If I Had Chicken Pox Mumps Measles Can I Get Them Again

Measles, Mumps, and Rubella

Disease Problems Contraindications and Precautions Vaccine Recommendations Pregnancy and Postpartum Considerations Administering Vaccines Vaccine Safety Scheduling Vaccines Storage and Handling For Healthcare Personnel

Disease Problems

What is the current situation with measles, mumps, and rubella in the The states?

In 2019, a conditional total of one,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a unmarried year since 1992; 73% of cases were associated with outbreaks amongst unvaccinated people in New York. These outbreaks were independent and stopped before the stop of 2019. Betwixt January i and August xix, 2020, merely 12 measles cases were reported past 7 jurisdictions. Express travel as a event of the COVID-nineteen pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the U.s.. CDC measles surveillance updates tin can be found at www.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, there has been a more than 99% decrease in mumps cases in the United States. However, outbreaks even so occasionally occur. In 2006, at that place was an outbreak affecting more than six,584 people in the United States, with many cases occurring on college campuses. In 2009, an outbreak started in close-knit religious communities and schools in the Northeast, resulting in more than than iii,000 cases. Since 2015, numerous outbreaks have been reported across the US, in college campuses, prisons, and close-knit communities, including a big outbreak in northwest Arkansas where nigh iii,000 cases were reported in 2016. These outbreaks have shown that when people with mumps have close contact with a lot of other people (such every bit among residential college students and families in close-knit communities) mumps can spread even amidst vaccinated people. Withal, outbreaks are much larger in areas where vaccine coverage rates are lower. A conditional total of three,484 cases of mumps were reported to CDC in 2019.

Rubella was declared eliminated (the absence of owned manual for 12 months or more) from the U.s. in 2004. Fewer than 10 cases (primarily import-related) have been reported annually in the United states of america since emptying was declared. Rubella incidence in the United states of america has decreased by more than 99% from the pre-vaccine era. A provisional total of 3 cases of rubella, and no cases of built rubella syndrome, were reported in 2019.

How serious are measles, mumps, and rubella?

Measles can pb to serious complications and death, even with mod medical intendance. The 1989–1991 measles outbreak in the U.S. resulted in more than than 55,000 cases and more 100 deaths. In the United States, from 1987 to 2000, the almost unremarkably reported complications associated with measles infection were pneumonia (6%), otitis media (7%), and diarrhea (8%). For every i,000 reported measles cases in the U.s., approximately 1 case of encephalitis and two to 3 deaths resulted. The risk for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

Mumps well-nigh normally causes fever and parotitis. Up to 25% of persons with mumps have few or no symptoms. Complications of mumps include orchitis (inflammation of the testicle) and oophoritis (inflammation of the ovary). Other complications of mumps include pancreatitis, deafness, hygienic meningitis, and encephalitis. Mumps disease is typically milder, with fewer complications, in fully vaccinated case patients.

Rubella is generally a mild affliction with depression-grade fever, lymphadenopathy, and angst. Up to 50% of rubella virus infections are subclinical. Complications tin can include thrombocytopenic purpura and encephalitis. Rubella virus is teratogenic and infection in a meaning woman, specially during the offset trimester can result in miscarriage, stillbirth, and nascency defects including cataracts, hearing loss, mental retardation, and built center defects.

What are the signs and symptoms healthcare providers should await for in diagnosing measles?

Healthcare providers should doubtable measles in patients with a febrile rash affliction and the clinically compatible symptoms of cough, coryza (runny nose), and/or conjunctivitis (red, watery eyes). The disease begins with a prodrome of fever and angst before rash onset. A clinical case of measles is defined as an affliction characterized by

• a generalized rash lasting iii or more days, and • a temperature of 101°F or higher (38.3°C or higher), and • coughing, coryza, and/or conjunctivitis.

Koplik spots, a rash nowadays on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from 1 to ii days before the measles rash appears to 1 to 2 days afterward. They appear as punctate blue-white spots on the brilliant red background of the buccal mucosa. Pictures of measles rash and Koplik spots can be constitute at www.cdc.gov/measles/near/photos.html.

Providers should be especially aware of the possibility of measles in people with fever and rash who have recently traveled abroad or who have had contact with international travelers.

Providers should immediately isolate and report suspected measles cases to their local health department and obtain specimens for measles testing, including viral specimens for confirmation and genotyping. Providers should also collect blood for serologic testing during the start clinical run across with a person who has suspected or probable measles.

What should our clinic do if we suspect a patient has measles?

Measles is highly contagious. A person with measles is infectious up to 4 days before through 4 days after the day of rash onset. Patients with suspected measles should be isolated for 4 days afterward they develop a rash. Airborne precautions should exist followed in healthcare settings by all healthcare personnel. The preferred placement for patients who require airborne precautions is in a single-patient airborne infection isolation room. Providers should immediately isolate and written report suspected measles cases to their local health department and obtain specimens for measles testing, including serum sample for measles serologic testing and a throat swab (or nasopharyngeal swab) for viral confirmation.

Measles is a nationally notifiable disease in the U.S.; healthcare providers should study all cases of suspected measles to public wellness government immediately to help reduce the number of secondary cases. Practise not wait for the results of laboratory testing to study clinically-suspected measles to the local health department.

More information on measles disease, diagnostic testing, and infection control can be found at world wide web.cdc.gov/measles/hcp/index.html.

How long does information technology take to evidence signs of measles, mumps, and rubella after being exposed?

For measles, at that place is an average of ten to 12 days from exposure to the appearance of the first symptom, which is usually fever. The measles rash doesn't unremarkably appear until approximately 14 days after exposure (range: 7 to 21 days), and the rash typically begins 2 to iv days after the fever begins. The incubation period of mumps averages 16 to 18 days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation period of rubella is 14 days (range: 12 to 23 days). Nevertheless, every bit noted above, up to one-half of rubella virus infections cause no symptoms.

Vaccine Recommendations Dorsum to top

What are the current recommendations for the use of MMR vaccine?

The about recent comprehensive ACIP recommendations for the use of MMR vaccine were published in 2013 and are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a second dose at age four through six years. The 2d dose of MMR can exist given as early as four weeks (28 days) later the start dose and exist counted as a valid dose if both doses were given afterward the child's showtime altogether. The second dose is not a booster, but rather is intended to produce immunity in the minor number of people who fail to respond to the first dose.

Adults with no prove of immunity (show of immunity is defined as documented receipt of 1 dose [2 doses iv weeks autonomously if high take chances] of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of affliction, or birth earlier 1957) should become 1 dose of MMR vaccine unless the adult is in a high-risk group. High-risk people need 2 doses and include school-age children, healthcare personnel, international travelers, and students attending post-high school educational institutions.

Live attenuated measles vaccine became available in the U.Southward. in 1963. An ineffective, inactivated measles vaccine was besides available in the U.S. in 1963–1967. Combined MMR vaccine (MMRII, Merck) was licensed in 1971. For people who previously received a dose of measles vaccine in 1963–1967 and are unsure which blazon of vaccine information technology was, or are sure information technology was inactivated measles vaccine, that dose should exist considered invalid and the patient revaccinated as age- and adventure-advisable with MMR vaccine. At the discretion of the state public health section, anyone exposed to measles in an outbreak setting tin receive an boosted dose of MMR vaccine even if they are considered completely vaccinated for their age or risk status.

What is considered adequate prove of immunity to measles?

Acceptable presumptive evidence of amnesty confronting measles includes at to the lowest degree one of the following:

• written documentation of acceptable vaccination: • laboratory evidence of immunity • laboratory confirmation of measles (verbal history of measles does not count) • birth before 1957

Although nativity before 1957 is considered acceptable prove of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do not have other evidence of amnesty with 2 doses of MMR vaccine (minimum interval 28 days).

During an outbreak of measles, healthcare facilities should recommend 2 doses of MMR vaccine at the appropriate interval for unvaccinated healthcare personnel regardless of birth year if they lack laboratory evidence of measles immunity.

For which adults are 0, 1, or 2 doses of MMR vaccine recommended to foreclose measles?

Nothing, one, or two doses of MMR vaccine are needed for the adults described below.

Nothing doses:

• adults born before 1957 except healthcare personnel* • adults built-in 1957 or afterward who are at low take chances (i.e., not an international traveler or healthcare worker, or person attending college or other postal service-loftier schoolhouse educational institution) and who take already received one or more documented doses of alive measles vaccine • adults with laboratory testify of immunity or laboratory confirmation of measles

I dose of MMR vaccine:

• adults born 1957 or later who are at low take a chance (i.east., not an international traveler, healthcare worker, or person attention college or other mail service-loftier school educational institution) and accept no documented vaccination with alive measles vaccine and no laboratory evidence of amnesty or prior measles infection

Two doses of MMR vaccine:

� high-risk adults without any prior documented live measles vaccination and no laboratory evidence of immunity or prior measles infection, including:

Persons who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine it was, or are certain it was inactivated measles vaccine, should exist revaccinated with either one (if low-risk) or two (if loftier-risk) doses of MMR vaccine.

* Healthcare personnel built-in before 1957 should be considered for MMR vaccination in the absence of an outbreak, only are recommended for MMR vaccination during outbreaks.

Given the adventure of outbreaks of measles in the U.S., should all healthcare personnel, including those built-in before 1957, have 2 doses of MMR vaccine?

Although nascence earlier 1957 is considered acceptable evidence of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born before 1957 who do not have laboratory evidence of measles amnesty, laboratory confirmation of affliction, or vaccination with two appropriately spaced doses of MMR vaccine.

All the same, during a local outbreak of measles, all healthcare personnel, including those born before 1957, are recommended to have two doses of MMR vaccine at the advisable interval if they lack laboratory evidence of measles.

Healthcare facilities should check with their country or local health department's immunization plan for guidance. Access contact information hither: www.immunize.org/coordinators.

If there is an outbreak in my area, can we vaccinate children younger than 12 months?

MMR tin can exist given to children equally immature as 6 months of age who are at high risk of exposure such as during international travel or a community outbreak. All the same, doses given BEFORE 12 months of age cannot be counted toward the 2-dose series for MMR.

How does being built-in before 1957 confer immunity to measles?

People born before 1957 lived through several years of epidemic measles earlier the commencement measles vaccine was licensed in 1963. As a result, these people are very likely to accept had measles disease. Surveys advise that 95% to 98% of those built-in before 1957 are immune to measles. Persons born before 1957 can be presumed to exist allowed. However, if serologic testing indicates that the person is not immune, at least ane dose of MMR should exist administered.

Why is a second dose of MMR necessary?

Approximately 7% of people practice not develop measles immunity afterwards the first dose of vaccine. This occurs for a multifariousness of reasons. The second dose is to provide another run a risk to develop measles amnesty for people who did non answer to the kickoff dose. Most 97% of people develop immunity to measles after two doses of measles-containing vaccine.

Are in that location any situations where more than 2 doses of MMR are recommended?

At that place are 2 circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing age who take received 2 doses of rubella-containing vaccine and take rubella serum IgG levels that are not conspicuously positive should receive 1 additional dose of MMR vaccine (maximum of three doses). Farther testing for serologic show of rubella immunity is not recommended. MMR should non be administered to a pregnant adult female.

In 2018, ACIP published guidance for MMR vaccination of people at increased risk for acquiring mumps during an outbreak. People previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified by public health government equally existence office of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus�containing vaccine (MMR or MMRV) to improve protection against mumps illness and related complications. More information almost this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

When is it appropriate to utilise MMR vaccine for measles post-exposure prophylaxis?

MMR vaccine given within 72 hours of initial measles exposure tin reduce the risk of getting sick or reduce the severity of symptoms. Another option for exposed, measles-susceptible individuals at high adventure of complications who cannot be vaccinated is to requite immunoglobulin (IG) within six days of exposure. Exercise not administer MMR vaccine and IG simultaneously, as the IG invalidates the vaccine.

Information on mail service-exposure prophylaxis for measles can be institute in the 2013 ACIP guidance at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 24.

Practice whatever adults need "booster" doses of MMR vaccine to forbid measles?

No. Adults with evidence of amnesty do not need any farther vaccines. No "booster" doses of MMR vaccine are recommended for either adults or children. They are considered to have life-long immunity once they accept received the recommended number of MMR vaccine doses or have other evidence of immunity.

Many people who were young children in the 1960s do not take records indicating what blazon of measles vaccine they received in the mid-1960s. What measles vaccine was most frequently given in that time menstruation? That guidance would assist many older people who would adopt not to be revaccinated.

Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. The killed vaccine was found to be not effective and people who received it should be revaccinated with live vaccine. Without a written record, it is not possible to know what blazon of vaccine an private may have received. So persons built-in during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot certificate having been vaccinated or having laboratory-confirmed measles disease should receive at least 1 dose of MMR. Some people at increased risk of exposure to measles (such every bit healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least 4 weeks.

Do people who received MMR in the 1960s need to have their dose repeated?

Not necessarily. People who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown blazon should exist revaccinated with at least i dose of live attenuated measles vaccine. This recommendation is intended to protect people who may have received killed measles vaccine which was available in the United States in 1963 through 1967 and was not effective. People vaccinated earlier 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at loftier take a chance for mumps infection (such as people who piece of work in a healthcare facility) should exist considered for revaccination with 2 doses of MMR vaccine.

I sympathise that ACIP changed its definition of evidence of amnesty to measles, rubella, and mumps in 2013. Please explain.

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of affliction as evidence of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease equally testify of immunity for measles and mumps. Medico diagnosis of disease had not previously been accepted as evidence of immunity for rubella. With the decrease in measles and mumps cases over the terminal 30 years, the validity of physician-diagnosed disease has get questionable. In add-on, documenting history from md records is not a practical choice for most adults. The 2013 MMR ACIP recommendations are bachelor at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Is there anything that tin can exist washed for unvaccinated people who accept already been exposed to measles, mumps, or rubella?

Measles vaccine, given equally MMR, may be effective if given within the first 3 days (72 hours) later exposure to measles. Immune globulin may be constructive for as long as 6 days subsequently exposure. Postexposure prophylaxis with MMR vaccine does non forbid or alter the clinical severity of mumps or rubella. However, if the exposed person does non have evidence of mumps or rubella immunity they should be vaccinated since not all exposures upshot in infection.

What are the current ACIP recommendations for use of immune globulin (IG) for measles, mumps, and rubella post-exposure prophylaxis?

In the 2013 revision of its MMR vaccine recommendations ACIP expanded the apply of post-exposure IG prophylaxis for measles. Intramuscular IG (IGIM) should be administered to all infants younger than 12 months who have been exposed to measles. The dose of IGIM is 0.five mL/kg of torso weight; the maximum dose is 15 mL. Alternatively, MMR vaccine can be given instead of IGIM to infants age 6 through 11 months, if information technology can be given inside 72 hours of exposure.

Pregnant women without evidence of measles immunity who are exposed to measles should receive an intravenous IG (IGIV) dose of 400 mg/kg of body weight. Severely immunocompromised people, irrespective of show of measles immunity or vaccination, who have been exposed to measles should receive an IGIV dose of 400 mg/kg of body weight.

For persons already receiving IGIV therapy, administration of at to the lowest degree 400 mg/kg body weight within 3 weeks earlier measles exposure should be sufficient to preclude measles infection. For patients receiving subcutaneous immune globulin (IGSC) therapy, assistants of at least 200 mg/kg body weight for ii consecutive weeks earlier measles exposure should exist sufficient.

Other people who exercise not accept bear witness of measles immunity can receive an IGIM dose of 0.five mL/kg of torso weight. Requite priority to people who were exposed to measles in settings where they have intense, prolonged close contact (such as household, kid care, classroom, etc.). The maximum dose of IGIM is 15 mL.

IG is not indicated for persons who have received 1 dose of measles-containing vaccine at age 12 months or older unless they are severely immunocompromised. IG should not exist used to control measles outbreaks.

IG has not been shown to forestall mumps or rubella infection after exposure and is not recommended for that purpose.

Nosotros often see college students who lack vaccination records, but whose titer results bear witness they are not immune to some combination of measles, rubella, and/or mumps. What type of vaccine should these students receive?

Unmarried antigen vaccine is no longer available in the U.Due south.; the student should get the combined MMR vaccine. If a higher student or other person at increased risk of exposure cannot produce written documentation of either immunization or disease, and titers are negative, they should receive two doses of MMR.

I take patients who claim to remember receiving MMR vaccine but have no written record, or whose parents report the patient has been vaccinated. Should I take this as evidence of vaccination?

No. Cocky-reported doses and history of vaccination provided past a parent or other caregiver are non considered to be valid. You should only have a written, dated record as evidence of vaccination.

Under what circumstances should adults be considered for testing for measles-specific antibody prior to getting vaccinated?

Adults without evidence of immunity and no contraindications to MMR vaccine tin can be vaccinated without testing. Only adults without evidence of immunity might be considered for testing for measles-specific IgG antibody, only testing is not needed prior to vaccination.

CDC does non recommend measles antibody testing after MMR vaccination to verify the patient's immune response to vaccination.

Two documented doses of MMR vaccine given on or subsequently the first birthday and separated by at least 28 days is considered proof of measles immunity, according to ACIP. Documentation of appropriate vaccination supersedes the results of serologic testing for measles, mumps, rubella, and varicella.

A patient born in 1970 has a history of measles disease and is besides immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, but is concerned about the measles exposure risk. Should the patient receive the MMR vaccine?

A history of having had measles is not sufficient evidence of measles immunity. A positive serologic test for measles-specific IgG will ostend that the person is immune and is not at adventure of infection regardless of the multiple myeloma. Multiple myeloma is a hematologic cancer and is considered immunosuppressive so MMR vaccine is contraindicated in this person.

We have adult patients in our practice at loftier risk for measles, including patients going dorsum to college or preparing for international travel, who don't retrieve ever receiving MMR vaccine or having had measles disease. How should we manage these patients?

Y'all take ii options. You can exam for immunity or you can just give 2 doses of MMR at to the lowest degree 4 weeks autonomously. There is no harm in giving MMR vaccine to a person who may already be immune to 1 or more than of the vaccine viruses. If you or the patient opt for testing, and the tests indicate the patient is non allowed to one or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks apart. If any test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does non recommend serologic testing later on vaccination considering commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity.

I take a 45-year-old patient who is traveling to Republic of haiti for a mission trip. She doesn't recall ever getting an MMR booster (she didn't become to higher and never worked in wellness care). She was rubella immune when pregnant 20 years ago. Her measles titer is negative. Would you recommend an MMR booster?

ACIP recommends 2 doses of MMR given at to the lowest degree 4 weeks apart for any developed built-in in 1957 or later who plans to travel internationally. In that location is no harm in giving MMR vaccine to a person who may already be immune to one or more of the vaccine viruses.

A patient who was born before 1957 and is not a healthcare worker wants to get the MMR vaccine before international travel. Does he need a dose of MMR?

No, it is not considered necessary, but he may be vaccinated. Earlier implementation of the national measles vaccination program in 1963, most every person acquired measles earlier adulthood. So, this patient tin can exist considered immune based on their nativity year. Nonetheless, MMR vaccine also may be given to any person born earlier 1957 who does non have a contraindication to MMR vaccination.

Routine testing of patients built-in before 1957 for measles-specific antibiotic is not recommended by CDC.

Nosotros have measles cases in our community. How tin I best protect the young children in my practice?

First of all, make sure all your patients are fully vaccinated co-ordinate to the U.S. immunization schedule.

In sure circumstances, MMR is recommended for infants age six through 11 months. Give infants this age a dose of MMR earlier international travel. In addition, consider measles vaccination for infants as young as age vi months every bit a control measure during a U.S. measles outbreak. Consult your country wellness section to find out if this is recommended in your situation. Exercise non count whatsoever dose of MMR vaccine as part of the 2-dose series if it is administered before a kid'southward beginning birthday. Instead, echo the dose when the child is age 12 months.

In the case of a local outbreak, y'all likewise might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age iv through 6 years.

Finally, think that infants also young for routine vaccination and people with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage amidst those around them. Be certain to encourage all your patients and their family unit members to get vaccinated if they are not allowed.

During a mumps outbreak should we offer a third dose of MMR (MMR Ii, Merck) to persons who have two prior documented doses of MMR?

In recent years, mumps outbreaks take occurred primarily in populations in institutional settings with close contact (such as residential colleges) or in close-knit social groups. The current routine recommendation for 2 doses of MMR vaccine appears to be sufficient for mumps control in the general population, but insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 doses of MMR vaccine is high.

In Jan 2018, the Advisory Committee on Immunization Practices (ACIP) published new guidance for MMR vaccination of persons at increased risk for acquiring mumps during an outbreak. Persons previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified past public health government equally existence part of a group at increased adventure for acquiring mumps because of an outbreak should receive a 3rd dose of a mumps virus�containing vaccine to improve protection against mumps affliction and related complications. More information nigh this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

In a measles outbreak, do children who accept not had MMR vaccine pose a threat to vaccinated people? It is my understanding that vaccinated people can nevertheless contract measles. Am I correct?

You are right that vaccinated people tin notwithstanding be infected with viruses or bacteria against which they are vaccinated. No vaccine is 100% effective. Vaccine effectiveness varies from greater than 95% (for diseases such as measles, rubella, and hepatitis B) to much lower (60% for influenza in years with a practiced match of circulating and vaccine viruses, and 70% for acellular pertussis vaccines in the iii-5 years after vaccination). More data is available for each vaccine and disease at www.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines.

Administering Vaccines Back to top

Our clinic has been giving MMR by the wrong route (IM rather than SC) for years. Should these doses exist repeated?

All live injected vaccines (MMR, varicella, and yellowish fever) are recommended to be given subcutaneously. However, intramuscular administration of any of these vaccines is non likely to decrease immunogenicity, and doses given IM exercise not demand to be repeated.

Nosotros often need to give MMR vaccine to large adults. Is a 25-gauge needle with a length of v/viii" sufficient for a subcutaneous injection?

Yep. A 5/8" needle is recommended for subcutaneous injections for people of all sizes.

MMRV was mistakenly given to a 31-year-old instead of MMR. Can this exist considered a valid dose?

Yes, however, this effect is not addressed in the 2010 MMRV ACIP recommendations. Although this is off-label use, CDC recommends that when a dose of MMRV is inadvertently given to a patient historic period 13 years and older, information technology may be counted towards completion of the MMR and varicella vaccine series and does not need to exist repeated.

Scheduling Vaccines Back to meridian

How shortly can we requite the second dose of MMR vaccine to a kid vaccinated at 12 months old?

For routine vaccination, children without contraindications to MMR vaccine should receive 2 doses of MMR vaccine with the first dose at age 12–xv months old and the second dose at age iv–half-dozen years former. The minimum interval is 28 days for dose 2. If yous have an outbreak in your customs or a child is traveling internationally, then consider using the minimum interval instead of waiting until age iv–6 years onetime for dose 2.

Does the four-day "grace period" utilise to the minimum age for administration of the get-go dose of MMR? What about the 28-solar day minimum interval between doses of MMR?

A dose of MMR vaccine administered up to 4 days before the start birthday may be counted every bit valid. Yet, school entry requirements in some states may mandate administration on or later on the first altogether. The 4-mean solar day "grace menses" should not exist applied to the 28-day minimum interval betwixt ii doses of a live parenteral vaccine.

Can MMR exist given on the same twenty-four hours as other alive virus vaccines?

Yes. However, if two parenteral or intranasal live vaccines (MMR, varicella, LAIV and/or yellow fever) are non administered on the same day, they should be separated past an interval of at least 28 days.

If you tin can give the second dose of MMR as early as 28 days after the showtime dose, why do we routinely await until kindergarten entry to requite the second dose?

The second dose of MMR may be given equally early on every bit 4 weeks after the beginning dose, and be counted every bit a valid dose if both doses were given subsequently the starting time birthday. The second dose is not a booster, but rather information technology is intended to produce immunity in the small number of people who fail to respond to the first dose. The risk of measles is higher in schoolhouse-historic period children than those of preschool age, and then it is important to receive the second dose by school entry. It is besides user-friendly to give the second dose at this historic period, since the kid will have an immunization visit for other schoolhouse entry vaccines.

What is the primeval historic period at which I can requite MMR to an infant who will exist traveling internationally? Likewise, which countries pose a high take chances to children for contracting measles?

ACIP recommends that children who travel or live away should exist vaccinated at an earlier age than that recommended for children who reside in the United States. Before their deviation from the United states of america, children historic period 6 through eleven months should receive i dose of MMR. The risk for measles exposure can be loftier in high-, center- and depression-income countries. Consequently, CDC encourages all international travelers to be upward to appointment on their immunizations regardless of their travel destination and to continue a re-create of their immunization records with them equally they travel. For additional information on the worldwide measles situation, and on CDC'due south measles vaccination information for travelers, go to wwwnc.cdc.gov/travel.

If we give a child a dose of MMR vaccine at 6 months of historic period because they are in a community with cases of measles, when should we requite the side by side dose?

The next dose should be given at 12 months of age. The child will also need another dose at least 28 days later. For the kid to be fully vaccinated, they demand to have 2 doses of MMR vaccine given when the child is 12 months of age and older. A dose given at less than 12 months of age does non count as part of the MMR vaccine two-dose serial.

I have an 8-month-old patient who is traveling internationally. The infant needs to be protected from hepatitis A also every bit measles, mumps, and rubella. The family unit is leaving in eleven days. Can I give hepatitis A IG and MMR vaccine simultaneously?

No. IG may comprise antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in February 2022 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age half-dozen through xi months traveling outside the United States when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this historic period group. Neither vaccine is counted as part of the child's routine vaccination series. For details of this recommendation, see the CDC ACIP recommendations for the prevention and control of hepatitis A at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page 18.

Can I give the second dose of MMR earlier than historic period four through 6 years (the kindergarten entry dose) to immature children traveling to areas of the world where there are measles cases?

Yep. The 2d dose of MMR can exist given a minimum of 28 days after the first dose if necessary.

If I requite MMR to an infant traveler younger than age one twelvemonth, volition that dose exist considered valid for the U.Due south. immunization schedule?

No. A measles-containing vaccine administered more than 4 days before the first birthday should non be counted equally part of the series. MMR should be repeated when the kid is age 12 through 15 months (12 months if the kid remains in an area where disease gamble is high). The 2nd dose should be administered at least 28 days later the first dose.

Tin I give a tuberculin skin test (TST) on the same day as a dose of MMR vaccine?

Yep. A TST can be applied earlier or on the aforementioned day that MMR vaccine is given. Nonetheless, if MMR vaccine is given on the previous day or before, the TST should exist delayed for at least 28 days. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin test because of mild suppression of the immune arrangement.

An 18-twelvemonth-old college student says he had both measles and mumps diseases as a preschooler, but never had MMR vaccine. Is rubella vaccine recommended in such a state of affairs?

This student should receive two doses of MMR, separated by at to the lowest degree 28 days. A personal history of measles and mumps is non adequate as proof of immunity. Adequate prove of measles and mumps immunity includes a positive serologic test for antibody, nativity earlier 1957, or written documentation of vaccination. For rubella, but serologic evidence or documented vaccination should exist accustomed as proof of amnesty. Additionally, people built-in prior to 1957 may be considered immune to rubella unless they are women who accept the potential to get pregnant.

When not given on the aforementioned day, is the interval betwixt xanthous fever and MMR vaccines 4 weeks (28 days) or 30 days? I accept seen the yellow fever and alive virus vaccine recommendations published both ways.

The General All-time Practise Guidelines for Immunization (see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html) makes the generic recommendation that live parenterally or nasally administered vaccines not given on the same day should be separated past at least 28 days. The CDC travel health website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated by at least xxx days if possible. Either interval is acceptable.

For Healthcare Personnel Dorsum to top

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP born during or later on 1957 take adequate presumptive show of amnesty to measles, mumps, and rubella, defined as documentation of ii doses of measles and mumps vaccine and at least i dose of rubella vaccine, laboratory testify of immunity, or laboratory confirmation of illness. Further, ACIP recommends that healthcare facilities should consider vaccination of all unvaccinated healthcare personnel who were built-in earlier 1957 and who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend ii doses of MMR separated by at to the lowest degree 4 weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory evidence of measles or mumps amnesty or laboratory confirmation of affliction. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of birth year who lack laboratory prove of rubella immunity or laboratory confirmation of infection or disease.

Would you lot consider healthcare personnel with two documented doses of MMR vaccine to be allowed even if their serology for 1 or more of the antigens comes back negative?

Yep. Healthcare personnel (HCP) with 2 documented doses of MMR vaccine are considered to be immune regardless of the results of a subsequent serologic test for measles, mumps, or rubella. Documented age-advisable vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who do not accept documentation of MMR vaccination and whose serologic examination is interpreted as "indeterminate" or "equivocal" should be considered not immune and should receive 2 doses of MMR vaccine (minimum interval 28 days). ACIP does non recommend serologic testing later on vaccination. For more information, see ACIP's recommendations on the apply of MMR vaccine at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 22.

If a healthcare worker develops a rash and low-grade fever after MMR vaccine, is s/he infectious?

Approximately 5 to 15% of susceptible people who receive MMR vaccine volition develop a low-grade fever and/or mild rash seven to 12 days later vaccination. However, the person is non infectious, and no special precautions ( such as exclusion from work) need to exist taken.

A 22-twelvemonth-former female is going to chemist's school and the school wants her to have a 2d dose of MMR vaccine. She had the showtime dose as a kid and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles but not immune to rubella. Tin I requite her a 2nd dose of the MMR with her having measles after the first dose?

Yes, equally a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. In that location is no harm in providing MMR to a person who is already immune to one or more of the components. If she developed measles merely one day after getting her first MMR, she must accept been exposed to the affliction prior to vaccination.

Contraindications and Precautions Back to top

What are the contraindications and precautions for MMR vaccine?

Contraindications:

• history of a severe (anaphylactic) reaction to whatsoever vaccine component (e.g., neomycin) or following a previous dose of MMR • pregnancy • severe immunosuppression from either illness or therapy

Precautions:

• receipt of an antibiotic-containing blood product in the previous 3–eleven months, depending on the type of blood product received. Meet www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Table three-5 for more information on this issue • moderate or severe astute disease with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Important details about the contraindications and precautions for MMR vaccine are in the current MMR ACIP statement, bachelor at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

We have many patients who are immunocompromised and cannot go the MMR vaccine. How should nosotros advise our patients?

People with medical weather condition that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. To assistance foreclose the spread of measles virus, make sure all your staff and patients who can be vaccinated are fully vaccinated according to the U.S. immunization schedule. Likewise, encourage patients to remind their family members and other close contacts to get vaccinated if they are non immune.

If patients who cannot get MMR vaccine are exposed to measles, CDC has guidelines for immune globulin for postal service-exposure prophylaxis which can be found at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Nosotros accept a patient who has selective IgA deficiency. We also have patients with selective IgM deficiency. Tin MMR or varicella vaccine exist administered to these patients?

There is no known risk associated with MMR or varicella vaccination in someone with selective IgA or IgM deficiency. It is possible that the immune response may exist weaker, but the vaccines are probable effective.

I have a patient who is traveling internationally and needs MMR vaccine. He recently received an injectable steroid. How long should he wait earlier receiving MMR vaccine?

There is no need to await a specific interval before giving MMR. Injectable steroids are non considered immunosuppressive for the purpose of vaccination decisions, and so there is no concern well-nigh safety or efficacy of MMR.

Can I give MMR to a child whose sibling is receiving chemotherapy for leukemia?

Yes. MMR and varicella vaccines should be given to the healthy household contacts of immunosuppressed children.

We take a 40 lb half-dozen-year-old patient who has been taking xv mg of methotrexate weekly for arthritis for 12 months. Can we give the kid MMR and varicella vaccine based on this methotrexate dosage?

Based on the weight and dosage provided (40 lbs and fifteen mg/week), the child is currently receiving more than 0.4 mg/kg/week of methotrexate. This meets the Infectious disease Society of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced. The 2013 IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/week. For additional details, run across the 2013 IDSA Clinical Do Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/11/26/cid.cit684.total.pdf.

Is information technology true that egg allergy is not considered a contraindication to MMR vaccine?

Several studies accept documented the safety of measles and mumps vaccine (which are grown in chick embryo tissue civilization) in children with astringent egg allergy. Neither the American Academy of Pediatrics nor ACIP consider egg allergy every bit a contraindication to MMR vaccine. ACIP recommends routine vaccination of egg-allergic children without the utilize of special protocols or desensitization procedures.

Can I give MMR to a breastfeeding mother or to a breastfed infant?

Yes. Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no take a chance to the infant being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the babe is asymptomatic.

If a patient recently received a claret product, can he or she receive MMR vaccine?

Yes, only there should be sufficient time between the blood product and the MMR to reduce the chance of interference. The interval depends on the claret product received. Run across Table 3-5 of ACIP's General Best Practise Guidelines for Immunization for more information, bachelor at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Is it acceptable practise to administrate MMR, Tdap, and influenza vaccines to a postpartum mom at the same time as administering RhoGam?

Yes. Receipt of RhoGam is not a reason to delay vaccination. For more information meet the ACIP General Best Exercise Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Delight draw the electric current ACIP recommendations for the utilize of MMR vaccine in people who are infected with HIV.

ACIP recommendations for vaccinating people with HIV infection were revised in 2013. The current recommendations are every bit follows:

Administer 2 doses of MMR vaccine to all HIV-infected people age 12 months and older who do non accept testify of current astringent immunosuppression or current evidence of measles, rubella, and mumps immunity. To exist regarded as not having prove of current astringent immunosuppression, a child age 5 years or younger must have CD4 percentages of 15% or more than for 6 months or longer; a person older than 5 years must have CD4 percentages of xv% or more than and a CD4 lymphocyte count of 200 or more than/mm3 for six months or longer. If laboratory results state merely one type of parameter (percentage or counts) this is sufficient for vaccine decision-making.

Administrate the first dose at 12 through 15 months and the second dose to children historic period 4 through 6 years, or as early as 28 days after the outset dose.

Unless they have acceptable current bear witness of measles, mumps, and rubella amnesty, people with perinatal HIV infection who were vaccinated prior to establishment of effective antiretroviral therapy (ART) should receive 2 accordingly spaced doses of MMR vaccine after effective Art has been established. Established constructive ART is defined as receiving ART for at to the lowest degree half-dozen months in combination with CD4 percentages of 15% or more than for 6 months or longer for children age v years or younger. People older than 5 years should have CD4 percentages of fifteen% or more and a CD4 lymphocyte count of 200 or more than/mm3 for half-dozen months or longer. If laboratory results state only ane type of parameter (percentages or counts) this is sufficient for vaccine controlling.

Pregnancy and Postpartum Considerations Back to top

What is the recommended length of time a woman should wait subsequently receiving rubella (MMR) vaccine before condign pregnant?

Although the MMR vaccine package insert recommends a 3-month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for 4 weeks. For details on this issue, see ACIP's Control and Prevention of Rubella: Evaluation and Direction of Suspected Outbreaks, Rubella in Pregnant Women, and Surveillance for Built Rubella Syndrome.

How should teenage girls and women of child-bearing age be screened for pregnancy before MMR vaccination?

ACIP recommends that women of childbearing age be asked if they are currently significant or attempting to become pregnant. Vaccination should be deferred for those who respond "yes." Those who answer "no" should be advised to avoid pregnancy for 4 weeks following vaccination. Pregnancy testing is not necessary.

If a pregnant woman inadvertently receives MMR vaccine, how should she be advised?

No specific action needs to exist taken other than to reassure the woman that no adverse outcomes are expected every bit a result of this vaccination. MMR vaccination during pregnancy is non a reason to terminate the pregnancy. You should consult with others in your healthcare setting to place ways to forestall such vaccination errors in the future. Detailed information nigh MMR vaccination in pregnancy is included in the most recent MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

We require a pregnancy test for all our 7th graders before giving an MMR. Is this necessary?

No. ACIP recommends that women of childbearing historic period be asked if they are currently meaning or attempting to become significant. Vaccination should be deferred for those who answer "yes." Those who respond "no" should be brash to avert pregnancy for one calendar month following vaccination.

Can we give an MMR to a fifteen-month-old whose mother is two months pregnant?

Aye. Measles, mumps, and rubella vaccine viruses are not transmitted from the vaccinated person, then MMR vaccination of a household contact does not pose a risk to a pregnant household member.

If a woman's rubella test effect shows she is "not immune" during a prenatal visit, only she has 2 documented doses of MMR vaccine, does she demand a third dose of MMR vaccine postpartum?

In 2013, ACIP inverse its recommendation for this situation (run into www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages xviii–twenty). It is recommended that women of childbearing age who have received 1 or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not conspicuously positive should be administered 1 boosted dose of MMR vaccine (maximum of 3 doses) and do not need to be retested for serologic evidence of rubella immunity. MMR should not be administered to a pregnant woman.

I have a female patient who has a non-immune rubella titer 2 months afterward her second MMR vaccination. Should she be revaccinated? If and so, should the titer again be checked to determine seroconversion?

ACIP recommends that vaccinated women of childbearing age who take received 1 or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is non clearly positive should be administered one additional dose of MMR vaccine (maximum of 3 doses). Repeat serologic testing for show of rubella immunity is not recommended. See www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–xx, for more information on this issue.

MMR vaccines should not be administered to women known to be meaning or attempting to become pregnant. Considering of the theoretical take chances to the fetus when the mother receives a alive virus vaccine, women should be counseled to avoid becoming pregnant for 28 days after receipt of MMR vaccine.

How soon after commitment can MMR exist given to the female parent?

MMR can exist administered any fourth dimension afterward delivery. The vaccine should be administered to a woman who is susceptible to either measles, mumps, or rubella before hospital discharge, fifty-fifty if she has received RhoGam during the hospital stay, leaves in less than 24 hours, or is breastfeeding.

Vaccine Safety Back to peak

Is in that location whatsoever evidence that MMR or thimerosal causes autism?

No. This issue has been studied extensively, including a thorough review past the independent Establish of Medicine (IOM). The IOM issued a written report in 2004 that concluded there is no bear witness supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. For more than information on thimerosal and vaccines in general, visit world wide web.cdc.gov/vaccinesafety/Concerns/thimerosal/alphabetize.html.

A few parents are asking that their children receive split up components of the MMR vaccine considering they fear MMR may be linked to autism. What should I do?

Merck no longer produces unmarried antigen measles, mumps, and/or rubella vaccines for the U.S. market place. Just combined MMR is available. Yous should educate parents about the lack of association betwixt MMR and autism.

How likely is information technology for a person to develop arthritis from rubella vaccine?

Arthralgia (joint hurting) and transient arthritis (joint redness or swelling) following rubella vaccination occurs only in people who were susceptible to rubella at the time of vaccination. Articulation symptoms are uncommon in children and in adult males. About 25% of not-immune mail service-pubertal women report articulation pain afterward receiving rubella vaccine, and virtually 10% to 30% study arthritis-like signs and symptoms.

When joint symptoms occur, they generally begin 1 to iii weeks after vaccination, unremarkably are mild and not incapacitating, last nearly 2 days, and rarely recur.

Is there whatever harm in giving an actress dose of MMR to a kid of age vii years whose record is lost and the mother is not sure most the terminal dose of MMR?

In general, although information technology is not ideal, receiving actress doses of vaccine poses no medical trouble. However, receiving excessive doses of tetanus toxoid (eastward.1000., DTaP, DT, Tdap, or Td) can increase the gamble of a local agin reaction. For details run across the Extra Doses of Vaccine Antigens section of the ACIP Full general All-time Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Vaccination providers frequently encounter people who do non have adequate documentation of vaccinations. Providers should only have written, dated records as evidence of vaccination. With the exception of flu vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should non exist accepted. An attempt to locate missing records should exist made whenever possible by contacting previous healthcare providers, reviewing state or local immunization information systems, and searching for a personally held record.

If records cannot be located or will definitely non be available anywhere because of the patient'south circumstances, children without acceptable documentation should be considered susceptible and should receive age-appropriate vaccination. Serologic testing for amnesty is an alternative to vaccination for sure antigens (eastward.g., measles, rubella, hepatitis A, diphtheria, and tetanus).

Storage and Handling Dorsum to top

How long can reconstituted MMR vaccine exist stored in a refrigerator before information technology must be discarded?

The amount of time in which a dose of vaccine must be used afterward reconstitution varies by vaccine and is usually outlined somewhere in the vaccine'due south bundle insert. MMR must be used within 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff educational activity piece that outlines the time allowed between reconstitution and use, every bit stated in the bundle inserts for a number of vaccines. Handout can exist found at the following link: www.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine be stored?

MMR may be stored either in the refrigerator at 2°C to 8°C (36°F to 46°F) or in the freezer at -l°C to -15°C (-58°F to +5°F). The diluent should not be frozen and can be stored in the refrigerator or at room temperature.

If the MMR is combined with varicella vaccine as MMRV (ProQuad, Merck), it must exist stored in the freezer at -50°C to -15°C (-58°F to +v°F).

A box of MMR vaccine (non reconstituted) was left at room temperature overnight. Can I use it?

Unfortunately, serious errors in vaccine storage and handling like this occur besides oft. If you suspect that vaccine has been mishandled, you should shop the vaccine as recommended, then contact the manufacturer or state/local wellness department for guidance on its use. This is especially important for live virus vaccines similar MMR and varicella.

In one case MMR vaccine has been reconstituted with diluent, how shortly must it be used?

Information technology is preferable to administer MMR immediately after reconstitution. If reconstituted MMR is not used within 8 hours, information technology must be discarded. MMR should always be refrigerated and should never exist left at room temperature.

I misplaced the diluent for the MMR dose so I used normal saline instead. Is at that place any problem with doing this?

Merely the diluent supplied with the vaccine should be used to reconstitute any vaccine. Any vaccine reconstituted with the incorrect diluent should be repeated.

Back to tiptop

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Source: https://www.immunize.org/askexperts/experts_mmr.asp

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