Primary prevention

Measles can be prevented by immunisation with a live attenuated measles virus vaccine.[14] The WHO recommends that more than 95% of the population receive two doses of measles-containing vaccine in order to maintain high levels of population immunity and eliminate measles.[2] Of those vaccinated, 95% are protected after a single dose and 99% protected after a 2-dose series.[3][13]​​​​​​​​

In the UK, measles vaccine is available only in combination with mumps and rubella (MMR vaccine). The first dose of MMR vaccine is given at 1 year of age and the second dose typically before school entry, though may be given at any time after age 18 months.[15]

In the US, measles vaccine is available in combination with mumps and rubella (MMR vaccine) and also in combination with mumps, rubella, and varicella (MMRV). Monovalent measles vaccines are no longer available. The first dose of vaccine is given routinely at age 12 to 15 months, and the second at age 4 to 6 years.[16] Since 1978, there has only been one MMR vaccine used in the United States, M-M-R II; in June 2022, PRIORIX was licensed as an additional MMR vaccine option.[17]

​Children, adolescents, and adults who are not completely immunised may receive a measles-containing vaccine in a catch-up programme.[15][16]​​​​​​​[18] Travellers to epidemic or endemic areas should ensure they are fully immunised. ​​​In the US, all international travellers (regardless of destination) who do not have presumptive evidence of measles immunity, and who have no contraindications to vaccination, are advised to receive a measles-containing vaccine before travel. Infants aged 6 to 11 months should receive one MMR dose; this dose does not count as one of the recommended doses and these children will then need to receive measles-containing vaccine at age appropriate intervals.[19]​ One study found that less than half of eligible US adult travellers received MMR vaccine before travel, increasing the risk of importation and transmission of measles by returning travellers.[20]​

In other countries, measles-containing vaccines are given at ages specified by local or national recommendations. In countries with ongoing transmission where the risk of measles mortality among infants remains high, the World Health Organization (WHO) recommends that the first dose of measles-containing vaccine is administered at nine months of age.[2] Administering vaccine at younger ages (e.g., <12 months) helps protect infants when they are most vulnerable, but may result in lower seroconversion rates due to interference with passively transferred maternal measles antibody​.

Measles vaccine has been associated with high fever in 5% to 15% of recipients, and transient rashes in about 5%.[3] Transient thrombocytopenia occurs among approximately 1 in 22,000 to 40,000 recipients of measles-containing vaccines, specifically MMR.[21] Encephalitis (or encephalopathy) occurs in fewer than 1 in 1 million vaccine recipients.[21] One review of delayed early childhood vaccines and seizures showed that delayed vaccination with the MMR vaccine in the second year of life is associated with an increased risk of post-vaccination seizures compared with vaccinations given on time according to the vaccination schedule. The strength of this association is doubled with the MMRV vaccine.[22] Another review of a large cohort of children immunised with either MMR or MMRV did not identify new safety concerns but confirmed increased risk of post-vaccination fever and seizure in infants receiving MMRV compared with those receiving MMR plus varicella vaccine.[23]​ In the US, MMRV is not recommended for the first dose of MMR vaccine.

Although evidence is limited, measles vaccination appears to be safe in immunocompetent HIV-infected children, and vaccination should be considered for immunocompetent children of HIV-infected women beginning, especially in regions of highest risk, as early as 6 months of age regardless of the child's HIV status.[24]​ MMRV vaccine is contraindicated in the US for children with HIV.[25]​ MMR and MMRV vaccines are contraindicated in people with severe immunodeficiency, those with family history of altered immunocompetence (unless verified as immunocompetent) and those who are pregnant as well as those with severe allergic reaction after previous dose or to a vaccine component.[15][16][18]​​[26]

A study assessing levels of maternal measles antibodies in infants found that by 6 months of age, antibody levels were below the mean predicted threshold for protection in 97% of infants.[27] These findings suggest that infants under 6 months might be at risk of infection. Administration of the first dose of measles-containing vaccine before 9 months of age, in high-risk settings, has the potential to reduce morbidity and mortality. Two systematic reviews suggest that this approach is safe and results in high vaccine effectiveness, although there is some evidence that antibodies titres are higher in infants who receive their first vaccination at 9 months or older.[28][29]

Measles-containing vaccines may be administered on the same day or separated by 28 days from other injectable or nasally administered live virus vaccines. They may be given at any interval from other non-live vaccines.[30] UK recommendations call for a 28-day interval between MMR and yellow fever vaccines.[15]

Multiple studies have failed to demonstrate a link between measles-containing vaccines and autism.[14][31][32]

Secondary prevention

Control measures include isolating patients from susceptible individuals, immunising potentially exposed individuals, and strengthening immunisation programmes in the areas where cases are occurring.[26]​

Susceptible people (defined as those who have not been vaccinated and have not had measles previously) may be given post-exposure prophylaxis to prevent or modify measles infection, either with immunoglobulin within 6 days of exposure, or MMR vaccine within 72 hours of exposure.[21][37][48]​​​ Use of immunoglobulin or vaccination depends of age and vulnerability of exposed individual; local guidelines should be consulted.

Detailed guidance for prevention and control of measles in health care settings is available from the Centers for Disease Control and Prevention and NHS England. CDC: interim infection prevention and control recommendations for measles in healthcare settings Opens in new window NHS England: Guidance for risk assessment and infection prevention and control measures for measles in healthcare settings Opens in new window​​

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