Measles vaccination

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

The measles vaccination is the best protection against infection with measles virus. The pathogens are highly infectious and can - albeit rarely - make you seriously ill, sometimes with fatal consequences! Read here how often you have to be vaccinated against measles, for whom the vaccination is important or even mandatory, which side effects the measles vaccination can have and what the so-called vaccination measles are!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B05

Measles vaccination: when is it given?

The measles vaccination is very important: the disease can cause serious complications such as otitis media, pneumonia or encephalitis. Such complications, while rare, can be serious and even fatal. Children under the age of five and adults over the age of 20 are particularly susceptible to measles complications.

The Standing Vaccination Commission (STIKO) at the Robert Koch Institute (RKI) therefore recommends vaccination against measles for all people born after 1970. The vaccination is usually given in the following age groups:

Infants and toddlers (basic immunization within the first two years of life)
Adults born after 1970 if they were not vaccinated against measles, or only vaccinated once in childhood, or if their vaccination status is unclear

The measles vaccination is not necessary for adults who were born before 1970 (i.e. before the measles vaccination became standard). It is assumed that almost all of them became infected with the highly contagious measles virus at some point, went through the disease and thus acquired immunity.

Regulations according to the measles protection law

The vaccination recommendations of the STIKO have been supplemented by the Measles Protection Act since March 1, 2020. It prescribes a compulsory measles vaccination in certain cases:

For example, a measles vaccination is now mandatory for children from the age of 1 if they want to attend a community facility such as day nursery, day care, kindergarten or school. This means that before the child enters the community facility, parents must prove that their child has been vaccinated against measles (vaccination card) or has lived through measles disease (medical certificate).

Young people who attend a school, training facility or other community facility where predominantly minors are cared for are also subject to the Measles Protection Act. As in the case of children, it must also be proven here that they have been vaccinated twice against measles or that there is sufficient immunity as a result of the measles illness.

The measles vaccination is also compulsory for working young people and adults who want to work in medical or community facilities (e.g. in hospitals, doctors' offices, schools, kindergartens, asylum or refugee homes) - provided they have not already had measles and were born after 1970 .

All children, adolescents and adults born after 1970 who were already cared for or were working in a community facility on March 1, 2020, must submit proof of a measles vaccination or immunity by July 31, 2021 at the latest.

In addition, according to the Measles Protection Act, asylum seekers and refugees are obliged to prove that they are vaccinated against measles four weeks after admission to a communal accommodation facility.

The compulsory vaccination applies to everyone who regularly works in the facilities mentioned - for example, also for temporary workers, volunteers, interns and service personnel (kitchen, cleaning)!

Measles vaccination: when should I not be vaccinated?

The measles vaccination should generally not be given in the following cases:

During pregnancy (see also notes below)
If you have an acute fever (> 38.5 degrees Celsius) or another severe, acute illness
If you are hypersensitive to any of the components of the vaccine

If someone has a congenital or acquired immune deficiency, the doctor should clarify whether the vaccination against measles makes sense or not. A severely weakened immune system cannot produce enough antibodies. However, patients with weakened immune systems are also at an increased risk of the measles having a severe course. You could therefore particularly benefit from the measles vaccination.

The measles vaccine

The measles vaccine is a so-called live vaccine. It contains weakened pathogens that are no longer able to reproduce (attenuated measles viruses). Nevertheless, the immune system reacts to this by producing specific antibodies. This means that the measles vaccination is a so-called active vaccination (in contrast to a passive vaccination, in which finished antibodies are injected, e.g. against tetanus).

It takes some time for antibodies to form after the measles vaccine has been administered. The first antibodies are usually detectable in the blood 12 to 15 days after the vaccination. It is assumed that the majority of those vaccinated will be protected against measles virus after three to four weeks.

No more single measles vaccine

No single vaccine (single vaccine) against measles has been available in the EU since 2018. Only combination vaccines are still available - either the MMR vaccination (combined vaccine against measles, mumps and rubella) or the MMRV vaccination (additionally protects against varicella, i.e. chickenpox pathogens).

The advantage of these combination vaccines is that fewer "pricks" are necessary. A total of six injection syringes would be required for adequate vaccination protection against measles, mumps and rubella when using individual vaccines. With the combined MMR vaccine, two vaccinations are sufficient to build up effective protection against all three infectious diseases. Even with the MMRV vaccine, two doses are sufficient.

In addition, the combination vaccines have proven to be just as effective and well tolerated as the respective individual vaccines.

Even if someone already has immunity to one of the diseases measles, mumps, rubella or varicella (MMRV) (e.g. because of a previous illness), the combination vaccine can be administered - there is no increased risk of side effects.

Measles vaccination: pregnancy and breastfeeding

The fact that the measles vaccine is a live vaccine explains why it cannot be given during pregnancy. Pregnant women are generally not allowed to receive live vaccines. The weakened pathogens of such vaccines may not be dangerous for the mother, but may be dangerous for the unborn child.

Pregnancy should be avoided for four weeks after a measles vaccination!

If a pregnancy does occur or if the doctor has vaccinated because the pregnancy was not yet known, no termination of the pregnancy is necessary. Many hundreds of recorded vaccinations during or shortly before pregnancy did not result in an increased risk of malformations in the child.

The measles-mumps-rubella vaccine is possible during breastfeeding. Studies after an MMR vaccination have shown that mothers excrete the weakened vaccine virus in breast milk and can thus transmit it. However, there were no indications of a measles disease in the child.

Measles vaccination: how often is vaccinated?

Doctors usually give the vaccine against measles (as a combination vaccine) twice. This is necessary for basic immunization, i.e. safe and complete vaccination protection. Studies have shown that after the first vaccination dose, five to ten out of 100 people who are vaccinated are not yet adequately protected against measles infection. That changes with the second vaccination dose: After that, about 99 out of 100 people who have been vaccinated have built up enough antibodies against the measles pathogen.

The general vaccination recommendation for adults born after 1970 who do not have adequate immunity against measles provides for a one-time measles vaccination.

According to the Measles Protection Act, adults born after 1970 who work in medical or community facilities must have been vaccinated against measles at least twice or prove that they have immunological protection, for example due to a previous illness!

Measles vaccination: how is it carried out?

The first dose of vaccine is usually given to babies between the ages of 11 and 14 months. The second should be given no earlier than four weeks afterwards and no later than towards the end of the second year of life (at 23 months).

Children and adolescents who received only one vaccination dose or none at all as a toddler should have the measles vaccination made up as soon as possible: The missing second vaccination dose is administered or the complete basic vaccination with two vaccine doses at least four weeks apart .

The following applies to measles vaccination in adults who were born after 1970 and have only incomplete or no immunity to measles virus:

If you work in a medical or community facility, two measles vaccinations are required if no measles disease can be proven.
A single measles vaccination is recommended for all other adults born after 1970 with insufficient immunity to measles.

Where will the vaccine be injected?

The measles vaccine (as an MMR or MMRV vaccine) is injected under the skin (subcutaneously) or into a muscle (intramuscularly). The doctor usually chooses the upper arm or the side of the thigh for this.

Measles vaccination: side effects

Like any vaccination and any other medication, the measles vaccination - more precisely: the MMR or MMRV vaccination - can cause side effects, even if it is generally considered to be well tolerated. Only a few vaccinated people develop local reactions at the injection site such as reddening, pain and swelling in the days after vaccination. Occasionally, swelling of the lymph nodes near the puncture site is observed.

Some people develop side effects of a general nature after the measles vaccination, such as an increased body temperature or fever (in small children possibly with febrile convulsions), fatigue, headache or gastrointestinal complaints. Like the local vaccination reactions, these complaints usually subside after a short time and without any consequences. They are most likely to show up after the first dose of vaccine and very rarely after the second.

Occasionally a slight swelling of the parotid gland will develop. There is rarely a slight swelling of the testicles or joint problems (the latter is preferred in adolescents and adults).

Very rare side effects of the measles vaccination (or MMR or MMRV vaccination) are allergic reactions and prolonged joint inflammation.

In a few individual cases worldwide, encephalitis has been observed after the measles vaccination. However, it has not yet been proven whether this was actually caused by the vaccination.

Infants and toddlers can rarely get febrile seizures as a result of the increase in temperature. As a rule, these have no consequences. The risk of febrile seizures is slightly higher if health professionals use the MMRV instead of the MMR vaccine for the first vaccination. Therefore, doctors often choose the MMR vaccine for the first injection and give the varicella vaccine to a different part of the body. The next vaccination can then easily be given with the MMRV vaccine.

Vaccine fibers

Two to five out of 100 people who are vaccinated get what is known as vaccine measles one to four weeks after the measles vaccination: They look similar to real measles, which means that those affected develop a mild measles-like rash, often accompanied by a fever.

It is a reaction to the weakened but still living vaccine virus. The rest of these are not transferable. So don't be afraid of someone with vaccine fibers - they are not contagious. Even people with weakened immune systems cannot become infected with vaccine measles.

No autism from the MMR vaccination!

A study published in 1998 with twelve participants unsettled the population for a long time - and in some cases it still does today: The study assumed a possible connection between the MMR vaccination and autism.

It is now known, however, that false and invented results were deliberately published at the time - the responsible doctor lost his medical license in Great Britain and the published study was completely revoked.

In addition, later, high-quality studies found that there was no association between the MMR vaccination and the occurrence of autistic disorders. This includes, for example, a large-scale Danish study with more than 650,000 children.

How long does the measles vaccination work?

Experts assume that the full basic immunization - i.e. the two measles vaccination - will last for life. It may be the case that the amount of certain antibodies (immunoglobulin G, IgG for short) against measles viruses in the blood of the vaccinated person decreases over time. According to the current state of knowledge, this does not affect vaccination protection.

Do I need a measles booster vaccination?

It cannot be completely ruled out that the immunity acquired with the measles vaccination may decline at some point in life. Because the widespread vaccination means that fewer measles viruses are circulating in the population. The immune system of vaccinated persons comes into contact with the pathogens less often - the "natural" boosting of the vaccination protection via such contact with the virus does not occur.

So far, however, there is nothing to suggest that this has an effect on measles immune protection in the population. According to the current state of knowledge, it is therefore not necessary to have the measles vaccination refreshed.

Measles despite vaccination

In addition to the vaccine measles mentioned above, people can also get the "real" measles in rare cases after the two measles vaccination. With regard to the cause, doctors differentiate between primary and secondary vaccination failure.

Primary vaccination failure

In the case of primary vaccination failure, the measles vaccination does not develop the intended protective effect from the start. In about one to two percent of those vaccinated, the double measles vaccination does not work. This means that those affected do not produce enough antibodies against measles viruses.

This can happen, for example, in people with a congenital or acquired immune deficiency. With them, the immune system is not able to react to the measles vaccination with sufficient antibody formation.

In infants, it can also be due to maternal antibodies. These circulate in the child's blood and can thus interact with the measles vaccine. As a result, vaccination protection cannot be established in rare cases.

Incorrect storage or administration of the vaccine can also lead to primary vaccination failure.

Secondary vaccination failure

One speaks of this when the vaccination protection wears off over time after the measles vaccination, so that a measles disease becomes possible. Secondary vaccination failure is rare.

Post-exposure measles vaccination

If unprotected people have had contact with a measles patient, they should ideally get a quick vaccination within the first three days afterwards (a maximum of five days afterwards). This can prevent an outbreak of the disease or alleviate the severity of the disease (relief is also possible with vaccination up to the seventh day after contact). The combination vaccine against measles, mumps and rubella (MMR vaccination) is used for this "emergency" vaccination.

Experts recommend this post-exposure active vaccination to all those affected who are older than nine months. In individual cases, an earlier vaccination outside the approval area "off-label" is possible - at the age of six to eight months. Affected children should still receive the usual two-time measles vaccination afterwards. This is the only way to achieve vaccination protection.

Measles lock vaccination

For example, if measles has broken out in a nursing home or daycare center, one of the most important measures is the so-called locking vaccination. This is also an active measles immunization. The vaccination should be given as soon as possible in the first three days so that the disease does not spread any further.

Post-exposure passive vaccination

For people with a weakened immune system, the post-exposure measles vaccination can also be carried out by means of passive immunization: two to six days after the (suspected) infection, finished antibodies (immunoglobulins) against measles viruses are injected. In contrast to the "normal" (active) measles vaccination, this gives the vaccinated person immediate protection. However, this only lasts for a limited time: The "foreign" antibodies are gradually broken down by the immune system.

Pregnant women and babies under six months old can also receive passive immunization as a precautionary measure after a possible measles infection. The active measles vaccination is not allowed during pregnancy (no live vaccines!) And not allowed for children under six months.

After a passive immunization (immunoglobulin administration), a subsequent MMR or MMRV vaccination is not definitely effective for about eight months!