Measles is a vaccine-preventable contagious viral infection that causes fever, cough, runny nose, and rash. Though most people recover fully, for some measles can result in severe complications and even death.
The virus is contagious four days before the characteristic rash appears, and it spreads through the air and respiratory secretions. Therefore, you can catch measles simply from being in the same room as a contagious person (1).
When exposed to measles, time is of the essence! Read on to learn what you can do to prevent measles if you, or a family member, have been exposed to measles.* This article covers appropriate steps to take after exposure to measles, post-exposure vaccination & immune globulin treatment options, and natural ways to support the immune system for people of all ages and vaccination statuses.
*This article outlines steps you can take after being exposed but before developing symptoms of measles. If you’re looking for ways to manage symptoms and support healing of symptomatic measles, you may prefer this article: Measles – A Holistic Perspective.
Step 1: Call A Doctor Right Away
Upon finding out that you’ve potentially been exposed to measles, the first step is to call your doctor. They can give you up-to-date advice about local procedures for measles treatment and prevention as well as symptoms to watch out for.
If necessary, your doctor will give you individualized advice about treatment options, including active immunization with the MMR vaccine, passive immunization with immune globulin, and quarantine length to prevent further community spread of measles. In some cases, if the risk of complications is low or the effective time frame has passed for MMR vaccine or immune globulin treatment, “wait and see” is the preferred approach.
You should call ahead if you suspect measles, so that procedures can be put in place at your doctor’s office to prevent the spread of measles to anyone else.
Note: If you are fully vaccinated and/or if you don’t plan on taking advantage of conventional treatment options, you should still call your doctor if you have reason to believe that you’ve been exposed to measles. This is important for public health information & tracking and to receive up-to-date guidance on quarantine procedures if applicable.
Step 2: Determine Appropriate Post Exposure Treatment*
The second step post measles exposure is to work with a healthcare provider to determine your course of treatment. If you come into contact with measles and are not fully vaccinated, you may be offered either the MMR vaccine or immune globulin, if appropriate. Below, I discuss the difference between these two options and cases where one is more appropriate than the other. This is general information and the most appropriate treatment for you will be determined by your healthcare provider.
*This information is based on American guidelines created by the CDC and ACIP which can be viewed here. Other countries have different guidelines for measles post exposure prophylaxis.
MMR Vaccine For Post Exposure Measles Prophylaxis
The MMR vaccine is a live virus vaccine that protects against measles, mumps, and rubella. It has been shown to be 83.4% effective at preventing measles when given within 3 days of exposure in previously unvaccinated people (3). Post exposure measles prophylaxis is an off-label indication for PRIORIX and an on-label indication for M-M-R-II; see package inserts below.
The MMR vaccine requires a healthy immune system to effectively create the antibodies that confer measles protection; therefore, if you’re immune compromised, measles immune globulin (described below) is usually recommended instead of the vaccine.
The MMR vaccine is not recommended for pregnant women, immune compromised people, people with medical contraindications to the MMR vaccine, or for infants under 6 months of age. In these cases immune globulin is usually recommended (2).
Note: The MMR vaccine is not believed to be helpful for post exposure protection from either mumps or rubella, so this option is only for measles.
- See MMR vaccine PRIORIX package insert here.
- See MMR vaccine M-M-R-II package insert here.
FAQ: How Can I Support The Body After The MMR Vaccine?
According to conventional research, vaccines are tolerated by most people without medical contraindications (6); however, we at Dr. Green Mom believe in giving the body extra support during vaccination. Most importantly, this includes ensuring that the body has enough vitamin A, vitamin C, vitamin D, zinc, DHA, methyl B12, folate, and other nutrients important for healthy immune function. Additionally, supporting the body’s routes of detoxification, inflammatory balance, and immune balance through the thoughtful use of herbal medicine may be helpful.
It’s important to note that if potential measles exposure has occurred and there isn’t the time to put into place the above holistic vaccination support, do not delay getting the MMR vaccine. We consider the added nutritional support “nice-to-have” not “need-to-have”.
- Learn more about caring for your child during vaccination in this article: 6 Ways To Support Your Child’s Health On Vaccination Day – Dr. Green Mom
- To learn about the herbs that we like for vaccine support, check out this article: The Story Behind VaxClear® – Vaccination Support For Children – Dr. Green Life
- For a deeper dive into all things vaccines, you may be interested in our Vaccine Strategy Guide.
Immune Globulin For Measles Prophylaxis
Immune globulin is made from donated human blood and contains antibodies that provide immediate short term protection against several infectious diseases including measles. This therapy may prevent infection or make the infection less severe. Immune globulin treatment may be prioritized for those at highest risk of severe measles complications including infants <12 months, immune compromised people, and pregnant people.
Measles immune globulin treatment reduces the risk of getting measles by 83% if given within 6 days of exposure. It also reduces the risk of death from measles infection by 76% (4). A small 2021 study showed that immune globulin treatment was up to 99% effective at preventing measles for infants who didn’t have maternal measles antibodies (5).
To ensure safety, the blood that immune globulin is made from is thoroughly tested for viruses like HIV and hepatitis. Additionally, there are a number of steps taken throughout the procedure that are intended to eliminate any microbes from the final preparation. The risk for disease transmission from a human immune globulin product is extremely low, but it is not zero. The safety data for use of immune globulin during pregnancy is limited. For more information, see the package insert linked below.
Some people should not get immune globulin treatment, including those with certain underlying health concerns or those who have been immunized against measles, mumps, rubella, or chickenpox within 14 days of exposure.
Immune globulin treatment does not provide long term protection against measles, and vaccination with MMR may be desired. In this case, MMR vaccination should be postponed for at least 3-11 months after getting immune globulin or as directed by your doctor (6).
- See the immune globulin package insert for GamaSTAN S/D here.
If You Are Fully Vaccinated Or Have Evidence Of Immunity
If you are fully vaccinated — or have evidence of immunity from a previous infection or measles titre blood test — and have a healthy immune system, then you don’t need to take any further action, including quarantining or getting any additional treatment, unless you develop symptoms. Two doses of the MMR vaccine is 97% effective, so all that is required is to watch for measles symptoms for the 21 days following exposure: look out for cough, red eyes, runny nose, and a fever. If any of these symptoms appear, stay home and contact your doctor right away.
If you are fully vaccinated and have a severe immune deficiency due to an immune condition or medication, then you may not be fully protected by the vaccine and your doctor may prescribe immune globulin treatment if appropriate.
FAQ: Does measles immunity wane over the years?
The immunity conferred by the MMR vaccine is considered by the CDC to be lifelong in most cases (6); however, research shows that for a small subset of the population this may not be the case (7). Measles titres can be checked via a simple blood test if you are curious about your level of immunity.
If You Are Partially Vaccinated
The first dose of the measles vaccine is 93-98% effective at producing protection against measles (6). If you have had your titres tested after one dose of the MMR or MMRV vaccines, you may have evidence of immunity as described above. If you don’t have evidence of immunity, then you may be recommended a second MMR shot in order to improve your level of protection. The second dose of the MMR vaccine needs to be at least 28 days after the first (6). Immune globulin generally isn’t recommended for people partially vaccinated against measles unless there is a severe immune deficiency or other reason to believe that you’re highly susceptible to measles.
Your doctor will give you individualized advice about the need for quarantine.
If You Are Unvaccinated
If you are unvaccinated and come into contact with someone with measles, you may be recommended either the MMR vaccine or an injection of measles immune globulin depending on the different factors discussed above (time, health status, age, etc). In some cases, “wait and see” is preferred to immune globulin prophylaxis if risk for severe measles complications is low.
The MMR vaccine is most helpful if given within 3 days of exposure to measles. Immune globulin is most effective if given within 6 days of exposure to measles. Because measles is extremely contagious, it is likely that you will develop symptoms if you’re not vaccinated and decline post exposure prophylaxis.
- For information about ways to manage measles symptoms, see: Measles – A Holistic Perspective.
Infants Under 6 Months
Newborn infants receive some measles antibodies from their mothers at birth, provided that their mothers already have antibodies in their systems. The level and duration of protection that the infant gets from their mother’s antibodies depends on how many antibodies she has: Mothers who have had measles infection tend to have more antibodies than mothers who received the measles vaccine.
Studies have shown that approximately 7% of infants born in the United States don’t have any immunity to measles, and that number increases to 90% by 6 months of age as maternal antibody levels wane (8). For young infants, rapid access to testing for measles immunity and potentially immune globulin treatment is essential.
Infants 6-12 Months
After 6 months, infants may receive the MMR vaccine (if within 72 hours of exposure) instead of immune globulin for post exposure measles prophylaxis. Infants who receive the MMR vaccine under 12 months of age require two more doses of the vaccine after age 12 months in order to be considered fully vaccinated (8).
Step 3: Support The Immune System
After contacting your doctor and determining your best treatment, the third step is to support the immune system. Supporting the immune system after possible exposure to measles makes sense from an integrative perspective; however, it shouldn’t be counted on to prevent measles infection in the same way that the MMR vaccine or immune globulin therapy would.
There are a number of ideas about how best to support the body’s immune system, and when it comes to my own medical practice, I help families create individualized plans based on the following principles:
- Get enough sleep – this is essential to a well functioning immune system.
- Spend time outside with fresh air & sunshine – this may not be possible if quarantining, but even time near an open window on a sunny day can be helpful.
- Ensure the body has enough nutrients, with a focus on immune supporting nutrients like vitamin A, vitamin C, vitamin D, and zinc.
- Promote white blood cell production with herbal medicines like echinacea, astragalus, and elderberry.
- Support the microbiome with fermented foods and/or a quality probiotic.
Any of the above ideas for immune support may be implemented in addition to the MMR vaccine or immune globulin. Always speak to your doctor about what is right for you.
- For information on natural health strategies to manage symptoms and support healing of symptomatic measles, see: Measles – A Holistic Perspective.
FAQ: Should I Take A Vitamin A Megadose Post Measles Exposure?
A vitamin A megadose is recommended by the CDC to people experiencing acute measles infection as it seems to help reduce the incidence of severe outcomes (2).
When it comes to measles exposure without acute measles symptoms, I would not give a vitamin A megadose to any patients in my own practice who had already been supplementing with vitamin A — or vitamin A containing supplements like Cod Liver Oil or Beef Liver Capsules — as I would expect their vitamin A levels to be at an already optimum level for immune health.
However, I would consider a vitamin A megadose for patients who haven’t been supplementing with vitamin A and who eat a primarily plant-based diet as their vitamin A levels may be lower than ideal.
In contrast, when it comes to acute measles symptoms, I would generally give a megadose to most non-pregnant patients regardless of their diet/supplementation status per the CDC recommendations.
Speak to your own doctor for individual guidance about vitamin A and other treatments.
- Learn more about vitamin A megadosing here: Vitamin A Megadose For Viral Infections – Dr. Green Mom.
Summary
Measles is a contagious infection that may have severe outcomes in some populations. If you’ve been exposed to measles, contact your doctor right away. If you have been fully vaccinated, no further steps are needed unless you develop symptoms. If unvaccinated or partially vaccinated, your treatment options may include post exposure vaccination or human immune globulin. At Dr. Green Mom, we also recommend supporting the immune system post measles exposure through quality sleep, fresh air, healthy diet, and supplementation as needed. Always speak to your doctor for individualized recommendations.
- For a deeper dive into vaccine-preventable diseases, you may be interested in our Vaccine Strategy Guide.
References:
- Moss W. J. (2017). Measles. Lancet (London, England), 390(10111), 2490–2502. https://doi.org/10.1016/S0140-6736(17)31463-0
- Blutinger E, Schmitz G, Kang C, Comp G, Wagner E, Finnell JT, Cozzi N, Haddock A. Measles: Contemporary considerations for the emergency physician. J Am Coll Emerg Physicians Open. 2023 Sep 9;4(5):e13032. doi: 10.1002/emp2.13032. PMID: 37692196; PMCID: PMC10492449.
- Arciuolo, R. J., Jablonski, R. R., Zucker, J. R., & Rosen, J. B. (2017). Effectiveness of Measles Vaccination and Immune Globulin Post-Exposure Prophylaxis in an Outbreak Setting-New York City, 2013. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 65(11), 1843–1847. https://doi.org/10.1093/cid/cix639
- Young, M. K., Nimmo, G. R., Cripps, A. W., & Jones, M. A. (2014). Post-exposure passive immunisation for preventing measles. The Cochrane database of systematic reviews, 2014(4), CD010056. https://doi.org/10.1002/14651858.CD010056.pub2
- Kohlmaier, B., Holzmann, H., Stiasny, K., Leitner, M., Zurl, C., Strenger, V., Kundi, M., & Zenz, W. (2021). Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants. Frontiers in pediatrics, 9, 762793. https://doi.org/10.3389/fped.2021.762793
- CDC. (2021). Pinkbook: Measles. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html#
- Quach, H. Q., Ovsyannikova, I. G., Grill, D. E., Warner, N. D., Poland, G. A., & Kennedy, R. B. (2022). Seroprevalence of Measles Antibodies in a Highly MMR-Vaccinated Population. Vaccines, 10(11), 1859. https://doi.org/10.3390/vaccines10111859
- CDC. (2013). Prevention of measles, rubella, congenital rubella syndrome, and MUMPS: Summary recommendations of the Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
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