Controversies in measles immunization recommendations.

Controversy in medicine is inevitable, but it becomes problematic when the issue is a serious public health problem requiring a clear plan of action. In recent years measles has made a major resurgence in this country, with provisional figures showing 89 measles-related deaths in 1990. The Immunization Practices Advisory Committee of the US Public Health Service, the Committee on Infectious Diseases of the American Academy of Pediatrics, and the US Preventive Services Task Force have all issued recommendations for measles immunization. Most of these recommendations are in agreement, but they conflict on the age at which vaccination should be given and the number of doses. To assist physicians in disentangling this complex web, I review the history of measles immunization in the United States and give the rationale for particular positions wherein the groups disagree. I describe protocols for routine vaccinations, endemic areas, outbreak control, colleges and universities, and international travel.