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Measles
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==Prevention== {{further|Measles vaccine|MMR vaccine|MMRV vaccine}} [[File:Measles vaccination coverage world.svg|thumb|upright=1.4|Rates of measles vaccination worldwide]] Mothers who are immune to measles pass antibodies to their children while they are still in the womb, especially if the mother acquired immunity through infection rather than vaccination.<ref name="Pink Book" /><ref name="Leuridan2012">{{cite journal | vauthors = Leuridan E, Sabbe M, Van Damme P | title = Measles outbreak in Europe: susceptibility of infants too young to be immunized | journal = Vaccine | volume = 30 | issue = 41 | pages = 5905–13 | date = September 2012 | pmid = 22841972 | doi = 10.1016/j.vaccine.2012.07.035 }}</ref> Such antibodies will usually give newborn infants some immunity against measles, but these antibodies are gradually lost over the course of the first nine months of life.<ref name="Merck Manual" /><ref name="Leuridan2012"/> However, immunization with live vaccines is not recommended in pregnancy; pregnant people found to be non-immune to measles should be immunized after delivery.<ref name=":13" /> Infants under one year of age whose maternal anti-measles antibodies have disappeared become susceptible to infection with the measles virus.<ref name="Leuridan2012"/> It is generally recommended that children be immunized against measles at 12 months, as part of a three-part [[MMR vaccine]] (measles, [[mumps]], and [[rubella]]). The vaccine is generally not given before this age because younger infants respond inadequately to the vaccine due to an immature immune system. A second dose of the vaccine is recommended between the ages of four and five, to increase rates of immunity.<ref name="ACIP2013" /><ref name=":14">{{Cite web |date=28 April 2017 |title=Measles vaccines: WHO position paper |url=https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers/measles |access-date=23 March 2025 |website=[[World Health Organization]] (WHO) |archive-date=14 February 2025 |archive-url=https://web.archive.org/web/20250214032347/https://www.who.int/teams/immunization-vaccines-and-biologicals/policies/position-papers/measles |url-status=live }}</ref> Adverse reactions to vaccination are rare, with fever and pain at the injection site being the most common. Life-threatening adverse reactions occur in less than one per million vaccinations (<0.0001%).<ref name="cubavac">{{cite journal | vauthors = Galindo BM, Concepción D, Galindo MA, Pérez A, Saiz J | title = Vaccine-related adverse events in Cuban children, 1999-2008 | journal = MEDICC Review | volume = 14 | issue = 1 | pages = 38–43 | date = January 2012 | pmid = 22334111 | doi = 10.37757/MR2012V14.N1.8 | doi-access = free | title-link = doi }}</ref> In areas with a high risk of measles infection, the [[World Health Organization]] (WHO) recommends the first two doses of vaccine be given earlier, at nine and eighteen months of age.<ref name=":14" /> The vaccine should be given whether the child is HIV-infected or not.<ref>{{cite journal | vauthors = Helfand RF, Witte D, Fowlkes A, Garcia P, Yang C, Fudzulani R, Walls L, Bae S, Strebel P, Broadhead R, Bellini WJ, Cutts F | title = Evaluation of the immune response to a 2-dose measles vaccination schedule administered at 6 and 9 months of age to HIV-infected and HIV-uninfected children in Malawi | journal = The Journal of Infectious Diseases | volume = 198 | issue = 10 | pages = 1457–65 | date = November 2008 | pmid = 18828743 | doi = 10.1086/592756 | doi-access = free | title-link = doi }}</ref> The vaccine is less effective in HIV-infected infants than in the general population, but early treatment with antiretroviral drugs can increase its effectiveness.<ref>{{cite journal | vauthors = Ołdakowska A, Marczyńska M | title = [Measles vaccination in HIV infected children] | journal = Medycyna Wieku Rozwojowego | volume = 12 | issue = 2 Pt 2 | pages = 675–80 | year = 2008 | pmid = 19418943 }}</ref> Measles vaccination programs are often used to deliver other child health interventions as well, such as bed nets to protect against [[malaria]], antiparasitic medicine, and vitamin A supplements, and so contribute to the reduction of child deaths from other causes.<ref>{{cite press release|url=http://www.unicef.org/media/media_38076.html|title=Global goal to reduce measles deaths in children surpassed|publisher=UNICEF|year=2007|access-date=11 March 2015|url-status=dead|archive-url=https://web.archive.org/web/20150204152400/http://www.unicef.org/media/media_38076.html|archive-date=4 February 2015 }}</ref> The [[Advisory Committee on Immunization Practices]] (ACIP) of the US [[Centers for Disease Control and Prevention]] (CDC) recommends that all adult international travelers who do not have positive evidence of previous measles immunity receive two doses of MMR vaccine before traveling.<ref name="ACIP2013" /><ref>{{cite web | title=Plan for Travel | website=Measles (Rubeola) | date=15 July 2024 | url=https://www.cdc.gov/measles/travel/index.html | access-date=3 May 2025 | archive-date=28 April 2025 | archive-url=https://web.archive.org/web/20250428062450/https://www.cdc.gov/measles/travel/index.html | url-status=live }}</ref> Birth before 1957 is presumptive evidence of immunity.<ref name="ACIP2013" /> People born before 1957 are likely to have been naturally infected with the measles virus and generally need not be considered susceptible.<ref name="ACIP2013">{{cite journal | vauthors = McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS | title = Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR. Recommendations and Reports | volume = 62 | issue = RR-04 | pages = 2, 19 | date = June 2013 | pmid = 23760231 | url = https://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf|url-status=live|archive-url=https://web.archive.org/web/20200413110343/https://www.cdc.gov/mmwr/pdf/rr/rr6204.pdf |archive-date= 13 April 2020}}</ref><ref name="Pink Book" /><ref>{{cite web |title=Measles Prevention: Recommendations of the Immunization Practices Advisory Committee (ACIP) |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |date=29 December 1989 |access-date=13 November 2020 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm |archive-date=15 May 2012 |archive-url=https://web.archive.org/web/20120515055632/http://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm |url-status=live }}</ref> There have been false claims of an association between the measles vaccine and [[autism]]; this incorrect concern has reduced the rate of vaccination and increased the number of cases of measles where immunization rates became too low to maintain [[herd immunity]].<ref name=Medscape2018/> Additionally, there have been false claims that measles infection protects against cancer.<ref name="Russell2019"/> Administration of the MMR vaccine may prevent measles after exposure to the virus (post-exposure prophylaxis).<ref name=":10">{{cite journal |last1=Di Pietrantonj |first1=Carlo |last2=Rivetti |first2=Alessandro |last3=Marchione |first3=Pasquale |last4=Debalini |first4=Maria Grazia |last5=Demicheli |first5=Vittorio |title=Vaccines for measles, mumps, rubella, and varicella in children |journal=The Cochrane Database of Systematic Reviews |date=22 November 2021 |volume=2021 |issue=11 |pages=CD004407 |doi=10.1002/14651858.CD004407.pub5 |pmid=34806766 |pmc=8607336 |issn=1469-493X}}</ref> Post-exposure prophylaxis guidelines are specific to jurisdiction and population.<ref name=":10"/> [[Immunization|Passive immunization]] against measles by an [[intramuscular injection]] of antibodies could be effective up to the seventh day after exposure.<ref name="pmid24687262">{{Cite journal|last1=Young|first1=MK|last2=Nimmo|first2=GR|last3=Cripps|first3=AW|last4=Jones|first4=MA|date=April 2014|title=Post-exposure passive immunisation for preventing measles|url=https://doi.org/10.1002/14651858.CD010056.pub2|journal=Cochrane Database of Systematic Reviews |volume=2014 |issue=4 |pages=CD010056 |doi=10.1002/14651858.cd010056.pub2|pmid=24687262|pmc=11055624 |issn=1465-1858|hdl=10072/65474|hdl-access=free}}</ref> Compared to no treatment, the risk of measles infection is reduced by 83%, and the risk of death by measles is reduced by 76%. However, the effectiveness of passive immunization in comparison to active measles vaccine is not clear.<ref name="pmid24687262"/> The MMR vaccine is 95% effective for preventing measles after one dose if the vaccine is given to a child who is twelve months of age or older; if a second dose of the MMR vaccine is given, it will provide immunity in 97-99% of children.<ref name="cdc.gov" /><ref name="Bester2016">{{Cite journal|last=Bester|first=JC|date=December 2016|title=Measles and Measles Vaccination: A Review |journal=JAMA Pediatrics |volume=170|issue=12|pages=1209–15 |doi=10.1001/jamapediatrics.2016.1787|pmid=27695849|issn=2168-6203}}</ref> ===Vitamin A and measles prevention=== "Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death."<ref name="Cochrane2022"/> Vitamin A deficiency is rare in the United States.<ref name=":8">{{Cite web |title=Office of Dietary Supplements - Vitamin A and Carotenoids |url=https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/ |access-date=8 April 2025 |website=ods.od.nih.gov |archive-date=12 December 2016 |archive-url=https://web.archive.org/web/20161212224704/https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/ |url-status=live }}</ref> A meta-analysis of clinical trials conducted in countries where VAD is prevalent concluded that when children were supplemented with vitamin A, there was a 50% reduction in incidence of contracting measles.<ref name="Cochrane2022">{{cite journal |vauthors=Imdad A, Mayo-Wilson E, Haykal MR, Regan A, Sidhu J, Smith A, Bhutta ZA |title=Vitamin A supplementation for preventing morbidity and mortality in children from six months to five years of age |journal=Cochrane Database Syst Rev |volume=3 |issue=3 |pages=CD008524 |date=March 2022 |pmid=35294044 |pmc=8925277 |doi=10.1002/14651858.CD008524.pub4 }}</ref> By way of comparison, vaccination with two doses of the measles vaccine in childhood provides 97-99% protection at preventing measles.<ref name="cdc.gov" /><ref name="ACIP2013" /><ref name="Bester2016" /> Vitamin A supplementation is not thought to reduce the risk of death from measles.<ref name=":8" /> Children given high doses of vitamin A from supplements or [[cod liver oil]] can accumulate to toxic levels and this can lead to [[hypervitaminosis A]] and [[Liver disease|liver damage]].<ref name=":8" /> In the [[2025 Southwest United States measles outbreak]], centered in [[West Texas]], some families continued to refuse vaccines and instead opted for giving vitamin A supplements or vitamins A- and D-containing cod liver oil to their children after [[Robert F. Kennedy Jr.]], promoted vitamin A as prevention and treatment.<ref name="NYTimes">{{cite web | last=Rosenbluth | first=Teddy | title=For Some Measles Patients, Vitamin A Remedy Supported by RFK Jr. Leaves Them More Ill | website=The New York Times | date=25 March 2025 | url=https://www.nytimes.com/2025/03/25/health/measles-kennedy-vitamin-a.html | access-date=26 March 2025 | archive-date=25 March 2025 | archive-url=https://web.archive.org/web/20250325225627/https://www.nytimes.com/2025/03/25/health/measles-kennedy-vitamin-a.html | url-status=live }}</ref> Multiple children hospitalized for measles at Covenant Children's Hospital in Lubbock also showed signs of [[liver damage]], a symptom of vitamin A toxicity.<ref name=":8" /><ref name="NYTimes" /><ref name="Davies2025">{{cite web | last=Davies | first=David Martin | title=West Texas children treated for vitamin A toxicity as medical disinformation spreads alongside measles outbreak | website=TPR | date=28 March 2025 | url=https://www.tpr.org/public-health/2025-03-27/west-texas-children-treated-for-vitamin-a-toxicity-as-medical-disinformation-spreads-alongside-measles-outbreak | access-date=28 March 2025 | archive-date=19 April 2025 | archive-url=https://web.archive.org/web/20250419192912/https://www.tpr.org/public-health/2025-03-27/west-texas-children-treated-for-vitamin-a-toxicity-as-medical-disinformation-spreads-alongside-measles-outbreak | url-status=live }}</ref> As of May 2025, regardless of such serious side effects—and possibly resulting in increased disease spread—Kennedy, in his role as [[United States Secretary of Health and Human Services|Secretary of Health and Human Services]], has nevertheless continued to endorse vitamin A during the measles epidemic, along with other unscientific, non-vaccine measures, a response for which he has been widely criticized.<ref>{{Cite web |last=Fischman |first=Josh |date=May 5, 2025 |title=Do 'alternative' measles treatments touted by RFK Jr. work? |url=https://www.scientificamerican.com/article/do-alternative-measles-treatments-touted-by-rfk-jr-work/ |access-date=2025-05-09 |website=Scientific American |language=en}}</ref>
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