What are the primary prevention and treatment strategies for measles versus rubella?

Measles versus Rubella: Prevention and Treatment Strategies

Primary Prevention: Vaccination Strategy

Both measles and rubella are prevented through the same two-dose MMR vaccine schedule, administered at 12-15 months for the first dose and 4-6 years for the second dose, with this unified approach achieving >99% reduction in both diseases since vaccine licensure. 1

Standard Vaccination Schedule

• First dose: Administer MMR vaccine at age 12-15 months (can be given as early as 12 months in high-risk areas) 1
• Second dose: Administer at age 4-6 years before school entry 1
• The two-dose schedule addresses primary vaccine failure, which occurs in approximately 5% of recipients after a single dose 1, 2
• Almost all persons who fail to respond to the first dose will develop immunity after the second dose 1

High-Risk Area Considerations

Accelerated vaccination is indicated in counties with: 1

• Large inner city populations
• Recent measles outbreaks among unvaccinated preschool-aged children
• More than five measles cases among preschool-aged children during each of the last 5 years

Healthcare Personnel Requirements

• All healthcare workers must have acceptable evidence of measles and rubella immunity 1
• Two documented doses of MMR vaccine constitute acceptable evidence 3
• Healthcare personnel should use N95 respirators when caring for suspected or confirmed measles cases 4

Disease Severity and Clinical Implications

Measles (Rubeola)

Measles is significantly more severe than rubella, with mortality occurring in 1-2 per 1,000 cases and encephalitis in 1 per 1,000 cases, making aggressive prevention critical. 1

• Incubation period: 10-12 days to prodrome, 14 days to rash (range: 7-18 days) 1
• Common complications: diarrhea, otitis media, bronchopneumonia 1
• Serious complications: encephalitis (often causing permanent brain damage), death 1
• Highest mortality risk: infants, young children, and adults 1
• Clinical presentation: fever, cough, runny nose, Koplik spots, followed by cephalocaudal maculopapular rash 5

Rubella

• Generally milder disease than measles 1
• Primary concern: congenital rubella syndrome (CRS) when infection occurs during pregnancy 1
• CRS prevention is the main public health goal for rubella vaccination 1

Treatment Approaches

Measles Treatment

There is no specific antiviral treatment for measles; management is entirely supportive with treatment of bacterial superinfections when present. 5

• Symptomatic care for fever, cough, and systemic symptoms 5
• Antibiotic therapy only for documented bacterial superinfections 5
• Hospitalization for severe complications (pneumonia, encephalitis) 1

Rubella Treatment

• Supportive care only (no specific antiviral therapy available) 1
• Focus on preventing CRS through vaccination of susceptible women of childbearing age 1

Post-Exposure Prophylaxis

Measles Post-Exposure Management

MMR vaccine administered within 72 hours of measles exposure can prevent or modify disease, making rapid identification and vaccination of susceptible contacts the cornerstone of outbreak control. 6, 4

Vaccine Post-Exposure Prophylaxis

• Administer MMR within 72 hours of initial exposure for susceptible persons 6, 4
• Effective even in previously vaccinated individuals with potential waning immunity 4

Immune Globulin Post-Exposure Prophylaxis

For susceptible contacts not vaccinated within 72 hours: 6

• Immunocompetent persons: 0.25 mL/kg IM (maximum 15 mL)
• Immunocompromised persons: 0.5 mL/kg IM (maximum 15 mL)
• Infants birth to 6 months: IGIM is now recommended 3
• Severely immunocompromised and pregnant women: Use IGIV instead of IGIM 3
• Patients on regular IGIV therapy: Standard dose of 100-400 mg/kg within 3 weeks before exposure is sufficient 6

Rubella Post-Exposure Management

• Post-exposure vaccination does not prevent rubella infection 1
• Immune globulin is not routinely recommended for rubella post-exposure prophylaxis 1
• Focus on identifying and vaccinating susceptible women before pregnancy 1

Outbreak Control Strategies

Measles Outbreak Response

Any single confirmed measles case constitutes an urgent public health situation requiring immediate vaccination of all susceptible persons at risk for exposure. 2

• Prompt vaccination of susceptible persons may prevent dissemination 2
• All persons without acceptable evidence of immunity should be vaccinated or excluded from outbreak settings (schools, day care, hospitals) 2
• Persons exempted from vaccination must be excluded from involved institutions until 21 days after rash onset in the last case 2, 6
• Mass revaccination of entire communities is generally not necessary 2

Rubella Outbreak Response

• Similar exclusion policies as measles (21 days after rash onset in last case) 6
• Emphasis on protecting pregnant women and women of childbearing age 1

Special Populations

HIV-Infected Persons

• MMR vaccine is recommended for all HIV-infected persons aged ≥12 months without current severe immunosuppression 3
• Persons with perinatal HIV infection vaccinated before effective ART should be revaccinated with 2 appropriately spaced doses once ART is established 3
• Severely immunocompromised HIV patients should receive immune globulin prophylaxis if exposed to measles, regardless of vaccination status 6

Pregnancy Considerations

• Measles during pregnancy increases rates of premature labor, spontaneous abortion, and low birth weight 1
• Mumps during first trimester is associated with increased fetal death risk but not congenital malformations 6
• MMR vaccine is contraindicated during pregnancy 1

Common Pitfalls to Avoid

• Do not assume birth before 1957 guarantees immunity: During outbreaks, consider MMR vaccination for pre-1957 individuals who may be exposed 1, 2
• Do not delay outbreak control measures: Act immediately on suspected cases without waiting for laboratory confirmation 2
• Do not revaccinate based solely on negative titers: Persons with 2 documented MMR doses are considered immune even with negative serology 4
• Do not confuse post-exposure efficacy: MMR works for measles post-exposure but NOT for mumps or rubella 6