 forms:

• Monovalent form (measles component only)
• Fixed combinations with one or more of vaccines against mumps, rubella and varicella.

Two intramuscular doses are administered at an interval of at least 4 weeks.