Address Measles Vaccine Concerns and Promote Immunization

Recent outbreaks will lead to renewed focus on measles vaccination.

We know it's a big problem in areas with low immunization rates...with 9 out of 10 nonimmune patients getting measles after exposure.

Explore vaccine concerns. Remain open to questions...be prepared with answers...and put benefits and risks into perspective.

Reassure that numerous studies show MMR and other vaccines DON'T cause autism. But about one in 1,000 patients who get measles will die.

Discourage delaying vaccines. Educate that giving multiple vaccines according to the recommended schedule can't overwhelm the immune system.

Give clear, strong recommendations...and share positive experiences.

For example, saying "I'm fully vaccinated and so are my kids" helps build trust. Use our conversation starter, Vaccine Adherence: Addressing Myths and Hesitancy, and share it with your staff...to support discussions with patients and help tackle barriers.

Promote appropriate vaccination. Continue to give two doses of MMR or MMRV to kids...at 12 to 15 months, then at 4 to 6 years.

Make sure kids are protected before traveling to an outbreak area or anywhere outside the U.S. Recommend kids 12 months or older have two MMR doses at least 4 weeks apart...or one MMR dose for infants 6 to 11 months.

But keep in mind, infants who get MMR before one year of age still need two MORE doses per the usual schedule...instead of two doses total.

Ensure adults have had at least ONE dose of MMR if born in 1957 or later. Or give TWO doses at least 4 weeks apart for adults at higher risk of exposure...college students, healthcare workers, and international travelers. If patients don't have a record of getting MMR, vaccinate.

Don't give MMR to severely immunocompromised or pregnant patients...since it's a live vaccine. Ensure their household contacts are vaccinated.

During an outbreak, follow your local health department's advice. Explain MMR boosters aren't recommended during a measles outbreak. About 97% of people develop lifelong immunity after two doses of a measles vaccine. This differs from mumps, where waning immunity is a concern.

Be alert for measles symptoms, such as fever, the "three Cs"...cough, coryza, and conjunctivitis...and a red rash starting on the face. Be aware, patients are contagious 4 days before AND after the rash appears.

See our chart, Measles FAQs, for answers to common questions.

Key References

  • www.cdc.gov/measles/cases-outbreaks.html
  • Ann Intern Med Published online Mar 5, 2019; doi:10.7326/M18-2101
  • MMWR Recomm Rep 2013;62(RR-04):1-34
  • www.cdc.gov/measles/hcp/index.html
Prescriber's Letter. Apr 2019, No. 350401



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