Primary prevention

Measles can be prevented by immunization 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 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.[15] 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.[16]

​Children, adolescents, and adults who are not completely immunized may receive a measles-containing vaccine in a catch-up program.[15][17]​​​​[18]​​ Travelers to epidemic or endemic areas should ensure they are fully immunized. ​​In the US, all international travelers (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 ages 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 travelers received MMR vaccine before travel, increasing the risk of importation and transmission of measles by returning travelers.[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 in the US.[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 immunized 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][17]​​​[18][26]

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 nonlive vaccines.[27] UK recommendations call for a 28-day interval between MMR and yellow fever vaccines.[17]

Multiple studies have failed to demonstrate a link between measles-containing vaccines and autism.[14][28][29]

Secondary prevention

Control measures include isolating patients from susceptible individuals, immunizing potentially exposed individuals, and strengthening immunization programs 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 postexposure prophylaxis to prevent or modify measles infection, either with immune globulin within 6 days after exposure, or MMR vaccine within 72 hours of exposure.[21][46]​​ Use of immune globulin 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. CDC: interim infection prevention and control recommendations for measles in healthcare settings Opens in new window

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