What are the immediate recommendations for a patient without a Measles, Mumps, and Rubella (MMR) record on file who has been exposed to measles?

Immediate Recommendations for Measles Post-Exposure Prophylaxis in Patients Without MMR Records

For patients without MMR vaccination records who have been exposed to measles, MMR vaccine should be administered within 72 hours of exposure if they are immunocompetent and ≥12 months of age, while immune globulin should be administered within 6 days of exposure for those with contraindications to vaccination or when more than 72 hours have elapsed since exposure. 1

Standard Risk Patients (Immunocompetent)

If ≤72 hours since exposure:

• Administer MMR vaccine immediately for individuals ≥12 months of age without evidence of immunity 1
• This may prevent or modify disease if given within this timeframe 2, 1

If >72 hours but ≤6 days since exposure:

• Administer immune globulin (IG) 0.25 mL/kg (maximum 15 mL) intramuscularly 1

High-Risk Patients

Infants <6 months:

• Administer IG 0.25 mL/kg intramuscularly within 6 days of exposure 1
• These infants typically have some maternal antibody protection but require IG for additional protection

Infants 6-12 months:

• Administer MMR vaccine if within 72 hours of exposure 1
• If >72 hours but ≤6 days: administer IG 0.25 mL/kg intramuscularly 1

Pregnant women without immunity:

• Administer IG 0.25 mL/kg (maximum 15 mL) intramuscularly within 6 days of exposure 1
• MMR vaccine is contraindicated during pregnancy 3

Immunocompromised individuals:

• Administer IG 0.5 mL/kg (maximum 15 mL) intramuscularly regardless of vaccination status 1
• For severely immunocompromised patients: consider intravenous immune globulin (IGIV) at 400 mg/kg 4, 5
• Severely immunocompromised patients should receive IG prophylaxis regardless of vaccination status 2

Special Considerations

For patients receiving IGIV therapy:

• If exposed within 3 weeks of receiving standard IGIV dose (100-400 mg/kg), additional IG is not needed 2, 1
• If exposed more than 3 weeks after IGIV, consider additional dose 1

For healthcare workers:

• Healthcare workers without evidence of immunity should be offered first dose of MMR vaccine and excluded from work from day 5-21 following exposure 2
• Those with documentation of 1 vaccine dose may remain at work and should receive the second dose 2

Important Caveats

1. Timing is critical: Earlier administration within the recommended windows provides better protection 1

2. Documentation: Record all post-exposure prophylaxis administration 1

3. Follow-up: For those receiving IG, observe for signs of measles for 28 days as IG may prolong the incubation period 2, 1

4. Future vaccination: For infants or others receiving MMR before routine schedule, ensure they still receive routine MMR doses at appropriate intervals 1

5. Serologic testing: Consider testing if time permits, but do not delay prophylaxis while awaiting results 1

The recommendations above align with the most current guidelines from the Centers for Disease Control and Prevention and should be implemented immediately upon learning of measles exposure to prevent severe disease.