1 Measles Vaccine

Measles and
Measles Vaccine
Epidemiology and Prevention of Vaccine-
Preventable Diseases
National Immunization Program

Centers for Disease Control and Prevention
Revised March 2002
Measles
Highly contagious viral illness
First described in 7th century
Near universal infection of

childhood in prevaccination era
Frequent and often fatal in

developing areas
Measles Virus
Paramyxovirus (RNA)
One antigenic type
Hemagglutinin important surface

antigen
Rapidly inactivated by heat and light

Measles Pathogenesis
Respiratory transmission of virus
Replication in nasopharynx and regional

lymph nodes
Primary viremia 2-3 days after exposure
Secondary viremia 5-7 days after

exposure with spread to tissues
Measles Clinical Features
Incubation period 10-12 days
Prodrome
Stepwise increase in fever to
103 F or higher
Cough, coryza, conjunctivitis
Koplik spots
Measles Clinical Features
Rash
2-4 days after prodrome, 14 days
after exposure
Maculopapular, becomes
confluent
Begins on face and head
Persists 5-6 days
Fades in order of appearance
Measles Complications
Condition Percent reported
Diarrhea 8
Otitis media 7
Pneumonia 6
Encephalitis 0.1
Death 0.2
Hospitalization 18
Based on 1985-1992 surveillance data

Measles Complications by Age Group
30 Pneumonia Hospitalization
25
20
Percent
15
10
0
<5 5-19 20+
Age group (yrs)
Measles Laboratory Diagnosis
Isolation of measles virus from a
clinical specimen (e.g., nasopharynx,
urine)
Significant rise in measles IgG by any

standard serologic assay (e.g., EIA, HA)
Positive serologic test for measles IgM

antibody
Measles Epidemiology
Reservoir Human
Transmission Respiratory
Airborne
Temporal pattern Peak in late winter and spring
Communicability 4 days before to 4 days after

rash onset
Measles United States, 1950-2001*
900
800
Cases (thousands)
700 Vaccine Licensed

600
500
400
300
200
100
0
1950 1960 1970 1980 1990 2000
*2001 provisional data

Measles United States, 1980-2001*
30000
25000
20000
Cases
15000
10000
5000
0
80 82 84 86 88 90 92 94 96 98 '00
*2001 provisional data
Age Distribution of Reported
Measles, 1975-2000
90 Preschool-age School-age Adult
80
70
60
Percent
50
40
30
20
10
0
1975 1980 1985 1990 1995 2000
Age group (yrs)
Measles Resurgence United
States, 1989-1991
Cases 55,622
Age group affected Children <5 yrs
Hospitalizations >11,000
Deaths 123
Direct medical costs >$150 million

Measles 1993-2001
Endemic transmission interrupted
Record low annual total in 2000

(86 total cases)
Many cases among adults
Many cases due to importation

Measles Clinical Case Definition
Generalized rash lasting >3 days, and
Temperature >38.3 C (101 F), and
Cough, coryza, or conjunctivitis

Measles Vaccines
1963 Live attenuated and killed vaccines
1965 Live further attenuated vaccine
1967 Killed vaccine withdrawn
1968 Live further attenuated vaccine
(Edmonston-Enders strain)
1971 Licensure of combined measles-
mumps-rubella vaccine
1989 Two dose schedule
Measles Vaccine
Composition Live virus
Efficacy 95% (range, 90%-98%)
Duration of
Immunity Lifelong
Schedule 2 doses
Should be administered with mumps and

rubella as MMR
MMR Vaccine Failure
Measles, mumps, or rubella disease (or
lack of immunity) in a previously
vaccinated person
2%-5% of recipients do not respond to the

first dose
Caused by antibody, damaged vaccine,

record errors
Most persons with vaccine failure will

respond to second dose
Measles (MMR) Vaccine Indications
All infants >12 months of age
Susceptible adolescents and

adults without documented
evidence of immunity
Measles Mumps Rubella Vaccine
12 months is the recommended
and minimum age
MMR given before 12 months

should not be counted as a valid
dose
Revaccinate at >12 months of age

Second Dose of Measles Vaccine
Intended to produce measles
immunity in persons who failed to
respond to the first dose (primary
vaccine failure)
May boost antibody titers in some

persons
Second Dose Recommendation
First dose of MMR at 12-15 months
Second dose of MMR at 4-6 years
Second dose may be given any

time >4 weeks after the first dose
ACIP Recommendations
All states ensure that 2 doses of
MMR required for school entry
All children in kindergarten

through grade 12 have 2 doses of
MMR by 2001
Adults at Increased
Risk of Measles
College students
International travelers
Health-care personnel
Measles Immunity in
Health Care Personnel
All persons who work in
medical facilities should
be immune to measles
Measles Immunity
Born before 1957
Documentation of physician-
diagnosed measles
Serologic evidence of immunity
Documentation of receipt of
measles-containing vaccine
Measles Vaccine
Indications for Revaccination
Vaccinated before the first birthday
Vaccinated with killed measles vaccine
Vaccinated prior to 1968 with an

unknown type of vaccine
Vaccinated with IG in addition to a

further attenuated strain or vaccine of
unknown type
MMR Adverse Reactions
Fever 5%-15%
Rash 5%
Joint symptoms 25%
Thrombocytopenia <1/30,000 doses
Parotitis rare
Deafness rare
Encephalopathy <1/1,000,000 doses
MMR Vaccine and Autism
Measles vaccine connection first
suggested by British
gastroenterologist
Diagnosis of autism often made in

second year of life
Multiple studies have shown no

association
MMR Vaccine and Autism
The evidence favors a rejection
of a causal relationship at the
population level between MMR
vaccine and autism spectrum
disorders (ASD).
- Institute of Medicine, April 2001

MMR Vaccine
Contraindications and Precautions
Severe allergic reaction to prior
dose or vaccine component
Pregnancy
Immunosuppression
Moderate or severe acute illness
Recent blood product
Measles and Mumps Vaccines
and Egg Allergy
Measles and mumps viruses
grown in chick embryo fibroblast
culture
Studies have demonstrated safety

of MMR in egg allergic children
Vaccinate without testing

Measles Vaccine and HIV Infection
MMR recommended for persons with
asymptomatic and mildly
symptomatic HIV infection
NOT recommended for those with

evidence of severe immuno-
suppression
Prevaccination HIV testing not

recommended
PPD and Measles Vaccine
Apply PPD at same visit as MMR
Delay PPD >4 weeks if MMR given

first
Apply PPD first - give MMR when

skin test read
National Immunization Program
Hotline 800.232.2522
Email [email protected]
Website www.cdc.gov/nip

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Measles and

National Immunization Program

First described in 7th century

Near universal infection of

Frequent and often fatal in

One antigenic type

Hemagglutinin important surface

Rapidly inactivated by heat and light

Replication in nasopharynx and regional

Primary viremia 2-3 days after exposure

Secondary viremia 5-7 days after

Based on 1985-1992 surveillance data

Significant rise in measles IgG by any

Positive serologic test for measles IgM

Temporal pattern Peak in late winter and spring

Communicability 4 days before to 4 days after

700 Vaccine Licensed

*2001 provisional data

Age group affected Children <5 yrs

Direct medical costs >$150 million

Record low annual total in 2000

Many cases among adults

Many cases due to importation

Temperature >38.3 C (101 F), and

Cough, coryza, or conjunctivitis

Efficacy 95% (range, 90%-98%)

Should be administered with mumps and

2%-5% of recipients do not respond to the

Caused by antibody, damaged vaccine,

Most persons with vaccine failure will

All infants >12 months of age

Susceptible adolescents and

MMR given before 12 months

Revaccinate at >12 months of age

May boost antibody titers in some

Second dose of MMR at 4-6 years

Second dose may be given any

All children in kindergarten

Serologic evidence of immunity

Vaccinated with killed measles vaccine

Vaccinated prior to 1968 with an

Vaccinated with IG in addition to a

Diagnosis of autism often made in

Multiple studies have shown no

- Institute of Medicine, April 2001

Studies have demonstrated safety

Vaccinate without testing

NOT recommended for those with

Prevaccination HIV testing not

Delay PPD >4 weeks if MMR given

Apply PPD first - give MMR when

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