Measles and Measles Vaccination: A Review

Johan Christiaan Bester
JAMA Pediatrics 2016 December 1, 170 (12): 1209-1215

Importance: Measles is a highly communicable viral infection with serious complications. There have been continued outbreaks of measles in countries in which measles is considered to be eliminated, such as the United States and the Netherlands, and measles remains endemic in some countries. Health care professionals play an important role in diagnosing and managing acute cases of measles, preventing spread during outbreaks, and vaccination uptake.

Objective: To provide an overview of measles and vaccination for health care professionals.

Evidence Review: MEDLINE and PubMed were searched from January 1, 1980, to April 30, 2016, in addition to the data repositories of the Centers for Disease Control and Prevention and World Health Organization.

Findings: Seven systematic reviews, 15 reviews, 15 observational studies, 1 qualitative study, 5 epidemiologic reports, and 2 books were included, in addition to World Health Organization and Centers for Disease Control and Prevention data, position papers, and statements. Transmission of measles is dependent on person-to-person spread through respiratory droplets or direct contact. Diagnosis is based on recognizing the clinical picture and can be confirmed with results of laboratory testing, such as serologic tests or polymerase chain reaction. Measles infection leads to immune suppression for weeks to months. Complications of measles are of high frequency and severity. There is no specific antiviral treatment for measles; treatment with vitamin A is recommended for younger children to decrease mortality from measles. Vaccination against measles is effective, cost-effective, and safe. There is no link between the measles vaccination and autism. Measles can be eliminated from a population; this outcome requires coverage with 2 doses of vaccine at rates of 93% to 95% of the population. Countries with high rates of measles vaccination experience outbreaks by virtue of imported cases causing transmission through susceptible groups of individuals who are not immune to the measles virus. Endemic transmission can be reestablished if rates of vaccination fall below the elimination threshold.

Conclusions and Relevance: Measles remains of high clinical importance. Health care professionals should be able to diagnose and manage an acute case and assist in prevention of the spread of measles during an outbreak. Health care professionals also play an important role in uptake of measles vaccination through establishing trusting relationships with parents, offering vaccination at indicated times, and engaging parents in discussion on facts and concerns about vaccination.

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