PUBLIC HEALTH
routine recommended schedule3.
• Children ≥12 months and adults who plan to travel outside the
United States should receive two doses of MMR vaccine, separated
by at least 28 days.
• Report suspected cases of measles immediately to the Louisville
Metro Department of Public Health and Wellness and provide
appropriate Post-exposure Prophylaxis to contacts of cases.
» » Determine measles immunity in all identified contacts.
» » For people exposed to measles who cannot provide evi-
dence of immunity against measles, offer Post-exposure
prophylaxis (PEP)
• MMR vaccine:
» »
MMR vaccine, if administered within 72 hours of initial
measles exposure, and immunoglobulin (IG), if admin-
istered within six days of exposure, may provide some
protection or modify the clinical course of disease among
susceptible persons. Any exposed individual who refuses
vaccine should be excluded from school, hospital or child-
care setting to protect others.
o Vaccination should be offered at any interval following
exposure in order to offer protection from future exposures.
o Monitor contacts of cases for signs and symptoms con-
sistent with measles for at least one incubation period
after the exposure (21 days), even if MMR vaccine or IG
has been administered.
• Immune Globulin:
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People who are at risk for severe illness and complications
from measles, such as infants younger than 12 months of
age, pregnant women without evidence of measles im-
munity, and people with severely compromised immune
systems, should receive IG.
Priority for IG administration should be given to people
exposed in settings with intense, prolonged, close contact,
such as a household, daycare, or classroom where the risk
of transmission is highest.
For infants aged six through 11 months, MMR vaccine
can be given in place of IG, if administered within 72
hours of exposure.
People with severely compromised immune systems who
are exposed to measles should receive IGIV regardless of
immunologic or vaccination status because they might
not be protected by MMR vaccine.
The recommended dose of IGIM is 0.5 mL/kg of body
weight (maximum dose = 15 mL) and the recommended
dose of IGIV is 400 mg/kg.
WHEN CAN SOMEONE EXPOSED TO MEASLES RE-
TURN TO WORK OR SCHOOL?
• Except in healthcare settings, unvaccinated people who receive
their first dose of MMR vaccine within 72 hours after exposure may
return to childcare, school or work.
duty from day five after first exposure to day 21 after last exposure,
regardless of post-exposure vaccine.
ISOLATION RECOMMENDATIONS:
• Infected people should be isolated for four days after they develop
the maculopapular rash
• Airborne precautions should be followed in health care settings.
Regardless of presumptive immunity status, all health care staff
entering the room should use respiratory protection consistent with
airborne infection control precautions (use of an N95 respirator
or a respirator with similar effectiveness in preventing airborne
transmission).
HOW DO I KNOW IF SOMEONE IS ADEQUATELY PRO-
TECTED FROM MEASLES?
Acceptable presumptive evidence of immunity against measles includes at
least one of the following:
• Written documentation of adequate vaccination:
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One or more doses of MMR administered on or after the first
birthday for preschool-age children and adults not at high risk
» »
Two doses of MMR vaccine separated by at least 28 days, for
school-age children and adults at high risk, including college
students, healthcare personnel and international travelers
• Laboratory evidence of immunity
• Laboratory confirmation of measles
• Birth before 1957
• Health care providers should not accept verbal reports of vaccination
without written documentation as presumptive evidence of immunity.
• For additional details about evidence of immunity criteria, see Table 3 in
Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps,
2013: Summary Recommendations of the Advisory Committee on Immuni-
zation Practices (ACIP)4.
TREATMENT FOR MEASLES:
• There is no specific antiviral therapy for measles. Supportive care
and treatment of symptoms is indicated.
• The Centers for Disease Control and Prevention recommends
treatment with vitamin A for severe measles cases among children.
Vitamin A should be administered immediately on diagnosis and
repeated the next day. The recommended age-specific daily doses are:
» » 50,000 IU for infants younger than six months of age
» » 100,000 IU for infants six to 11 months of age
» » 200,000 IU for children 12 months of age and older
» » Doses of MMR vaccine separated by at least 28 days, for
school-age children and adults at high risk, including
college students, health care personnel, and international
travelers.
Dr. Caloia is medical director of the Louisville Metro Department of
Public Health and Wellness.
• Exclude healthcare personnel without evidence of immunity from
MAY 2019
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