AAP Updates Measles Recommendations

Laird Harrison

February 12, 2015

The American Academy of Pediatrics released updated measles guidelines online in response to the national outbreak of the disease.

The new guidelines from the academy's Red Book: 2015 Report of the Committee on Infectious Diseases feature changes in the evidence required for measles immunity, the use of immune globulin, vaccination for healthcare personnel, and the management of patients with HIV infections and other susceptibilities.

The book is not scheduled for publication until May, but the academy made the chapter available online to give clinicians immediate access to the updated recommendations during the current outbreak.

Evidence of Immunity

Under the new guidelines, any of the following constitutes evidence of immunity to measles:

  • Documentation of age-appropriate vaccination with a live measles virus–containing vaccine (one dose for preschool-aged children, two doses for children in kindergarten through 12th grade)

  • Laboratory evidence of immunity

  • Laboratory confirmation of disease

  • Birth before 1957

Use of Immune Globulin

Clinicians can administer immune globulin either intramuscularly or intravenously within 6 days of exposure to prevent or modify measles response in people who lack evidence of measles immunity.

The recommended dose is 0.50 mL/kg administered intramuscularly, with a maximum volume of 15 mL.

Groups who are at higher risk for complications from severe measles should receive intravenous application, the guidelines say, at a dose of 400 mg/kg.

People With HIV Infections

The guidelines recommend measles immunization (in the form of the measles, mumps, and rubella vaccine) for everyone older than 12 months who are infected by HIV except those who have evidence of severe immunosuppression. Measles can be fatal in patients with HIV.

The guidelines also recommend immune globulin prophylaxis for HIV-infected children who are exposed to measles, depending on their immune status and measles vaccine history.

Healthcare Personnel

The guidelines call for immunization programs for healthcare personnel, including students, who may be in contact with patients with measles.

The document warns that birth before 1957 "is not a guarantee of measles immunity" and recommends that facilities "consider" vaccination of unimmunized healthcare personnel who lack laboratory evidence of immunity who were born before 1957.

Management of Susceptible Individuals

Clinicians can best manage immunodeficient and immunosuppressed patients exposed to measles if they have previous knowledge of the patients' immune status, the guidelines say.

They call for children to receive measles vaccination prior to treatment with biological response modifiers, such as tumor necrosis factor antagonists. And they recommend that susceptible patients with immunodeficiencies receive immune globulin after measles exposure.

They warn against giving live-virus measles vaccines to immunocompromised patients with disorders associated with increased severity of viral infections (except people with HIV who do not have evidence of severe immunosuppression).

In addition, they recommend not giving immunization for at least a month after a patient has finished a high-dose course of corticosteroids, such as prednisone.

American Academy of Pediatrics. Early Release From Red Book: 2015 Report of the Committee on Infectious Diseases. Full text

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