Prevention and treatment of measles
- Jorge L Barinaga, MD, MS
Jorge L Barinaga, MD, MS
- Assistant Professor of Medicine
- Tufts University School of Medicine
- Paul R Skolnik, MD, FACP, FIDSA
Paul R Skolnik, MD, FACP, FIDSA
- Professor of Medicine
- University of Connecticut School of Medicine
Measles is a highly contagious viral infection . Mathematical models have estimated that the average number of secondary infections that follow a single introduction of measles into a susceptible population ranges from 12 to 18 . Infection with measles is highly preventable.
Control measures for the prevention and spread of measles and treatment modalities for the virus will be reviewed here. The epidemiology, aims for global eradication, clinical manifestations, and diagnosis are discussed separately. (See "Epidemiology and transmission of measles" and "Clinical manifestations and diagnosis of measles".)
PREVENTION OF MEASLES
Vaccination — Measles vaccination has markedly reduced the incidence of measles throughout the developed world. However, measles cases still occur in low-incidence countries via importation by travelers. Therefore, maintenance of herd immunity is important even in countries with a low incidence of measles, since a single imported case can result in large measles outbreaks in the setting of waning immunity. (See "Epidemiology and transmission of measles".)
Measles vaccine is recommended for all children and for certain high-risk adolescents and adults. Factors to be considered when determining the need for measles vaccination include the age of the recipient, the date of administration of the first dose of vaccine (if any), and local measles epidemiology, including the potential risk of exposure, the type of measles vaccine administered previously, contraindications to vaccination, travel plans, and evidence of prior measles infection. (See "Measles-mumps-rubella vaccination in high risk adults".)
The importance of maintenance of immunity was underscored by a United States Centers for Disease Control and Prevention (CDC) analysis of United States measles cases reported in 2011, which found that the majority of cases could have been prevented by vaccination; 89 percent of 118 measles cases occurred in unvaccinated individuals . Immunization is also important for preventing severe sequelae of measles infection, including subacute sclerosing panencephalitis . (See "Clinical manifestations and diagnosis of measles".)
- Moss WJ, Griffin DE. Measles. Lancet 2012; 379:153.
- Fine P. Community immunity. In: Vaccines, 4th ed, Plotkin S, Orenstein W (Eds), Elsevier, Philadelphia 2004. p.1443.
- Centers for Disease Control and Prevention (CDC). Measles: United States, January--May 20, 2011. MMWR Morb Mortal Wkly Rep 2011; 60:666.
- Bellini WJ, Rota JS, Lowe LE, et al. Subacute sclerosing panencephalitis: more cases of this fatal disease are prevented by measles immunization than was previously recognized. J Infect Dis 2005; 192:1686.
- Greenaway C, Dongier P, Boivin JF, et al. Susceptibility to measles, mumps, and rubella in newly arrived adult immigrants and refugees. Ann Intern Med 2007; 146:20.
- Centers for Disease Control (CDC). Measles prevention. MMWR Morb Mortal Wkly Rep 1989; 38 Suppl 9:1.
- Use of Combination Measles, Mumps, Rubella, and Varicella Vaccine: Recommendations of the Advisory Committee on Immuniation Practices http://www.cdc.gov/mmwr/pdf/rr/rr5903.pdf.
- http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5903a1.htm?s_cid=rr5903a1_e#box (Accessed on October 26, 2011).
- Low N, Bavdekar A, Jeyaseelan L, et al. A randomized, controlled trial of an aerosolized vaccine against measles. N Engl J Med 2015; 372:1519.
- Watson JC, Hadler SC, Dykewicz CA, et al. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1998; 47:1.
- Fowlkes A, Witte D, Beeler J, et al. Persistence of vaccine-induced measles antibody beyond age 12 months: a comparison of response to one and two doses of Edmonston-Zagreb measles vaccine among HIV-infected and uninfected children in Malawi. J Infect Dis 2011; 204 Suppl 1:S149.
- Wolfson LJ, Strebel PM, Gacic-Dobo M, et al. Has the 2005 measles mortality reduction goal been achieved? A natural history modelling study. Lancet 2007; 369:191.
- Talley L, Salama P. Short report: assessing field vaccine efficacy for measles in famine-affected rural Ethiopia. Am J Trop Med Hyg 2003; 68:545.
- Kaninda AV, Legros D, Jataou IM, et al. Measles vaccine effectiveness in standard and early immunization strategies, Niger, 1995. Pediatr Infect Dis J 1998; 17:1034.
- Akramuzzaman SM, Cutts FT, Hossain MJ, et al. Measles vaccine effectiveness and risk factors for measles in Dhaka, Bangladesh. Bull World Health Organ 2002; 80:776.
- Cutts FT, Grabowsky M, Markowitz LE. The effect of dose and strain of live attenuated measles vaccines on serological responses in young infants. Biologicals 1995; 23:95.
- Mina MJ, Metcalf CJ, de Swart RL, et al. Vaccines. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science 2015; 348:694.
- American Academy of Pediatrics. Measles. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.535.
- Centers for Disease Control and Prevention (CDC). Recommendations of the Advisory Committee on Immunization Practices: revised recommendations for routine poliomyelitis vaccination. MMWR Morb Mortal Wkly Rep 1999; 48:590.
- McLean HQ, Fiebelkorn AP, Temte JL, et al. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62:1.
- World Health Organization. Weekly epidemiological record: Measles vaccines: WHO position paper. 2009; 35(84):349. www.who.int/wer/2009/wer8435.pdfSimilar (Accessed on February 10, 2012).
- Papania M, Baughman AL, Lee S, et al. Increased susceptibility to measles in infants in the United States. Pediatrics 1999; 104:e59.
- Maldonado YA, Lawrence EC, DeHovitz R, et al. Early loss of passive measles antibody in infants of mothers with vaccine-induced immunity. Pediatrics 1995; 96:447.
- Markowitz LE, Albrecht P, Rhodes P, et al. Changing levels of measles antibody titers in women and children in the United States: impact on response to vaccination. Kaiser Permanente Measles Vaccine Trial Team. Pediatrics 1996; 97:53.
- Leuridan E, Hens N, Hutse V, et al. Early waning of maternal measles antibodies in era of measles elimination: longitudinal study. BMJ 2010; 340:c1626.
- Martins CL, Garly ML, Balé C, et al. Protective efficacy of standard Edmonston-Zagreb measles vaccination in infants aged 4.5 months: interim analysis of a randomised clinical trial. BMJ 2008; 337:a661.
- Kim JJ. Human papillomavirus vaccination in the UK. BMJ 2008; 337:a842.
- Gans HA, Yasukawa LL, Sung P, et al. Measles humoral and cell-mediated immunity in children aged 5-10 years after primary measles immunization administered at 6 or 9 months of age. J Infect Dis 2013; 207:574.
- Uzicanin A, Zimmerman L. Field effectiveness of live attenuated measles-containing vaccines: a review of published literature. J Infect Dis 2011; 204 Suppl 1:S133.
- De Serres G, Boulianne N, Defay F, et al. Higher risk of measles when the first dose of a 2-dose schedule of measles vaccine is given at 12-14 months versus 15 months of age. Clin Infect Dis 2012; 55:394.
- Kamboj M, Sepkowitz KA. Risk of transmission associated with live attenuated vaccines given to healthy persons caring for or residing with an immunocompromised patient. Infect Control Hosp Epidemiol 2007; 28:702.
- Brickman HF, Beaudry PH, Marks MI. The timing of tuberculin tests in relation to immunization with live viral vaccines. Pediatrics 1975; 55:392.
- http://www.cdc.gov/vaccinesafety/vaccines/mmrv/mmrv_qa.html (Accessed on August 07, 2013).
- Adverse Effects of Vaccines: Evidence and Causality, Stratton K, Ford A, Rusch E, Clayton EW (Eds), Institute of Medicine, 2011.
- Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.
- Measles — United States, January-May 20, 2011 http://www.cdc.gov/mmwr/pdf/wk/mm6020.pdf (Accessed on November 15, 2011).
- Rice P, Young Y, Cohen B, Ramsay M. MMR immunisation after contact with measles virus. Lancet 2004; 363:569.
- King GE, Markowitz LE, Patriarca PA, Dales LG. Clinical efficacy of measles vaccine during the 1990 measles epidemic. Pediatr Infect Dis J 1991; 10:883.
- Barrabeig I, Rovira A, Rius C, et al. Effectiveness of measles vaccination for control of exposed children. Pediatr Infect Dis J 2011; 30:78.
- Measles: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook - 12th Edition (April 2011) http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html (Accessed on November 15, 2011).
- Steingart KR, Thomas AR, Dykewicz CA, Redd SC. Transmission of measles virus in healthcare settings during a communitywide outbreak. Infect Control Hosp Epidemiol 1999; 20:115.
- Bolyard EA, Tablan OC, Williams WW, et al. Hospital Infection Control Advisory Committee. Guidelines for infection control in health-care personnel. Am J Infect Control 1998; 26:289.
- Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 1997; 46:1.
- ACIP Provisional Recommendations for Measles-Mumps-Rubella (MMR) 'Evidence of Immunity' Requirements for Healthcare Personnel http://www.cdc.gov/vaccines/recs/provisional/downloads/mmr-evidence-immunity-Aug2009-508.pdf (Accessed on November 15, 2011).
- Raad II, Sherertz RJ, Rains CS, et al. The importance of nosocomial transmission of measles in the propagation of a community outbreak. Infect Control Hosp Epidemiol 1989; 10:161.
- http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf?source=govdelivery (Accessed on February 12, 2015).
- Gershon AA. Measles Virus. In: Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases, 4th ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 1995. p.1519.
- Bernstein DI, Schiff GM. Measles. In: Infectious Diseases, 2nd ed, Gorbach SL, Bartlett JG, Blacklow NR (Eds), WB Saunders Company, 1998. p.1296.
- Treating measles in children. World Health Organization, Geneva, 2004 updated. http://www.measlesinitiative.org/mi-files/Reports/Treatment/Treating%20Measles%20in%20Children.pdf.
- Barclay AJ, Foster A, Sommer A. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br Med J (Clin Res Ed) 1987; 294:294.
- Hussey GD, Klein M. A randomized, controlled trial of vitamin A in children with severe measles. N Engl J Med 1990; 323:160.
- Vitamin A for treating measles in chidlren (Review) http://www.measlesinitiative.org/mi-files/Reports/Treatment/Huiming%20Cochrane%20Database%20Syst%20Rev%20Vit%20A%20Measles%202005%20Issue%204%20CD001479.pdf.
- http://www.who.int/mediacentre/factsheets/fs286/en/ (Accessed on March 14, 2014).
- Krasinski K, Borkowsky W. Measles and measles immunity in children infected with human immunodeficiency virus. JAMA 1989; 261:2512.
- Forni AL, Schluger NW, Roberts RB. Severe measles pneumonitis in adults: evaluation of clinical characteristics and therapy with intravenous ribavirin. Clin Infect Dis 1994; 19:454.
- PREVENTION OF MEASLES
- - Types of vaccines
- - Vaccine effectiveness
- - General approach
- Approach in high-risk areas
- - Timing
- - Contraindications
- - Precautions
- - Adverse events
- - Lack of association with autism
- Evidence of measles immunity
- - Documentation of vaccination
- - Laboratory evidence of immunity
- - Laboratory confirmation of disease
- - Birth before 1957
- Controlling spread
- - Postexposure prophylaxis
- Immune globulin
- - Infants aged <12 months
- - Pregnant women without evidence of immunity
- - Immunocompromised patients
- - Outbreak control measures
- Case definitions
- Healthcare facilities
- - Healthcare personnel
- - Infection control
- TREATMENT OF MEASLES
- Vitamin A
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS