11 Measles

11.5 Recommended immunisation schedule

11.5.1 Children

MMR vaccine is recommended irrespective of a history of measles, mumps, rubella infection or measles immunisation. A clinical history does not reliably indicate immunity unless confirmed by serology. There are no known ill effects from vaccinating children, even if they have had serologically confirmed infection with any of the viruses.

Measles vaccine is recommended as MMR at age 15 months and at age 4 years. Two doses of measles vaccine are recommended because nearly all of the 5–10 percent who fail to be protected by the first dose will be protected by the second. The second dose of measles vaccine can be given as soon as four weeks after the first dose. MMR vaccine may be given to children aged 12 months or older whose parents/guardians request it, and no opportunity should be missed to achieve immunity. In an outbreak situation, children aged 6–14 months may be offered MMR vaccine. Children who receive MMR vaccine when aged under 12 months will still require two further doses administered after age 12 months (see section 11.8.3).

11.5.2 Adolescents and adultsTop

Two doses of MMR (at least four weeks apart) are recommended and funded for any adolescent or adult who is known to be susceptible to one or more of the three diseases.

Adults born before 1969 should be considered to be immune to measles as circulating virus and disease was prevalent prior to the introduction of measles vaccine in 1969.

Adults born after 1968

All individuals born after 1968 who do not have documented evidence of two doses of an MMR-containing vaccine given after age 1 year (even if they have received two doses of a measles-containing vaccine) or who do not have serological evidence of protection for measles, mumps and rubella should be considered susceptible.

This particularly applies to:

Some adults may have received one dose of measles vaccine and one dose of MMR during one of the catch-up campaigns (eg, the 1997 campaign, when all those aged up to 10 years were offered MMR vaccine). They will have therefore received the recommended two doses of measles, but only one of mumps and rubella. While the main reason for a two-dose MMR schedule is to protect against measles, two doses of all three antigens is recommended and funded. These individuals can receive a second dose of MMR (ie, a third dose of measles vaccine) without any concerns. It is important that women of childbearing age are immune to rubella (see chapter 18).

All persons born after 1968 with only one documented dose of prior MMR should receive a further dose of MMR; if there are no documented doses of prior MMR, then two doses should be administered, at least four weeks apart.

11.5.3 ImmunosuppressionTop

MMR is contraindicated in immunosuppressed children (see section 4.3). They can be partially protected from exposure to infection by ensuring that all contacts are fully immunised, including hospital staff and family members. There is no risk of transmission of MMR vaccine viruses from a vaccinee to the immune-compromised individual.

MMR vaccination at 12 months of age is recommended for children with HIV infection who are asymptomatic and who are not severely immune compromised (see the HIV discussion in section 4.3.3). MMR is contraindicated in children with severe immunosuppression from HIV because vaccine-related pneumonitis (from the measles component) has been reported.3 Discuss vaccination of children with HIV infection with their specialist.

MMR vaccine is funded for (re-)vaccination following immunosuppression. However, this first must be discussed with the individual’s specialist.

11.5.4 MMR vaccine when aged under 12 monthsTop

MMR may be recommended for infants aged 6–12 months during measles outbreaks if cases are occurring in the very young (see section 11.8). These children still require a further two doses of MMR at ages 15 months and 4 years because their chance of protection from measles is lower when the vaccine is given when they are aged under 12 months. Any recommendations will be made by the medical officer of health and the Ministry of Health based on local epidemiology.

11.5.5 Pregnancy and breastfeedingTop

MMR vaccine is contraindicated during pregnancy. Pregnancy should be avoided for four weeks after MMR vaccination.

MMR vaccine can be given to breastfeeding women.

(See also sections 4.1 and 18.5.2).

11.5.6 TravelTop

The US reported21 that of the 251 cases of measles reported from 2001 to 2004, 177 (71 percent) were in US residents, and of these 100 were preventable. Forty-three percent of these preventable cases were associated with international travel; the rest acquired the disease in the US. Travel was also linked to the measles outbreaks in New Zealand in 201111 and 2014. Because international travel is an important factor in reintroducing measles into a country, a measles-containing vaccine should be considered for those travelling overseas if they have not previously been adequately vaccinated.