Vaccination has dramatically reduced the incidence of measles, along with its associated encephalitis and mortality. Introduced in 1963, the initial vaccine was based on an inactivated virus that did not provide a long duration of protection. In 1967, a live, attenuated vaccine providing long-lasting immunity was introduced. Vaccination with the attenuated strain should be routine not only for individuals aged 15 months but also for persons born between 1957 and 1967 who were neither vaccinated nor infected and for persons who received the inactivated viral vaccine. Individuals born before 1957 are considered immune by virtue of natural infection. The vaccine is contraindicated for persons with allergic or previous anaphylactic reactions to gelatin or neomycin but is safe for patients with hypersensitivity to eggs. Measles-mumps-rubella (MMR) vaccination is recommended for all children and is usually given first at about 15 months and again when the child is between the ages of 4 and 6, but the second dose can be given sooner if necessary. The preservative thimerosal is no longer used in this vaccine, and multiple studies have refuted previous concerns about an association between MMR vaccines and autism. For nonimmunized persons exposed to measles, postexposure prophylaxis with immunoglobulin should be given within 6 days of exposure.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.