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Public Health England position on early administration of second dose MMR vaccine
GP practices may be contacted by parents of children who have been informed of recent exposure to suspected or confirmed cases of measles in the wider Bristol area. Since the beginning of 2018, there have been a total of 104 confirmed and 38 probable cases of measles across the Avon, Gloucestershire and Wiltshire area. A significant number of these cases have required letters to be sent to ‘common space’ contacts with advice for patients on any urgent or precautionary actions that may be required.
GPs are urged to be familiar with the recommendations of the national measles guideline produced by Public Health England (PHE) which are available online here:
Parents of children who may have been exposed to measles, but who have already had a first dose of MMR, may be eager to arrange early administration of the second dose to ensure their child is fully protected (i.e. before the routine second dose vaccination at 3 years and 4 months).
Chapter 21 of the Green Book advises the following:
“A second dose is normally given before school entry but can be given routinely at any time from three months after the first dose. Allowing three months between doses is likely to maximise the response rate, particularly in young children under the age of 18 months where maternal antibodies may reduce the response to vaccination. Where protection against measles is urgently required, the second dose can be given one month after the first. If the child is given the second dose less than three months after the first dose and at less than 18 months of age, then the routine pre-school dose (a third dose) should be given in order to ensure full protection.”
PHE recommends that urgent protection in this context relates to the following situations:
- Where there has been documented direct exposure to a likely or confirmed case of measles; 2. Where the partially immunised child is at risk of continued exposure in a given setting or congregation, for example as a result of an outbreak in a school or nursery; 3. Where the background incidence of measles in the wider community is considered to be sufficiently high.
The consensus advice from PHE is that the current incidence of measles across the Avon, Gloucestershire and Wiltshire area does not warrant early administration of the second dose MMR on a routine basis.
Parents should be advised to follow the normal childhood immunisation schedule where possible.
GPs can offer an early second dose where the specific circumstances warrant this in their clinical opinion.
This may include, for example, children who will be travelling to measles endemic countries during the summer break: https://travelhealthpro.org.uk/disease/116/measles
Early second dose MMR will not affect COVER data, however practices should ensure that parents are reminded of the need to attend at 3 years, 4 months for their other pre-school booster.
https://www.nhs.uk/conditions/vaccinations/childhood-vaccines-timeline/
Dominic Mellon
Consultant in Health Protection
Public Health England South West
Dr Ardiana Gjini Screening and Immunisation Lead
Public Health England South West
NHS England South West
Last updated: 06/07/18