Students at post-high school educational institutions
Students at post-high school educational institutions who do not have presumptive evidence of immunityshould receive two doses of MMR vaccine, each dose separated by at least 28 days.
International travelers
Persons aged 6 months and older who will be traveling internationally to any country outside the United States who do not have presumptive evidence of immunity should be vaccinated with measles-containing vaccine if they are not already protected against measles, mumps, and rubella. Before any international travel—
- Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses according to the routinely recommended schedule. (The first dose should be given at 12 through 15 months of age and the second dose at 4 through 6 years of age. The second dose can be administered earlier as long as at least 28 days have elapsed since the first dose).
- Persons 12 months of age and older should receive two doses of measles-containing vaccine, separated by at least 28 days, unless they have other presumptive evidence of immunityagainst measles.
Healthcare personnel without presumptive evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days. Although birth before 1957 is considered acceptable evidence of immunity, in routine circ*mstances, healthcare facilities should consider vaccinating healthcare personnel born before 1957 who lack laboratory evidence of immunity or laboratory confirmation of disease.
Household and close contacts of immunocompromised persons
People with compromised immune systems are at high risk for severe complications if infected with measles. All family and other close contacts of people with compromised immune systems 12 months of age and older should receive two doses of MMR vaccine separated by 28 days, unless they have other presumptive evidence of measles immunity.
People with Human Immunodeficiency Virus (HIV) infection
People 12 months of age and older with HIV infection who do not have presumptive evidence of measles immunity or evidence of severe immunosuppression should receive two doses of MMR vaccine, separated by 28 days. Severe immunosuppression is defined as CD4 percentages less than 15% for 6 months or longer (for children five years of age or younger) and CD4 percentages less than 15% and CD4 count less than 200 cells/mm3 for 6 months or longer (for persons older than five years).
Adults who know they got the killed (inactivated) measles vaccine
A very small proportion of adults (less than 5%) may have received killed measles vaccine from 1963 through 1967 during childhood. The ACIP recommends re-vaccinating anyone who received measles vaccine of unknown type, inactivated measles vaccine, or further attenuated measles vaccine accompanied by IG or high-titer measles immune globulin (no longer available in the United States) during these years with 1 or 2 doses.
Groups at increased risk for measles because of a measles outbreak
During measles outbreaks, health departments may provide additional recommendations to protect their communities. The at-risk population is defined by local and state health departments and depends on the epidemiology of the outbreak (e.g., only specific age groups are affected). In addition to the routine recommendations for MMR vaccine, health departments may recommend a second dose for adults or an earlier second dose for children 1 to 4 years of age who are residing in or visiting the affected areas, with the second dose given at least 28 days after the first dose.
If there is ongoing community-wide transmission affecting young infants, health departments may recommend an early dose for infants 6 to 11 months of age. The decision to vaccinate should be made carefully after weighing the risks of the potential long-term impact of lower immune responses when infants are vaccinated less than 12 months of age (versus greater than or equal to 12 months of age) compared to the benefit of early protection when measles is circulating in the community. Infants who get one dose of MMR vaccine before their first birthday should get two more doses according to the routinely recommended schedule (first dose should be given at 12 through 15 months of age and the second dose at 4 through 6 years of age. The second dose can be administered earlier as long as at least 28 days have elapsed since the first dose).
During an outbreak of measles in a healthcare facility, or in healthcare facilities serving a measles outbreak area, two doses of MMR vaccine are recommended for healthcare personnel, regardless of birth year, who lack other presumptive evidence of measles immunity
There are no recommendations to receive a third dose of MMR vaccine during measles outbreaks.
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