With measles outbreaks ongoing in both America and abroad, you are likely getting an increasing number of questions about measles and measles vaccines, so KPhA has compiled some information to help you and your patients stay safe!
- If your vaccine protocol includes measles vaccines, you can administer the vaccine per protocol. If the vaccine is not currently included in your protocol, you will need to update your protocol and get it signed by your protocol physician before you can administer the vaccine.
- Pharmacists cannot administer a measles vaccine to someone under the age of 12.
- Measles is highly contagious and virulent. It will infect 90% of unvaccinated individuals who come into contact with the virus. Infected individuals shed virus from four days before through four days after the rash shows up.
- MMR vaccines have been routinely administered since the 60’s and 70’s, so most adults have been vaccinated against measles. After an outbreak of measles in the early 90’s, the Vaccines for Children program was introduced, vastly improving access to vaccines for uninsured children. The two-vaccine series is >97% effective at preventing measles.
- It is recommended to check KSWebIZ (Kansas’s immunization registry) for evidence of previous vaccination before vaccinating to avoid possible duplication.
- ACIP recommends that persons without acceptable documentation of presumptive evidence of immunity be vaccinated. Examples of evidence are:
- Documentation of age appropriate vaccination
- Laboratory evidence of immunity
- Lab confirmation of disease
- Persons born before 1957
- There are several special populations to take into consideration:
- All children entering school, including colleges, need evidence of immunity
- Health care personnel born after 1957 should have evidence of two doses of a measles containing vaccine (if you attended pharmacy school after the 90’s, this was likely assessed in pharmacy school)
- Household and close contacts of immunocompromised people should have two doses of MMRII vaccine
- International travelers to high risk areas (including many parts of Europe!) should be assessed by a travel clinic – please refer these patients to a travel clinic! (HH28, 32, 33, and PC25)
So let’s say that your patient falls outside the 4 categories of immunity listed above (eg. 44y/o female without immunization records, not at high risk for exposure from travel) – for this patient, it would either be appropriate to provide one dose of MMRII or refer them to their physician for serologic testing (looking for measles specific IgG antibodies).
If you have a patient that is traveling internationally without evidence of immunity as defined above, a two-dose series of MMRII is recommended, with the doses at least 28 days apart, ideally completed before leaving the United States.
For more information on measles vaccine recommendations, please visit www.cdc.gov.
In the event of an outbreak in our state, we would receive further guidance from the Kansas Department of Health and Environment and local public health authorities. Outbreaks in populations that have high rates of vaccination are unlikely, but the most recent data from the CDC shows Missouri and Colorado rank in the bottom five states with coverage below the recommended 90%. Kansas is in the bottom 20% of states, with coverage just below 90% as well.
To best protect your communities, make sure that your pharmacy is a part of the immunization neighborhood – vaccinate who you can and refer those you can’t to the appropriate place!