Measles vaccines

Kathryn Dzintars, Pharm.D., BCPS
Pediatric Dosing Author: Bethany Sharpless Chalk, Pharm.D., BCPPS

VACCINE TYPE

Live attenuated measles virus vaccine

INDICATIONS

ACIP RECOMMENDATIONS

  • All adults and children should have routine vaccination at 12-15 months (first MMR dose) and 4-6 years (second dose of MMR).
  • All persons who work in health-care facilities must have acceptable evidence of immunity.
  • All adults born during or after 1957 should receive >1 dose of MMR unless they have a medical contraindication, documentation of >1 dose, history of measles based on health-care provider diagnosis, or laboratory evidence of immunity.
  • The second dose of MMR is recommended for adults who: 1) have been recently exposed to measles or are in an outbreak setting; 2) received killed measles vaccine or have been vaccinated with an unknown type of measles vaccine during 1963–1967; 3) are students in postsecondary educational institutions; 4) work in a health-care facility; or 5) plan to travel internationally.
  • A third dose of MMR (e.g., a mumps-containing vaccine) is recommended for individuals who have previously received two vaccinations who are part of a population at risk for mumps during an outbreak.

OTHER INFORMATION

  • Vaccination is recommended for susceptible international travelers leaving the U.S.
  • Vaccination following exposure to natural measles may provide protection if the vaccine is given within 3 days of the exposure.
  • High-risk, susceptible individuals should receive measles immune globulin within 6 days of exposure. HIV-infected children and adolescents receive IG regardless of immunization status.

FORMS

brand name

preparation

manufacturer

route

form

dosage^

cost*

ProQuad

Measles, Mumps, Rubella and Varicella (MMRV, live)

Chiron

SC

vial

3-4.3-3

$180.05

M-M-R II

Measles, Mumps, Rubella (MMR, live)

Merck

SC

vial

12500/0.5

$62.79

Attenuvax

Measles (live, further attenuated); no longer manufactured in the U.S.

Merck

SC

vial

one vial

*Prices represent cost per unit specified, are representative of "Average Wholesale Price" (AWP).
^Dosage is indicated in mg unless otherwise noted.

PATHOGEN DIRECTED PROTECTION

DOSE/ADMINISTRATION

Adult PRIMARY SERIES

  • All adults born during or after 1957 should receive >1 dose of MMR unless they have a medical contraindication, documentation of >1 dose, history of measles based on health-care provider diagnosis, or laboratory evidence of immunity.
  • The second dose of MMR is recommended for adults who: 1) have been recently exposed to measles or are in an outbreak setting; 2) received killed measles vaccine or have been vaccinated with an unknown type of measles vaccine during 1963–1967; 3) are students in postsecondary educational institutions; 4) work in a health-care facility; or 5) plan to travel internationally.
  • Administration for those living with HIV Infection
    • Vaccination is contraindicated with CD4< 200 cells/mm3 because it is a live vaccine.
      • Use routine vaccination indications when CD4>200 cells/mm3.
    • Use the routine schedule for asymptomatic infants with HIV.

Pediatric PRIMARY SERIES

Primary Immunization

  • Children ≥ 12 months of age: 0.5 mL per dose subcutaneously for a total of two doses. Dose 1 is indicated at age 12-15 months of age, and dose 2 is indicated at 4-6 years of age (recommended prior to entering kindergarten or first grade)
    • The minimum interval between doses: 4 weeks

International Travel

  • Infants aged 6 - 11 months of age: administer dose 1 prior to departure; revaccinate with 2-dose series (dose 1 at 12-15 months of age, and dose 2 as early as 4 weeks later)
  • Unvaccinated children aged ≥ 12 months of age: administer the 2-dose series, with at least 4 weeks between doses, prior to departure.

Catch-Up Immunization

  • Unvaccinated children and adolescents: administer the 2-dose series with at least 4 weeks between doses.

Measles Outbreak Without Acceptable Evidence of Immunity / At Risk of Exposure

  • The dose should be administered within 72 hours post-exposure
  • Infants 6 - 11 months of age: 0.5 mL per dose subcutaneously for a single dose. Revaccinate with 2-dose series (dose 1 at 12-15 months of age, and dose 2 as early as 4 weeks later).
  • Children 1 - 4 years of age who have received 1 dose of MMR previously should be considered for their second dose if the outbreak involves preschool-aged children.

ADVERSE DRUG REACTIONS

COMMON

  • Fever (associated with the measles component of the vaccine, occurs in ~5%)
  • Transient rash (5%)
  • Urticaria or a wheal and flare at the injection site
  • Pain at the injection site

OCCASIONAL

  • Transient lymphadenopathy
  • Arthralgia and transient arthritis (associated with rubella components)

RARE

  • Parotitis
  • Anaphylaxis reaction
  • Thrombocytopenia (use with caution with a history of thrombocytopenia)
  • Febrile seizure (9 per 10,000 vaccinations among MMRV vaccine recipients vs. 4 per 10,000 vaccinations among MMR + varicella vaccine recipients; adjusted OR of 2.3)
  • Aseptic meningitis (associated with the Urabe strain mumps vaccine)
  • Encephalitis
  • Guillain-Barre syndrome (but no increase incidence over background rates)

VACCINE/DRUG INTERACTIONS

  • M-M-R II may be co-administered with varicella virus vaccine (Varivax) and Haemophilus b conjugate vaccine using separate injection sites and syringes.
  • Although data are limited concerning the simultaneous administration of the entire recommended vaccine series (i.e., DTaP, IPV [or OPV], Hib with or without hepatitis B vaccine, and varicella vaccine), data from numerous studies have indicated no interference between routinely recommended childhood vaccines (either live, attenuated, or killed).
  • Avoid immune globulin administration within 3 months of vaccination.
  • Measles vaccine administration should be delayed for 3-12 months after receiving immune globulin (source: AAP Red Book, 2020).

CONTRAINDICATIONS

  • Immunosuppressed patients (e.g., blood dyscrasias, leukemia, lymphomas, malignant neoplasms of bone or lymphatics, cellular immune deficiencies, hypogammaglobulinemia, dysgammaglobulinemia).
  • Severe allergy to components of the vaccine (including neomycin and gelatin).
  • Severe febrile illness.
  • Pregnancy (should be avoided for 30 days post-vaccination).
  • Use with caution in patients with a history seizure and severe thrombocytopenia.
  • Egg allergy is not a contraindication (risk of a serious reaction to M-M-R is extremely low).
  • May be administered in HIV pts if not severely immunosuppressed (CD4 % < 15%), although there is the possibility of an inadequate immune response.

IMMUNE RESPONSE

  • The immune response is measured by the presence of detectable antibodies in the serum using the ELISA assay for measles.
  • The protective antibody response to measles was seen with greater than 255 mIU/ml. In several randomized trials, children 12 to 23 months of age received a single dose of ProQuad and achieved response rates of the following: 97.4% for measles, 95.8% to 98.8% for mumps, 98.5% for rubella.
  • The duration of immune response is at least 11 to 15 years in patients receiving 2-dose series.

CLINICAL EFFICACY

  • Since the introduction of MMR, the number of reported cases of measles, mumps, and congenital rubella syndrome have decreased by more than 99%.

OTHER INFORMATION

  • Almost all recent cases of measles in the U.S. have been initiated as a consequence of an imported strain of virus carried by a susceptible traveler or immigrant.

Basis for recommendation

  1. McLean HQ, Fiebelkorn AP, Temte JL, et al. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013;62(RR-04):1-34.  [PMID:23760231]

    Comment: Current ACIP recommendations for the use of the MMR vaccines and prevention of associated syndromes.

References

  1. Marin M, Marlow M, Moore KL, et al. Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus-Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak. MMWR Morb Mortal Wkly Rep. 2018;67(1):33-38.  [PMID:29324728]

    Comment: Updated ACIP recommendations for the third dose of a mumps-containing vaccine to be provided to those at risk during an outbreak situation.

  2. Perry RT, Murray JS, Gacic-Dobo M, et al. Progress toward regional measles elimination - worldwide, 2000-2014. MMWR Morb Mortal Wkly Rep. 2015;64(44):1246-51.  [PMID:26562349]

    Comment: Rates are decreasing despite difficulties with using a vaccine that requires maintenance with a cold chain.

Measles vaccines is a sample topic from the Johns Hopkins ABX Guide.

To view other topics, please or .

Pediatrics Central™ is an all-in-one application that puts valuable medical information, via your mobile device or the web, in the hands of clinicians treating infants, children, and adolescents. .

Last updated: September 5, 2020