|
In the U.S., we are currently experiencing measles outbreaks in 23
states, with 839 individual cases confirmed between January 1 and
May 10, 2019. This is the greatest number of cases reported in the
U.S. in a single year since 1994 and since measles was declared
eliminated in 2000. Most of the people getting infected are
unvaccinated. Many vulnerable people in our communities are
unvaccinated because they are too young for vaccination or have
medical conditions like cancers and immune system disorders for
which MMR vaccination is contraindicated. For their protection,
these individuals must rely on those around them having high MMR
vaccination coverage rates.
We can help stop these outbreaks and heighten community
immunity. Make sure your patients, their families, and healthcare
personnel (HCP) are protected by following the measles vaccination
recommendations of CDC's Advisory Committee on Immunization
Practices (ACIP), briefly described below.
Protecting Children from Measles
Two doses of MMR vaccine are routinely recommended for children.
The first dose is given at age 12–15 months and the second dose at
age 4–6 years. But instead of waiting until age 4–6 years, the
second dose may be given as soon as 4 weeks (28 days) after the
first dose and still be counted as a valid dose if both doses were
given after the child's first birthday. Giving the second dose as
early as 4 weeks after the first dose should be considered in
communities where measles is circulating. The second dose is not a
booster, but rather is intended to produce immunity in the small
number of people who fail to respond to the first dose.MMR
vaccine may be administered to infants as young as age 6–11 months
who are at high risk of exposure. This includes international
travelers, as well as infants living in communities experiencing
measles outbreaks. Consult your local or state health department to
find out if this is recommended in your community. If you give a
dose of MMR vaccine to an infant before the first birthday, it does
not count as part of the routine 2-dose MMR series. The first dose
should be repeated when the child is age 12 months.
Protecting Adults from Measles
For adults born before 1957Adults born before 1957 can
be assumed to be immune to measles. This includes international
travelers and students, but it does not necessarily apply to
healthcare personnel (HCP). Healthcare facilities should consider
vaccinating unvaccinated HCP born before 1957 who do not have
laboratory evidence of measles immunity, laboratory confirmation of
disease, or vaccination with 2 appropriately spaced doses of MMR
vaccine. CDC recommends that, during an outbreak of measles,
healthcare facilities should recommend 2 doses of MMR vaccine at
the appropriate interval for unvaccinated HCP who lack laboratory
evidence of measles immunity, regardless of birth year.
For adults born in 1957 or later
Adults born in 1957 or later should receive at least 1 dose of
MMR vaccine unless they have acceptable evidence of immunity
(i.e., 1 documented dose of MMR or a measles-containing vaccine,
laboratory evidence of immunity, or laboratory confirmation of
disease).
Certain adults born in 1957 or later may need 2 doses. Adults
who are going to be in a setting that poses a high risk for
measles transmission should make sure they have had 2 doses
separated by at least 28 days. These adults include:
- students at post-high school education institutions;
- healthcare personnel;
- international travelers; and
- people who public health authorities determine are at
increased risk for getting measles during a measles outbreak.
People who previously received a dose of MMR vaccine between
1963–1967 and are unsure which type of vaccine (live or
inactivated measles vaccine) was used, or
who are sure it was inactivated measles vaccine, should be revaccinated with either 1 dose (if low risk) or 2 doses (if high
risk) of MMR vaccine.
If a person born in 1957 or later has no documentation of MMR,
you could check the patient's blood for a measles titer; however,
commercial tests currently available are
not sensitive enough to reliably detect vaccine-induced immunity,
leading to false negatives. In addition, this step will require
an extra office visit and add to the cost.
There is no harm in receiving 1 or 2 doses of MMR vaccine if a
person is already immune to measles (or mumps or rubella). ACIP
does not recommend testing for
immunity after appropriate MMR vaccination.
On May 17,
CDC released a "Dear Provider" letter discussing what clinicians need to know about protecting adult
patients from measles.
During this time of outbreaks in so many states with case counts
climbing week after week, it's important to make sure your
patients are protected from this highly
contagious virus.
References
|
ACIP Recommendations
Vaccine Information Statements 
