The Centers for Disease Control and Prevention (CDC) issued guidance to health care providers on early vaccination for measles and reporting cases amid an outbreak that has infected hundreds.
In communications to providers, the CDC says measles-mumps-rubella (MMR) vaccine remains the best protection against measles and summarizes existing guidance for routine and travel-related vaccination.
It also highlights the importance of identifying measles or exposures, notifying public health, collecting samples and managing patients with supportive care.
As of April 3, the CDC reported 607 confirmed measles cases, including three deaths. The majority of cases (97%) are unvaccinated or have an unknown vaccination status. Seventy-four of the cases have been hospitalized, including 42 children under 5 years and 19 in children ages 5-19 years.
The risk of measles is low for most of the United States due to high immunization coverage and rapid case identification and response efforts, according to the CDC.
Vaccination recommendations
The CDC routinely recommends two doses of MMR vaccine: the first dose at age 12-15 months and the second dose at age 4 through 6 years before school entry. One dose is 93% effective against measles, and two doses are 97% effective.
Health care providers in areas experiencing sustained, community-wide measles transmission and an ongoing risk of exposure should follow vaccination recommendations issued by state, local, tribal or territorial health departments. In some cases, additional vaccinations may be recommended beyond the routine schedule.
For example, health departments may recommend a second dose of MMR vaccine for children ages 1-4 years who received one prior dose and live in or plan to travel to the outbreak area. Children with no documentation of vaccination history should receive two doses, at least 28 days apart.
Health departments also may recommend an early dose of MMR vaccine for infants ages 6-11 months who live in or are traveling to an outbreak area. Infants younger than 12 months are at greatest risk of severe illness. Vaccination of infants ages 6-11 months minimizes the risk of disease and death that could occur during measles outbreaks.
Providers should weigh the benefit of protection from measles during an outbreak against the risk of decreased immune responses in infants vaccinated with MMR before 12 months of age. Infants who receive one dose of MMR vaccine before their first birthday should receive two more doses according to the routine recommended schedule.
Treating patients, reporting cases
The letters highlight the importance of identifying measles or exposures to measles in patient populations and responding appropriately with action to mitigate community spread. If measles is suspected, providers should:
- Isolate the patient immediately, ideally in a single-patient airborne infection isolation room or in a private room. Patients with measles should call ahead so health care facilities can limit additional exposures, including offering measles triaging and testing outside the facility.
- Immediately notify public health: Use the 24-hour Epi On Call contact list. Health departments will provide guidance on testing, isolating and managing patients with suspected measles and people exposed to measles. People exposed to measles who do not have evidence of immunity may be eligible for post-exposure prophylaxis either with MMR vaccine (within 72 hours of exposure) or immunoglobulin (within six days of exposure).
- Collect samples, either a nasopharyngeal (NP) swab or throat (OP) swab for reverse transcription polymerase chain reaction testing, as well as a blood specimen for serology testing. Collecting a urine specimen along with an NP/OP swab may improve sensitivity of testing.
- Manage patients with supportive care. There is no specific antiviral therapy for measles. Medical care is supportive to help relieve symptoms. Complications, such as pneumonia and other infections, should be tested and treated appropriately. Vitamin A may be administered to patients with confirmed measles under supervision of a health care provider. Overuse of vitamin A can lead to toxicity and cause damage to the liver, bones, central nervous system and skin.
In early March, the CDC issued a Health Alert Network advisory, which includes additional vaccination details and travel recommendations.
