Should I Get a Measles Vaccine Again

Measles, Mumps, and Rubella

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

Disease Issues

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

In 2019, a provisional total of i,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a unmarried twelvemonth since 1992; 73% of cases were associated with outbreaks amongst unvaccinated people in New York. These outbreaks were independent and stopped before the finish of 2019. Betwixt January ane and August xix, 2020, only 12 measles cases were reported past 7 jurisdictions. Limited travel as a result of the COVID-19 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% subtract in mumps cases in the United States. However, outbreaks still occasionally occur. In 2006, there was an outbreak affecting more than than 6,584 people in the United states, with many cases occurring on college campuses. In 2009, an outbreak started in shut-knit religious communities and schools in the Northeast, resulting in more than iii,000 cases. Since 2015, numerous outbreaks accept been reported across the U.s., in college campuses, prisons, and close-knit communities, including a large outbreak in northwest Arkansas where almost 3,000 cases were reported in 2016. These outbreaks have shown that when people with mumps have close contact with a lot of other people (such as amid residential college students and families in shut-knit communities) mumps can spread even among vaccinated people. Even so, outbreaks are much larger in areas where vaccine coverage rates are lower. A conditional total of 3,484 cases of mumps were reported to CDC in 2019.

Rubella was alleged eliminated (the absenteeism of endemic transmission for 12 months or more) from the United States in 2004. Fewer than 10 cases (primarily import-related) have been reported annually in the United states of america since elimination was declared. Rubella incidence in the United States has decreased by more than 99% from the pre-vaccine era. A conditional total of 3 cases of rubella, and no cases of congenital rubella syndrome, were reported in 2019.

How serious are measles, mumps, and rubella?

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

Mumps nigh unremarkably causes fever and parotitis. Upwardly to 25% of persons with mumps take 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, aseptic meningitis, and encephalitis. Mumps affliction is typically milder, with fewer complications, in fully vaccinated case patients.

Rubella is mostly a mild affliction with low-form fever, lymphadenopathy, and angst. Up to fifty% of rubella virus infections are subclinical. Complications can include thrombocytopenic purpura and encephalitis. Rubella virus is teratogenic and infection in a pregnant woman, especially during the first trimester can result in miscarriage, stillbirth, and nascence defects including cataracts, hearing loss, mental retardation, and congenital heart defects.

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

Healthcare providers should suspect measles in patients with a delirious rash illness and the clinically compatible symptoms of cough, coryza (runny nose), and/or conjunctivitis (red, watery eyes). The illness begins with a prodrome of fever and malaise earlier rash onset. A clinical example of measles is defined equally an affliction characterized by

• a generalized rash lasting 3 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 present on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from 1 to 2 days before the measles rash appears to ane to 2 days afterward. They appear every bit punctate blue-white spots on the bright red background of the buccal mucosa. Pictures of measles rash and Koplik spots can exist institute 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 accept recently traveled abroad or who accept 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 kickoff clinical encounter with a person who has suspected or likely measles.

What should our dispensary exercise 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 mean solar day of rash onset. Patients with suspected measles should be isolated for 4 days after they develop a rash. Airborne precautions should be followed in healthcare settings past all healthcare personnel. The preferred placement for patients who crave airborne precautions is in a single-patient airborne infection isolation room. Providers should immediately isolate and study 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 report all cases of suspected measles to public health authorities immediately to help reduce the number of secondary cases. Do not wait for the results of laboratory testing to study clinically-suspected measles to the local health department.

More than data on measles disease, diagnostic testing, and infection control can be found at www.cdc.gov/measles/hcp/index.html.

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

For measles, in that location is an average of 10 to 12 days from exposure to the advent 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 four 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 catamenia of rubella is 14 days (range: 12 to 23 days). Still, equally noted above, up to one-half of rubella virus infections cause no symptoms.

Vaccine Recommendations Back to summit

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

The most recent comprehensive ACIP recommendations for the utilise of MMR vaccine were published in 2013 and are bachelor 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 4 through vi years. The second dose of MMR can be given as early equally 4 weeks (28 days) subsequently the start dose and exist counted as a valid dose if both doses were given afterwards the child's first birthday. The second dose is not a booster, but rather is intended to produce immunity in the small number of people who fail to respond to the first dose.

Adults with no evidence of immunity (bear witness of immunity is defined as documented receipt of one dose [ii doses 4 weeks apart if high risk] of live measles virus-containing vaccine, laboratory evidence of amnesty or laboratory confirmation of affliction, or birth before 1957) should go i dose of MMR vaccine unless the adult is in a loftier-run a risk grouping. Loftier-risk people demand 2 doses and include school-age children, healthcare personnel, international travelers, and students attending post-loftier school educational institutions.

Live attenuated measles vaccine became available in the U.S. in 1963. An ineffective, inactivated measles vaccine was also 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 type of vaccine it was, or are sure it was inactivated measles vaccine, that dose should be considered invalid and the patient revaccinated as historic period- and risk-appropriate with MMR vaccine. At the discretion of the state public health department, 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 gamble status.

What is considered adequate evidence of immunity to measles?

Acceptable presumptive bear witness of amnesty against measles includes at to the lowest degree one of the post-obit:

• written documentation of adequate vaccination: • laboratory show of immunity • laboratory confirmation of measles (verbal history of measles does not count) • nascency earlier 1957

Although birth before 1957 is considered acceptable evidence of measles amnesty, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do not take other evidence of immunity 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 advisable interval for unvaccinated healthcare personnel regardless of birth twelvemonth if they lack laboratory evidence of measles immunity.

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

Null, 1, or ii doses of MMR vaccine are needed for the adults described beneath.

Zippo doses:

• adults born before 1957 except healthcare personnel* • adults born 1957 or afterward who are at low hazard (i.east., not an international traveler or healthcare worker, or person attending college or other mail-high school educational establishment) and who have already received 1 or more documented doses of live measles vaccine • adults with laboratory testify of amnesty or laboratory confirmation of measles

One dose of MMR vaccine:

• adults built-in 1957 or later who are at low risk (i.e., non an international traveler, healthcare worker, or person attending college or other post-high school educational institution) and have no documented vaccination with live measles vaccine and no laboratory evidence of immunity or prior measles infection

Ii doses of MMR vaccine:

� high-risk adults without any prior documented alive measles vaccination and no laboratory testify 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 information technology was inactivated measles vaccine, should be revaccinated with either i (if low-take chances) or two (if high-chance) doses of MMR vaccine.

* Healthcare personnel born before 1957 should exist considered for MMR vaccination in the absenteeism of an outbreak, but are recommended for MMR vaccination during outbreaks.

Given the risk of outbreaks of measles in the U.S., should all healthcare personnel, including those born before 1957, have two doses of MMR vaccine?

Although birth 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 exercise not have laboratory bear witness of measles immunity, laboratory confirmation of disease, or vaccination with 2 appropriately spaced doses of MMR vaccine.

However, during a local outbreak of measles, all healthcare personnel, including those born earlier 1957, are recommended to have ii doses of MMR vaccine at the advisable interval if they lack laboratory show of measles.

Healthcare facilities should bank check with their country or local health department'south immunization programme 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 young equally half-dozen months of historic period who are at high risk of exposure such as during international travel or a community outbreak. Notwithstanding, doses given Before 12 months of age cannot be counted toward the two-dose series for MMR.

How does being born before 1957 confer immunity to measles?

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. Equally a upshot, these people are very likely to take had measles illness. Surveys advise that 95% to 98% of those built-in before 1957 are immune to measles. Persons born before 1957 can be presumed to be allowed. However, if serologic testing indicates that the person is non allowed, at to the lowest degree 1 dose of MMR should be administered.

Why is a 2d dose of MMR necessary?

Approximately 7% of people do not develop measles immunity later the commencement dose of vaccine. This occurs for a diversity of reasons. The second dose is to provide another gamble to develop measles immunity for people who did non respond to the first dose. About 97% of people develop immunity to measles after two doses of measles-containing vaccine.

Are there whatever situations where more than than 2 doses of MMR are recommended?

At that place are two circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing historic period who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are non clearly positive should receive 1 boosted dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. MMR should not be administered to a pregnant woman.

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 every bit being part of a group or population at increased run a 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 confronting mumps disease and related complications. More information nigh this recommendation is bachelor at world wide web.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

When is it appropriate to apply MMR vaccine for measles mail-exposure prophylaxis?

MMR vaccine given within 72 hours of initial measles exposure can reduce the risk of getting sick or reduce the severity of symptoms. Another choice for exposed, measles-susceptible individuals at high risk of complications who cannot be vaccinated is to give immunoglobulin (IG) within 6 days of exposure. Practice non administrate MMR vaccine and IG simultaneously, as the IG invalidates the vaccine.

Information on post-exposure prophylaxis for measles tin be found in the 2013 ACIP guidance at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 24.

Do any adults need "booster" doses of MMR vaccine to prevent measles?

No. Adults with prove of immunity practice not need whatever further vaccines. No "booster" doses of MMR vaccine are recommended for either adults or children. They are considered to take life-long amnesty once they have received the recommended number of MMR vaccine doses or have other show of amnesty.

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

Both killed and alive adulterate 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 information technology should be revaccinated with live vaccine. Without a written record, it is not possible to know what type of vaccine an individual may have received. So persons born during or subsequently 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 run a risk of exposure to measles (such equally healthcare professionals and international travelers) should receive 2 doses of MMR separated past at to the lowest degree iv 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 non demand to exist revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown blazon should be revaccinated with at to the lowest degree one dose of alive adulterate measles vaccine. This recommendation is intended to protect people who may accept received killed measles vaccine which was bachelor in the Us in 1963 through 1967 and was not effective. People vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such as people who work in a healthcare facility) should exist considered for revaccination with 2 doses of MMR vaccine.

I understand that ACIP changed its definition of show 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 disease every bit prove of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of amnesty for measles and mumps. Physician diagnosis of illness had not previously been accepted as evidence of immunity for rubella. With the decrease in measles and mumps cases over the last 30 years, the validity of doctor-diagnosed illness has become questionable. In improver, documenting history from physician records is not a practical option for well-nigh adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Is at that place anything that can exist done for unvaccinated people who take already been exposed to measles, mumps, or rubella?

Measles vaccine, given every bit MMR, may be effective if given within the first 3 days (72 hours) after exposure to measles. Immune globulin may exist effective for as long equally vi days after exposure. Postexposure prophylaxis with MMR vaccine does not prevent or modify the clinical severity of mumps or rubella. All the same, if the exposed person does not have evidence of mumps or rubella immunity they should be vaccinated since not all exposures result 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 employ of mail service-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.v mL/kg of body weight; the maximum dose is 15 mL. Alternatively, MMR vaccine can be given instead of IGIM to infants age vi through 11 months, if information technology can be given within 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 evidence of measles immunity or vaccination, who have been exposed to measles should receive an IGIV dose of 400 mg/kg of torso weight.

For persons already receiving IGIV therapy, administration of at to the lowest degree 400 mg/kg body weight inside 3 weeks before measles exposure should be sufficient to forbid measles infection. For patients receiving subcutaneous allowed globulin (IGSC) therapy, administration of at least 200 mg/kg torso weight for two sequent weeks earlier measles exposure should be sufficient.

Other people who do not have testify of measles amnesty tin can receive an IGIM dose of 0.5 mL/kg of body weight. Give priority to people who were exposed to measles in settings where they have intense, prolonged close contact (such as household, child intendance, classroom, etc.). The maximum dose of IGIM is 15 mL.

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

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

We frequently see higher students who lack vaccination records, but whose titer results show they are non immune to some combination of measles, rubella, and/or mumps. What type of vaccine should these students receive?

Single antigen vaccine is no longer available in the U.Southward.; the educatee should get the combined MMR vaccine. If a college educatee or other person at increased take a chance of exposure cannot produce written documentation of either immunization or illness, and titers are negative, they should receive two doses of MMR.

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

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

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

Adults without prove of amnesty and no contraindications to MMR vaccine can be vaccinated without testing. Simply adults without evidence of amnesty might be considered for testing for measles-specific IgG antibiotic, but testing is not needed prior to vaccination.

CDC does not recommend measles antibody testing afterwards MMR vaccination to verify the patient'south allowed response to vaccination.

Two documented doses of MMR vaccine given on or subsequently the showtime birthday and separated past 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 also immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, but is concerned most the measles exposure risk. Should the patient receive the MMR vaccine?

A history of having had measles is not sufficient prove of measles immunity. A positive serologic exam for measles-specific IgG will confirm that the person is allowed and is not at risk 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 practise at high risk for measles, including patients going back to college or preparing for international travel, who don't remember ever receiving MMR vaccine or having had measles disease. How should we manage these patients?

You have 2 options. Y'all can test for amnesty or you tin just requite two doses of MMR at least 4 weeks autonomously. There is no harm in giving MMR vaccine to a person who may already exist immune to ane or more of the vaccine viruses. If yous or the patient opt for testing, and the tests indicate the patient is not immune to one or more of the vaccine components, give your patient ii doses of MMR at least 4 weeks apart. If any test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination considering commercial tests may not be sensitive enough to reliably notice vaccine-induced immunity.

I accept a 45-year-old patient who is traveling to Haiti for a mission trip. She doesn't recall always getting an MMR booster (she didn't go to higher and never worked in health intendance). She was rubella immune when pregnant twenty years ago. Her measles titer is negative. Would you lot recommend an MMR booster?

ACIP recommends 2 doses of MMR given at least 4 weeks apart for whatsoever adult born in 1957 or subsequently who plans to travel internationally. There is no harm in giving MMR vaccine to a person who may already exist immune to i or more of the vaccine viruses.

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

No, information technology is non considered necessary, simply he may be vaccinated. Before implementation of the national measles vaccination plan in 1963, nigh every person acquired measles before adulthood. So, this patient tin be considered immune based on their birth year. However, MMR vaccine also may be given to any person born before 1957 who does not have a contraindication to MMR vaccination.

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

We accept measles cases in our community. How can I best protect the young children in my exercise?

Starting time of all, make sure all your patients are fully vaccinated co-ordinate to the U.Due south. immunization schedule.

In certain circumstances, MMR is recommended for infants historic period 6 through eleven months. Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants as young as age 6 months as a control measure during a U.S. measles outbreak. Consult your state health section to find out if this is recommended in your situation. Do non count any dose of MMR vaccine equally part of the 2-dose serial if it is administered before a child's first birthday. Instead, repeat the dose when the child is age 12 months.

In the case of a local outbreak, you lot too might consider vaccinating children age 12 months and older at the minimum historic period (12 months, instead of 12 through fifteen months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age four through six years.

Finally, remember that infants too young for routine vaccination and people with medical conditions that contraindicate measles immunization depend on loftier MMR vaccination coverage among those around them. Be certain to encourage all your patients and their family members to get vaccinated if they are not immune.

During a mumps outbreak should we offering a 3rd dose of MMR (MMR II, Merck) to persons who have two prior documented doses of MMR?

In recent years, mumps outbreaks have occurred primarily in populations in institutional settings with close contact (such equally 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, fifty-fifty where coverage with two 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 by public health authorities every bit being function of a grouping at increased risk for acquiring mumps because of an outbreak should receive a tertiary dose of a mumps virus�containing vaccine to better protection against mumps disease and related complications. More data well-nigh this recommendation is available at world wide web.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

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

You lot are correct that vaccinated people tin still 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 flu in years with a skilful match of circulating and vaccine viruses, and 70% for acellular pertussis vaccines in the 3-five years later on vaccination). More information 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 road (IM rather than SC) for years. Should these doses be repeated?

All alive injected vaccines (MMR, varicella, and yellow fever) are recommended to be given subcutaneously. However, intramuscular assistants of any of these vaccines is not probable to decrease immunogenicity, and doses given IM practise not demand to exist repeated.

We often need to requite MMR vaccine to large adults. Is a 25-estimate needle with a length of five/8" sufficient for a subcutaneous injection?

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

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

Aye, however, this outcome is non 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 age 13 years and older, it may exist counted towards completion of the MMR and varicella vaccine series and does not need to be repeated.

Scheduling Vaccines Back to top

How soon can nosotros give the second dose of MMR vaccine to a kid vaccinated at 12 months onetime?

For routine vaccination, children without contraindications to MMR vaccine should receive 2 doses of MMR vaccine with the offset dose at historic period 12–15 months old and the second dose at age 4–vi years sometime. The minimum interval is 28 days for dose 2. If y'all have an outbreak in your community or a child is traveling internationally, and then consider using the minimum interval instead of waiting until age 4–six years old for dose ii.

Does the 4-mean solar day "grace period" apply to the minimum age for assistants of the first dose of MMR? What about the 28-day minimum interval between doses of MMR?

A dose of MMR vaccine administered upwardly to four days before the start birthday may be counted every bit valid. However, school entry requirements in some states may mandate administration on or subsequently the first birthday. The 4-mean solar day "grace period" should not exist practical to the 28-24-hour interval minimum interval between two doses of a live parenteral vaccine.

Tin can MMR be given on the aforementioned day as other live virus vaccines?

Yes. However, if 2 parenteral or intranasal live vaccines (MMR, varicella, LAIV and/or yellow fever) are not administered on the same day, they should be separated by an interval of at to the lowest degree 28 days.

If you can give the second dose of MMR as early as 28 days subsequently the first dose, why do we routinely wait until kindergarten entry to give the second dose?

The 2nd dose of MMR may be given equally early as 4 weeks after the beginning dose, and exist counted every bit a valid dose if both doses were given later on the kickoff birthday. The second dose is non a booster, but rather it is intended to produce immunity in the small-scale number of people who fail to respond to the first dose. The take chances of measles is college in school-age children than those of preschool historic period, so it is important to receive the 2nd dose by schoolhouse entry. Information technology is also convenient to give the second dose at this historic period, since the child will have an immunization visit for other school entry vaccines.

What is the earliest age at which I tin requite MMR to an infant who volition be traveling internationally? Also, which countries pose a loftier risk to children for contracting measles?

ACIP recommends that children who travel or alive abroad should exist vaccinated at an earlier age than that recommended for children who reside in the United States. Earlier their departure from the United States, children age 6 through 11 months should receive 1 dose of MMR. The adventure for measles exposure can be high in loftier-, middle- and low-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to go on a copy of their immunization records with them as they travel. For additional data on the worldwide measles situation, and on CDC's measles vaccination data for travelers, become to wwwnc.cdc.gov/travel.

If we requite a kid a dose of MMR vaccine at 6 months of age because they are in a community with cases of measles, when should we give the next dose?

The side by side dose should be given at 12 months of age. The child will too need some other dose at least 28 days subsequently. For the child to be fully vaccinated, they demand to have ii doses of MMR vaccine given when the child is 12 months of age and older. A dose given at less than 12 months of historic period does not count as office of the MMR vaccine two-dose series.

I take an 8-calendar month-old patient who is traveling internationally. The baby needs to exist protected from hepatitis A as well as measles, mumps, and rubella. The family is leaving in 11 days. Tin I give hepatitis A IG and MMR vaccine simultaneously?

No. IG may contain 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 6 through 11 months traveling exterior the Usa when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this age grouping. Neither vaccine is counted as part of the child'southward routine vaccination series. For details of this recommendation, run into the CDC ACIP recommendations for the prevention and command of hepatitis A at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page 18.

Can I requite the second dose of MMR earlier than historic period 4 through six years (the kindergarten entry dose) to young children traveling to areas of the world where there are measles cases?

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

If I give MMR to an infant traveler younger than historic period 1 year, will that dose be considered valid for the U.S. immunization schedule?

No. A measles-containing vaccine administered more than four days before the starting time birthday should not be counted as role of the series. MMR should be repeated when the child is age 12 through fifteen months (12 months if the kid remains in an surface area where illness risk is high). The 2nd dose should be administered at least 28 days after the first dose.

Can I give a tuberculin skin examination (TST) on the same mean solar day as a dose of MMR vaccine?

Yes. A TST tin can be applied before or on the same day that MMR vaccine is given. However, if MMR vaccine is given on the previous day or before, the TST should be delayed for at to the lowest degree 28 days. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin test because of balmy suppression of the immune system.

An eighteen-twelvemonth-old college student says he had both measles and mumps diseases as a preschooler, only never had MMR vaccine. Is rubella vaccine recommended in such a situation?

This student should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is not adequate as proof of immunity. Acceptable show of measles and mumps amnesty includes a positive serologic test for antibody, nascency before 1957, or written documentation of vaccination. For rubella, merely serologic testify or documented vaccination should be accepted every bit proof of immunity. Additionally, people built-in prior to 1957 may exist considered allowed to rubella unless they are women who have the potential to become pregnant.

When non given on the aforementioned day, is the interval betwixt yellow fever and MMR vaccines 4 weeks (28 days) or 30 days? I have seen the yellow fever and live virus vaccine recommendations published both ways.

The General All-time Practise Guidelines for Immunization (see world wide web.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 solar day should be separated by at least 28 days. The CDC travel wellness website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated by at least 30 days if possible. Either interval is acceptable.

For Healthcare Personnel Back to top

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP born during or subsequently 1957 have adequate presumptive evidence of amnesty to measles, mumps, and rubella, defined every bit documentation of ii doses of measles and mumps vaccine and at least i dose of rubella vaccine, laboratory show of immunity, or laboratory confirmation of affliction. Further, ACIP recommends that healthcare facilities should consider vaccination of all unvaccinated healthcare personnel who were born before 1957 and who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of affliction. During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated past at to the lowest degree four weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory evidence of measles or mumps immunity or laboratory confirmation of illness. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of birth year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or illness.

Would you consider healthcare personnel with 2 documented doses of MMR vaccine to be immune even if their serology for i or more of the antigens comes back negative?

Yes. Healthcare personnel (HCP) with 2 documented doses of MMR vaccine are considered to be allowed 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 dissimilarity, HCP who do not have documentation of MMR vaccination and whose serologic test is interpreted as "indeterminate" or "equivocal" should be considered non immune and should receive 2 doses of MMR vaccine (minimum interval 28 days). ACIP does not recommend serologic testing subsequently vaccination. For more than data, see ACIP's recommendations on the use of MMR vaccine at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 22.

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

Approximately 5 to xv% of susceptible people who receive MMR vaccine will develop a depression-class fever and/or mild rash 7 to 12 days later on vaccination. Nonetheless, the person is not infectious, and no special precautions ( such equally exclusion from piece of work) need to be taken.

A 22-year-old female person is going to pharmacy school and the schoolhouse wants her to have a second dose of MMR vaccine. She had the first dose as a child and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles merely not immune to rubella. Can I give her a 2nd dose of the MMR with her having measles afterward the first dose?

Yeah, as a healthcare professional, this person should become a second dose of MMR to ensure she is allowed to rubella. In that location is no harm in providing MMR to a person who is already immune to ane or more of the components. If she adult measles simply one twenty-four hour period later on getting her first MMR, she must have been exposed to the disease prior to vaccination.

Contraindications and Precautions Dorsum to superlative

What are the contraindications and precautions for MMR vaccine?

Contraindications:

• history of a severe (anaphylactic) reaction to any vaccine component (e.thou., neomycin) or post-obit a previous dose of MMR • pregnancy • severe immunosuppression from either disease or therapy

Precautions:

• receipt of an antibody-containing blood product in the previous three–eleven months, depending on the type of blood product received. See www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Table 3-v for more data on this issue • moderate or severe acute illness with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Of import details about the contraindications and precautions for MMR vaccine are in the current MMR ACIP statement, available at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

People with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those effectually them. To help forbid the spread of measles virus, make sure all your staff and patients who can exist vaccinated are fully vaccinated according to the U.South. 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 go MMR vaccine are exposed to measles, CDC has guidelines for immune globulin for mail-exposure prophylaxis which can be establish at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

We have a patient who has selective IgA deficiency. Nosotros also take patients with selective IgM deficiency. Can MMR or varicella vaccine be administered to these patients?

There is no known take a chance associated with MMR or varicella vaccination in someone with selective IgA or IgM deficiency. It is possible that the immune response may be weaker, but the vaccines are likely constructive.

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

There is no need to wait a specific interval before giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, and then in that location is no concern almost safety or efficacy of MMR.

Tin 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 have a xl lb six-twelvemonth-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can nosotros give the child MMR and varicella vaccine based on this methotrexate dosage?

Based on the weight and dosage provided (40 lbs and xv mg/calendar week), the child is currently receiving more than 0.4 mg/kg/week of methotrexate. This meets the Infectious Disease Guild of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time equally the methotrexate dosage tin 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, see the 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/11/26/cid.cit684.total.pdf.

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

Several studies have documented the condom 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 babe?

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

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

Aye, but there should be sufficient time between the claret production and the MMR to reduce the chance of interference. The interval depends on the blood product received. Run into Table 3-five of ACIP's General All-time Practice Guidelines for Immunization for more information, bachelor at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

Is it acceptable practice to administer MMR, Tdap, and flu vaccines to a postpartum mom at the same time as administering RhoGam?

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

Please describe the current ACIP recommendations for the use 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 as follows:

Administer ii doses of MMR vaccine to all HIV-infected people historic period 12 months and older who do not have evidence of current astringent immunosuppression or current evidence of measles, rubella, and mumps amnesty. To be regarded every bit not having evidence of current severe immunosuppression, a child age five years or younger must take CD4 percentages of xv% or more for vi months or longer; a person older than 5 years must have CD4 percentages of 15% or more and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results state just 1 blazon of parameter (percentage or counts) this is sufficient for vaccine controlling.

Administrate the starting time dose at 12 through 15 months and the second dose to children age iv through 6 years, or every bit early equally 28 days after the start dose.

Unless they have acceptable current evidence of measles, mumps, and rubella immunity, people with perinatal HIV infection who were vaccinated prior to institution of constructive antiretroviral therapy (ART) should receive 2 appropriately spaced doses of MMR vaccine after effective Fine art has been established. Established constructive Art is defined equally receiving Fine art for at to the lowest degree 6 months in combination with CD4 percentages of xv% or more for 6 months or longer for children age 5 years or younger. People older than 5 years should have CD4 percentages of 15% or more and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results state simply 1 blazon of parameter (percentages or counts) this is sufficient for vaccine decision-making.

Pregnancy and Postpartum Considerations Back to height

What is the recommended length of time a adult female should wait after receiving rubella (MMR) vaccine earlier becoming significant?

Although the MMR vaccine packet insert recommends a 3-month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for iv weeks. For details on this issue, encounter ACIP's Command and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella in Meaning Women, and Surveillance for Built Rubella Syndrome.

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

ACIP recommends that women of childbearing historic period be asked if they are currently pregnant 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 four weeks post-obit vaccination. Pregnancy testing is not necessary.

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

No specific action needs to be taken other than to reassure the woman that no agin outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy is not a reason to terminate the pregnancy. You should consult with others in your healthcare setting to identify means to prevent such vaccination errors in the future. Detailed information almost MMR vaccination in pregnancy is included in the about recent MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

No. 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 exist brash to avoid pregnancy for one month following vaccination.

Can nosotros give an MMR to a fifteen-month-former whose mother is 2 months pregnant?

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

If a woman's rubella test result shows she is "not allowed" during a prenatal visit, but 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 (see www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages eighteen–20). It is recommended that women of childbearing historic period who accept received 1 or 2 doses of rubella-containing vaccine and accept rubella serum IgG levels that are not clearly positive should exist administered 1 additional 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 significant woman.

I take a female patient who has a not-immune rubella titer two months after her second MMR vaccination. Should she exist revaccinated? If so, should the titer once more exist checked to determine seroconversion?

ACIP recommends that vaccinated women of childbearing age who accept received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not conspicuously positive should be administered one additional dose of MMR vaccine (maximum of three doses). Repeat serologic testing for evidence of rubella immunity is not recommended. See www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20, for more information on this issue.

MMR vaccines should not be administered to women known to be pregnant or attempting to go significant. Because of the theoretical take a chance to the fetus when the mother receives a live virus vaccine, women should be counseled to avoid becoming meaning for 28 days after receipt of MMR vaccine.

How presently subsequently delivery tin can MMR exist given to the mother?

MMR can exist administered whatever time after commitment. The vaccine should be administered to a woman who is susceptible to either measles, mumps, or rubella before hospital belch, fifty-fifty if she has received RhoGam during the hospital stay, leaves in less than 24 hours, or is breastfeeding.

Vaccine Safe Back to top

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

No. This outcome has been studied extensively, including a thorough review by the contained Institute of Medicine (IOM). The IOM issued a report in 2004 that concluded there is no bear witness supporting an clan between MMR vaccine or thimerosal-containing vaccines and the development of autism. For more than data on thimerosal and vaccines in full general, visit world wide web.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

A few parents are asking that their children receive separate components of the MMR vaccine because they fear MMR may be linked to autism. What should I practise?

Merck no longer produces single antigen measles, mumps, and/or rubella vaccines for the U.S. marketplace. Only combined MMR is available. You should educate parents about the lack of clan between MMR and autism.

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

Arthralgia (joint pain) and transient arthritis (joint redness or swelling) post-obit rubella vaccination occurs but in people who were susceptible to rubella at the time of vaccination. Joint symptoms are uncommon in children and in adult males. Virtually 25% of not-immune post-pubertal women report joint pain later on receiving rubella vaccine, and about 10% to 30% written report arthritis-similar signs and symptoms.

When joint symptoms occur, they more often than not brainstorm ane to three weeks after vaccination, commonly are mild and not incapacitating, last most 2 days, and rarely recur.

Is at that place any damage in giving an actress dose of MMR to a child of age seven years whose tape is lost and the mother is not sure about the concluding dose of MMR?

In general, although information technology is not ideal, receiving extra doses of vaccine poses no medical trouble. However, receiving excessive doses of tetanus toxoid (e.m., DTaP, DT, Tdap, or Td) tin can increase the risk of a local agin reaction. For details see the Extra Doses of Vaccine Antigens section of the ACIP General All-time Do Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Vaccination providers oft encounter people who do non accept adequate documentation of vaccinations. Providers should only take written, dated records as evidence of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, cocky-reported doses of vaccine without written documentation should not be accepted. An endeavour to locate missing records should exist made whenever possible past 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 not exist bachelor anywhere considering of the patient's circumstances, children without adequate documentation should be considered susceptible and should receive historic period-appropriate vaccination. Serologic testing for immunity is an alternative to vaccination for certain antigens (eastward.g., measles, rubella, hepatitis A, diphtheria, and tetanus).

Storage and Handling Back to top

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

The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is normally outlined somewhere in the vaccine's bundle insert. MMR must exist used inside 8 hours of reconstitution. MMRV must exist used inside thirty minutes; other vaccines must exist used immediately. The Immunization Activeness Coalition has a staff education slice that outlines the time allowed between reconstitution and use, every bit stated in the package inserts for a number of vaccines. Handout can exist institute 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 ii°C to 8°C (36°F to 46°F) or in the freezer at -50°C to -15°C (-58°F to +5°F). The diluent should not exist frozen and tin can be stored in the fridge or at room temperature.

If the MMR is combined with varicella vaccine every bit MMRV (ProQuad, Merck), information technology must exist stored in the freezer at -50°C to -15°C (-58°F to +5°F).

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

Unfortunately, serious errors in vaccine storage and handling like this occur too oft. If you suspect that vaccine has been mishandled, y'all should store the vaccine as recommended, then contact the manufacturer or state/local wellness department for guidance on its use. This is particularly of import for live virus vaccines like MMR and varicella.

In one case MMR vaccine has been reconstituted with diluent, how soon must information technology exist used?

It is preferable to administer MMR immediately after reconstitution. If reconstituted MMR is not used within viii hours, it must be discarded. MMR should ever exist refrigerated and should never be left at room temperature.

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

Only the diluent supplied with the vaccine should exist used to reconstitute whatever vaccine. Any vaccine reconstituted with the incorrect diluent should be repeated.

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

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