Measles Outbreak 2019

Measles Update

The current measles outbreak has expanded to 764 cases in 23 states as of May 3, 2019. Kansas is not one of the states involved with an outbreak at this time. Measles is a very contagious disease caused by a virus. It spreads through the air when an infected person coughs or sneezes. Measles starts with a cough, runny nose, red eyes, and fever. Then a rash of tiny, red spots breaks out, starting at the head and spreading to the rest of the body. The Centers for Disease Control and Prevention (CDC) recommends that people get the MMR vaccine to protect against measles, mumps and rubella.

What are the current recommendations for the use of MMR vaccine?

The most recent comprehensive ACIP (Advisory Committee on Immunization Practices) recommendations for the use of MMR vaccine were published in 2013 and are available at the CDC Website. MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a second dose at age 4 through 6 years. The second dose of MMR can be given as early as 4 weeks (28 days) after the first dose and be counted as a valid dose if both doses were given after the child's first birthday. The second dose is not a booster, but rather is intended to produce immunity in the small number of people who fail to respond to the first dose.

Adults with no evidence of immunity (evidence of immunity is defined as documented receipt of 1 dose [2 doses 4 weeks apart if high risk] of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or birth before 1957) should get 1 dose of MMR unless the adult is in a high-risk group. High-risk people need 2 doses and include healthcare personnel, international travelers, and students at post-high school educational institutions.

Persons who previously received a dose of MMR vaccine in 1963–1967 and are unsure which type of vaccine it was, or are sure it was inactivated measles vaccine, should be revaccinated with either one (if low-risk) or two (if high-risk) doses of MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered complete for their age or risk status.

How does being born before 1957 confer immunity to measles?

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered.

Many people age 60 years and older do not have records indicating what type of measles vaccine they received as children in the early 1960s. What measles vaccine was most frequently given in that time period? That guidance would assist many older people in determining the need for revaccination.

Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. The killed vaccine was found to be not effective and people who received it should be revaccinated with live vaccine. Without a written record, it is not possible to know what type of vaccine an individual may have received. So persons born during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles disease should receive at least 1 dose of MMR. Some people at increased risk of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least 4 weeks.

Special Situations:

Pregnancy with no evidence of immunity to rubella: MMR is contraindicated during pregnancy; 1 dose MMR after pregnancy (before discharged from health care facility).

Non-pregnant women of childbearing age with no evidence of rubella: 1 dose MMR.

HIV infection with CD4 count ≥200 cells/μL for at least 6 months and no evidence of immunity to measles, mumps or rubella: 2 dose series MMR at least 4 weeks apart; MMR contraindicated in HIV infection with CD$ count <200 cells/μL.

Severe immunocompromising conditions: MMR contraindicated.

Students in postsecondary educational institutions, international travelers, and household or close personal contacts of immunocompromised persons with no evidence of immunity to measles, mumps, or rubella: 1 dose MMR if previously received 1 dose MMR, or 2 dose series MMR at least 4 weeks apart if previously did not receive any MMR.

Health care personnel born in 1957 or later with no evidence of immunity to measles, mumps, or rubella: 2 dose series MMR at least 4 weeks apart for measles or mumps, or at least 1 dose MMR for rubella; if born before 1957 consider 2 dose series MMR at least 4 weeks apart for measles or mumps, or 1 dose MMR for rubella.

Summary: For additional information regarding the measles outbreak or the MMR vaccine, check the CDC website or view the Measles FAQs. Please make sure you and your family are up to date on your MMR vaccination. Call the Harper County Health Department at 620-842-5132 or your medical provider to check your vaccination record