Available Vaccines
Measles
Introduction
Measles is due to a highly contagious single-stranded RNA measles virus from the Paramyxoviridae family. The infection is a highly contagious viral disease transmitted through airborne droplets, with an incubation period of 10–14 days and infectivity from four days before to four days after rash onset. Humans are the only natural host, and the disease is entirely vaccine preventable. In the absence of vaccination, up to 95% of the population would acquire measles by age 15; with widespread childhood immunisation, susceptibility has shifted to unvaccinated adolescents and young adults. Maintaining high vaccination coverage is therefore critical to prevent outbreaks and protect vulnerable populations.
The severity, risk of complications, and clinical outcomes vary by age, nutritional status, and comorbidities. Common complications include otitis media, pneumonia, croup, diarrhoea, post-infectious encephalitis, and subacute sclerosing panencephalitis (SSPE). Young children are prone to life-threatening pneumonia, while adults over 20 years are at higher risk of encephalitis. Immunocompromised individuals, including those with HIV, may present atypically without rash and experience severe or fatal disease. In pregnancy, measles increases the risk of hospitalisation, pneumonia, foetal loss, preterm labour, and maternal death, although it is not teratogenic. Travellers face a higher risk of exposure in measles-endemic regions, while college and university students are vulnerable due to close-contact living and learning environments that facilitate transmission.
Table 15.1 Vaccines Registered in Malaysia
Table 15.2 High-risk Group in Malaysia
Measles vaccine recommendations for non-pregnant adults* aged ≥19 years by birth year—United States
This infographic for healthcare providers summarizes ACIP and CDC recommendation
* MMR vaccine should NOT be administered during pregnancy. Refer to Adult Immunization Schedule by Age | Vaccines & Immunizations | CDC (www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html) for more contraindications and precautions, and other details.
† Healthcare personnel include all paid and unpaid persons working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or contaminated air.
‡ Acceptable laboratory evidence of immunity includes: measles IgG in serum (equivocal results should be considered negative).
§ Refer to Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013 (www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm) for details about absence of severe immunosuppression. In addition to the adults belonging to one of these population groups, health departments may
consider a second dose for adults (including visitors) who have received one dose who are living in or traveling to domestic areas with sustained, community-wide measles transmission affecting adults where there is ongoing risk of exposure.
Refer to VPD surveillance manual (www.cdc.gov/surv-manual/php/table-of-contents/chapter-7-measles.html).
** A small number (<5%) of adults vaccinated between 1963–1967 received an inactivated (killed) measles vaccine. Check documentation to ensure that the adult did not receive inactivated vaccine. Adults who received killed vaccine, or do not know what type of vaccine they received between 1963–1967, should receive 1 or 2 doses of current MMR vaccine (i.e. those killed or unknown doses do not count).
Implication for Healthcare Workers (HCWs)
All healthcare workers (HCWs) should have documented immunity to measles, as transmission in healthcare settings poses serious risks to infants and immunocompromised patients. HCWs without evidence of immunity should receive two doses of a measles-containing vaccine, given at least four weeks apart.
Notes
Post-exposure Prophylaxis
- Measles vaccine may be used to protect susceptible individuals against measles if the vaccine is administered within 72 hours of the initial virus exposure. Timely administration of the vaccine is effective in preventing, shortening the duration, or reducing the severity of the disease.
- In the event that measles vaccination is contraindicated (e.g., pregnant women and immunocompromised individuals) or was not given within 72 hours of initial exposure, human immunoglobulin may be given within 6 days of the exposure to prevent measles or reduce the severity or duration of illness.
Evidence of Safety & Effectiveness
In adults, a single dose of measles-containing vaccine (MCV1) confers partial protection but is insufficient for reliable long-term immunity, leaving individuals vulnerable during outbreaks. Administration of two doses (MCV2) provides robust and durable protection, with vaccine effectiveness exceeding 98–99% in children and young adults, remaining around 98% through the mid-20s and persisting above 91% in adults aged 26–31 years.
References
- Centers for Disease Control and Prevention. (2024, September 20). Measles vaccine recommendations. U.S. Department of Health & Human Services. https://www.cdc.gov/measles/hcp/vaccine-considerations/index.html
- Centers for Disease Control and Prevention. (2025). Adult immunization schedule notes [Web page]. U.S. Department of Health & Human Services. Retrieved September 30, 2025, from https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-notes.html#note-mmr
- Centers for Disease Control and Prevention. (2025). Measles vaccine recommendations for non-pregnant adults aged ≥ 19 years by birth year — United States [PDF]. U.S. Department of Health & Human Services. https://www.cdc.gov/measles/downloads/adult-mmr-algorithm-508.pdf
- Franconeri, L., Antona, D., Cauchemez, S., Lévy-Bruhl, D., & Paireau, J. (2023). Two-dose measles vaccine effectiveness remains high over time: A French observational study, 2017–2019. Vaccine, 41(37), 5797–5804. https://doi.org/10.1016/j.vaccine.2023.08.018
- National Pharmaceutical Regulatory Agency (NPRA) Sistem Pendaftaran Produk & Perlesenan.https://quest3plus.bpfk.gov.my/pmo2/index.php
- PRIORIX: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. Morbidity and Mortality Week Report Weekly/ November 18, 2022 / 71(46);1465–1470 https://www.cdc.gov/mmwr/volumes/71/wr/mm7146a1.htm
- World Health Organization. (2017, April 28). Measles vaccines: WHO position paper, WER No. 17, 92, 205–227. Weekly Epidemiological Record, 92(17), 205–227. https://iris.who.int/server/api/core/bitstreams/3eb838f7-724d-41d4-9a66-47ed008deb48/content