Measles (Rubeola) Resources for Health Care Providers
Measles cases are rising in the United States and globally.
Prompt recognition, reporting, and investigation of measles cases are important. You can help limit disease spread with vaccines and early case identification.
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For Local Health Departments
The MMR vaccine is the best way to protect against measles.
- Make sure patients are up to date on routine vaccination. Talk with parents about the importance of the vaccine.
- If a patient without evidence of immunity is exposed to measles, they may be eligible for post-exposure prophylaxis (PEP) right away.
- Early vaccination may be recommended for some infants:
- Before international travel or to an area of the U.S. where an outbreak is occurring, or
- When there is community transmission in their area of residence in NC.
CDC recommendations
- Dose 1: 12-15 months
- Dose 2: 4-6 years (before school entry)
Effectiveness
- One dose: 93% effective
- Two doses: ≥97% effective
Do not accept verbal reports of vaccination without written documentation.
Presumptive evidence of measles immunity includes:
- Written documentation of:
- One or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk
- Two doses of a measles-containing vaccine, administered at least 28 days apart, for school-age children and adults at high risk, including college students, health care workers and international travelers
- Birth before 1957
- Laboratory evidence of immunity
- Laboratory confirmation of disease
Use the North Carolina Immunization Registry (NCIR) to access MMR coverage of your eligible patient population. One dose of MMR vaccine, or other presumptive immunity, is sufficient for most U.S. adults born in or after 1957.
Early MMR Vaccination for Infants (6-11 Months)
Early vaccination may be considered for
- Infants living in counties with sustained community transmission
- Infants in nearby areas with likely exposure risk
- Infants planning international travel
Areas with possible community transmission
- Buncombe County
- The Charlotte Metropolitan area, including these counties: Cabarrus, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Union
Travel recommendations
All U.S. residents 6 months and older without evidence of immunity who are planning to travel internationally or to U.S. areas with known outbreaks should get the MMR vaccine before departure.
| Age | Doses |
|---|---|
| Infants 6-11 months | One dose MMR before departure Infants who get the MMR vaccine before their first birthday should get two additional doses as part of the routine childhood immunization schedule, beginning at 12-15 months. |
| Children 12 months and older | Two doses of MMR, at least 28 days apart, before departure |
| Teens and adults without evidence of measles immunity | Two doses of MMR, at least 28 days apart, before departure |
Measles is highly contagious and can cause severe illness in infants:
- 1 in 5 are hospitalized
- 1 in 20 develop pneumonia
- 1 in 1,000 develop encephalitis
- 1 to 3 in 1,000 may die
Infants younger than 12 months are at highest risk for severe complications.1, 2
Early MMR vaccination (6-11 months) can reduce risk of disease and death during outbreaks.
- 1
Leung J, Munir NA, Mathis AD, et al. The Effects of Vaccination Status and Age on Clinical Characteristics and Severity of Measles Cases in the United States in the Postelimination Era, 2001-2022. Clinical Infectious Diseases. 2025;80(3):663-672.
- 2
Perry RT, Halsey NA. The clinical significance of measles: a review. Journal of Infectious Diseases. 2004;189 Suppl 1:S4-16. doi: 10.1086/377712.
- Pediatricians should weigh benefits of early protection vs. slightly lower immune response in younger infants.
- Efficacy concerns: Data suggest many infants may not derive high levels of protection from this early dose, possibly due to maternal antibodies blunting the immune response.3
- Because of this, the dose is "extra": This early dose does not count toward the primary series. The child will still require the standard two doses starting at or after 12 months of age.
- Long-term immunity: There is some evidence that children who receive an early dose may experience a more rapid decay of antibody titers later in life, potentially resulting in lower overall protection as adults.4, 5, 6
- There is no need for immune globulin (IG) post-exposure or home quarantine if infant has previously received one early MMR dose.
- MMR is preferred over IG for infants 6–11 months if given within 72 hours of exposure. If ≥72 hours post-exposure, IGIM/IVIG may be considered within 6 days of exposure. Infant would still need home quarantine.
- VFC MMR can be used for the early dose for VFC eligible infants.
- 3
Brinkman ID, de Wit J, Smits GP, et al. Early measles vaccination during an outbreak in the Netherlands: short-term and Long-term decreases in antibody responses among children vaccinated before 12 months of age. Journal of Infectious Diseases 2019;220(4):594–602.
- 4
Gans HA, Yasukawa LL, Sung P, et al. Measles humoral and cell-mediated immunity in children aged 5–10 years after primary measles immunization administered at 6 or 9 months of age. Journal of Infectious Disease 2013;207(4):574–82.
- 5
van der Staak M, Hulscher HI, Nicolaie AM, et al. Long-term Dynamics of Measles Virus–Specific Neutralizing Antibodies in Children Vaccinated Before 12 Months of Age. Clinical Infectious Diseases 2025;80(4):904-910
- 6
Vittrup DM, Jensen A, Sørensen JK, et al. Immunogenicity and reactogenicity following MMR vaccination in 5-7-month-old infants: a double-blind placebo-controlled randomized clinical trial in 6540 Danish infants. EClinicalMedicine 2024;68:102421.
- Infants who receive early dose should be scheduled for:
- Routine Dose 1 at 12-15 months (at least 28 days after the early dose)
- Routine Dose 2 at 4-6 years
- Maintain clear documentation of all doses
Safety of the MMR Vaccine
- MMR is safe and effective; serious adverse events are rare.
- Reactions to the MMR vaccine can resemble measles disease. Common side effects include: mild fever, rash, sore arm.
- Febrile seizures are rare and not associated with long-term health effects.
Post-Exposure Prophylaxis (PEP)
People exposed to a confirmed case of measles may be eligible for post-exposure prophylaxis (PEP) if they do not have evidence of immunity.
Options
- MMR vaccine within 72 hours of exposure
- Immunoglobulin (IG) within six days of exposure.
IG is recommended for people at high risk of complications, including:
- Infants younger than 12 months*
- Pregnant women
- People who have compromised immune systems, regardless of vaccination status
*In a measles outbreak setting, infants 6-11 months can get MMR vaccine in lieu of IG if administered within 72 hours of exposure.
Don't administer MMR vaccine and IG at the same time. This practice invalidates the vaccine.
- Fever, Rash and Travel? Consider Measles (PDF)
- Think Measles: Clinician Job Aid (American Academy of Pediatrics) (PDF)
- REDBook Measles Guidance
Suspect measles? Call the state Communicable Disease Branch at 919-733-3419 (available 24/7) or your local health department to discuss lab testing and control measures.
Reduce exposures in health care settings as much as possible before and upon arrival of a patient with a known or suspected measles case.
- Notify EMS and/or the receiving facility before transporting or referring patients.
- Have patient use alternative entrance, avoid placing patient in a waiting room, place patient in a private room immediately, and mask patient as soon as possible. This helps avoid exposing others.
- Post visual alerts and instructions at entry points.
- Prepare triage stations to rapidly identify patients with measles.
- Adhere to standard and airborne precautions for patients with known or suspected measles. If an airborne isolation room is not available:
- Place the masked patient in a private room with the door closed.
- Preferably, avoid placement where room exhaust is recirculated without high-efficiency particulate air (HEPA) filtration
- Do not use the room for two hours after the patient leaves.
Laboratory Testing
The most common methods for confirming measles infection are detection of:
- Measles virus RNA via polymerase chain reaction (PCR)
- Measles-specific IgM antibody
Testing through the State Laboratory of Public Health (SLPH)
SLPH offers measles PCR testing on-site and send-out testing, including serology and vaccine RNA testing for situations involving recent vaccination. Some commercial laboratories also offer testing for measles serology and PCR. In most circumstances, testing through SLPH is faster than commercial testing.
You must get prior approval to test through SLPH: Call the state Communicable Disease Branch at 919-733-3419 (available 24/7) or your local health department.
Treatment
There is no specific antiviral therapy available for treatment of measles. Patient management focuses on supportive care to relieve symptoms and treatment of complications such as pneumonia and secondary bacterial infections.
Vitamin A
Vitamin A does not prevent measles and is not a substitute for vaccination. Overuse of Vitamin A can lead to toxicity and cause nausea, vomiting, headache, fatigue, blurry vision, confusion and coma. It can also lead to damage to the liver, bones, central nervous system and skin.
NCDHHS recommends following guidance from the American Academy of Pediatrics and World Health Organization (WHO). Vitamin A may be administered to infants and children in the United States with measles under the supervision of a health care provider as part of supportive management. Vitamin A should be administered to all children with severe measles, such as those who are hospitalized.
Vitamin A for treatment of measles is administered as one dose immediately upon diagnosis and repeated the next day for a total of 2 doses. The recommended age-specific daily doses are:
- 50,000 IU for infants < 6 months
- 100,000 IU for infants 6 through 11 months
- 200,000 IU for children 12 months or older
- An additional (i.e., a third) age-specific dose of vitamin A should be given 2-6 weeks later to children with clinical signs and symptoms of vitamin A deficiency
More information: National Foundation for Infectious Diseases: Vitamin A for the Management of Measles in the United States (PDF)
More Information from the CDC
This page was last modified on 02/17/2026