When to Get Measles Vaccine Again

Measles, Mumps, and Rubella

Affliction Issues Contraindications and Precautions Vaccine Recommendations Pregnancy and Postpartum Considerations Administering Vaccines Vaccine Safety Scheduling Vaccines Storage and Treatment For Healthcare Personnel

Illness Issues

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

In 2019, a conditional total of i,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a single year since 1992; 73% of cases were associated with outbreaks among unvaccinated people in New York. These outbreaks were contained and stopped before the end of 2019. Between January 1 and August 19, 2020, just 12 measles cases were reported by vii jurisdictions. Limited travel equally a result of the COVID-19 pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the The states. CDC measles surveillance updates tin be institute 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. All the same, outbreaks nevertheless occasionally occur. In 2006, there was an outbreak affecting more than vi,584 people in the U.s.a., 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 3,000 cases. Since 2015, numerous outbreaks have been reported across the Us, 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 among residential college students and families in close-knit communities) mumps can spread even among vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A conditional full of three,484 cases of mumps were reported to CDC in 2019.

Rubella was alleged eliminated (the absence of endemic manual for 12 months or more) from the United States in 2004. Fewer than 10 cases (primarily import-related) have been reported annually in the U.s. since elimination was declared. Rubella incidence in the U.s. has decreased past more 99% from the pre-vaccine era. A provisional full 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 intendance. The 1989–1991 measles outbreak in the U.Due south. resulted in more than than 55,000 cases and more than 100 deaths. In the Us, from 1987 to 2000, the near 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 example of encephalitis and two to three deaths resulted. The adventure for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

Mumps almost commonly causes fever and parotitis. Up 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, hygienic meningitis, and encephalitis. Mumps disease is typically milder, with fewer complications, in fully vaccinated case patients.

Rubella is generally a balmy illness with depression-grade fever, lymphadenopathy, and angst. Upwardly 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, specially during the first trimester can outcome in miscarriage, stillbirth, and nascency defects including cataracts, hearing loss, mental retardation, and congenital heart defects.

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

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

• a generalized rash lasting 3 or more days, and • a temperature of 101°F or college (38.3°C or higher), and • cough, 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 bright red background of the buccal mucosa. Pictures of measles rash and Koplik spots can be found at www.cdc.gov/measles/nigh/photos.html.

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

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

What should our clinic practise if nosotros 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 four days after they develop a rash. Airborne precautions should be followed in healthcare settings past 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 report all cases of suspected measles to public health authorities immediately to assist reduce the number of secondary cases. Exercise not await for the results of laboratory testing to written report clinically-suspected measles to the local health department.

More information on measles illness, diagnostic testing, and infection command can be found at www.cdc.gov/measles/hcp/alphabetize.html.

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

For measles, there is an average of 10 to 12 days from exposure to the appearance of the commencement symptom, which is usually fever. The measles rash doesn't commonly appear until approximately 14 days after exposure (range: vii to 21 days), and the rash typically begins two to 4 days later the fever begins. The incubation menstruum of mumps averages 16 to xviii 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). However, every bit noted above, up to half of rubella virus infections cause no symptoms.

Vaccine Recommendations Back to top

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

The near recent comprehensive ACIP recommendations for the use 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 historic period 4 through six years. The second dose of MMR can be given as early as 4 weeks (28 days) afterwards the first dose and be counted as a valid dose if both doses were given after the child's first birthday. The second dose is not a booster, only rather is intended to produce amnesty in the pocket-size number of people who fail to respond to the beginning dose.

Adults with no evidence of immunity (evidence of immunity is divers as documented receipt of i dose [ii doses 4 weeks apart if high gamble] of alive measles virus-containing vaccine, laboratory show of immunity or laboratory confirmation of disease, or birth before 1957) should get 1 dose of MMR vaccine unless the adult is in a loftier-risk group. High-risk people need 2 doses and include school-age children, healthcare personnel, international travelers, and students attending mail-high school educational institutions.

Alive adulterate measles vaccine became available in the U.S. in 1963. An ineffective, inactivated measles vaccine was besides available in the U.South. 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 it was, or are sure it was inactivated measles vaccine, that dose should be considered invalid and the patient revaccinated as age- and risk-appropriate with MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered completely vaccinated for their age or risk condition.

What is considered acceptable evidence of immunity to measles?

Adequate presumptive show of immunity against measles includes at least one of the following:

• written documentation of acceptable vaccination: • laboratory evidence of amnesty • laboratory confirmation of measles (verbal history of measles does non count) • nascence earlier 1957

Although birth earlier 1957 is considered acceptable evidence of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel built-in before 1957 who practice not have 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 appropriate interval for unvaccinated healthcare personnel regardless of nascence year if they lack laboratory prove of measles immunity.

For which adults are 0, ane, or ii doses of MMR vaccine recommended to prevent measles?

Aught, i, or two doses of MMR vaccine are needed for the adults described beneath.

Goose egg doses:

• adults born before 1957 except healthcare personnel* • adults born 1957 or afterwards who are at low risk (i.eastward., not an international traveler or healthcare worker, or person attending higher or other mail-high school educational institution) and who accept already received i or more documented doses of live measles vaccine • adults with laboratory bear witness of immunity or laboratory confirmation of measles

One dose of MMR vaccine:

• adults born 1957 or later who are at depression risk (i.eastward., not an international traveler, healthcare worker, or person attending higher or other post-high schoolhouse educational institution) and have no documented vaccination with live measles vaccine and no laboratory evidence of immunity or prior measles infection

Two doses of MMR vaccine:

� high-take chances adults without any prior documented live measles vaccination and no laboratory bear witness 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 sure it was inactivated measles vaccine, should exist revaccinated with either one (if low-risk) or 2 (if high-take chances) doses of MMR vaccine.

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

Given the risk of outbreaks of measles in the U.South., should all healthcare personnel, including those born earlier 1957, accept ii doses of MMR vaccine?

Although nascence before 1957 is considered acceptable evidence of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born earlier 1957 who practise not take laboratory show of measles amnesty, 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 built-in before 1957, are recommended to have ii doses of MMR vaccine at the appropriate interval if they lack laboratory prove of measles.

Healthcare facilities should check with their state or local wellness department'southward immunization program for guidance. Access contact information here: www.immunize.org/coordinators.

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

MMR tin can be given to children as young as 6 months of age who are at high hazard of exposure such as during international travel or a community outbreak. However, doses given BEFORE 12 months of historic period cannot be counted toward the ii-dose serial for MMR.

How does being born before 1957 confer immunity to measles?

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

Why is a 2nd dose of MMR necessary?

Approximately 7% of people do not develop measles immunity afterward the beginning dose of vaccine. This occurs for a variety of reasons. The second dose is to provide another chance to develop measles amnesty for people who did non respond to the start dose. About 97% of people develop immunity to measles later two doses of measles-containing vaccine.

Are there whatsoever situations where more than two doses of MMR are recommended?

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

In 2018, ACIP published guidance for MMR vaccination of people at increased hazard for acquiring mumps during an outbreak. People previously vaccinated with two doses of a mumps virus�containing vaccine who are identified by public health authorities equally being function of a group or population at increased risk for acquiring mumps because of an outbreak should receive a 3rd dose of a mumps virus�containing vaccine (MMR or MMRV) to ameliorate protection against mumps disease and related complications. More information nearly this recommendation is available at world wide web.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

When is information technology advisable to use MMR vaccine for measles post-exposure prophylaxis?

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

Information on postal service-exposure prophylaxis for measles can be found in the 2013 ACIP guidance at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 24.

Practise whatever adults need "booster" doses of MMR vaccine to prevent measles?

No. Adults with evidence of immunity 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 have received the recommended number of MMR vaccine doses or have other bear witness of immunity.

Many people who were immature children in the 1960s do not have records indicating what type of measles vaccine they received in the mid-1960s. What measles vaccine was most frequently given in that fourth dimension period? That guidance would assist many older people who would prefer not to exist revaccinated.

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

Practise people who received MMR in the 1960s demand to have their dose repeated?

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

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

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of illness as bear witness of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of affliction equally evidence of immunity for measles and mumps. Physician diagnosis of affliction had not previously been accepted every bit evidence of immunity for rubella. With the decrease in measles and mumps cases over the last 30 years, the validity of medico-diagnosed affliction has go questionable. In improver, documenting history from dr. records is not a applied option for most adults. The 2013 MMR ACIP recommendations are available at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Is there annihilation that can be done for unvaccinated people who take already been exposed to measles, mumps, or rubella?

Measles vaccine, given as MMR, may be effective if given inside the first 3 days (72 hours) later on exposure to measles. Immune globulin may be effective for every bit long as 6 days after exposure. Postexposure prophylaxis with MMR vaccine does not forestall or change the clinical severity of mumps or rubella. Withal, if the exposed person does non accept 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 use 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 body weight; the maximum dose is xv mL. Alternatively, MMR vaccine can exist given instead of IGIM to infants historic period 6 through eleven months, if information technology can be given within 72 hours of exposure.

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

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

Other people who do not have evidence of measles amnesty 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 shut contact (such as household, kid care, classroom, etc.). The maximum dose of IGIM is xv mL.

IG is non indicated for persons who have received 1 dose of measles-containing vaccine at historic period 12 months or older unless they are severely immunocompromised. IG should not be used to command measles outbreaks.

IG has non been shown to forbid mumps or rubella infection after exposure and is non recommended for that purpose.

We often see college students who lack vaccination records, but whose titer results show they are not 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 student should go the combined MMR vaccine. If a college 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 ii doses of MMR.

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

No. Self-reported doses and history of vaccination provided by a parent or other caregiver are not considered to be valid. You should only have a written, dated record equally evidence of vaccination.

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

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

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

Two documented doses of MMR vaccine given on or afterwards the offset birthday and separated by at least 28 days is considered proof of measles immunity, according to ACIP. Documentation of advisable 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, merely 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 confirm that the person is allowed and is non at chance 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 accept adult patients in our practice 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 take two options. You can test for immunity or you tin can just give two doses of MMR at least iv weeks apart. There is no harm in giving MMR vaccine to a person who may already be immune to one or more of the vaccine viruses. If you or the patient opt for testing, and the tests betoken the patient is not allowed to 1 or more of the vaccine components, give your patient 2 doses of MMR at least four weeks apart. If any test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing later on vaccination because commercial tests may non exist sensitive plenty to reliably detect vaccine-induced immunity.

I have a 45-year-old patient who is traveling to Haiti for a mission trip. She doesn't recall e'er getting an MMR booster (she didn't become to higher and never worked in wellness care). She was rubella allowed when pregnant twenty years ago. Her measles titer is negative. Would you lot recommend an MMR booster?

ACIP recommends two doses of MMR given at to the lowest degree 4 weeks autonomously for any adult born in 1957 or later who plans to travel internationally. There is no damage in giving MMR vaccine to a person who may already be allowed to one or more of the vaccine viruses.

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

No, information technology is non considered necessary, merely he may be vaccinated. Before implementation of the national measles vaccination plan in 1963, virtually every person caused measles earlier machismo. So, this patient can be considered immune based on their birth yr. However, MMR vaccine also may be given to whatsoever person born earlier 1957 who does not have a contraindication to MMR vaccination.

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

We take measles cases in our community. How tin can I best protect the immature children in my exercise?

First of all, make certain all your patients are fully vaccinated according to the U.South. immunization schedule.

In certain circumstances, MMR is recommended for infants age 6 through 11 months. Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants as young as historic period 6 months as a control measure out during a U.Due south. measles outbreak. Consult your state health department to find out if this is recommended in your state of affairs. Do non count whatsoever dose of MMR vaccine as part of the two-dose series if it is administered earlier a child's showtime altogether. Instead, echo 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 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 historic period 4 through 6 years.

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

During a mumps outbreak should we offer a third dose of MMR (MMR 2, 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 shut contact (such as residential colleges) or in shut-knit social groups. The current routine recommendation for 2 doses of MMR vaccine appears to be sufficient for mumps command in the general population, merely insufficient for preventing mumps outbreaks in prolonged, shut-contact settings, even where coverage with two doses of MMR vaccine is high.

In Jan 2018, the Informational Committee on Immunization Practices (ACIP) published new guidance for MMR vaccination of persons at increased chance for acquiring mumps during an outbreak. Persons previously vaccinated with two doses of a mumps virus�containing vaccine who are identified by public health authorities as being part of a group at increased chance for acquiring mumps because of an outbreak should receive a third dose of a mumps virus�containing vaccine to ameliorate protection against mumps disease and related complications. More than data nigh this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

In a measles outbreak, do children who have not had MMR vaccine pose a threat to vaccinated people? Information technology is my agreement that vaccinated people can still contract measles. Am I correct?

You are correct that vaccinated people can yet 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 every bit measles, rubella, and hepatitis B) to much lower (60% for influenza in years with a practiced friction match of circulating and vaccine viruses, and 70% for acellular pertussis vaccines in the iii-5 years after vaccination). More information is available for each vaccine and disease at www.cdc.gov/vaccines/vpd-vac/default.htm and world wide web.immunize.org/vaccines.

Administering Vaccines Dorsum to elevation

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

All live injected vaccines (MMR, varicella, and yellow fever) are recommended to exist given subcutaneously. Still, intramuscular administration of any of these vaccines is not likely to decrease immunogenicity, and doses given IM do not demand to exist repeated.

We often need to give MMR vaccine to big adults. Is a 25-gauge needle with a length of v/8" sufficient for a subcutaneous injection?

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

MMRV was mistakenly given to a 31-twelvemonth-one-time instead of MMR. Tin this be considered a valid dose?

Yes, however, this effect is not addressed in the 2010 MMRV ACIP recommendations. Although this is off-characterization apply, CDC recommends that when a dose of MMRV is inadvertently given to a patient age xiii years and older, it may be 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 sometime?

For routine vaccination, children without contraindications to MMR vaccine should receive 2 doses of MMR vaccine with the showtime dose at age 12–15 months old and the second dose at age 4–half-dozen years erstwhile. The minimum interval is 28 days for dose 2. If you accept an outbreak in your community or a child is traveling internationally, then consider using the minimum interval instead of waiting until age 4–6 years old for dose 2.

Does the iv-24-hour interval "grace period" apply to the minimum historic period for assistants of the first dose of MMR? What nigh the 28-mean solar day minimum interval between doses of MMR?

A dose of MMR vaccine administered upwards to four days before the first birthday may be counted as valid. Withal, school entry requirements in some states may mandate assistants on or later the first birthday. The iv-24-hour interval "grace period" should non exist practical to the 28-mean solar day minimum interval between ii doses of a alive parenteral vaccine.

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

Yes. Yet, 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 by an interval of at least 28 days.

If yous can requite the 2d dose of MMR as early as 28 days after the outset dose, why do we routinely wait until kindergarten entry to give the second dose?

The 2nd dose of MMR may exist given as early equally four weeks afterward the first dose, and exist counted as a valid dose if both doses were given after the first birthday. The second dose is not a booster, but rather it is intended to produce amnesty in the pocket-size number of people who fail to answer to the first dose. The chance of measles is higher in school-age children than those of preschool age, so it is important to receive the second dose by schoolhouse entry. Information technology is also convenient to give the second dose at this age, since the child will have an immunization visit for other school entry vaccines.

What is the earliest historic period at which I can requite MMR to an baby who will be traveling internationally? Also, which countries pose a high risk to children for contracting measles?

ACIP recommends that children who travel or live abroad should exist vaccinated at an earlier age than that recommended for children who reside in the U.s.a.. Earlier their difference from the Usa, children age 6 through xi months should receive ane dose of MMR. The risk for measles exposure can exist loftier in high-, eye- and low-income countries. Consequently, CDC encourages all international travelers to be upwardly to date on their immunizations regardless of their travel destination and to go along a copy of their immunization records with them as they travel. For boosted data 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 age because they are in a community with cases of measles, when should nosotros give the side by side dose?

The side by side dose should be given at 12 months of age. The child will also need another dose at least 28 days later. For the child to exist fully vaccinated, they need 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 historic period does not count every bit part of the MMR vaccine ii-dose series.

I have an 8-month-old patient who is traveling internationally. The infant needs to be protected from hepatitis A every bit well as measles, mumps, and rubella. The family unit is leaving in xi days. Can 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 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age six through eleven months traveling outside the Us 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, run across the CDC ACIP recommendations for the prevention and command of hepatitis A at world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page eighteen.

Can I give the 2d dose of MMR before than age 4 through vi years (the kindergarten entry dose) to young children traveling to areas of the globe where there are measles cases?

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

If I give MMR to an baby traveler younger than age 1 year, will that dose exist considered valid for the U.South. immunization schedule?

No. A measles-containing vaccine administered more than iv days before the first birthday should not exist counted every bit part of the serial. MMR should exist repeated when the child is age 12 through 15 months (12 months if the child remains in an area where disease adventure is loftier). The second dose should be administered at least 28 days after the first dose.

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

Yes. A TST can be applied before or on the same twenty-four hours that MMR vaccine is given. However, if MMR vaccine is given on the previous day or earlier, 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 allowed organisation.

An 18-yr-quondam higher student says he had both measles and mumps diseases every bit a preschooler, merely never had MMR vaccine. Is rubella vaccine recommended in such a situation?

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 not adequate as proof of immunity. Adequate evidence of measles and mumps immunity includes a positive serologic test for antibody, birth before 1957, or written documentation of vaccination. For rubella, but serologic bear witness or documented vaccination should exist accepted as proof of immunity. Additionally, people built-in prior to 1957 may be considered allowed to rubella unless they are women who take the potential to become pregnant.

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

The General All-time Exercise 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 aforementioned day should exist separated past at least 28 days. The CDC travel health website recommends that yellowish fever vaccine and other parenteral or nasal live vaccines should be separated by at least thirty days if possible. Either interval is adequate.

For Healthcare Personnel Back to top

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP born during or after 1957 have adequate presumptive prove of immunity to measles, mumps, and rubella, defined as documentation of two doses of measles and mumps vaccine and at least i dose of rubella vaccine, laboratory evidence of amnesty, or laboratory confirmation of disease. Further, ACIP recommends that healthcare facilities should consider vaccination of all unvaccinated healthcare personnel who were born before 1957 and who lack laboratory prove of measles, mumps, and/or rubella immunity or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated by at least 4 weeks for unvaccinated healthcare personnel regardless of nascence year who lack laboratory bear witness 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 yr who lack laboratory prove of rubella amnesty or laboratory confirmation of infection or disease.

Would you consider healthcare personnel with 2 documented doses of MMR vaccine to be immune even if their serology for 1 or more of the antigens comes dorsum negative?

Yes. Healthcare personnel (HCP) with 2 documented doses of MMR vaccine are considered to exist allowed regardless of the results of a subsequent serologic exam for measles, mumps, or rubella. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who do non have documentation of MMR vaccination and whose serologic examination 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 after vaccination. For more information, see ACIP'south 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-grade fever after MMR vaccine, is s/he infectious?

Approximately five to fifteen% of susceptible people who receive MMR vaccine will develop a depression-class fever and/or mild rash seven to 12 days after vaccination. Notwithstanding, the person is non infectious, and no special precautions ( such every bit exclusion from piece of work) need to be taken.

A 22-twelvemonth-old female is going to pharmacy school and the school wants her to take a 2d dose of MMR vaccine. She had the first dose as a kid and adult 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 can I give her a second dose of the MMR with her having measles after the first dose?

Yes, as a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. There is no damage in providing MMR to a person who is already allowed to ane or more of the components. If she adult measles only one twenty-four hours later on getting her first MMR, she must take been exposed to the disease prior to vaccination.

Contraindications and Precautions Back to top

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

• receipt of an antibody-containing claret product in the previous three–11 months, depending on the type of blood production received. Come across world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Table three-5 for more data on this upshot • moderate or severe astute illness with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Important details almost the contraindications and precautions for MMR vaccine are in the current MMR ACIP statement, bachelor at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Nosotros have many patients who are immunocompromised and cannot become the MMR vaccine. How should we advise our patients?

People with medical weather condition that contraindicate measles immunization depend on high MMR vaccination coverage among those effectually them. To aid prevent the spread of measles virus, brand certain all your staff and patients who tin exist vaccinated are fully vaccinated co-ordinate to the U.S. immunization schedule. Also, encourage patients to remind their family unit members and other close contacts to get vaccinated if they are not immune.

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

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

In that location is no known gamble associated with MMR or varicella vaccination in someone with selective IgA or IgM deficiency. It is possible that the immune response may exist weaker, only the vaccines are likely effective.

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

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

Tin can I requite MMR to a child whose sibling is receiving chemotherapy for leukemia?

Yeah. MMR and varicella vaccines should be given to the salubrious household contacts of immunosuppressed children.

Nosotros have a 40 lb six-year-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 15 mg/week), the child is currently receiving more than 0.4 mg/kg/week of methotrexate. This meets the Communicable diseases Society of America (IDSA) definition of high-level immunosuppression. Assistants of both varicella and MMR vaccines are contraindicated until such fourth dimension 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, see the 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/xi/26/cid.cit684.full.pdf.

Is it true that egg allergy is non considered a contraindication to MMR vaccine?

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

Tin I requite MMR to a breastfeeding mother or to a breastfed infant?

Yeah. Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no risk to the infant beingness breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via chest milk, the infection in the infant is asymptomatic.

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

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

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

Yes. Receipt of RhoGam is non a reason to filibuster vaccination. For more data see the ACIP General All-time Exercise Guidelines for Immunization, bachelor at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Please describe the current ACIP recommendations for the employ of MMR vaccine in people who are infected with HIV.

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

Administer 2 doses of MMR vaccine to all HIV-infected people age 12 months and older who exercise not have bear witness of current astringent immunosuppression or current evidence of measles, rubella, and mumps amnesty. To exist regarded equally not having evidence of electric current severe immunosuppression, a kid age v years or younger must accept CD4 percentages of fifteen% or more for 6 months or longer; a person older than 5 years must have CD4 percentages of 15% or more than and a CD4 lymphocyte count of 200 or more/mm3 for half dozen months or longer. If laboratory results land only ane blazon of parameter (pct or counts) this is sufficient for vaccine controlling.

Administrate the start dose at 12 through 15 months and the second dose to children age iv through 6 years, or as early equally 28 days afterwards the showtime dose.

Unless they have adequate current testify 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 effective ART is defined as receiving ART for at least 6 months in combination with CD4 percentages of fifteen% 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 just i blazon of parameter (percentages or counts) this is sufficient for vaccine determination-making.

Pregnancy and Postpartum Considerations Back to meridian

What is the recommended length of time a woman should wait later on receiving rubella (MMR) vaccine earlier becoming pregnant?

Although the MMR vaccine package insert recommends a 3-calendar month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for 4 weeks. For details on this event, see ACIP's Control and Prevention of Rubella: Evaluation and Management 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 earlier MMR vaccination?

ACIP recommends that women of childbearing age be asked if they are currently pregnant or attempting to get pregnant. Vaccination should be deferred for those who respond "yep." Those who answer "no" should exist advised to avert pregnancy for 4 weeks following vaccination. Pregnancy testing is non necessary.

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

No specific action needs to be taken other than to reassure the woman that no adverse outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy is not a reason to stop the pregnancy. You should consult with others in your healthcare setting to place ways to foreclose such vaccination errors in the futurity. Detailed information about MMR vaccination in pregnancy is included in the most contempo MMR ACIP argument, available at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

No. ACIP recommends that women of childbearing historic period exist asked if they are currently pregnant or attempting to go significant. Vaccination should be deferred for those who respond "yes." Those who answer "no" should be advised to avoid pregnancy for 1 month post-obit vaccination.

Can we give an MMR to a 15-calendar month-old whose mother is ii months meaning?

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

If a woman'due south rubella test event shows she is "not immune" during a prenatal visit, just she has 2 documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum?

In 2013, ACIP changed its recommendation for this situation (see www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages xviii–xx). Information technology is recommended that women of childbearing age who take received one or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should exist administered one additional dose of MMR vaccine (maximum of iii doses) and practice not need to be retested for serologic evidence of rubella amnesty. MMR should not be administered to a meaning woman.

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

ACIP recommends that vaccinated women of childbearing historic period who take received 1 or 2 doses of rubella-containing vaccine and accept a rubella serum IgG levels that is non conspicuously positive should exist administered one boosted dose of MMR vaccine (maximum of three doses). Repeat serologic testing for prove of rubella immunity is non recommended. Run into www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–xx, for more information on this issue.

MMR vaccines should non be administered to women known to be pregnant or attempting to become pregnant. Because of the theoretical risk to the fetus when the mother receives a live virus vaccine, women should exist counseled to avert becoming meaning for 28 days after receipt of MMR vaccine.

How before long afterward delivery can MMR be given to the mother?

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

Vaccine Rubber Dorsum to tiptop

Is there any evidence that MMR or thimerosal causes autism?

No. This issue has been studied extensively, including a thorough review past the contained Institute of Medicine (IOM). The IOM issued a report in 2004 that concluded there is no evidence supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. For more information on thimerosal and vaccines in general, visit www.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

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

Merck no longer produces single antigen measles, mumps, and/or rubella vaccines for the U.South. marketplace. Only combined MMR is available. You should educate parents nigh the lack of association betwixt MMR and autism.

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

Arthralgia (joint hurting) and transient arthritis (joint redness or swelling) post-obit rubella vaccination occurs just in people who were susceptible to rubella at the time of vaccination. Joint symptoms are uncommon in children and in developed males. About 25% of non-immune post-pubertal women report joint pain after receiving rubella vaccine, and almost 10% to 30% report arthritis-like signs and symptoms.

When joint symptoms occur, they mostly begin 1 to three weeks afterward vaccination, usually are mild and not incapacitating, terminal about two days, and rarely recur.

Is in that location whatever harm in giving an extra dose of MMR to a child of historic period seven years whose record is lost and the female parent is not certain about the final dose of MMR?

In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem. Notwithstanding, receiving excessive doses of tetanus toxoid (eastward.g., DTaP, DT, Tdap, or Td) can increase the risk of a local adverse reaction. For details see the Extra Doses of Vaccine Antigens section of the ACIP General Best Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Vaccination providers oftentimes encounter people who practice not have acceptable documentation of vaccinations. Providers should only accept 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 accustomed. 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 exist located or will definitely non be available anywhere considering of the patient's circumstances, children without adequate documentation should be considered susceptible and should receive age-appropriate vaccination. Serologic testing for immunity is an alternative to vaccination for certain antigens (e.g., measles, rubella, hepatitis A, diphtheria, and tetanus).

Storage and Treatment Back to top

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

The amount of time in which a dose of vaccine must exist used after reconstitution varies by vaccine and is unremarkably outlined somewhere in the vaccine'southward packet 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 education piece that outlines the time immune between reconstitution and employ, as stated in the package inserts for a number of vaccines. Handout can exist constitute at the following link: www.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine exist stored?

MMR may exist stored either in the fridge at two°C to 8°C (36°F to 46°F) or in the freezer at -50°C to -15°C (-58°F to +five°F). The diluent should not be frozen and can exist stored in the fridge or at room temperature.

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

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

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

Once MMR vaccine has been reconstituted with diluent, how soon must it exist used?

Information technology is preferable to administer MMR immediately subsequently reconstitution. If reconstituted MMR is non used within eight hours, it must be discarded. MMR should always be refrigerated and should never be left at room temperature.

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

Just the diluent supplied with the vaccine should be used to reconstitute any vaccine. Whatever vaccine reconstituted with the wrong diluent should be repeated.

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

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