Measles Frequently Asked Questions

Does Vitamin A prevent measles?

Vitamin A does not prevent measles; only the MMR vaccine can prevent measles. Vitamin A should not be used to try to prevent measles, nor should it be used in high dosages as it can lead to toxicity (eg. nausea, vomiting, headache, fatigue, joint and bone pain, blurry vision, skin/hair problems, increased intracranial pressure, liver damage, confusion, coma, etc)

Vitamin A is recommended for those infected with measles, regardless of hospitalization status. It is recommended for administration once daily for 2 days (ie, immediately on diagnosis and repeated the next day), at the following doses:

• 200 000 IU (60 000 μg retinol activity equivalent [RAE]) for children 12 months or older;
• 100 000 IU (30 000 μg RAE) for infants 6 through 11 months of age; and
• 50 000 IU (15 000 μg RAE) for infants younger than 6 months.
• An additional (ie, a third) age-specific dose of vitamin A should be given 2 through 6 weeks later to children with clinical signs and symptoms of vitamin A deficiency.

Additional information can be found in the Measles Chapter of Red Book Online. Information to share with families can be found here. 

Should pediatricians adjust the timing of doses if there is a measles outbreak in their community?

The routine vaccination series is for the 1st dose of MMR to be administered at 12-15 months of age with the 2nd dose at 4-6 years of age.

Pediatricians should follow state and local guidance on early administration of MMR vaccine doses. For example, the Texas Department of State Health Services (DSHS) has issued the following recommendations for the affected counties in Texas:

• Infants 6 through 11 months receive an early dose of MMR vaccine (ie, infant dose), and a second dose at 12-15 months, at least 28 days after the first.
• Children older than 12 months who have not been vaccinated should receive one dose immediately and follow with a second dose at least 28 days after the first. Children older than 12 months with one prior dose should receive an early second dose of MMR vaccine separated by at least 28 days.
• Teenagers and adults with no evidence of immunity should receive one dose of MMR vaccine immediately and follow with a second dose at least 28 days later. 

MMR can be used as post-exposure prophylaxis if administered ≤ 72 hours after measles exposure in individuals 6 months of age and older who do not have evidence of measles immunity.

If a rash occurs after receiving the MMR vaccine, does that indicate that the person has measles?

Transient rashes have been reported in approximately 5% of vaccine recipients, usually between 5 and 12 days after receipt of MMR vaccine. Recipients who develop rash and/or fever are not considered contagious. However, if the vaccine was administered as part of an outbreak response, it is important to ensure rapid differentiation of vaccine reaction from infections with wild-type virus. Local public health authorities can assist with this. 

Can an immunocompromised child receiving the MMR vaccine spread measles?

Since the introduction of measles vaccine in the United States in 1963, with millions of MMR doses being administered, transmission of measles through the MMR vaccine has not occurred for anyone (immunocompetent or immunocompromised).     

Do adults need an MMR booster?

According to CDC, adults are considered to have presumptive evidence of immunity to measles if they have written documentation of at least 1 dose of MMR vaccine on or after their  1st birthday, written documentation of 2 doses of MMR vaccine for individuals at high risk, laboratory evidence of measles immunity, laboratory confirmation of measles infection, or birth before 1957.  During measles outbreaks, health departments may provide additional recommendations to protect their communities, including a second dose of MMR for adults who have received only 1 dose previously. 

During an outbreak of measles in a healthcare facility, or in healthcare facilities serving a measles outbreak area, two doses of MMR vaccine are recommended for healthcare personnel, regardless of birth year, who lack other presumptive evidence of measles immunity

There are no recommendations to receive a third dose of MMR vaccine during measles outbreaks.

Should healthcare personnel (HCP) receive the MMR vaccine?

Because measles in HCP has contributed to spread of this disease during outbreaks, evidence of immunity to measles should be required for HCP. Evidence of immunity is established by laboratory confirmation of infection, laboratory evidence of immunity (positive serologic test result for measles antibody), or documented receipt of 2 appropriately spaced doses of live virus-containing measles vaccine, the first of which was administered on or after the first birthday. People born before 1957 generally are considered immune to measles. However, because measles cases have occurred in HCP in this age group, health care facilities should consider offering 2 doses of measles-containing vaccine to HCP who lack proof of immunity to measles. In communities with documented measles outbreaks, 2 doses of MMR vaccine are recommended for unvaccinated HCP born before 1957 unless evidence of serologic immunity is demonstrated.

Should people have their titer checked just to confirm they are immune?

Vaccines are the most effective way to ensure immunity to measles. After vaccination, it is not necessary to test patients for antibodies to confirm immunity.  According to the CDC, if you were born after 1957 one dose of measles vaccine is sufficient to be considered protected from measles. Adults who are in a setting that poses a high risk for measles transmission should make sure they have had two vaccine doses. People who are unsure of their vaccine status should talk to their healthcare provider.

What infection prevention steps should be taken if there is a suspected case of measles in a pediatric office?

Given the increase in global and domestic measles cases and outbreaks, healthcare providers should familiarize themselves with the clinical features of measles in order to quickly identify and minimize the spread of the virus. Measles should be considered in any patient presenting with febrile rash illness, especially if unvaccinated for measles or traveled internationally in the last 21 days. Providers should ask about recent international travel, exposure to international travelers, travel to areas with active measles or exposure to people with measles. 

It is important to follow Infection Prevention Precautions, including immediate public health notification when treating suspected measles cases.  CDC guidelines should be followed when treating measles or suspected measles cases. 

Below is a quick summary of recommended infection prevention and control practices:

• Provide face masks for patients (2 years of age and older) and family before they enter the facility. Patients unable to wear a mask should be “tented” with a blanket or towel when entering the facility.
• Immediately move patient and family to an isolated location, ideally an airborne infection isolation room (AIIR) if available. If unavailable, use a private room with the door closed.
• No other children should accompany a child with suspected measles.
• Patients (2 years of age and older) and family should leave face masks on if feasible.
• Standard and airborne precautions should be followed, including use of N95 mask.
• Only health care providers with evidence of measles immunity should provide care.

How effective is the MMR vaccine in preventing measles?

Vaccination is the most effective way to prevent measles. A dose of measles vaccine administered after 12 months of age results in immunity in 93% of people. The 2nd dose increases immunity to 97%.