A number of live, attenuated measles vaccines are currently available, either as monovalent vaccine or as measles-containing vaccine combinations with one or more of rubella (R), mumps (M) and varicella vaccines. The measles/ mumps/rubella (MMR) or measles/rubella (MR) vaccine is given in many countries instead of monovalent measles vaccine. The measles vaccines that are now internationally available are safe and effective and may be used interchangeably in immunization programmes. Every child should receive two doses of measles vaccine. The second dose may be given as early as 1 month following the first, depending on the local programmatic and epidemiological situation.
Special attention must be paid to all children and adolescent/young adult travellers who have not received two doses of measles vaccine. Measles is still common in many countries and travel in densely populated areas may favour transmission. For infants travelling to countries experiencing extensive measles transmission, a dose of vaccine may be given as early as 6 months of age. However, children who receive the first dose between 6 and 8 months of age should subsequently receive the two doses according to the national schedule. Older children or adults who did not receive the two lifetime doses should consider measles vaccination before travel.
Given the severe course of measles in patients with advanced HIV infection, measles vaccination should be routinely administered to potentially susceptible, asymptomatic HIV-positive children and adults. Measles vaccination may be considered even in individuals with symptomatic HIV infection, provided that they are not severely immunosuppressed. Where the risk of contracting measles infection is negligible, physicians who are able to monitor CD4 counts may prefer to delay the use of measles vaccine until CD4 counts are above 200. Following measles vaccination no increased risk of serious adverse events has been demonstrated in HIV-positive compared with HIV-negative children, although lower antibody levels may be found in the former group.