Measles Prevention and Control Implementation

Please use this page to implement practices in your office to prevent and control measles spread. You’ll find details about measles vaccination recommendations, a sample, customizable measles policy, and tips to help implement it in your office.

Vaccination is critical

The best way to prevent measles infection is through vaccination. The Recommended Immunization Schedule calls for vaccination as follows.

Routine recommendation

1^stdose is given at 12-15 months of age
2^nd dose is given at 4-6 years of age

Recommendation during community transmission

Health care clinicians should follow vaccination recommendations issued by the state, local, tribal, or territorial health departments for areas experiencing sustained, community-wide measles transmission and an ongoing risk of exposure. In some cases, early or additional doses of MMR vaccine may be recommended beyond the routine MMR vaccination schedule. For example, health departments may recommend:

The second dose of MMR vaccine be given earlier for children aged 1-4 years who live in or plan to travel to an area with a measles outbreak. This dose is valid and countable for school.. Children with no documentation of vaccination history should receive two doses, at least 28 days apart.
An early dose of MMR vaccine for infants aged 6-11 months who live in or are traveling to an outbreak area.
- Clinicians should weigh the benefit of protection from measles during an outbreak against the risk of decreased immune responses in infants vaccinated with MMR before 12 months of age.
- Infants younger than 12 months of age are at greatest risk of severe illness. Vaccination of infants aged 6–11 months minimizes the risk of disease and death that could occur in these infants during measles outbreaks.
- The level of protective antibodies is lower and may remain lower in children vaccinated at younger than 12 months of age than in children vaccinated later. Infants who receive one doses of MMR vaccine before their first birthday should receive two more doses according to the routinely recommended schedule (one dose at 12 through 15 months of age and another dose at 4 through 6 years of age or at least 28 days later).

Recommendation for international travel

There are additional MMR vaccine recommendations for international travelers. Before leaving the United States, travelers aged 6 months and older who do not otherwise have acceptable evidence of measles immunity should be vaccinated with MMR vaccine, as described below.

Infants aged 6 through 11 months should receive one dose of MMR vaccine (ideally, at least two weeks before travel). Infants who received MMR vaccine at <12 months of age should still receive 2 doses according to the routine childhood schedule.
Children older than 12 months, teens, and adults born during or after 1957 who do not have other evidence of measles immunity should receive two doses of MMR vaccine (ideally with the second dose given at least two weeks before travel and at least 28 days apart).

Additional notes

If MMR is given in combination with varicella vaccine (MMRV), a minimum interval of 3 months from the previous varicella vaccine is needed. MMR and other live virus vaccines can be given simultaneously or 1 month apart.
For most patients, checking a titer after immunization is not recommended.

Staff vaccination

It is recommended that all clinical staff be up to date with their MMR vaccinations or show proof of adequate titer. Consider a policy that non-clinical staff who may have direct patient interaction should also have documented evidence of immunity to measles or current vaccination.

Preparing for measles in your practice

There is always the possibility that a person with measles may present in your office. Preparing your clinic and staff for this possibility will help limit additional spread of the virus.

Develop a policy for potential measles exposure/encounters

Draft and/or maintain an office policy to protect the health and safety of patients, staff, and visitors by outlining proper procedures to follow in the event of a measles exposure in the pediatric office. The policy should include proper triaging strategies to reduce potential exposure.

View a sample here and revise it with specifics for your practice (link will open a Word document to download).

Train and prepare staff

The sooner suspected measles cases are identified, the sooner proper precautions can be taken to minimize exposures.

Consider education for the following staff:

Those who interface with patients/families/caregivers via phone
Front desk staff who check in patients
Nurses, medical assistants and other clinical staff who will encounter or triage patients and listen/log presenting complaints and/or take a history
Physicians, nurse practitioners, physician assistants and all other health care providers.

During a measles outbreak especially, advise staff to identify patients who report measles symptoms and instruct them to inquire about measles vaccination status, as well as international travel or travel to measles outbreak areas. Consider handy educational aids (postings or note cards) to remind staff of the symptoms of measles, including:

High Fever
Cough
Coryza (runny nose)
Conjunctivitis (red, watery eyes)
Maculopapular Rash
- Typically appears 2-4 days after symptoms begin.
- Begins at hairline, spreads downward, to face, neck, and trunk.
- Rash appears red on light complexions, but may be harder to see or appear as purple or darker than surrounding skin on dark complexions.

When measles is suspected in the office:

All areas where the exposed patient has been should be thoroughly disinfected – standard cleaning and disinfection procedures are adequate for measles virus environmental control in all healthcare settings.
- Use cleaners and water to pre-clean surfaces prior to applying disinfectants to frequently touched surfaces or objects for indicated contact times.
- Use an EPA-registered disinfectant for healthcare settings, per manufacturer's instructions.
Manage used, disposable PPE and other patient care items for measles patients as regulated medical waste according to federal and local regulations.
Rooms in which a patient with measles was seen should be vacant for up to 2 hours before placing a new patient in the room.