Measles Vaccine (Rubeola Vaccine)

Despite its success, there continue to be periodic measles outbreaks in the US. Although it is very unlikely to contract measles if properly immunized as a child, unvaccinated or inadequately vaccinated individuals are at increased risk of measles if they: Live in crowded and/or unsanitary conditions Travel to less developed countries where measles is common Are immunocompromised (eg, untreated HIV), even if previously vaccinated People born after 1956 that have never been diagnosed with measles or only received an inactivated or killed vaccine prior to 1968 are also at increased risk. (Today's live vaccines are much more effective.) Because measles is caused by a virus, it cannot be treated with antibiotics. Efforts are focused on relieving the symptoms until the infection runs its natural course. Such measures include: Gargling with warm salt water Cool mist humidification Lukewarm sponge baths Plenty of fluids and nonaspirin, fever-reducing medications Note: Aspirin should never be used in children and teens suspected of having a current or recent viral infection. In areas of the world where nutritional deficiencies are common, vitamin A has been shown to reduce the severity of measles.

What Is the Measles Vaccine? The measles vaccine consists of live measles viruses made in chicken embryo cells. The viruses found in the vaccine have been rendered harmless (attenuated) during the manufacturing process. Although it is available as a single vaccine, it is normally given in combination with the mumps and rubella vaccines (MMR) or the mumps, rubella, and varicella (chicken pox) vaccine (MMRV). The vaccine is given subcutaneously (under the skin) at a dose of 0.5 ml by a nurse or similar healthcare professional; it must be kept refrigerated and in the dark prior to administration. Who Should Get Vaccinated and When? All children (with few exceptions) should receive the measles vaccine two times: at 12-15 months and again at 4-6 years (school entry). The second dose can be given earlier, but the two doses must be separated by at least four weeks. Infants aged 6-11 months can receive their first dose if they are exposed to a measles epidemic or will be travelling internationally. However, they still should receive the other two doses as normally scheduled for a total of three doses. For catch-up vaccination, for those up to 18 years of age and who have not been vaccinated, two doses of MMR are given, separated by four weeks or greater. The minimum age at first dose is 12 months.

Adults, aged 19-49, who have not been previously vaccinated receive one dose. Those who work in healthcare or a school/university settings, and those at high risk of exposure to mumps should get two doses. For adults 50 years and older who have not been vaccinated, one dose is given to those considered at high risk.* In general, all older teens and adults should be vaccinated unless they meet one of the following criteria for measles immunity (protection): Documentation of two live attenuated measles vaccines after their first birthday and spaced at least four weeks apart Documentation of physician-diagnosed measles Blood test indicated immunity to measles Born before 1957 What Are the Risks Associated With the Measles Vaccine? The vast majority of individuals tolerate the measles vaccine without any side effects. The most common side effects are a significant fever (103F or higher) lasting up to five days and/or a temporary rash, which occur in 5%-15% of vaccine recipients. Localized allergic reactions (redness and swelling) at the injection site may uncommonly occur; while anaphylaxis (life-threatening widespread allergic reaction) is extremely rare. Other more serious complications, also extremely uncommon, include:

Temporary thrombocytopenia (low platelet count)1 in 25,000 to 1 in 2 million vaccinations Encephalitis or encephalopathy (inflammation or other abnormality of the brain)1 in 1 million vaccinations Seizuresin children predisposed to febrile seizures (convulsion during high fevers) Who Should Not Get Vaccinated? The vast majority of children and teens can and should receive their vaccinations on schedule. However, individuals in whom the risks of vaccination outweigh the benefits include: Severely immunocompromised patients (eg, active AIDS patients)HIV-positive individuals who are doing well, however, should receive the vaccine since measles can be serious and often fatal in HIV patients Pregnant womenPregnancy should be avoided for at least one month after receiving the measles vaccine. Previous severe allergic reaction (ie, anaphylaxis) to the vaccine or one of its constituents (most commonly gelatin or the antibiotic neomycin)In some cases, the vaccine can be safely given after treatment Previous thrombocytopenia clearly related to the vaccine Since unvaccinated individuals are susceptible to measles, all household and other close contacts of these individuals must be vaccinated or carry documentation of either measles immunity or previous infection.

In some cases, the vaccine should be delayed, but ultimately given. Such cases include: Children experiencing a significant illness with feverThe vaccine can be safely given in the presence of a minor respiratory illness. Recent immunoglobulin (ie, antibody) or corticosteroids therapy What Other Ways Can Measles Be Prevented Besides Vaccination? Isolating those with any contagious disease has long been the main approach to preventing its spread. It is essential, for example, to keep children with measles at home until the illness has run its course. Unvaccinated household contacts may receive immunoglobulin (ready made antibodies against measles), which may prevent or at least modify measles if given within six days of exposure. This is especially important in children less than one year old, pregnant women, and immunocompromised individuals, all of whom are at particular risk for a complicated case of measles. Immunoglobulin is not for those who have received at least one vaccination after 12 months of age unless they are immunocompromised. What Happens in the Event of an Outbreak? First of all, it is essential for every suspected case of measles to be promptly reported, so public health authorities can quickly determine that an outbreak has taken place. If you think your child may have measles, contact your doctor immediately even if you think he or she is not very sick.

In the event of a suspected or confirmed measles outbreak, all individuals who were potentially exposed to a measles case within the past two weeks should be vaccinated unless they meet the criteria for immunity described above. This would include all those living in the same household as the infected person, as well as all those attending the infected persons childcare facility, school, college, or other institution. Consult your doctor on the need for isolation. WHERE CAN I GET MORE INFORMATION? Childrens Health Topics: Immunizations/Vaccines American Academy of Pediatrics http://www.aap.org/healthtopics/immunizations.cfm National Immunization Program Centers for Disease Control and Prevention http://www.cdc.gov/vaccines/ References: *Updated Who Should Get Vaccinated and When section on 1/31/2008 according to the following study, as cited by DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 yearsUnited States, 2008. MMWR. 2008;57;Q1-Q4. Centers for Disease Control and Prevention, MMWR website. Available at:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm. Updated January 10, 2008. Accessed January 28, 2008.

Last reviewed February 2008 by David Horn, MD, FACP Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.