Health care providers do not need to actively screen for measles immunity in low-risk patients who are likely to have received at least one dose of measles, mumps, rubella (MMR) vaccine during their lifetime and live in non-outbreak areas such as Colorado. However, if a patient is traveling internationally or to an outbreak-affected area and measles immunity is unknown, providers should vaccinate, unless there are contraindications. Vaccination recommendations are as follows:
Routine vaccination for children and low-risk adults
Children
- Two doses of measles-containing vaccine either measles, mumps, and rubella (MMR) or measles, mumps, rubella, and varicella (MMRV), one at 12–15 months and a second at 4-6 years.
Adults
- Adults should be up to date on MMR vaccinations, depending on their risk factors, unless they have presumptive evidence of immunity. One dose of MMR in those without presumptive evidence of immunity is enough for most adults. There is no recommendation for a catch-up program among low-risk adults for a second dose of MMR (e.g., persons born before 1989).
- Adults born during or after 1957 who received at least one dose of live measles virus-containing vaccine (MMR) on or after their first birthday should be protected against measles, but adults in certain high-risk groups (see below) should have two doses or other evidence of measles immunity.
- Adults vaccinated from 1963 through 1967 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live, attenuated measles vaccine (MMR). A killed measles vaccine available during this time and given to a small percentage of the population was not as effective.
- People born before 1957 are likely to have been infected and are presumed to be protected against measles, mumps, and rubella. Health care personnel are considered at high-risk for measles and need two documented doses of MMR vaccine or other proof that they are immune to measles, even if they were born before 1957.
Vaccination for people considered to be at high risk for either acquiring measles and/or transmitting measles to vulnerable people
Health care personnel
- Health care personnel (including volunteers, trainees, nurses, physicians, technicians, receptionists, and other clerical and support staff) should have two documented doses of MMR vaccine or serologic evidence of immunity to measles (i.e., a positive measles IgG titer). Health care personnel without evidence of immunity to measles may be excluded from work if they are exposed.
International travelers
- Infants aged 6 - 11 months should receive one dose of MMR vaccine before international travel. Infants who get one dose of MMR vaccine before their first birthday should get two more doses according to the routinely recommended schedule (one dose at aged 12 -15 months and another dose at aged 4 -6 years or at least 28 days later).
- People aged ≥12 months without evidence of measles immunity (birth before 1957, physician-diagnosed measles, or serologic evidence of immunity) should have two doses (at least 28 days apart) of MMR before traveling abroad.
- While people born before 1957 are generally considered immune to measles, they should consider getting an MMR vaccine if visiting specific countries with ongoing measles transmission.
Travel within the United States
- People traveling within the United States should be up to date on routine vaccinations as exposures may occur in areas with ongoing measles outbreaks and in places like airports and tourist destinations where travelers frequent.
- There is no recommendation for infants aged 6 - 11 months to receive an early dose of MMR vaccine before domestic travel, but physicians may consider early vaccination for patients visiting specific areas with ongoing measles transmission. The decision to vaccinate early should follow careful assessment of the benefit of early protection against measles and the risk of a decreased immune response following subsequent MMR doses in infants vaccinated at <12 months old compared with infants vaccinated at ≥12 months old.
- While people born before 1957 are generally considered immune to measles, they should consider getting an MMR vaccine if they’re visiting specific areas in states with ongoing measles transmission.
Students at post-high school education institutions such as colleges and universities
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Two doses of measles-containing vaccine (either MMR or MMRV) given at least four weeks apart with the first dose on or after their first birthday.
People with compromised immune systems
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MMR/MMRV vaccine is contraindicated for many people with compromised immune systems, but their family members and household contacts who are 12 months of age or older should receive two doses of MMR vaccine unless they have other evidence of measles immunity.