In Reply

Letters to the Editor regarding the article The Epidemiology and Diagnosis of Measles Special Aspects Relating to Low Incidence by Dorothea Matysiak-Klose, Annette Mankertz, and Heidemarie Holzmann in issue 26/2024

As Schalk et al. rightly say, in our article on the epidemiology and laboratory diagnosis of measles we described the population based standard recommendation of the Standing Committee on Vaccination (STIKO) for the general population, which in principle recommends the MMR vaccine for all adults born after 1970 with unclear vaccination status, without vaccination or with only one dose of vaccine against measles in childhood (1, 2). The recommendation aims to achieve individual protection against measles as well as high population immunity. This guarantees the fast disruption of transmission chains and can thus also protect persons who cannot currently be vaccinated—for example, infants, pregnant women, or persons with congenital or acquired immunodeficiency.

This general recommendation does not assume that all persons for whom the recommendation is formulated can actually be vaccinated. The medical vaccination service comprises the vaccination itself but also checking for potential contraindications (2). The guidance in the summary of product characteristics (SMPC) applies and should be heeded.

The absolute prerequisite for successful vaccination and for limiting the vaccination risk is a competent, adaptive immune system. Live vaccines such as the measles vaccines can in persons with certain congenital or acquired disorders of the immune system lead to severe or even fatal infections as a result of the potentially uncontrolled replication of the attenuated vaccine pathogen (3). Live vaccines, such as the MMR [measles, mumps, rubella] vaccine, are therefore contraindicated in these diseases or can be administered only after a certain time lag, for example after immunosuppressive therapy (2, 4). In immunodeficient persons, the respective actual immune status should always be checked and the live vaccine should be given only after consultation with the treating specialists (2, 3, 4).

DOI: 10.3238/arztebl.m2025.0050

On behalf of the authors

Dr. med. Dorothea Matysiak-Klose

Fachgebiet Impfprävention

Robert Koch-Institut

Berlin

Conflict of interest statement

DMK is head of the office of the National Verification Commission for Measles/Rubella at the Robert Koch Institute.

References

1. Matysiak-Klose D, Mankertz A, Holzmann H: The epidemiology and diagnosis of measles—special aspects relating to low incidence. Dtsch Arztebl Int 2024; 121: 875–81

2. Robert Koch-Institut: Empfehlungen der Ständigen Impfkommission beim Robert Koch-Institut 2025. Epid Bull 2025; 4: 1–75.

3. Stellungnahme der Ständigen Impfkommission (STIKO) am RKI: Fachliche Anwendungshinweise zur Masern-Postexpositionsprophylaxe bei Risikopersonen. Epid Bull 2017; 2: 17–25.

4. Niehues T, Bogdan C, Hecht J, Mertens T, Wiese-Posselt M, Zepp F: Impfen bei Immundefizienz: Anwendungshinweise zu den von der Ständigen Impfkommission empfohlenen Impfungen. (I) Grundlagenpapier. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60: 674–84