The CDC said it issued the Health Alert Network (HAN) Health Advisory to “inform clinicians and public health officials of an increase in global and U.S. measles cases and to provide guidance on measles prevention for all international travelers aged ≥6 months and all children aged ≥12 months who do not plan to travel internationally.”
Public health officials warn that measles (rubella) is highly contagious and that one person infected with measles can infect nine out of 10 unvaccinated individuals with whom they come in close contact.
The information is significant for pharmacists because although state laws vary in age restrictions for pharmacy vaccine administration for children and adolescents, the Public Readiness and Emergency Preparedness Act (PREP Act) of 2020 authorized pharmacists to order and administer approved COVID-19 and childhood vaccines to children aged 3 to 18 years through this year.
Through March 14, the CDC said it had been notified of 58 confirmed U.S. cases of measles across 17 jurisdictions, including seven outbreaks in seven jurisdictions compared with 58 total cases and four outbreaks reported the entire year in 2023.
Among the 58 cases reported in 2024, the vast majority, 93%, were linked to international travel. In addition, most cases reported in 2024 have been among children aged 12 months and older who had not received measles-mumps-rubella (MMR) vaccine.
The agency also pointed out that many countries, including destinations such as Austria, the Philippines, Romania, and the United Kingdom, are experiencing measles outbreaks. “To prevent measles infection and reduce the risk of community transmission from importation, all U.S. residents traveling internationally, regardless of destination, should be current on their MMR vaccinations,” the CDC advised. “Healthcare providers should ensure children are current on routine immunizations, including MMR. Given currently high population immunity against measles in most U.S. communities, the risk of widescale spread is low. However, pockets of low coverage leave some communities at higher risk for outbreaks.”
Measles can cause severe health complications, including pneumonia, encephalitis, and death, especially in unvaccinated persons. Measles typically begins with fever, cough, coryza, and conjunctivitis lasting 2 to 4 days before rash onset, according to the alert. The incubation period for measles from exposure to fever is usually about 10 days (range 7-12 days), while rash onset is typically visible around 14 days (range 7-21 days) after initial exposure.
The CDC noted that the virus is transmitted through direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes, and it can remain infectious in the air and on surfaces for up to 2 hours after an infected person leaves an area. Individuals infected with measles are contagious from 4 days before the rash starts through 4 days afterward, it added.
Measles vaccination rates have decreased globally, increasing the risk of measles outbreaks worldwide, including in the U.S. “Measles cases continue to be brought into the United States by travelers who are infected while in other countries,” the CDC wrote. “As a result, domestic measles outbreaks have been reported in most years, even following the declaration of U.S. measles elimination in 2000. Most importations come from unvaccinated U.S. residents.”
Yet, the alert adds, measles is almost entirely preventable through vaccination. Two doses of the MMR vaccine are 97% effective against measles; one dose is 93% effective.
“When more than 95% of people in a community are vaccinated (coverage >95%) most people are protected through community immunity (herd immunity),” the CDC explained. “However, vaccination coverage among U.S. kindergartners has decreased from 95.2% during the 2019–2020 school year to 93.1% in the 2022–2023 school year, leaving approximately 250,000 kindergartners susceptible to measles each year over the last three years.”
Here are the recommendations for pharmacists and other healthcare providers:
• Children who are not traveling internationally should receive their first dose of MMR at age 12 to 15 months and their second dose at age 4 to 6 years
• All U.S. residents older than age 6 months without evidence of immunity who are planning to travel internationally should receive MMR vaccine prior to departure
o Infants aged 6 through 11 months should receive one dose of MMR vaccine before departure. Infants who receive a dose of MMR vaccine before their first birthday should receive two more doses of MMR vaccine, the first of which should be administered when the child is age 12 through 15 months and the second at least 28 days later
o Children aged 12 months or older should receive two doses of MMR vaccine, separated by at least 28 days
o Teenagers and adults without evidence of measles immunity should receive two doses of MMR vaccine separated by at least 28 days
• At least one of the following is considered evidence of measles immunity for international travelers: 1) birth before 1957, 2) documented administration of two doses of live measles virus vaccine (MMR, MMRV, or other measles-containing vaccine), or 3) laboratory (serologic) proof of immunity or laboratory confirmation of disease
• Consider measles as a diagnosis in anyone with fever (≥101°F or 38.3°C) and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently been abroad, especially in countries with ongoing outbreaks.
If measles is suspected, healthcare providers, including pharmacy-based clinics, are urged to isolate patients. “Do not allow patients with suspected measles to remain in the waiting room or other common areas of a healthcare facility; isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room (AIIR) if available, or in a private room with a closed door until an AIIR is available,” the alert advised.
The CDC further recommends:
• Healthcare providers should be adequately protected against measles and should adhere to standard and airborne precautions when evaluating suspect cases, regardless of their vaccination status. Healthcare providers without evidence of immunity should be excluded from work from Day 5 after the first exposure until Day 21 following their last exposure. Offer testing outside of facilities to avoid transmission in healthcare settings. Call ahead to ensure immediate isolation for patients referred to hospitals for a higher level of care
• State, tribal, local, or territorial health departments must be immediately notified about any suspected case of measles to ensure rapid testing and investigation. States report measles cases to CDC
• CDC’s testing recommendations should be followed, with the collection of either a nasopharyngeal swab, throat swab, and/or urine test for or reverse transcription polymerase chain reaction (RT-PCR) and a blood specimen for serology from all patients with clinical features compatible with measles. RT-PCR is available at many state public health laboratories, through the APHL Vaccine Preventable Disease Reference Centers, and at CDC. Given potential shortages in IgM test kits, providers should be vigilant in contacting their state or local health department for guidance on testing
• In coordination with local or state health departments, appropriate measles postexposure prophylaxis (PEP) should be provided as soon as possible after exposure to close contacts without evidence of immunity, either with MMR (within 72 hours) or immunoglobulin (within 6 days). The choice of PEP is based on elapsed time from exposure or medical contraindications to vaccination.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
