Measles
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Rubeola virus
stain of measles

Measles is a highly contagious viral illness. More than 90% of susceptible persons will become infected after exposure. Measles is spread through respiratory droplets, especially when a person with measles coughs or sneezes. Measles can be spread from 4 days before to 4 days after the rash occurs.

Symptoms of measles begin about 10 to 12 days after exposure. Initial symptoms (prodrome) last about 2 to 4 days and include fever, which increases in a stepwise fashion, followed by cough, runny nose, and conjunctivitis (eye inflammation). Koplick spots (rash on the mucous membranes of the mouth) may also occur either before or after the typical measles rash. The measles rash is maculopapular (reddish with small pumps). It begins at the hairline and then gradually spreads downward and outward.

Even after exposure, measles can be prevented if the person is given measles vaccine (MMR vaccine) within 72 hours of the exposure. In addition, immune globulin may prevent or decrease the severity of measles if given within 6 days of exposure. However, once symptoms are present the only treatment is supportive care to relieve symptoms and treat complications.

About the Vaccine

Although in the past measles, mumps and rubella were available as individual (single antigen) vaccines, the manufacturer is no longer making these individual vaccines. Instead measles, mumps, and rubella vaccines are given as combined MMR vaccine or as MMRV vaccine (combined MMR vaccine and varicella vaccine).

Measles, Mumps, and Rubella Vaccines Licensed for Use in the U.S.

Product: M-M-R II® (Measles, Mumps, and Rubella)
Manufacturer: Merck & Co
Year licensed: 1971
Product Insert

Combination Vaccines Containing Measles, Mumps, and Rubella Vaccines Licensed for Use in the U.S.

Product: ProQuad® (Measles, Mumps, Rubella, and Varicella)
Manufacturer: Merck & Co
Year licensed: 2005
Product Insert

Indications Contraindications and precautions
Child
  • All infants and children 12 months of age and older.
  • Susceptible adolescents without documented evidence of immunity.
Adult
  • Adults born in 1957 or later.
  • Military personnel.
  • College students.
  • International travelers.
  • Healthcare personnel.
  • All non-pregnant women of childbearing age who do not have evidence of immunity or vaccination.
  • People who have had a severe allergic reaction to a previous dose of MMR vaccine or an MMR vaccine component.* If you are administering MMR combined with varicella vaccine also check for a history of severe allergic reaction to a previous dose of varicella vaccine.
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication.
  • Pregnancy or the possibility of pregnancy within 4 weeks.
  • People who are immune compromised due to disease, treatment, or medication.
  • People who have recently received blood products or immune globulin.
  • Unless the parent or caregiver expresses a preference for MMRV vaccine, separate MMR and varicella vaccines should be administered for the first dose for children 12 through 47 months of age.
  • A personal or family history of seizures is a precaution to MMRV vaccination.

* MMR vaccine contains egg protein, neomycin, and gelatin (see package insert). However, allergy to eggs in not a contraindication or precaution to MMR vaccine.

Vaccine Ages Dose/Route Routine Administration Schedule
M-M-R II 12 months through 18 years of age Dose: 0.5 ml

Route: Subcutaneous
2 doses at 12-15 months and 4-6 years of age. Minimum interval between doses is 4 weeks.
Adult born in 1957 or later and:
  • attending college
  • working in health care
  • traveling outside the United States
  • military personnel
2 doses given 28 days apart.
Adults born in 1957 or later 1 dose.
ProQuad
(MMRV)
12 months through 12 years of age Dose: 0.5 ml

Route: Subcutaneous
2 doses at 12-15 months and 4-6 years of age. Minimum interval between doses is 3 months.
Unless the parent or caregiver expresses a preference for MMRV vaccine, separate MMR and varicella vaccines should be administered for the first dose for children 12 through 47 months of age.     
MMR Side Effects*
  • Fever (up to 1 person out of 6).
  • Mild rash (about 1 person out of 20).
  • Swelling of glands in the cheeks or neck (rare).
  • Seizure caused by fever (about 1 out of 3,000 doses).
  • Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 25%).
  • Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses).
  • Severe allergic reaction (very rare).

Notes:
*When MMR antigens are given in combination with other antigens (e.g., variciella) in one vaccine, the other antigens in the vaccine may cause other side effects. For more information about these possible side effects, go to the varicella pages on the Vaccines section of this website.

Product Name Supplied Storage and Handling
M-M-R II
Merck & Co
10 dose multidose vial with diluent (1 set per package). Store refrigerated between 2° to 8°C (35° to 46°F) and protect from light. The diluent may be stored in the refrigerator with the lyophilized vaccine or separately at room temperature.

M-M-R II is a clear yellow liquid after reconstitution. Discard reconstituted vaccine if not used within 8 hours.
ProQuad
Merck & Co
0.5 mL single dose vials with diluent (10 sets per package). Store in freezer between 50°C and -15°C (58°F and +5°F) until it is reconstituted. Protect from light. ProQuad may be stored at refrigerator temperature (36° to 46°F, 2° to 8°C) for up to 72 hours prior to reconstitution. Discard any ProQuad vaccine stored at 36° to 46°F which is not used within 72 hours of removal from 5°F (-15°C) storage. The diluent may be stored in the refrigerator with the lyophilized vaccine or separately at room temperature.

ProQuad is a clear pale yellow to light pink liquid after reconstitution. Discard reconstituted vaccine if not used within 30 minutes.     
Other diseases in this vaccine group: Mumps, Rubella
In 2000 the US achieved measles elimination however, importation of measles continues and  in 2011 the US reported 222 measles cases and 17 outbreaks. 90% of cases reported last year were associated with importation from other countries.
Healthcare professionals are invited to join us as we discuss Measles, Mumps, Rubella (MMR) Vaccination Updates. Maj Troy W. Baker, USAF, MC (Director of Medical Education, 779th Medical Group, Chief, Allergy/Immunology) will provide information on clinical features, ACIP recommendations, policy updates, and issues/challenges. (Recorded on 16 Oct 2013)
The summit is hosted by the Immunization Partnership and Houston Community College. The 3 day event will cover topics to include Affordable healthcare act, building partnerships, measles outbreak review, communication strategies, basic epi for non epidemiologists, HPV, vaccine administration updates, utilizing social media and many more lectuers presented by national experts from the CDC, Children's Hospital of Philly and Texas. Continuing education credits will be offered.
GENADMIN PDF 21 Jun 13
III MEF FORCE HEALTH PROTECTION (FHP) REQUIREMENTS 2014
15 Feb 06

Sample Q&A: The Disease

How does measles spread from one person to another?
Measles is highly contagious. Infected people are usually contagious from about 4 days before their rash starts and for up to 4 days afterwards. The measles virus resides in the mucus in the nose and throat of infected people. When they sneeze or cough, droplets spray into the air and the droplets remain active and contagious on infected surfaces for up to 2 hours.
Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Recommendations of the Advisory Committee on Immunization Practices
National Foundation for Infectious Diseases
Package Insert - Vaccine
Package Insert - Vaccine
American National Red Cross
MMQC-12-1407 29 Jun 12
MERCK / M-M-R II (MEASLES, MUMPS, AND  RUBELLA VIRUS VACCINE, LIVE) / VOLUNTARY RECALL
Video: Dr. Swartzberg’s StoryDr. Swartzberg’s Story (3:58) 03 Nov 11
When a patient has measles a chain of cases ensues.
VIS
Vaccine Information Statement (Interim)
Vaccine Information Statement (Interim)