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Measles

Prevention and Treatment

Gary S. Marshall, MD 
Reviewed on October 18, 2024
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Introduction

Because there is no effective treatment for measles (see Assessment and Treatment), prevention is of paramount importance for both the maintenance of public health in regions where the disease is eliminated and for efforts to eliminate it in regions where it is still endemic. In this section, we discuss established guidelines for individual prophylaxis and outbreak control from the Advisory Committee on Immunization Practices (ACIP) (the vaccine advisory committee of the Centers for Disease Control (CDC).

Prevention Through Vaccination

In the early twentieth century, measles mortality began to drop in industrialized countries due to improvements in economic conditions, better nutrition and enhanced medical care. However, the introduction of vaccination in the early 1960s had a profound incremental effect on disease incidence and deaths. Between the year 2000 and 2016, the number of reported measles cases worldwide decreased by 84%. However, from 2016 to 2019, the incidence…

Introduction

Because there is no effective treatment for measles (see Assessment and Treatment), prevention is of paramount importance for both the maintenance of public health in regions where the disease is eliminated and for efforts to eliminate it in regions where it is still endemic. In this section, we discuss established guidelines for individual prophylaxis and outbreak control from the Advisory Committee on Immunization Practices (ACIP) (the vaccine advisory committee of the Centers for Disease Control (CDC).

Prevention Through Vaccination

In the early twentieth century, measles mortality began to drop in industrialized countries due to improvements in economic conditions, better nutrition and enhanced medical care. However, the introduction of vaccination in the early 1960s had a profound incremental effect on disease incidence and deaths. Between the year 2000 and 2016, the number of reported measles cases worldwide decreased by 84%. However, from 2016 to 2019, the incidence surged again. Measles-related deaths, which had decreased to fewer than 100,000 annually by 2016, rose again to 207,500 in 2019. Despite this dramatic surge, measles vaccination is estimated to have prevented 25.5 million deaths worldwide between 2000 and 2019. The reduction in mortality in different World Health Organization (WHO) regions between the year 2000 and 2022 is shown in Table 4-1.

The most significant progress in the reduction of measles cases and deaths resulted from widespread administration of the first dose of a measles-containing vaccine during infancy. The addition of a second dose through routine immunization further enhanced protection against the disease. The primary reason for a 2-dose schedule is to seroconvert individuals who did not respond appropriately to the first dose. In countries where the first measles, mumps, and Rubella (MMR) dose is given at <12 months of age, maternally-acquired immunoglobulin G (IgG) antibodies may diminish the immune response to the attenuated measles vaccine; maternal antibodies decrease over time and are absent in most children by 9 months of age.

Achieving and maintaining measles elimination requires vaccinating a sufficient percentage of the eligible population to establish herd immunity. Herd immunity, also known as “indirect protection” or “herd effect”, refers to the diminution of infection risk for susceptible individuals by virtue of a sufficiently large proportion of immune individuals in the same population. The threshold for herd immunity (i.e., the proportion of immune individuals in the population at which pathogen transmission is effectively prevented) is a function of the basic reproductive number (R₀) of the pathogen, and can be calculated with the formula: p = (1 - 1/R₀). It follows that herd immunity thresholds are higher for highly infectious diseases. For measles, R₀ is typically estimated at between 12 and 18, giving a herd immunity threshold of 92-94%. Most public health agencies, including the CDC, thus aim to establish vaccine coverage of 95% or greater.

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