• Highly contagious viral illness
• First described in 7th century
• Near universal infection of childhood in prevaccination era
• Frequent and often fatal in developing areas

• Paramyxovirus (RNA)
• Hemagglutinin important surface antigen
• One antigenic type
• Rapidly inactivated by heat and light

• Respiratory transmission of virus
• Replication in nasopharynx and regional lymph nodes
• Primary viremia (virus contact) 2-3 days after exposure
• Secondary viremia (virus contact) 5-7 days after exposure with spread to tissues

• Incubation period 10-12 days
• Stepwise increase in fever to 103 F (39 0 C) or higher
• Cough, coryza (runny nose), conjunctivitis
• Koplik spots

• 2-4 days after prodrome (beginning), 14 days after exposure
• Maculopapular, becomes confluent
• Begins on face and head
• Persists 5-6 days
• Fades in order of appearance

Percent reported
8
7
6
0.1
0.2
18

• Isolation of measles virus from a clinical specimen (e.g., nasopharynx, urine)
• Significant rise in measles IgG by any standard serologic assay (e.g., EIA, HA)
• Positive serologic test for measles IgM antibody

• Reservoir                        Human
• Transmission                  Respiratory Airborne
• Temporal pattern             Peak in late winter and spring
• Communicability             4 days before to 4 days after rash onset

• Should not receive MMR vaccine. Pregnancy should be avoided for 1 month after receipt of monovalent measles vaccine and MMR or other rubella-containing vaccines.
• Close contact with pregnant women is not a contraindication to MMR vaccination.
• If a pregnant woman thinks she has been exposed to German Measles, she should first of all check with her midwife or her doctor on her rubella status, ie whether the blood test, taken early in pregnancy shows her to be immune to rubella. In that case, she need not worry. You will not catch German Measles if you are immune, and if you do not catch it, your fetus cannot be affected, even if you come into contact with someone who has German Measles.

• There is an injection (immunoglobulin) which can reduce the likelihood of actually coming out with the obvious German Measles, but it does not prevent an infection in someone who is not immune who has come into contact with the disease, and is not recommended in the UK as a way of protecting susceptible pregnant women who have come into contact with rubella.

• Endemic transmission interrupted
• Record low annual total in 2002 (44 total cases)
• Many cases among adults
• Most cases imported or linked to importation

• Generalized rash lasting >3 days, and
• Temperature >38.3 C (101 F), and Cough or
• coryza or conjunctivitis

• Composition                  Live virus
• Efficacy 95%                 (range, 90%-98%)
• Duration of Immunity      Lifelong
• Schedule                      2 doses
• Should be administered with mumps and rubella as MMR

• Measles, mumps, or rubella disease (or lack of immunity) in a previously vaccinated person
• 2%-5% of recipients do not respond to the first dose
• Caused by antibody, damaged vaccine, record errors
• Most persons with vaccine failure will respond to second dose

• All infants >12 months of age
• Susceptible adolescents and adults without documented evidence of immunity

• 12 months is the recommended and minimum age
• MMR given before 12 months should not be counted as a valid dose
• Revaccinate at >12 months of age

• Intended to produce measles immunity in persons who failed to respond to the first dose (primary vaccine failure)
• May boost antibody titers in some persons

• First dose of MMR at 12-15 months
• Second dose of MMR at 4-6 years
• Second dose may be given any time >4 weeks after the first dose

• All states ensure that 2 doses of MMR required for school entry
• All children in kindergarten through grade 12 have 2 doses of MMR by 2001

Adults at Increased Risk of Measles

• College students
• International travelers
• Healthcare personnel

• All persons who work in medical facilities should be immune to measles

• Born before 1957
• Documentation of physician-diagnosed measles
• Serologic evidence of immunity
• Documentation of receipt of measles-containing vaccine

• Vaccinated before the first birthday
• Vaccinated with killed measles vaccine
• Vaccinated prior to 1968 with an unknown type of vaccine
• Vaccinated with IG in addition to a further attenuated strain or vaccine of unknown type

• Measles vaccine connection first suggested by British gastroenterologist
• Diagnosis of autism often made in second year of life
• Multiple studies have shown no association

• Severe allergic reaction to vaccine component or following prior dose
• Pregnancy
• Immunosuppression
• Moderate or severe acute illness
• Recent blood product

• Measles and mumps viruses grown in chick embryo fibroblast culture
• Studies have demonstrated safety of MMR in egg allergic children
• Vaccinate without testing

• MMR recommended for persons with asymptomatic and mildly symptomatic HIV infection
• NOT recommended for those with evidence of severe immuno- suppression
• Prevaccination HIV testing not recommended

• Apply PPD at same visit as MMR
• Delay PPD >4 weeks if MMR given first
• Apply PPD first - give MMR when skin test read

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