Vaccine Update: Measles Vaccine Recommendations During Outbreaks

Column Author: Maria Martinez, RN, BSN, MSN, MBA, CPN | Immunization Program Manager

Column Editor: Angela L. Myers, MD, MPH | Chief Wellbeing Officer

We have now seen two deaths from current measles outbreaks in the United States. The first person who died was an unvaccinated school-age child from West Texas. The child had been hospitalized and died on February 25 at Covenant Children’s Hospital in Lubbock, Texas. Unfortunately, it is likely that more deaths will follow, most of them children. Prior to these recent fatalities, the last death from measles in the United States was in 2015.

Measles was eradicated in the United States in 2000. In recent years, outbreaks have resurfaced with the rise in anti-vaccine sentiment. Outbreaks are most common in areas where the vaccination threshold of 95% or higher needed for herd immunity is not achieved. The current outbreak in Gaines County, Texas, is occurring in a pocket of the population where 13.6% of K-12th graders had a non-medical vaccine rate in 2023-2024.

The measles outbreaks that we see usually start from a travel related infection. Unvaccinated people traveling to countries where measles is common are at high risk for contracting the disease and bringing it back into the United States. When this individual is around a population that’s unvaccinated, the virus spreads quickly. ³ Measles is highly transmissible, infecting nearly all unvaccinated individuals in a room. The virus survives in the air for up to 2 hours- exposing anyone in that space even after the infectious person has left.

Prior to the first measles vaccine becoming available in the United States, there were 3-4 million cases of measles, 48,000 hospitalizations and 500 deaths every year. ⁴

Measles diagnosis should be considered for anyone with a fever and a generalized maculopapular rash with cough, coryza, or conjunctivitis who recently traveled internationally, or domestically to an area with a known outbreak, or has other known or suspected exposure. (CDC HAN)

Measles vaccine provides lasting protection in 99 percent of individuals that receive both doses. Even a single dose provides strong protection. ³

In children, the measles vaccine is typically recommended at 12-15 months of age and at 4 to 6 years of age. If there is a high likelihood of exposure to measles due to international travel or exposure to an outbreak, the second dose can be administered 4 weeks after the first dose. Of note, this second dose counts, and a third dose is not needed. Infants between 6 and 12 months of age who are at high risk for exposure can be immunized early. This will yield infants some protection but will need to be followed up with two more doses at age 12-15 months and a second dose at least 4 weeks after the first dose or at 4 to 6years of age to ensure optimal protection. ³

Adults who are unsure of their immunity to measles or vaccination status should get vaccinated against measles. The first measles vaccine used in the United States was licensed for use in 1963. ⁵Early versions of measles vaccines from 1963-1968 were made from inactivated virus which is not as effective at today’s live attenuated virus vaccine. Individuals vaccinated during those years should get revaccinated with at least one dose of the live attenuated vaccine. Adults born before 1957 likely have natural immunity due to measles infection-if history of measles infection cannot be confirmed, vaccination is recommended. ⁶

Because it is a live virus vaccine, MMR is contraindicated in pregnant individuals (theoretical risk) and individuals with immunosuppression. Vaccinating those that are eligible for vaccination is critical in protecting individuals that cannot be vaccinated.

Post-exposure, MMR vaccine can be administered to unvaccinated individuals 6 months of age and older. Vaccination must be administered within 72 hours for post-exposure prophylaxis. This may help yield some protection and alter the clinical course of the disease. For patients under the age of 6 months, immunoglobulin (IG) can be administered within 6 days of exposure. ⁷

Initiate the following for suspected measles cases:

Isolate immediately, in a single patient airborne infection isolation room (AIIR) or in a private room with the door closed until an AIIR is available.
Immediately notify state, tribal, local or territorial health departments about any suspected cases to ensure rapid testing, investigation and reporting to the CDC.
Test by either collecting a nasopharyngeal swab (NP) or oropharyngeal swab (OP) for reverse transcription polymerase chain reaction (RT-PCR). A blood sample should also be collected for serology testing. A urine sample along with an NP/OP swab could improve sensitivity of testing. ⁽⁸⁾

For those who become infected, there is not a specific antiviral indicated for treatment of measles. The World Health Organization and the AAP Red Book recommend healthcare providers administer 2 doses of vitamin A. The first dose to be given immediately on diagnosis and the second dose 24 hours later. This is indicated for pediatric and adult patients. Low levels of vitamin A can occur in even well-nourished children. This supplement can help prevent damage to the eyes and blindness. ⁹ The use of vitamin A in other countries for the treatment of measles has been associated with decreased morbidity and mortality.¹⁰

Measles resources for practitioners:

Click here for the new measles page available on Red Book Online.

Click here for the AAP.org FAQ page on measles.

Additional Resource Measles Links:

References

Accessed on 2/27/2025: https://publications.aap.org/aapnews/news/31468/Nearly-100-infected-with-measles-amid-outbreak-in?autologincheck=redirected
Accessed on 3/1/2025: How the Texas measles outbreak began: See graphics on vaccine data
Accessed on 2/27/2025: Measles: What You Should Know | Johns Hopkins Medicine
Accessed on 3/1/2025: Measles, Mumps and Rubella (MMR): The Diseases & Vaccines | Children's Hospital of Philadelphia
Accessed on 3/1/2025: History of measles: Outbreaks and vaccine timeline
Accessed on 2/28/2025: Do adults need a measles vaccine booster? : Shots - Health News : NPR
Accessed on 3/7/2025: Measles Vaccine Recommendations | Measles (Rubeola) | CDC
Accessed on 3/10/2025: https://www.cdc.gov/han/2025/han00522.html
Accessed on 2/28/2025: https://publications.aap.org/aapnews/news/31490/AAP-leaders-combating-misinformation-amid-measles?searchresult=1
Accessed on 2/28/2025: https://publications.aap.org/redbook/book/755/chapter/14079321/Measles?autologincheck=redirected

The Link

Vaccine Update: Measles Vaccine Recommendations During Outbreaks

Built for Kids™