Measles

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Measles

Measles is a disease caused by the measles virus. Measles symptoms begin with fever, cough, runny nose, and red, watery eyes. After these first symptoms, a rash begins to appear. Measles rash often starts as flat red spots (lesions) on the face near the hairline. The rash then spreads to the rest of the body (neck, chest, belly, arms, legs, and feet). Raised bumps may form, and the spots may become one connected rash. Most people with measles also develop Koplik spots, or blue-white spots on the soft part of the inside of the mouth. Measles can cause complications such as pneumonia and ear infection. 

Measles spreads through the air when an infected person coughs, sneezes, or speaks, which creates small droplets that contain the virus. Other people can become infected if they breathe in those droplets. Measles is highly infectious—9 out of 10 people exposed to measles will likely become infected if they are not immune either from vaccination or a previous infection. You can get measles just by being in a room where a person with measles has been. Two doses of MMR vaccine is the best way to prevent measles infection and illness.

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          Clinician guidance on early MMR vaccination

          While the general risk of measles in Utah remains low, we want clinicians to be aware of the option to vaccinate children early to protect them against measles, mumps, and rubella (MMR). 

          • Younger than age 1 year: Early first dose vaccine is only recommended for infants traveling on commercial flights or to areas in the U.S. with active, community-level measles spread.
          • Second dose before 4 years of age: Although the second dose of MMR vaccine is typically recommended at age 4–6 years, clinicians can give the second MMR dose to children older than 1 year as long as it has been at least 28 days from their first dose (see details below if considering giving MMRV).

          Rationale and details

          Early first dose for infants: 

          • Given the limited risk of community exposure to measles in Utah, we do not currently recommend routine early MMR vaccination for infants in Utah. While there have been people diagnosed with measles in Utah, these infections appear to be clustered in certain communities. The risk to the general population is very low, especially if the child is surrounded by vaccinated adults. 
          • Infants who are 6 to 11 months of age should be given an early dose if they are traveling on  commercial flights or to areas in the U.S. with active measles spread. It is appropriate to follow the standard guidance for early vaccination for international travel for domestic travelers at this time. An early dose is allowable for infants older than 6 months of age. Any infant who gets an early dose will need to get 2 later doses in accordance with the standard vaccination schedule at 12–15 months and then a dose at 4–6 years. 
          • We do not recommend wide-spread administration of an early dose for the following two reasons. First, the child will still need the 2 later doses. The data suggests that many children don’t actually get much protection from that early dose (possibly due to maternal antibodies blunting the response). Second, there is some evidence that children who get an early dose have a more rapid decay of antibody titers later in life. Therefore, given the low risk at this time and the possible negative impacts, we are not currently recommending an early dose.
          • MMRV should not be given to infants younger than age 1 year; instead MMR should be used. 

          Early second dose:

          • Data shows children mount a strong and long lasting immune response as long as the second dose is at least 28 days from the first dose if using MMR or 3 months if using MMRV (see additional details for MMRV below).
          • Providers can give the second dose early, however it is important to recognize the protection provided by just 1 dose is excellent (93% vaccine effectiveness) even prior to the second dose.

          General vaccination recommendations:

          The Utah Department of Health and Human Services recommends 2 doses of measles-containing vaccine routinely for children:

          • First dose at age 12 months through 15 months
          • Second dose at age 4 through 6 years before they enter school.

          This can be administered as MMR or MMRV. 

          MMRV: If you are giving MMRV you should delay the second dose by at least 3 months. In addition, separate MMR and varicella vaccines are recommended for any infant younger than 47 months of age to reduce the risk of febrile seizures. 

          We strongly encourage vaccination of all people older than 1 year of age, regardless of an exposure risk. One of the best ways to protect kids is to surround them by protected adults.

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