Measles

What

Measles is a highly infectious viral illness that is transmitted by respiratory aerosols.

Who

Measles-containing vaccine is recommended for:

• children ≥12 months of age
• adolescents and adults born during or since 1966 who have not received 2 doses of measles-containing vaccine, particularly
  • healthcare workers
  • childhood educators and carers
  • people who work in long-term care facilities
  • people who work in correctional facilities
  • travellers

How

Measles-containing vaccine is recommended for children at 12 months of age as MMR (measles-mumps-rubella) vaccine, and at 18 months of age as MMRV (measles-mumps-rubella-varicella) vaccine.

All adolescents and adults born during or since 1966 should have either:

• documented evidence of 2 doses of measles-containing vaccine given at least 4 weeks apart and with both doses given ≥12 months of age, or
• serological evidence of immunity to measles, mumps and rubella

Why

About 10% of measles cases involve complications. The World Health Organization is overseeing efforts to eliminate measles worldwide through immunisation and surveillance strategies.

Measles vaccines available in Australia

The Therapeutic Goods Administration website provides product information for each vaccine.

See also Vaccine information and Variations from product information for more details.

Dose and route

The dose of Priorix and M-M-R-II (MMR) vaccine for both children and adults is 0.5 mL given by either subcutaneous or intramuscular injection.

The dose of ProQuad and Priorix-tetra (MMRV) vaccine for children <14 years of age is 0.5 mL given by either subcutaneous or intramuscular injection.¹⁴

Co-administration with other vaccines

People can receive MMR or MMRV vaccine at the same time as other live attenuated parenteral vaccines or other inactivated vaccines.¹⁵ If a person does not receive MMR or MMRV vaccine at the same time as other live attenuated parenteral vaccines, wait at least 4 weeks between vaccinations.^16,17 

Measles, mumps and rubella vaccines are not available separately as an alternative to MMR vaccine. However, a monovalent varicella vaccine is available (see Varicella).

If a person receives MMR vaccine at the same time as monovalent varicella vaccine, use separate syringes and injection sites. Do not mix MMR vaccine and monovalent varicella vaccine together before injection.

Interchangeability of MMR-containing vaccines

The 2 brands of MMR vaccine are interchangeable, so the 2nd MMR vaccine dose does not have to be the same brand as the 1st. 

The same principle applies to the 2 MMRV vaccines,¹⁵ although they are not recommended in a 2-dose schedule.

Contraindications

Anaphylaxis to vaccine components

MMR and MMRV vaccines are contraindicated in people who have had:

• anaphylaxis after a previous dose of any MMR-containing vaccine
• anaphylaxis after any component of an MMR-containing vaccine

See Anaphylaxis in Adverse events for more details about MMR vaccination for people with a known egg allergy.

Pregnant women

MMR-containing vaccines are contraindicated in pregnant women. 

Vaccinated women should avoid pregnancy for 28 days after vaccination.¹⁸

There is no risk to pregnant women from contact with people who have recently been vaccinated. The vaccine viruses is not transmitted from vaccinated people to susceptible contacts.¹⁹ 

See also Rubella, Varicella, Vaccination for women who are planning pregnancy, pregnant or breastfeeding and Table. Vaccines that are contraindicated in pregnancy: live attenuated vaccines for more details.

Breastfeeding women can receive MMR vaccines. See also Rubella.

People who are immunocompromised

MMR-containing vaccines contain live attenuated viruses and are contraindicated in people who are immunocompromised. This means that MMR-containing vaccines are contraindicated in:

• people who are significantly immunocompromised because of a medical condition(s)
• people receiving high-dose systemic immunosuppressive therapy, such as chemotherapy, radiation therapy or oral corticosteroids 

See Vaccination for people who are immunocompromised for more details.

For more details on using live attenuated vaccines in people receiving corticosteroid therapy, see Table. Recommended timing of live vaccine doses in adults and children taking corticosteroids in Vaccination for people who are immunocompromised.

Precautions

Vaccination after receiving immunoglobulin or a blood product

A recent blood transfusion with washed red blood cells is not a contraindication to MMR or MMRV vaccines.

People who have received an immunoglobulin-containing blood product should wait 3–11 months before receiving a measles-containing vaccine. This is because the immunoglobulin may impair the expected immune response to the vaccine.^17,20 

The interval between receiving the blood product and the vaccine depends on the amount of immunoglobulin in each product.¹⁷ See Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination and Vaccination for people who have recently received normal human immunoglobulin and other blood products.

People may receive MMR vaccine at the same time as anti-D immunoglobulin, but at different injection sites. They can also receive MMR vaccine at any time before or after anti-D immunoglobulin. Anti-D immunoglobulin does not interfere with the antibody response to the vaccine.

Immunoglobulin or blood product administration after vaccination

People who have received a measles-containing vaccine should not receive immunoglobulin-containing products for 3 weeks after vaccination, unless the benefits of receiving the blood product outweigh the benefits of vaccination. If the person receives an immunoglobulin-containing product within 3 weeks after a measles-containing vaccine, the vaccinated person should be either:

• revaccinated later at the appropriate time, as indicated in Table. Recommended intervals between immunoglobulins or blood products, and measles-mumps-rubella, measles-mumps-rubella-varicella or varicella vaccination, or
• tested for immunity 6 months later and then revaccinated if seronegative

People may receive anti-D immunoglobulin at any time after receiving MMR vaccine.

People with HIV

The following people with HIV may receive MMR vaccine:^18,21-25

• asymptomatic children >12 months of age with an age-specific CD4⁺ count of ≥15%
• adults with a CD4⁺ cell count ≥200 cells per μL

See People with HIV in Vaccination for people who are immunocompromised. 

There have been no studies on combination MMRV vaccines in asymptomatic people with HIV or people with an age-specific CD4⁺ count of ≥15%. Therefore, it is recommended that these groups receive only MMR vaccine (and monovalent varicella vaccine — see Varicella).^23,25,26

No data are available on the safety, immunogenicity or efficacy of MMRV vaccines in children with HIV. These children should receive MMR vaccine and monovalent varicella vaccine, not MMRV vaccine.^18,20

People receiving corticosteroid therapy

People on low-dose systemic corticosteroids can receive MMR-containing vaccines. Low-dose systemic corticosteroid therapy includes: 

Children aged <16 years who weigh ≤10 kg and are on doses of

• ≤2 mg per kg per day for less than 14 days
• 1 mg per kg per day for less than 30 days

Children aged <16 years who weigh >10 kg and are on doses of

• <10 mg per day for less than 28 days
• <20 mg per day less than 14 days

All people aged ≥16 years who are on doses of <20 mg per day for any duration

People receiving high-dose corticosteroids can receive MMR-containing vaccines after they have stopped corticosteroid therapy for at least 1 month (see Contraindications).²⁷

Some experts suggest temporarily stopping lower doses of steroids 2–3 weeks before vaccination with live viral vaccines, if possible.^20,27 

See also Vaccination for people who are immunocompromised.

Household contacts of people who are immunocompromised

Household contacts of people who are immunocompromised should ensure that they are age-appropriately vaccinated against, or are immune to, measles, mumps, rubella and varicella.

Household contacts of people who are immunocompromised can safely receive measles-containing vaccines, because the vaccine viruses are not transmissible from vaccinated people to others.¹⁸

If using MMRV vaccine, see Varicella for details about varicella vaccine virus transmission.

People receiving long-term aspirin or salicylate therapy

There is no need to avoid salicylates before or after receiving MMR or MMRV vaccine.

People taking long-term salicylate therapy (aspirin) can receive MMRV vaccine if needed. The benefit is likely to outweigh any possible risk of Reye syndrome after vaccination with a varicella-containing vaccine (see Varicella).

People with a history of thrombocytopenia

Thrombocytopenia is a rare adverse event associated with MMR vaccination (see Adverse events).^19,28,29 

In children who have had an episode(s) of idiopathic thrombocytopenia purpura (ITP), the risk of vaccine-associated thrombocytopenia after a dose of MMR vaccine is uncertain.^18,29 However, a systematic review concluded that MMR vaccination, either a 1st or 2nd dose, did not lead to a recurrence of ITP.³⁰ In children due for their 2nd dose, serological testing can be used to determine whether the child needs the extra dose of MMR or MMRV vaccine.

People with possible IFNAR1 deficiency

IFNAR1 deficiency is a rare inherited condition affecting some people of Western Polynesian heritage, including Tongan, Samoan and Niuean. It is associated with severe illness and death from certain viral infections and also potentially from some live attenuated viral vaccines, including the measles, mumps and rubella (MMR) vaccine.³¹ Currently, diagnosis of IFNAR1 deficiency prior to vaccination is challenging and there is no established treatment.

Healthcare providers need to be aware that children of Western Polynesian heritage who present for medical attention and are very unwell in the 1-2 weeks following MMR vaccine may need further investigation by an immunologist to assess for an immune deficiency. Any suspected adverse event following immunisation should be reported. Family members of individuals who have had a severe reaction to a live attenuated viral vaccine, or are related to someone with known IFNAR1 deficiency, should be referred to an immunologist before having the MMR vaccine. Children who have safely received a first dose of MMR vaccine are highly unlikely to have IFNAR1 deficiency.³¹

Advice on vaccination of children or adults who have been diagnosed with IFNAR1 or any other specific immune deficiency should be sought from their immunologist, noting that disease from wild-type measles and mumps is probably more severe than from the vaccine viruses.³¹

Personal or close family history of seizures or convulsions

Children with a personal or close family history of seizures or convulsions can receive MMR or MMRV vaccine.

Ensure that the parents or carers understand that the child may develop a fever 6–14 days after vaccination.¹⁸ Advise parents or carers about how to manage the fever with paracetamol and other measures (see Adverse events following immunisation in After vaccination). 

MMRV vaccines are only recommended for use as the 2nd dose of measles-containing vaccine. This is because the risk of fever and febrile convulsions is higher if children receive MMRV vaccine as their 1st dose. See Recommendations and Adverse events. 

Tuberculin skin testing after MMR vaccination

The measles virus inhibits the response to tuberculin. Tuberculin-positive people may become tuberculin-negative for 4–6 weeks after measles infection, and measles-containing vaccines have a similar effect.^18,32 Because of this, a tuberculin skin test (TST; Mantoux) may be unreliable for at least 4–6 weeks in people who have received MMR vaccine.

There are no studies on if or how MMR or MMRV vaccination affects the results of interferon-gamma release assays used for testing for M. tuberculosis infection.³³ 

Adverse events after receiving a measles-containing vaccine are generally mild and well tolerated.¹ Adverse events are much less common after the 2nd dose of MMR or MMRV vaccine than after the 1st dose.

Measles-containing vaccine has been shown to be safe and well-tolerated when given to infants as young as 6 months of age.³⁴

Fever and febrile convulsions

MMR vaccines

People who receive MMR vaccine may develop a fever 7–10 days (range 5–12 days) after vaccination. This can last 2–3 days. The fever may be associated with malaise and/or a non-infectious rash. Up to 15% of young children receiving MMR vaccine develop a high fever (>39.4°C).^1,18 

An increased risk of febrile seizures of about 1 case per 3000–4000 doses occurs in the same time period.¹⁸

This time frame coincides with the period of peak measles vaccine virus replication.

Inform vaccine recipients, or their parents or carers, about:

• possible symptoms occurring 5–12 days after vaccination
• how to manage the symptoms, including using paracetamol for fever 

See Adverse events following immunisation in After vaccination.

MMRV vaccines

In clinical trials, people who received MMRV vaccine had higher rates of fever than people who received MMR vaccine and monovalent varicella vaccine at the same time but at separate sites.^35-38 Rates of fever were highest in young children who received MMRV vaccine as their 1st dose.

Post-marketing studies in the United States identified an approximately 2-fold increased risk of fever and febrile convulsions 7–10 days³⁹ (or 5–12 days)⁴⁰ after vaccination in children who received MMRV vaccine as a 1st dose. MMRV recipients were compared with recipients of separate MMR and varicella vaccines. MMRV vaccination resulted in 1 additional febrile seizure for every 2300 doses compared with separate MMR and varicella vaccination.³⁹ Children in these studies were mostly 12–23 months of age.

In the United States, post-marketing studies did not find an increase in fever or febrile convulsions after children received the 2nd dose of ProQuad (MMRV) vaccine. However, most 2nd-dose recipients were aged 4–6 years, an age at which the incidence of febrile convulsions is low.⁴¹ This side effect profile is expected to be similar in children who receive Priorix-tetra.

Rare adverse events

Anaphylaxis

Anaphylaxis after receiving an MMR vaccine is very rare (1.8–14.4 per million doses).¹⁸

Although no cases of anaphylaxis were reported in MMRV vaccine clinical trials, the incidence is likely to be similar to that of MMR vaccine.

Anaphylaxis after vaccination is probably due to anaphylactic sensitivity to gelatin or neomycin, not an egg allergy. Measles and mumps (not rubella or varicella) vaccine viruses are grown in chick embryo tissue cultures, but measles- and mumps-containing vaccines have negligible amounts of egg ovalbumin. See Variations from product information and Vaccination for people who have had an adverse event following immunisation.

People with an egg allergy can safely receive an MMR or MMRV vaccine.^19,42,43 Skin testing is not needed before vaccination.¹⁹ 

Thrombocytopenia

Thrombocytopenia has been very rarely associated with the rubella or measles component of MMR vaccine. It is usually self-limiting and occurs in 3–5 per 100,000 doses of MMR vaccine.^19,28,29 This is considerably less frequent than after natural measles, mumps and rubella infections.²⁹ 

Any association with MMRV vaccine is expected to be similar.

Encephalopathy

It is uncertain whether people can develop encephalopathy after MMR vaccination. If they do, it is at least 1000 times less frequent than encephalopathy as a complication from natural infection.¹

Lymphadenopathy, arthralgia and parotitis

Other rare adverse events attributed to MMR vaccine include:¹⁸

• transient lymphadenopathy 
• arthralgia (see Rubella)
• parotitis (see Mumps)

Conditions not linked to MMR vaccination

MMR vaccine is not associated with:

• autism
• autistic spectrum disorder 
• inflammatory bowel disease

No credible scientific evidence supports a link between MMR and these conditions. Most proponents of the link have retracted this claim.^44,45 There is a substantial body of evidence to refute these claims.^46-49

Measles is caused by a paramyxovirus from the genus Morbillivirus. The measles virus is an RNA virus with 6 structural proteins, 3 complexed to the RNA and 3 associated with the viral envelope. The 2 envelope proteins — F (fusion) and H (haemagglutinin) — are the most important in pathogenesis.¹

The measles virus can survive for up to 2 hours in air. It is rapidly inactivated by:^1,19

• heat
• light 
• extremes of pH

Pathogenesis

Measles is a highly infectious, acute viral illness. The incubation period is usually 10–14 days.

Transmission

Measles is spread by respiratory secretions, including by aerosols.¹⁹ It is infectious from the beginning of the prodromal period (typically 2 to 4 days before rash onset) and for up to 4 days after the rash appears.⁵⁰ See Symptoms of measles.

Symptoms of measles

The prodrome lasts 2–4 days. It is characterised by:

• fever
• malaise
• cough
• coryza
• conjunctivitis

A maculopapular rash typically begins on the face and upper neck, and then becomes generalised.

Complications of measles

Measles is often a severe disease. Frequent complications are:^1,19

• otitis media (in around 9% of people)
• pneumonia (in around 6%)
• diarrhoea (in around 8%)

Acute encephalitis occurs in 1 per 1000 cases, and has a mortality rate of 10–15%. A high proportion of survivors have permanent brain damage.⁵¹

Subacute sclerosing panencephalitis is a late complication of measles. It occurs, on average, 7 years after infection.¹

Complications from measles are more common and more severe in:¹

• people who are chronically ill
• children <5 years of age 
• adults 

Measles infection during pregnancy can result in miscarriage and premature delivery. It is not associated with congenital malformation.¹ 

Death from measles

During the resurgence of measles in the United States between 1989 and 1991, subacute sclerosing panencephalitis (SSPE) subsequently occurred in about 22 per 100,000 measles cases (0.022%). This was significantly higher than the previous estimate of 1 SSPE case per 100,000 measles cases (0.001%).¹⁹ SSPE causes progressive brain damage and is always fatal.

About 60% of acute measles deaths are from pneumonia, especially in young children. Complications, including death, from encephalitis are more often seen in adults.^1,19

Measles in Australia

In March 2014, the World Health Organization (WHO) declared that endemic measles was eliminated from Australia. This was because an endemic measles strain had not been circulating for several years.⁵² 

However, measles cases in Australia continue to occur, mainly in non-immune travellers and their contacts. When these travellers return to Australia, they can cause measles outbreaks, typically of limited size and duration.⁵³

In 2014, Australia had 340 measles notifications — a notification rate of 1.4 per 100,000 population. This was 2.3 times the mean of the previous 5 years and an increase of 110% compared with 2013.¹³ Of the measles cases in 2014, 75% were confirmed to be either imported or import related.¹³ Most cases were in infants aged <12 months who are too young to be immunised, and in adolescents and adults aged 30–39 years. In 2019, Australia had 285 cases of measles reported^54,55, up from the 81 cases in 2017 (0.3 cases per 100,000 population).⁵⁴ This resurgence of cases was also associated with under-vaccinated travellers.⁵⁵

The last measles death in Australia was recorded in 1995.^3,56 Since 1998, subacute sclerosing panencephalitis has caused 2 deaths in Australia — 1 in 1999 and 1 in 2004.^57,58 

Global measles elimination

Measles remains one of the leading causes of death among young children, even though a safe and cost-effective vaccine is available. WHO is overseeing efforts to eliminate measles worldwide through immunisation and surveillance strategies.⁵⁹ After extensive vaccination campaigns, global measles deaths decreased by 84% — from more than 550,000 in 2000 to less than 90,000 in 2016.⁶⁰ 

In 2003, the Expanded Programme on Immunization for the WHO Western Pacific Region (WPRO) listed measles elimination as a regional goal.⁶¹ Although WPRO did not meet its 2012 target date, the measles elimination initiative led to a significant decline in cases, with the lowest level of transmission recorded in 2012.⁶²

Strategies for achieving measles control and elimination across all WHO regions are continually being developed and implemented.^63,64

During the COVID-19 pandemic, measles vaccination coverage rates fell around the world, with more than 40 million children missing a dose. Together with a decline in measles surveillance, measles is now again an imminent threat globally, emphasising the need to achieve high population immunity through vaccination.⁶⁵

Monovalent measles vaccine is not available in Australia. People receive measles vaccine as either MMR or MMRV vaccine.

Immunogenicity

1 dose of measles-containing vaccine provides long-term immunity in most people.^1,66 However, around 5% of people fail to develop immunity to measles after 1 dose.¹⁸ After a 2nd vaccine dose, about 99% of people are immune to measles.

Studies have demonstrated that a dose of measles-containing vaccine given as young as 6 months of age can be seroprotective^67-69 but requires 2 additional doses be given on the recommended schedule.

Clinical trials of MMR vaccine compared with MMRV vaccine were mainly done in children 12 months to 6 years of age. MMRV vaccines produce similar rates of seroconversion to all 4 vaccine components as MMR and monovalent varicella vaccines given at the same time at separate injection sites.^35-38

Vaccine effectiveness

Measles-containing vaccines are 90–95% effective in developed countries that have high vaccination coverage and low measles incidence.¹ In Australia, the overall vaccine effectiveness is about 96% for 1 dose and 99% for 2 doses of measles-containing vaccine.⁷⁰ A Cochrane review reported 1-dose vaccine effectiveness to be 95%.⁶⁹ However, some studies, especially in regions such as Asia and Africa, have shown effectiveness to be lower in 1-dose recipients.⁷²

A review by the World Health Organization (WHO) reported that the pooled vaccine effectiveness estimate for dose 1 of a measles-containing vaccine administered at 4. 5–9 months of age was 72%.³⁴

Transport according to National vaccine storage guidelines: Strive for 5.⁷³ Store at +2°C to +8°C. Do not freeze. Protect from light.

Both MMR and MMRV vaccines must be reconstituted. Add the entire contents of the diluent container to the vial containing the pellet.

Shake until the pellet completely dissolves. 

Use reconstituted Priorix (MMR), M-M-R II (MMR) and Priorix-tetra (MMRV) vaccines as soon as practicable. If reconstituted vaccine must be stored, hold at +2°C to +8°C for no more than 8 hours.

Use reconstituted ProQuad (MMRV) vaccine immediately. If it must be stored, hold at: 

• +2°C to +8°C for no more than 2.5 hours, or 
• +20°C to +25°C for no more than 1 hour

Notifying measles

Measles is a notifiable disease in all states and territories in Australia, and is an urgent public health priority.

The Communicable Diseases Network Australia national guidelines for measles² have details on:

• current case definitions
• testing
• post-exposure prophylaxis of contacts

State and territory public health authorities can provide further advice about the public health management of measles.

Managing measles cases

There is no specific therapy for an acute measles infection.

Managing contacts of measles cases

Non-immune people who are exposed to measles should receive an MMR vaccine (or MMRV in some instances) for post-exposure prophylaxis, ideally within 72 hours of exposure. See Table. Post-exposure prophylaxis needed within 6 days (144 hours) of 1st exposure for people exposed to measles. 

Children >12 months of age who have received 1 dose of measles-containing vaccine can receive their 2nd dose earlier that the scheduled 18-month age milestone if:

• they have or are at risk of coming in contact with a person with measles² (see Recommendations and Table. Post-exposure prophylaxis needed within 6 days (144 hours) of 1st exposure for people exposed to measles)
• it has been at least 4 weeks since the 1st dose

If varicella vaccination is also indicated, MMRV vaccine can be used. However, MMRV vaccine is not routinely recommended as the 1st dose of MMR-containing vaccine in children aged <4 years (see Recommendations).

If a child receives the 2nd dose of measles-containing vaccine early, they are considered to have completed their vaccination schedule. They do not need another dose at ≥18 months of age, as long as they received the 2 measles-containing vaccine doses at ≥12 months of age and at least 4 weeks apart.

Post-exposure vaccination beyond 72 hours of first measles exposure to measles is not as effective as vaccine given within 72 hours, that is as soon as possible after exposure. However, in settings with large numbers of people with uncertain vaccination histories and immunity (e.g. in high schools, adult workplaces(, where further cases of measles may occur, MMR vaccination, even if ≥72 hours after exposure, may reduce the likelihood of ongoing transmission.

Normal human immunoglobulin

In some individuals and settings, normal human immunoglobulin (NHIG), rather than MMR or MMRV, is recommended for post exposure prophylaxis. In these contexts, NHIG may be given up to 6 days (144 hours) post exposure (see Table. Post-exposure prophylaxis needed within 6 days (144 hours) of 1st exposure for people exposed to measles).² Public health authorities decide when NHIG is needed.

NHIG is a sterile solution of immunoglobulin, mainly IgG. It contains antibodies that are commonly present in adult human blood.

In Australia, the Australian Red Cross Blood Service supplies NHIG as a 16% solution.

Administration of NHIG

Give NHIG by deep intramuscular injection, using an appropriately sized needle. Introduce the NHIG slowly into the muscle, to reduce pain.

Never administer NHIG intravenously. This could cause severe adverse events. To ensure that the needle is not in a small vessel, try to draw back on the syringe after intramuscular insertion.

A special product for intravenous use — called NHIG (intravenous) — is for people who need large doses of immunoglobulin.

For more details about the use of intravenous immunoglobulins, see Criteria for the Clinical Use of Intravenous Immunoglobulin in Australia.⁷⁴

Recommendations for using NHIG

NHIG contains enough antibody against measles to prevent infection or reduce disease severity but does not provide long term protection against infection.

People with egg allergy

The product information for Priorix, M-M-R II and Priorix-tetra states that people with a history of anaphylactic or anaphylactoid reactions to egg should not receive these vaccines.

The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that these people can receive Priorix, M-M-R II, Priorix-tetra or ProQuad.¹⁸

Women planning pregnancy

The product information for M-M-R II and ProQuad recommends that women of child-bearing age should avoid pregnancy for 1 month after vaccination.

ATAGI recommends that these women should avoid pregnancy for 28 days after vaccination,¹⁸ as for Priorix and Priorix-tetra.

People taking salicylates

The product information for ProQuad and Priorix-tetra states that people should avoid taking salicylates for 6 weeks after vaccination. This is because Reye syndrome has been reported after using salicylates during natural varicella infection.

ATAGI recommends that non-immune people on long-term salicylate therapy can receive varicella-containing vaccines, because the benefit is likely to outweigh any possible risk of Reye syndrome after vaccination.

Recommended ages for MMR vaccines

The product information for M-M-R II and Priorix states vaccine is for use in children ≥12 months of age.

ATAGI recommends that children ≥6 months can receive both MMR vaccines in certain circumstances, including travel to highly endemic areas and during outbreaks.

Recommended ages for MMRV vaccines

The product information for ProQuad states that this vaccine is for use in children 12 months to 12 years of age. The product information for Priorix-tetra states that children ≥9 months of age can receive this vaccine.

ATAGI recommends that children up to 14 years of age can receive both MMRV vaccines. ATAGI also recommends that MMRV vaccine should not be used routinely as the 1st dose of MMR-containing vaccine in children aged <4 years.

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2. Communicable Diseases Network Australia (CDNA). Measles: CDNA national guidelines for public health units. Canberra: Australian Government Department of Health; 2015. http://www.health.gov.au/cdnasongs
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