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Measles andMeasles Vaccine
Epidemiology and Prevention of Vaccine-Preventable Diseases
National Immunization ProgramCenters for Disease Control and Prevention
Revised Marc !""!
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Measles
• #igly contagious viral illness
• $irst described in %t century
• Near universal infection ofcildood in prevaccination era
• $re&uent and often fatal indeveloping areas
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• Paramy'ovirus (RN)*
•
+ne antigenic type
• #emagglutinin important surface
antigen
• Rapidly inactivated by eat and ligt
Measles Virus
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Measles Patogenesis
• Respiratory transmission of virus
• Replication in nasoparyn' and regional
lymp nodes
• Primary viremia !-, days after e'posure
• econdary viremia .-% days aftere'posure /it spread to tissues
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Measles Clinical $eatures
• Incubation period 0"-0! days
• tep/ise increase in fever to0", $ or iger
• Coug1 coryza1 con2unctivitis
• 3opli4 spots
Prodrome
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Measles Clinical $eatures
• !-5 days after prodrome1 05 daysafter e'posure
• Maculopapular1 becomesconfluent
• 6egins on face and ead• Persists .-7 days
• $ades in order of appearance
Ras
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ConditionDiarrea+titis mediaPneumoniaEncepalitis
Deat#ospitalization
Percent reported8%7
"90
"9!08
Measles Complications
6ased on 0:8.-0::! surveillance data
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P e r c e n t
Pneumonia #ospitalization
Measles Complications by )ge =roup
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Measles >aboratory Diagnosis
• Isolation of measles virus from aclinical specimen (e9g91 nasoparyn'1urine*
• ignificant rise in measles Ig= by anystandard serologic assay (e9g91 EI)1 #)*
• Positive serologic test for measles IgMantibody
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Measles Epidemiology
• Reservoir #uman
• ?ransmission Respiratory
)irborne
• ?emporal pattern Pea4 in late /inter and spring
• Communicability 5 days before to 5 days after
ras onset
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)ge Distribution of ReportedMeasles1 0:%.-!"""
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Measles Resurgence @ Anitedtates1 0:8:-0::0
• Cases ..17!!
• )ge group affected Cildren ;. yrs
• #ospitalizations 001"""
• Deats 0!,
• Direct medical costs 0." million
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Measles 0::,-!""0
• Endemic transmission interrupted
•
Record lo/ annual total in !"""(87 total cases*
•
Many cases among adults
• Many cases due to importation
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Measles Clinical Case Definition
• =eneralized ras lasting , days1 and
•
?emperature ,89, C (0"0 $*1 and
• Coug1 coryza1 or con2unctivitis
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0:7, >ive attenuated and 4illed vaccines
0:7. >ive furter attenuated vaccine
0:7% 3illed vaccine /itdra/n
0:78 >ive furter attenuated vaccine
(Edmonston-Enders strain*
0:%0 >icensure of combined measles- mumps-rubella vaccine
0:8: ?/o dose scedule
Measles Vaccines
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Measles Vaccine
• Composition >ive virus
• Efficacy :.F (range1 :"F-:8F*
• Duration of Immunity >ifelong
• cedule ! doses
• ould be administered /it mumps andrubella as MMR
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• Measles1 mumps1 or rubella disease (or lac4 ofimmunity* in a previously vaccinated person
• !F-.F of recipients do not respond to te first
dose
• Caused by antibody1 damaged vaccine1 recorderrors
• Most persons /it vaccine failure /ill respondto second dose
MMR Vaccine $ailure
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Measles (MMR* Vaccine Indications
• )ll infants 0! monts of age
• usceptible adolescents andadults /itout documentedevidence of immunity
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• 0! monts is te recommendedand minimum age
• MMR given before 0! montssould not be counted as a validdose
• Revaccinate at 0! monts of age
Measles Mumps Rubella Vaccine
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econd Dose of Measles Vaccine
• Intended to produce measlesimmunity in persons /o failed torespond to te first dose (primaryvaccine failure*
•
May boost antibody titers in somepersons
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econd Dose Recommendation
• $irst dose of MMR at 0!-0. monts
•
econd dose of MMR at 5-7 years
• econd dose may be given any
time 5 /ee4s after te first dose
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)CIP Recommendations
• )ll states ensure tat ! doses ofMMR re&uired for scool entry
• )ll cildren in 4indergartentroug grade 0! ave ! doses of
MMR by !""0
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• College students
• International travelers
• #ealt-care personnel
)dults at IncreasedRis4 of Measles
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Measles Immunity in
#ealt Care Personnel• )ll persons /o /or4 in
medical facilities souldbe immune to measles
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• 6orn before 0:.%
• Documentation of pysician-
diagnosed measles
• erologic evidence of immunity
• Documentation of receipt ofmeasles-containing vaccine
Measles Immunity
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Measles VaccineIndications for Revaccination
• Vaccinated before te first birtday
• Vaccinated /it 4illed measles vaccine
• Vaccinated prior to 0:78 /it an un4no/ntype of vaccine
• Vaccinated /it I= in addition to a furterattenuated strain or vaccine of un4no/ntype
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MMR )dverse Reactions
• $ever .F-0.F
• Ras .F
•
Goint symptoms !.F• ?rombocytopenia ;0H,"1""" doses
• Parotitis rare
• Deafness rare
• Encepalopaty ;0H01"""1""" doses
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MMR Vaccine and )utism
• Measles vaccine connection firstsuggested by 6ritisgastroenterologist
• Diagnosis of autism often made insecond year of life
• Multiple studies ave so/n noassociation
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MMR Vaccine and )utism
?e evidence favors a re2ectionof a causal relationsip at tepopulation level bet/een MMRvaccine and autism spectrumdisorders ()D*9J
- Institute of Medicine1 )pril !""0
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• evere allergic reaction to prior
dose or vaccine component
• Pregnancy
• Immunosuppression
• Moderate or severe acute illness• Recent blood product
MMR VaccineContraindications and Precautions
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• Measles and mumps virusesgro/n in cic4 embryo fibroblastculture
• tudies ave demonstrated safetyof MMR in egg allergic cildren
• Vaccinate /itout testing
Measles and Mumps Vaccinesand Egg )llergy
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• MMR recommended for persons /itasymptomatic and mildly symptomatic#IV infection
• N+? recommended for tose /itevidence of severe immuno-suppression
• Prevaccination #IV testing notrecommended
Measles Vaccine and #IV Infection
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PPD and Measles Vaccine
• )pply PPD at same visit as MMR
•
Delay PPD 5 /ee4s if MMR givenfirst
• )pply PPD first - give MMR /ens4in test read
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National Immunization Program
• #otline 8""9!,!9!.!!
• Email nipinfoKcdc9gov
• Lebsite ///9cdc9govHnip