Can individuals with mild respiratory illnesses, such as cough and colds, receive the Measles (MR) vaccine?

MR Vaccine Can Be Given During Cough and Colds

Yes, children with minor respiratory illnesses such as cough and colds can and should receive the MR (measles-rubella) vaccine without delay. 1, 2

Key Recommendation

The Advisory Committee on Immunization Practices (ACIP) explicitly states that minor upper respiratory tract illnesses, including cough and colds with or without fever, are NOT contraindications to vaccination and should not delay immunization. 3, 1, 2

Evidence Supporting Vaccination During Minor Illness

Strong Immunologic Response

• Over 97% of children with mild illnesses produced measles antibody after vaccination in U.S. studies, demonstrating that minor illness does not compromise vaccine effectiveness 3, 2
• A prospective study of 386 children showed 98% measles seroconversion rates regardless of whether children had upper respiratory infections, with no difference between ill and well children 4
• Seroconversion rates remained robust: 98% for measles, 83% for mumps, and 98% for rubella among children with mild illness 4

Safety Profile Unchanged

• No association exists between mild illness and increased rates or severity of adverse events after MMR vaccination 4
• The majority of studies support both the safety and efficacy of vaccinating persons with mild illness 3, 5

Conditions Inappropriately Considered Contraindications

The ACIP specifically lists these as NOT valid reasons to delay vaccination: 3, 2

• Minor upper respiratory tract infections with or without fever
• Otitis media
• Diarrhea
• Low-grade fever
• Current antimicrobial therapy
• Mild to moderate local reactions to previous vaccine doses

When to Defer Vaccination

Only defer vaccination for moderate or severe acute illness with or without fever. 3, 1, 2

Practical Definition:

• Moderate to severe illness: Symptoms that significantly affect the child's daily functioning 5
• The decision depends on severity of symptoms, not simply the presence of illness 2
• Deferral in these cases avoids superimposing vaccine adverse effects on the underlying illness and prevents mistakenly attributing manifestations of the illness to the vaccine 3, 1

Critical Clinical Pitfall to Avoid

Delaying vaccination for minor illnesses seriously impedes vaccination efforts and creates missed opportunities. 3, 2, 5

• Among persons whose compliance with medical care cannot be ensured, use every opportunity to provide appropriate vaccinations 3, 2, 5
• Delaying vaccination leaves children vulnerable to vaccine-preventable diseases and lowers overall vaccination coverage rates 5
• No routine physical examination or temperature measurement is required before vaccinating children who appear healthy 2, 5

Algorithmic Approach

For a child presenting with cough and cold symptoms:

1. Assess severity: Is the child's daily functioning significantly affected? 5

   • If NO → Proceed with vaccination 1, 2
   • If YES → Defer until recovered from acute phase 3, 1

2. Check for true contraindications (rare): 3

   • Severe immunocompromise
   • Pregnancy (for live vaccines)
   • Severe allergic reaction to previous dose
   • If none present → Proceed with vaccination

3. Do NOT delay for: 3, 2

   • Runny nose, cough, or congestion
   • Low-grade fever
   • Concurrent antibiotic use
   • Mild ear infection

The presence of antibiotics does not interfere with vaccine efficacy or safety. 2