The CDC has had reports of 704 cases of measles in the United States between January 1st and April 26th of 2019. This is the greatest number of cases reported in the United States since 1994 and also since measles was declared eliminated in 2000. The measles, mumps, rubella (MMR) vaccine is highly effective against measles, as two doses of the vaccine are about 97% effective in preventing the disease.
Given recent measles activity nationwide, providers may encounter questions regarding vaccination recommendations for older individuals and individuals with unknown vaccination status. Providers are encouraged to discuss measles vaccination with their patients. Current CDC MMR vaccination guidelines can be found at https://www.cdc.gov/measles/ and are given below:
· Children 12 months of age or older should have 2 doses of MMR, the first dose at the age of 12 to 15 months and the second dose between 4 to 6 years.
Students at post-high school educational institutions
· Students who do not have evidence of immunity need two doses of MMR vaccine, separated by at least 28 days.
· Adults born before January 1, 1957 can be presumed to be immune to measles due to prevalence of disease.
· Adults born in or after 1957 who do not have evidence of immunity should get at least one dose of MMR vaccine. Per the Indiana Communicable Disease Rule (410 IAC 1-2.5-118), acceptable proof of immunity shall consist of:
o Written record from the student’s or employee’s physician, parent, or guardian that indicates the dates of vaccination (on or after the first birthday) and the type of vaccine administered;
o Laboratory report showing confirmation of previous measles infection; or
o Laboratory report showing a protective measles antibody titer.
· Patients who received a measles vaccine in the 1960s may not need to be revaccinated. People who have documentation of receiving LIVE measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective. More information is available at https://www.cdc.gov/vaccines/vpd/mmr/public/index.html.
· People 6 months of age and older who will be traveling internationally should be protected against measles.
· Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who receive one dose of MMR vaccine before their first birthday should still receive two more doses at 12 through 15 months and a second dose separated by at least 28 days.
· Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days.
· Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days.
· Adults with documentation of one dose of MMR vaccine should get a second dose.
· Healthcare professionals should have documented evidence of immunity. Those without evidence of immunity should get two doses of MMR vaccine separated by at least 28 days.
To ensure that all Hoosiers are properly vaccinated against measles, the ISDH has issued a standing order to enable pharmacists to assess and vaccinated persons who meet the following criteria:
· Any adults born after 1957 who may have received inactivated measles vaccine between 1963 and 1968
· Adults who are unsure of the specific measles vaccine that they received
· Adults with an unknown vaccination status
· Adults who are health care personnel (not just clinical staff)
· Students at post-secondary institutions (such as colleges or vocational schools)
· International travelers
Measles is a highly contagious virus that lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Measles virus can live for up to two hours in an airspace where the infected person coughed or sneezed. Around the fourth day of illness, the fever rises and a blotchy red rash appears on the face or near the hairline and then spreads down and out to the rest of the body. This rash usually lasts about four or five days before slowly fading in the same order that it appeared. Patients infected with measles are considered most infectious between approximately four days before they even get a rash and up to four days after the rash starts. Anyone who develops measles symptoms should stay home and immediately call a healthcare provider.