Pediatrics Academy Updates Measles Recommendations

In response to the national measles outbreak, the American Academy of Pediatrics has released updated measles guidelines on its website. The new guidelines from the Academy’s Red Book: 2015 Report of the Committee on Infectious Diseases weren’t scheduled for publication until May, but the academy made the chapter available online earlier to give clinicians immediate access to the updated recommendations. Following are highlights of the changes to the guidelines:

• Any of the following constitutes evidence of immunity to measles: 1) 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), 2) laboratory evidence of immunity, 3) laboratory confirmation of disease or 4) birth before 1957.
• Clinicians can administer immune globulin either intramuscularly or intravenously within six days of exposure to prevent or modify measles response in people who lack evidence of measles immunity.
• The measles, mumps and rubella vaccine is recommended for everyone older than 12 months who is infected by HIV, except those who have evidence of severe immunosuppression. And, HIV-infected children who are exposed to measles should be given immune globulin prophylaxis, depending on their immune status and measles vaccine history.
• For healthcare personnel, including students who may be in contact with patients with measles, immunization programs should be implemented. And, birth before 1957 isn’t a guarantee of measles immunity; therefore, facilities should consider vaccination of unimmunized healthcare personnel who lack laboratory evidence of immunity who were born before 1957.
• Immunodeficiency and immunosuppressed patients exposed to measles can best be managed with previous knowledge of patients’ immune status.
• Children should receive measles vaccination prior to treatment with biological response modifiers such as tumor necrosis factor antagonists.
• Susceptible patients with immunodeficiencies should receive immune globulin after measles exposure.
• Live-virus measles vaccines are not recommended for immunocompromised patients with disorders associated with increased severity of viral infections (except people with HIV who do not have evidence of severe immunosuppression).
• Immunization is not recommended for at least a month after a patient has finished a high-dose course of corticosteroids such as prednisone.

To view the updated chapter online, go to redbook.solutions.aap.org/DocumentLibrary/2015RedBookMeasles.pdf.