Provider Guidance: Early MMR Vaccination for Infants (6–11 Months) During a Measles Outbreak

Who Should Be Considered for Early Vaccination?

  • Infants in current outbreak area(s) with sustained community-wide transmission. Counties will be posted on the NCDHHS Measles Website in the Measles Resources for Healthcare Providers section.
  • Infants in surrounding geographic areas based on likelihood of exposure if traveling/visiting outbreak area
  • Infants with planned international travel

Why Early Vaccination Matters

  • Measles is highly contagious and can cause severe illness in infants:
    • 1 in 5 hospitalized, 1 in 20 develop pneumonia, 1 in 1,000 develop encephalitis.
    • 1 to 3 in 1,000 may die.
  • Infants <12 months are at highest risk for severe complications.1,2
  • Early MMR vaccination (6–11 months) can reduce risk of disease and death during outbreaks.

Key Considerations

  • Pediatricians should weigh benefits of early protection vs. slightly lower immune response in younger infants.
  • Efficacy concerns: Data suggest many infants may not derive high levels of protection from this early dose, possibly due to maternal antibodies blunting the immune response.3
  • Because of this, the dose is "extra": This early dose does not count toward the primary series. The child will still require the standard two doses starting at or after 12 months of age.
  • Long-term immunity: There is some evidence that children who receive an early dose may experience a more rapid decay of antibody titers later in life, potentially resulting in lower overall protection as adults.4,5,6
  • No need for immune globulin (IG) post-exposure or home quarantine if infant has previously received one early MMR dose.
  • MMR is preferred over IG for infants 6–11 months if given within 72 hours of exposure. If ≥72 hours post-exposure, IGIM/IVIG may be considered within 6 days of exposure. Infant would still need home quarantine.
  • VFC MMR can be used for the early dose for VFC eligible infants.
  • VFC-supplied MMRV cannot be given before 12 months of age.

Safety of MMR Vaccine

  • MMR is safe and effective; serious adverse events are rare.
  • Reactions to the MMR vaccine can resemble measles disease. Common side effects include: mild fever, rash, sore arm.
  • Febrile seizures are rare and not associated with long-term health effects.

Documentation & Follow-Up

  • Infants who receive early dose should be scheduled for:
    • Routine Dose 1 at 12–15 months (at least 28 days after the early dose)
    • Routine Dose 2 at 4–6 years
  • Maintain clear documentation of all doses

Resources for Providers

References

  1. Leung J, Munir NA, Mathis AD, et al. The Effects of Vaccination Status and Age on Clinical Characteristics and Severity of Measles Cases in the United States in the Postelimination Era, 2001-2022. Clinical Infectious Diseases. 2025;80(3):663-672.
  2. Perry RT, Halsey NA. The clinical significance of measles: a review. Journal of Infectious Diseases. 2004;189 Suppl 1:S4-16. doi: 10.1086/377712.
  3. Brinkman ID, de Wit J, Smits GP, et al. Early measles vaccination during an outbreak in the Netherlands: short-term and Long-term decreases in antibody responses among children vaccinated before 12 months of age. Journal of Infectious Diseases 2019;220(4):594–602.
  4. Gans HA, Yasukawa LL, Sung P, et al. Measles humoral and cell-mediated immunity in children aged 5–10 years after primary measles immunization administered at 6 or 9 months of age. Journal of Infectious Disease 2013;207(4):574–82.
  5. van der Staak M, Hulscher HI, Nicolaie AM, et al. Long-term Dynamics of Measles Virus–Specific Neutralizing Antibodies in Children Vaccinated Before 12 Months of Age. Clinical Infectious Diseases 2025;80(4):904-910
  6. Vittrup DM, Jensen A, Sørensen JK, et al. Immunogenicity and reactogenicity following MMR vaccination in 5-7-month-old infants: a double-blind placebo-controlled randomized clinical trial in 6540 Danish infants. EClinicalMedicine 2024;68:102421.

Bonnie Coyle, MD, MS, Mecklenburg County Medical Director

Kimberly Scott, DrPH, MPH, Interim Health Director