Measles

• Second dose before 4 years of age: Although the second dose of MMR vaccine is typically recommended at age 4–6 years, clinicians can give the second MMR dose to children older than 1 year as long as it has been at least 28 days from their first dose (see details below if considering giving MMRV).

Rationale and details

Early, extra dose for infants: 

• Given the limited risk of community exposure to measles in Utah, we only recommend an early, extra MMR for those who live in or plan to travel to Washington County. While there have been people diagnosed with measles in Utah, these infections appear to be clustered in certain communities. The risk to the general population is very low, especially if the child is surrounded by vaccinated adults.
• Infants who are 6 to 11 months of age should be given an early, extra dose if they are traveling on  commercial flights or to areas in the U.S. with active measles spread. It is appropriate to follow the standard guidance for early vaccination for international travel for domestic travelers at this time. An early, extra dose is allowable for infants older than 6 months of age. Any infant who gets an early, extra dose will need to get 2 later doses in accordance with the standard vaccination schedule at 12–15 months and then a dose at 4–6 years. 
• We do not recommend wide-spread administration of an early dose for the following 2 reasons. First, the child will still need the 2 later doses. The data suggests that many children don’t actually get much protection from that early dose (possibly due to maternal antibodies blunting the response). Second, there is some evidence that children who get an early dose have a more rapid decay of antibody titers later in life. Therefore, given the low risk at this time and the possible negative impacts, we do not currently recommend an early, extra dose.
• MMRV should not be given to infants younger than age 1 year; instead MMR should be used. 

Early second dose:

• Data shows children mount a strong and long lasting immune response as long as the second dose is at least 28 days from the first dose if using MMR or 3 months if using MMRV (see additional details for MMRV below).
• Providers can give the second dose early, however it is important to recognize the protection provided by just 1 dose is excellent (93% vaccine effectiveness) even before the second dose.

General vaccination recommendations:

The Utah Department of Health and Human Services recommends 2 doses of measles-containing vaccine routinely for children:

• First dose at age 12 months through 15 months
• Second dose at age 4 through 6 years before they enter school.

This can be administered as MMR or MMRV. 

MMRV: If you are giving MMRV you should delay the second dose by at least 3 months. In addition, separate MMR and varicella vaccines are recommended for any infant younger than 47 months of age to reduce the risk of febrile seizures. 

We strongly encourage vaccination of all people older than 1 year of age, regardless of an exposure risk. One of the best ways to protect kids is to surround them with protected adults.