Measles Vaccine Guidance: Are You Protected?

With measles cases on the rise globally, adults should ensure they are adequately vaccinated against this serious and potentially fatal disease. An Israeli flight attendant contracted measles and is currently in a coma due to encephalitis, which is a serious complication of the virus.¹ Additionally, evidence suggests that she received one but not two doses of the vaccine as a child.¹ There have recently been other cases of adults becoming infected with measles, which raises the important question of whether they received adequate vaccination as children. Pharmacists can play an important role in educating and administering the measles, mumps, and rubella (MMR) vaccine to adults.

The measles vaccine has changed over the years as well as the recommendations. Individuals who received a measles vaccine in the 1960s may need to be revaccinated depending on which immunization was administered. Between 1963 and 1967 there was a killed measles vaccine available, but it was found to not be effective.² These individuals are not adequately protected against measles and should be revaccinated. Patients who have documentation that they received a live dose of the vaccine in the 1960s should be adequately protected. However, if they are traveling internationally, they should receive a second MMR dose at least 2 weeks before traveling, according to the CDC.² Pharmacists should advise patients that do not have documentation of immunization or which measles vaccine they received to get at least one dose of the MMR.²

Individuals born before 1957 are considered to have likely been infected naturally with measles during childhood since the vaccine was not yet available and are generally considered protected and don’t need the MMR.² Healthcare personnel born before 1957 without laboratory evidence of immunity or disease should consider getting two MMR doses.²

One dose of the MMR is considered to be approximately 93% effective while 2 doses are about 97% effective against measles.² Prior to 1989 only 1 dose of the MMR was recommended for children. However, there was an outbreak in 1989 and some children who received one MMR dose became infected with measles.³ Therefore, the CDC’s Advisory Committee on Immunization Practices recommended in 1989 that children receive a second MMR dose at 4-6 years of age after the first dose at 12-15 months.³ Pharmacists should educate patients that 2 MMR doses offer the best protection. When in doubt about vaccine history, there really is no downside to getting another MMR dose especially in the midst of a measles outbreak in communities across the country, including those in New York, New Jersey, Washington, California, and Michigan.

Adults who will be traveling internationally and have not been vaccinated against measles should get 2 MMR doses separated by at least 28 days.² Pharmacists should advise patients who will be traveling on a plane or by a cruise ship to ensure that they are adequately vaccinated at least 2 weeks prior to traveling, as this is the time it takes for the MMR to be fully effective.

Locating vaccine records may be difficult for adults, and state immunization registries were created more recently. Pharmacists can recommend that patients check with their parents, high school or college, previous employers, and physician’s office or health clinic for childhood immunization records. If the records cannot be located, then it is better to err on the side of caution and get the MMR vaccine.

As Peter Marks, MD, PhD, director of FDA’s Center for Biologics Evaluation and Research, noted in a recently issued statement to the press: "We cannot state strongly enough, the overwhelming scientific evidence shows that vaccines are among the most effective and safest interventions to both prevent individual illness and protect public health. Vaccinating against measles, mumps and rubella not only protects us and our children, it protects people who can’t be vaccinated, including children with compromised immune systems due to illness and its treatment, such as cancer."

Watch the video below for more about measles immunization and state health officials' response to the recently reported measles outbreak in New Jersey.

References

• Nedelman M. Are you protected from measles? It may depend on when you were born. CNN. https://www.cnn.com/2019/04/19/health/measles-vaccine-protection-age/index.html. Published April 20, 2019. Accessed April 22, 2019.
• Measles, mumps, and rubella (MMR) vaccination: what everyone should know. CDC website. https://www.cdc.gov/vaccines/vpd/mmr/public/index.html. Last updated March 28, 2019. Accessed April 22, 2019.
• Measles—United States, first 26 weeks, 1989. MMWR Morb Mortal Wkly Rep 1989;38(50): 863-866;871-872. https://www.cdc.gov/mmwr/preview/mmwrhtml/00001522.htm. Accessed April 22, 2019.