Guidance

MMR catchup programme: diagnosis, case management, and advice

How to confirm a measles diagnosis, manage cases and contacts, control infection, and vaccinate young or partially-covered patients.

This guide is for health care workers (HCW), covering:

  • caring for patients who may have measles
  • bringing patients’ and workers’ measles, mumps and rubella (MMR) vaccinations up to date

Check patients’ vaccination history

  1. Have patients had measles?
  2. Were patients fully immunised?

Measles is very unlikely in people who are fully immunised, or who have had measles in the past.

People less than 30 years of age who did not receive 2 doses of MMR vaccine as children are most at risk of catching measles now.

Confirm the diagnosis

A laboratory test of oral fluid (saliva) samples can confirm the diagnosis of measles, mumps or rubella through non-invasive means.

At PHE Colindale laboratories, the oral fluid is tested for specific IgM or viral RNA. If you take a sample as soon as possible after the onset of rash or parotid gland swelling, the test is highly sensitive and specific to confirm these infections.

When sending samples to the lab, make sure you record the date of onset of symptoms on the form. You can send swabs up to 6 weeks after the onset of symptoms, but results are most reliable in the first 2 weeks.

Try to take oral fluid samples from all notified cases.

Advice on obtaining oral fluid samples is available from the local Health Protection Team (HPT).

Testing is typically done for surveillance purposes only and the routine turnaround time is 10 working days. The laboratories run tests Monday to Friday. The lab sends the results to the requester, and sends a copy to the local HPT.

The HPT can track the progress of the sample and results through the Measles Reporting Site

Urgent public health action should not wait for laboratory results.

In cases where there are vulnerable contacts and may require HNIG (immunoglobulin), same day laboratory testing is available Monday to Friday, if the sample is at Colindale before 8am.

To arrange same-day testing, a consultant in communicable disease control (CCDC) from a local HPT should contact the Virus Reference Department or speak to the local consultant virologist.

Managing cases and contacts

If a suspected case of measles arrives at a general practice surgery:

  • isolate patient promptly on arrival at the surgery
  • exclude the patient from childcare settings, school, college, or workplace for 5 days from the onset of rash

Most patients with measles can recover safely at home. If a case requires admission to hospital for clinical reasons or complications, please notify the hospital’s infection control team beforehand.

Managing close contacts

You protect vulnerable close contacts (immunosuppressed individuals, pregnant women and children under 1 year old) with MMR vaccination or human normal immunoglobulin (HNIG). You determine which treatment based on their exposure risk and susceptibility to infection.

Health care workers can get advice out of hours from PHE’s local health protection teams: enter your post code in the lookup to find your local health protection team.

MMR vaccination

The optimal age chosen for the MMR vaccine schedule is a compromise between risk of disease and level of protection.

The schedule recommends that children receive the first dose of MMR between 12 and 13 months of age (i.e. within a month of the first birthday). See the Green Book chapter about measles for details.

You can vaccinate a child before their first birthday if:

  • the child is travelling to an endemic country
  • a local outbreak puts the child at risk (on the advice of local health protection team)

However, residual maternal antibodies can reduce the child’s response rate to the vaccine.

If a child receives a dose of MMR before their first birthday, then you should still give 2 doses at the recommended times:

  • between 12 and 13 months of age (i.e. within a month of the first birthday)
  • at three years four months to five years of age

Vaccinating children who have previously received single vaccines

You can give MMR to any child who previously received single vaccines. Single vaccines imported into this country have not been independently tested for potency.

There is evidence that some of the single vaccines are less effective in protecting against measles.

Single dose vaccines do not contribute towards the recommended 2 doses of MMR.

Vaccination for travel to measles outbreak areas: children under 1 year of age (who have not received any MMR vaccine)

Ask the parents, “Do you really need to travel now to an area of reported measles outbreak?”

If travel is necessary, peform an individual risk assessment to determine:

  • the duration of stay
  • the likely degree of mixing with local families/communities
  • whether local measles outbreaks have been reported

For infants travelling on longer breaks to regions with local outbreaks, and who are likely to meet local families, you can give MMR vaccine as early as from 6 months of age.

However, as the response to vaccine in infants is sub-optimal, discount any dose given before 12 months of age.

These infants require 2 further doses of MMR vaccine, following the recommended schedule.

Record all immunisations in the routine manner and notify local Child Health Information systems of these immunisations.

Vaccination for travel to measles outbreak areas: for preschool children (who have not received the 2nd dose of MMR)

Ask the parents, “Do you really need to travel now to an area of reported measles outbreak?”

If travel is necessary, peform an individual risk assessment to determine

  • the duration of stay
  • the likely degree of mixing with local families/communities
  • whether local measles outbreaks have been reported

For infants travelling on longer breaks to regions with local outbreaks, and who are likely to meet local families, you can bring the second dose of MMR vaccine forward, as soon as one month after the first dose. If the child is over 18 months of age this will count as the pre-school dose.

For those children under 18 months of age and where the second dose is given within 3 months of the first dose, then give the routine pre-school dose (a third dose) to ensure full protection.

Record all immunisations in the routine manner and notify local Child Health Information systems of these immunisations.

Infection control in surgeries and clinics

Measles is highly infectious. Ensure that patients with rash illness kept separate from other patients in the waiting rooms in primary care, community and hospital settings.

Alert all staff, especially receptionists, about keeping anyone with a rash separate from other patients.

If a patient later turns out to have measles, putting the patient in a side room means you do not need a look back exercise to identify and assess all of the patients who were in the waiting room at the time.

Advise people with measles to avoid contact with others and stay away from school or nursery for 4 days after the onset of rash.

Do not allow vulnerable patients (immunosuppressed individuals, pregnant women and children under one year), to risk serious complications by being exposed to measles patients in a waiting room.

Further advice is available from infection control teams (hospitals setting) or local Health Protection teams.

Vaccinating healthcare workers against measles

See the joint letter from the Chief Medical Officer, the NHS England medical director and the NHS England nursing director on healthcare staff, working with vulnerable patients, keeping their vaccinations up to date.

Published 2 May 2013