Guidelines for Adult Immunisation

Available Vaccines



Measles is one of the most contagious viral infections affecting humans. The causative agent, measles virus (genus Morbillivirus, family Paramyxoviridae), is spread from human-to-human through air-borne respiratory droplets and direct contact with infected secretions. The disease is characterised by a prodromal stage of high grade fever, malaise, conjunctivitis, coryza and cough. One to two days before the onset of the characteristic morbilliform rash, multiple small whitish Koplik’s spots resembling grains of salt, a pathognomonic sign for measles, may be found on the buccal mucosa, just opposite to the first or second molar, and remain visible for 1-2 days after the appearance of skin rash. The incubation period for the measles is about 10-14 days. The infectious period of symptomatic cases starts from 4 days before through 4 days after the onset of the rash. Disease transmission from an asymptomatic exposed immune person has not been documented. As humans are the only natural hosts for the virus, measles is preventable and can be eliminated by vaccination. Without vaccination, approximately 95% of the population would have acquired measles infection by 15 years of age. In settings where there is reduced virus transmission among the younger population following rising vaccination coverage in the population, adolescents and young adults may become the most susceptible population group if they have not been exposed to wild-type measles virus or had no prior measles vaccination.

The severity, complication risk and clinical outcomes of measles virus infection varies greatly, depending on the person’s age, nutritional status and co-morbidities. The most common complications of measles are otitis media, pneumonia, croup, diarrhoea, post-infectious encephalitis and subacute sclerosing panencephalitis (SSPE). While young children are prone to develop severe life-threating pneumonia, either in the form of primary viral pneumonia or secondary bacterial pneumonia, adults aged >20 years are at risk of acute encephalitis. Measles infection in immunocompromised individuals, including the HIV infected, may have atypical presentation with no skin rash, and can be severe, prolonged and potentially fatal. Measles infection poses a special risk to susceptible females of reproductive age; it is associated with an increased risk of maternal, foetal, and neonatal complications. Infected pregnant women are at a higher risk of hospitalisation, foetal loss, premature labour, pneumonia and maternal death compared to infected non-pregnant women. Intrauterine measles virus infection may range from a mild illness including low birth weight to a severe, fatal outcome. Measles virus infection is not associated with teratogenicity.


  • A number of live-attenuated measles vaccines are available, either as monovalent vaccine or measles-containing vaccine (MCV) in combination with rubella, mumps or varicella vaccines or some combinations of these. When using the combined measles-rubella (MR) vaccine, measles-mumps-rubella (MMR) vaccine, or measles-mumps-rubella-varicella (MMRV) vaccine, the protective immune responses to each individual vaccine antigen as well as vaccine associated adverse events, remain largely unchanged. They are safe, effective and provide long-lasting immunity, and may be used interchangeably in immunisation programmes.

Vaccines Available in Malaysia


1. MMR II®
(Live attenuated measles, mumps and rubella vaccine)
Merck Sharp & Dohme (Malaysia) Sdn Bhd/Merck Sharp & Dohme Corp. USA

2. Proquad®
(Live attenuated measles, mumps and rubella plus varicella vaccine)
Merck Sharp & Dohme (Malaysia) Sdn Bhd/Merck Sharp & Dohme Corp. USA

3. Priorix®
(Live attenuated measles, mumps and rubella vaccine)
GlaxoSmithKline Pharmaceutical Sdn Bhd/GlaxoSmithKline Biologicals S.A., Belgium

4. Priorix Tetra®
(Live attenuated measles, mumps and rubella plus varicella vaccine)
GlaxoSmithKline Pharmaceutical Sdn Bhd/GlaxoSmithKline Biologicals S.A., Belgium

5. Measles vaccine®
(Live attenuated measles vaccine)
Propharm (M) Sdn Bhd/PT Bio Farma

6. SII Measles Vaccine®
(Live attenuated measles vaccine, single or 10 doses)
SM Pharmaceuticals Sdn Bhd/Serum Institute of India

7. Measles and Rubella®
(Live attenuated measles and rubella vaccine)
Serum Institute of India/SM Biomed

8. SII Measles and Rubella Virus Vaccine®
(Live attenuated measles and rubella vaccine, single or 10 doses)
SM Pharmaceuticals Sdn Bhd/Serum Institute of India

Mode of Administration

  • Measles vaccine is generally injected subcutaneously, but it is also effective when administered intramuscularly.

Post-exposure Prophylaxis

  • Measles vaccine may be used to protect susceptible individuals against measles if the vaccine is administered within 72 hours of the 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, infants aged <6 months 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.

Co-administration with Other Vaccines

  • Equal protection against measles is achieved when measles vaccine is used alone or in combined products such as measles-rubella (MR) vaccine or MMR. Immunogenicity and reactogenicity of the individual components are similar when MCVs are administered as combined products or simultaneously at different anatomical sites with other vaccines. These vaccines include diphtheria toxoid, tetanus toxoid, pertussis vaccine, Hib vaccine, oral polio vaccine or inactivated polio vaccine, varicella vaccine, hepatitis B vaccine, or pneumococcal vaccine. Vaccines against measles and yellow fever or Japanese encephalitis may be administered at the same time at different sites.

Contraindications and Adverse Effects

  • Measles-containing vaccine should be given at least 2 weeks before the administration of blood products or deferred until 3 -11 months after such administration depending on the nature of the blood product as passively acquired antibodies can interfere with response to the vaccine. (Refer to Table 10.1)

  • Mild, concurrent infections are not considered a contraindication to vaccination, but it should be avoided if the patient has a high fever or other signs of serious disease.

  • As a precautionary measure, measles vaccine, either alone or in combination, should be avoided during pregnancy. However, inadvertent administration of the vaccine during pregnancy should not be a reason for terminating the pregnancy.

  • People with a history of an anaphylactic reaction to neomycin, gelatin or other components of the vaccine should not be vaccinated. Furthermore, measles vaccine is contraindicated in people who are severely immunocompromised due to congenital disease, severe HIV infection, advanced leukaemia or lymphoma, serious malignant disease, treatment with high-dose steroids, alkylating agents or antimetabolites, or those who receive immunosuppressive therapeutic radiation.

  • Adverse reactions following measles vaccination are generally mild and transient. Slight pain and tenderness at the site of injection may occur within 24 hours; this is sometimes followed by a mild fever and local lymphadenopathy. There is an increased, albeit small, risk of febrile seizures following tetravalent measles-mumps-rubella-varicella vaccine when compared to concomitant administration of MMR and varicella vaccine in children aged 12-23 months when the vaccines are given for the first time. There was no increased risk of febrile seizures after the second dose of MMRV.

  • Allergic reactions to vaccine components, including neomycin and the stabilisers gelatin or sorbitol, may occur post vaccination. Anaphylactic reactions are rare, occurring in 1/100,000 doses of vaccine administered.

  • To date, the most frequently reported adverse events for the measles vaccines received by the National Pharmaceutical Regulatory Agency (NPRA) are local site reactions such as injection site pain and swelling, fever, nausea and vomiting.

  • Several well-conducted epidemiological studies have shown no link between the administration of measles vaccination and the development of inflammatory bowel disease or autism.

Target Groups in Malaysia

  • Measles vaccine may be offered to teenagers and adults likely to be susceptible and at risk of being exposed to measles virus e.g. those who are travelling to measles endemic areas.

  • College and university students: The risk for transmission of measles at these institutions is high due to large concentrations of persons who may be susceptible to measles. College entry requirements for measles immunity can substantially reduce the risk of measles outbreaks on college campuses where they are implemented and enforced. Therefore, colleges and universities should recommend that all undergraduate and graduate students have measles vaccination.

  • All healthcare workers (HCWs) and any staff who are in regular contact with patients should be immune to measles. Transmission of measles virus in health-care settings affects both HCWs and patients. It poses a considerable risk to infants and immunocompromised individuals. It is recommended that all HCWs without history of measles or measles vaccination should be vaccinated.

  • Measles vaccination should be routinely given to potentially susceptible, asymptomatic HIV-infected children and adults.

Evidence for Effectiveness

  • A single dose of correctly administered measles vaccine will confer lifelong protection for most healthy individuals. The median vaccine effectiveness of a single dose of MCV administered at 9–11 months and >12 months old is 84% and 93%, respectively. Among children who do not respond to their first MCV dose, approximately 95% develop protective immunity after the second MCV dose.

Table 10.1 Recommended Intervals Between Immunoglobulins or Blood Products and MMR, MMRV or Varicella Vaccination

Adapted from: (last accessed on 22 May 2019)


  1. The Malaysian National Centre of Adverse Drug Reactions Database. Accessed August 6, 2014.

  2. Measles vaccines: WHO position paper (2017). 17, 205-228

  3. National Pharmaceutical Regulatory Agency (NPRA), Ministry of Health Malaysia. Senarai Produk Vaksin Berdaftar Dengan Pihak Berkuasa Kawalan Dadah. Received December 16, 2013.

  4. Strebel, P.M., Papania, M.J., Fiebelkorn AP and Halsey, N.A. (2018). Measles vaccine in Stanley Plotkin, Walter Orenstein and Paul Offit (7th Ed). Vaccines. PA: Elsevier.