Can You Take the Measles Shot Again

Measles, Mumps, and Rubella

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

Disease Issues

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

In 2019, a conditional total of ane,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a unmarried year since 1992; 73% of cases were associated with outbreaks among unvaccinated people in New York. These outbreaks were contained and stopped before the cease of 2019. Betwixt January one and August 19, 2020, just 12 measles cases were reported past seven 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 Us. CDC measles surveillance updates can exist found at world wide web.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, there has been a more than than 99% decrease in mumps cases in the United States. Even so, outbreaks however occasionally occur. In 2006, there was an outbreak affecting more than 6,584 people in the United States, with many cases occurring on college campuses. In 2009, an outbreak started in close-knit religious communities and schools in the Northeast, resulting in more than 3,000 cases. Since 2015, numerous outbreaks have been reported beyond the United states of america, 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 shut contact with a lot of other people (such equally amongst residential higher students and families in close-knit communities) mumps tin can spread even amid vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A provisional total of three,484 cases of mumps were reported to CDC in 2019.

Rubella was declared eliminated (the absence of endemic manual for 12 months or more) from the United states in 2004. Fewer than x cases (primarily import-related) accept been reported annually in the U.s. since elimination was declared. Rubella incidence in the U.s.a. has decreased by more than 99% from the pre-vaccine era. A provisional 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 lead to serious complications and death, even with mod medical care. 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 United States, from 1987 to 2000, the most commonly reported complications associated with measles infection were pneumonia (vi%), otitis media (vii%), and diarrhea (8%). For every one,000 reported measles cases in the United States, approximately 1 case of encephalitis and ii to three deaths resulted. The risk for death from measles or its complications is greater for infants, immature children, and adults than for older children and adolescents.

Mumps virtually 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 affliction is typically milder, with fewer complications, in fully vaccinated instance patients.

Rubella is generally a mild illness with low-grade fever, lymphadenopathy, and malaise. Upwardly to 50% 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 birth defects including cataracts, hearing loss, mental retardation, and congenital centre defects.

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

Healthcare providers should suspect measles in patients with a febrile rash illness and the clinically compatible symptoms of coughing, coryza (runny nose), and/or conjunctivitis (ruby, watery eyes). The illness begins with a prodrome of fever and angst before rash onset. A clinical case of measles is defined as an illness characterized past

• a generalized rash lasting 3 or more days, and • a temperature of 101°F or higher (38.3°C or college), and • cough, 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 1 to 2 days afterward. They appear as punctate blueish-white spots on the bright ruby groundwork of the buccal mucosa. Pictures of measles rash and Koplik spots can be constitute at www.cdc.gov/measles/most/photos.html.

Providers should be particularly enlightened of the possibility of measles in people with fever and rash who have recently traveled away or who have had contact with international travelers.

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

What should our clinic practice if nosotros doubtable a patient has measles?

Measles is highly contagious. A person with measles is infectious upwardly to 4 days before through 4 days later on the 24-hour interval 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 by 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 report suspected measles cases to their local health department and obtain specimens for measles testing, including serum sample for measles serologic testing and a pharynx swab (or nasopharyngeal swab) for viral confirmation.

Measles is a nationally notifiable illness in the U.Southward.; healthcare providers should study all cases of suspected measles to public health regime immediately to help reduce the number of secondary cases. Do not expect for the results of laboratory testing to study clinically-suspected measles to the local health department.

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

How long does it take to show signs of measles, mumps, and rubella after existence exposed?

For measles, at that place is an boilerplate of ten to 12 days from exposure to the appearance of the first symptom, which is usually fever. The measles rash doesn't usually announced until approximately 14 days afterwards exposure (range: 7 to 21 days), and the rash typically begins two to 4 days after the fever begins. The incubation period of mumps averages xvi to eighteen 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). Notwithstanding, as noted in a higher place, up to half of rubella virus infections cause no symptoms.

Vaccine Recommendations Back to top

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

The most contempo 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 age iv through 6 years. The second dose of MMR can be given as early as 4 weeks (28 days) later the beginning dose and be counted as a valid dose if both doses were given after the kid's start birthday. The 2nd dose is not a booster, simply rather is intended to produce immunity in the small-scale number of people who neglect to respond to the start dose.

Adults with no bear witness of amnesty (evidence of amnesty is defined equally documented receipt of one dose [2 doses 4 weeks apart if loftier chance] of live measles virus-containing vaccine, laboratory show of immunity or laboratory confirmation of disease, or nascency before 1957) should become ane dose of MMR vaccine unless the adult is in a high-risk group. Loftier-risk people need two doses and include schoolhouse-age children, healthcare personnel, international travelers, and students attending post-high schoolhouse educational institutions.

Live adulterate measles vaccine became available in the U.S. in 1963. An ineffective, inactivated measles vaccine was also available in the U.Southward. 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 information technology was, or are sure it was inactivated measles vaccine, that dose should exist considered invalid and the patient revaccinated every bit age- and hazard-appropriate with MMR vaccine. At the discretion of the land public health section, anyone exposed to measles in an outbreak setting can receive an boosted dose of MMR vaccine even if they are considered completely vaccinated for their age or risk status.

What is considered acceptable evidence of immunity to measles?

Acceptable presumptive testify of immunity against measles includes at least 1 of the following:

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

Although nascence earlier 1957 is considered acceptable evidence of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do non take other evidence of amnesty with ii doses of MMR vaccine (minimum interval 28 days).

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

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

Nix, one, or two doses of MMR vaccine are needed for the adults described below.

Zip doses:

• adults born before 1957 except healthcare personnel* • adults born 1957 or later who are at low risk (i.e., not an international traveler or healthcare worker, or person attending college or other post-high schoolhouse educational institution) and who have already received one or more documented doses of live measles vaccine • adults with laboratory evidence of immunity or laboratory confirmation of measles

One dose of MMR vaccine:

• adults born 1957 or later who are at low take a chance (i.due east., not an international traveler, healthcare worker, or person attending higher or other postal service-loftier school educational establishment) and have no documented vaccination with live measles vaccine and no laboratory prove of immunity or prior measles infection

2 doses of MMR vaccine:

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

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

* Healthcare personnel born before 1957 should be considered for MMR vaccination in the absence of an outbreak, only 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 earlier 1957, take 2 doses of MMR vaccine?

Although birth before 1957 is considered acceptable bear witness of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born before 1957 who do not accept laboratory evidence of measles immunity, laboratory confirmation of illness, or vaccination with 2 appropriately spaced doses of MMR vaccine.

Nevertheless, during a local outbreak of measles, all healthcare personnel, including those born earlier 1957, are recommended to accept two doses of MMR vaccine at the appropriate interval if they lack laboratory evidence of measles.

Healthcare facilities should check with their country or local health department's immunization program for guidance. Admission 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 be given to children as young as 6 months of age who are at high risk of exposure such as during international travel or a customs outbreak. However, doses given BEFORE 12 months of age cannot be counted toward the two-dose serial for MMR.

How does being born earlier 1957 confer amnesty to measles?

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

Why is a 2d dose of MMR necessary?

Approximately 7% of people exercise not develop measles immunity afterwards the first dose of vaccine. This occurs for a variety of reasons. The second dose is to provide some other chance to develop measles immunity for people who did not respond to the beginning dose. About 97% of people develop amnesty to measles after 2 doses of measles-containing vaccine.

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

There are two 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 iii doses). Further testing for serologic show of rubella immunity is non 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 every bit being office of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus�containing vaccine (MMR or MMRV) to ameliorate protection against mumps disease and related complications. More than information about this recommendation is available at world wide web.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

When is it advisable to use 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 run a risk of complications who cannot be vaccinated is to give immunoglobulin (IG) within half dozen days of exposure. Do not administrate MMR vaccine and IG simultaneously, as the IG invalidates the vaccine.

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

Exercise any adults need "booster" doses of MMR vaccine to forestall measles?

No. Adults with show of immunity do not need any further 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 young 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 time period? That guidance would aid many older people who would prefer not to exist revaccinated.

Both killed and live attenuated measles vaccines became bachelor in 1963. Live attenuated vaccine was used more than 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, information technology is not possible to know what blazon of vaccine an individual may accept received. Then persons built-in during or afterward 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 1 dose of MMR. Some people at increased risk of exposure to measles (such as healthcare professionals and international travelers) should receive ii doses of MMR separated by at least 4 weeks.

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

Not necessarily. People who have documentation of receiving live measles vaccine in the 1960s do not need to 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 have received killed measles vaccine which was bachelor in the United States 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 piece of 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 immunity to measles, rubella, and mumps in 2013. Delight explicate.

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of illness as testify of amnesty for measles, mumps, and rubella. ACIP removed medico diagnosis of affliction equally evidence of immunity for measles and mumps. Md diagnosis of disease had not previously been accepted as evidence of immunity for rubella. With the subtract in measles and mumps cases over the last xxx years, the validity of physician-diagnosed illness has become questionable. In addition, documenting history from physician records is not a practical choice for nearly adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

Measles vaccine, given as MMR, may be constructive if given within the first 3 days (72 hours) after exposure to measles. Allowed globulin may be effective for as long every bit half dozen days afterward exposure. Postexposure prophylaxis with MMR vaccine does not foreclose or alter the clinical severity of mumps or rubella. Notwithstanding, if the exposed person does non have testify of mumps or rubella immunity they should be vaccinated since not all exposures outcome in infection.

What are the current ACIP recommendations for utilize of allowed 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 exist administered to all infants younger than 12 months who have been exposed to measles. The dose of IGIM is 0.5 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 xi months, if it 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 body weight.

For persons already receiving IGIV therapy, administration of at least 400 mg/kg torso weight within iii weeks earlier measles exposure should be sufficient to prevent measles infection. For patients receiving subcutaneous immune globulin (IGSC) therapy, administration of at to the lowest degree 200 mg/kg body weight for 2 sequent weeks before measles exposure should exist sufficient.

Other people who do non take prove of measles immunity tin can receive an IGIM dose of 0.five mL/kg of body weight. Give priority to people who were exposed to measles in settings where they take intense, prolonged shut contact (such as household, child intendance, classroom, etc.). The maximum dose of IGIM is fifteen mL.

IG is non indicated for persons who have received 1 dose of measles-containing vaccine at age 12 months or older unless they are severely immunocompromised. IG should non exist used to command measles outbreaks.

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

We ofttimes see higher students who lack vaccination records, but whose titer results show they are not immune to some combination of measles, rubella, and/or mumps. What blazon of vaccine should these students receive?

Single antigen vaccine is no longer available in the U.S.; the student should get 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 two doses of MMR.

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

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

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

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

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

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

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

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

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

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

I have a 45-year-old patient who is traveling to Republic of haiti for a mission trip. She doesn't think ever getting an MMR booster (she didn't get to college and never worked in health intendance). She was rubella immune when pregnant twenty years ago. Her measles titer is negative. Would you recommend an MMR booster?

ACIP recommends ii doses of MMR given at to the lowest degree 4 weeks apart for any adult built-in in 1957 or later on who plans to travel internationally. At that place is no harm in giving MMR vaccine to a person who may already exist allowed to one or more than of the vaccine viruses.

A patient who was born earlier 1957 and is non a healthcare worker wants to get the MMR vaccine before international travel. Does he demand a dose of MMR?

No, information technology is not considered necessary, simply he may be vaccinated. Before implementation of the national measles vaccination programme in 1963, virtually every person acquired measles before adulthood. So, this patient can exist considered immune based on their birth year. However, MMR vaccine also may exist 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 have measles cases in our community. How can I best protect the young children in my practice?

Beginning of all, make sure all your patients are fully vaccinated according to the U.S. immunization schedule.

In certain circumstances, MMR is recommended for infants age 6 through xi months. Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants as young as age six months every bit a control measure during a U.S. measles outbreak. Consult your state health department to find out if this is recommended in your state of affairs. Do non count whatever dose of MMR vaccine as part of the 2-dose series if information technology is administered before a child'south first birthday. Instead, echo the dose when the child is age 12 months.

In the instance of a local outbreak, yous 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 2d dose iv weeks later (at the minimum interval) instead of waiting until age 4 through half dozen 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 amidst those around 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 nosotros offering a third dose of MMR (MMR II, Merck) to persons who accept two prior documented doses of MMR?

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

In January 2018, the Advisory Committee on Immunization Practices (ACIP) published new guidance for MMR vaccination of persons at increased risk for acquiring mumps during an outbreak. Persons previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified past public health regime as being office of a grouping at increased adventure for acquiring mumps because of an outbreak should receive a third dose of a mumps virus�containing vaccine to improve protection against mumps illness and related complications. More data about this recommendation is bachelor at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

In a measles outbreak, do children who have non had MMR vaccine pose a threat to vaccinated people? Information technology is my understanding that vaccinated people tin still contract measles. Am I correct?

You are right that vaccinated people can 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 every bit measles, rubella, and hepatitis B) to much lower (60% for influenza in years with a good friction match of circulating and vaccine viruses, and seventy% for acellular pertussis vaccines in the three-v years after vaccination). More data is bachelor for each vaccine and disease at www.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines.

Administering Vaccines Dorsum to top

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 be given subcutaneously. Withal, intramuscular administration of whatever of these vaccines is not likely to subtract immunogenicity, and doses given IM do not need to be repeated.

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

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

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

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

Scheduling Vaccines Back to tiptop

How before long can we give the second dose of MMR vaccine to a child vaccinated at 12 months quondam?

For routine vaccination, children without contraindications to MMR vaccine should receive ii doses of MMR vaccine with the outset dose at age 12–fifteen months one-time and the 2d dose at age four–six years quondam. The minimum interval is 28 days for dose 2. If yous have an outbreak in your community or a kid is traveling internationally, so consider using the minimum interval instead of waiting until historic period 4–half dozen years old for dose 2.

Does the 4-24-hour interval "grace menses" apply to the minimum historic period for administration of the start dose of MMR? What about the 28-solar day minimum interval betwixt doses of MMR?

A dose of MMR vaccine administered upward to iv days before the starting time birthday may be counted as valid. However, schoolhouse entry requirements in some states may mandate administration on or after the first birthday. The 4-solar day "grace period" should not be applied to the 28-day minimum interval between two doses of a live parenteral vaccine.

Tin MMR exist given on the same day equally other live virus vaccines?

Yes. Even so, if two parenteral or intranasal live vaccines (MMR, varicella, LAIV and/or yellow fever) are not administered on the aforementioned mean solar day, they should be separated by an interval of at least 28 days.

If you can give the 2nd dose of MMR as early as 28 days after the first dose, why do we routinely await until kindergarten entry to give the second dose?

The second dose of MMR may be given equally early equally 4 weeks after the kickoff dose, and exist counted every bit a valid dose if both doses were given after the first altogether. The 2d dose is not a booster, merely rather it is intended to produce immunity in the small number of people who neglect to respond to the first dose. The take chances of measles is college in school-historic period children than those of preschool age, so it is important to receive the 2d dose by school entry. It 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 age at which I tin give MMR to an infant who will be traveling internationally? Also, which countries pose a high chance to children for contracting measles?

ACIP recommends that children who travel or live abroad should be vaccinated at an earlier age than that recommended for children who reside in the United States. Before their departure from the United States, children age 6 through eleven months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, middle- and low-income countries. Consequently, CDC encourages all international travelers to exist up to appointment on their immunizations regardless of their travel destination and to go on a copy of their immunization records with them equally they travel. For additional information on the worldwide measles situation, and on CDC's 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 we give the next dose?

The next dose should exist given at 12 months of age. The child will also demand some other dose at to the lowest degree 28 days later. For the kid to be fully vaccinated, they need to have ii doses of MMR vaccine given when the kid is 12 months of age and older. A dose given at less than 12 months of age does not count as role of the MMR vaccine 2-dose series.

I take an viii-month-old patient who is traveling internationally. The infant needs to be protected from hepatitis A too as measles, mumps, and rubella. The family is leaving in 11 days. Can I requite 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 historic period half-dozen through eleven months traveling outside the United states when protection confronting hepatitis A is recommended. MMR and hepatitis A vaccine may exist safely co-administered to children in this historic period group. Neither vaccine is counted as role of the child's routine vaccination serial. For details of this recommendation, see the CDC ACIP recommendations for the prevention and control of hepatitis A at world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page xviii.

Can I give the second dose of MMR earlier than age 4 through 6 years (the kindergarten entry dose) to young children traveling to areas of the globe where at that place are measles cases?

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

If I requite MMR to an babe traveler younger than age i year, volition that dose be considered valid for the U.S. immunization schedule?

No. A measles-containing vaccine administered more than 4 days before the first birthday should not be counted equally part of the series. MMR should exist repeated when the child is age 12 through 15 months (12 months if the kid remains in an area where disease risk is high). The second dose should be administered at to the lowest degree 28 days subsequently the first dose.

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

Yes. A TST tin can be applied earlier or on the same solar day that MMR vaccine is given. However, if MMR vaccine is given on the previous twenty-four hour period or earlier, the TST should be delayed for at least 28 days. Alive 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 organisation.

An xviii-year-onetime college student says he had both measles and mumps diseases as a preschooler, but never had MMR vaccine. Is rubella vaccine recommended in such a situation?

This pupil should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is non acceptable every bit proof of immunity. Adequate testify of measles and mumps immunity includes a positive serologic test for antibody, nascence before 1957, or written documentation of vaccination. For rubella, only serologic prove or documented vaccination should be accepted every bit proof of immunity. Additionally, people born prior to 1957 may be considered immune to rubella unless they are women who take the potential to become pregnant.

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

The Full general Best Practice Guidelines for Immunization (run across www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html) makes the generic recommendation that live parenterally or nasally administered vaccines not given on the same day should be separated by at to the lowest degree 28 days. The CDC travel health website recommends that xanthous fever vaccine and other parenteral or nasal alive 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 built-in during or later on 1957 take acceptable presumptive evidence of amnesty to measles, mumps, and rubella, divers as documentation of two doses of measles and mumps vaccine and at least one dose of rubella vaccine, laboratory evidence of immunity, 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 evidence of measles, mumps, and/or rubella amnesty or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend two doses of MMR separated past at least four weeks for unvaccinated healthcare personnel regardless of nativity twelvemonth who lack laboratory evidence of measles or mumps immunity or laboratory confirmation of disease. During outbreaks of rubella, healthcare facilities should recommend one dose of MMR for unvaccinated personnel regardless of nativity year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease.

Would you consider healthcare personnel with two documented doses of MMR vaccine to exist immune fifty-fifty if their serology for 1 or more of the antigens comes dorsum negative?

Aye. Healthcare personnel (HCP) with two documented doses of MMR vaccine are considered to exist immune regardless of the results of a subsequent serologic test for measles, mumps, or rubella. Documented historic period-appropriate vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who practice non have documentation of MMR vaccination and whose serologic examination is interpreted as "indeterminate" or "equivocal" should be considered not allowed 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 depression-grade fever later on MMR vaccine, is s/he infectious?

Approximately 5 to 15% of susceptible people who receive MMR vaccine will develop a depression-class fever and/or balmy rash 7 to 12 days after vaccination. However, the person is not infectious, and no special precautions ( such equally exclusion from work) need to be taken.

A 22-twelvemonth-old female is going to chemist's schoolhouse and the school wants her to have a second dose of MMR vaccine. She had the start dose every bit a child and developed measles within 24 hours of receiving the vaccine. Contempo serologic testing showed she is immune to mumps and measles merely not allowed to rubella. Can I give her a 2nd dose of the MMR with her having measles after the commencement dose?

Yes, as a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. At that place is no harm in providing MMR to a person who is already allowed to one or more of the components. If she adult measles only i twenty-four hours afterwards getting her showtime MMR, she must have been exposed to the affliction prior to vaccination.

Contraindications and Precautions Dorsum to meridian

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

• receipt of an antibody-containing blood production in the previous iii–eleven months, depending on the type of blood product received. See www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Tabular array 3-5 for more than information on this issue • moderate or severe acute affliction with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Important details about the contraindications and precautions for MMR vaccine are in the electric current MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

People with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. To help forestall the spread of measles virus, make sure all your staff and patients who can exist vaccinated are fully vaccinated according to the U.S. immunization schedule. Also, encourage patients to remind their family 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 immune globulin for post-exposure prophylaxis which tin be establish at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

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

I take 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 earlier giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, so in that location is no concern virtually prophylactic or efficacy of MMR.

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

Yes. MMR and varicella vaccines should exist given to the salubrious household contacts of immunosuppressed children.

Nosotros have a 40 lb 6-year-erstwhile patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can we requite the kid 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.four mg/kg/week of methotrexate. This meets the Infectious disease Society of America (IDSA) definition of loftier-level immunosuppression. Assistants of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced. The 2013 IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0.iv mg/kg/week. For additional details, encounter 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 take documented the safety of measles and mumps vaccine (which are grown in chick embryo tissue civilization) in children with severe egg allergy. Neither the American Academy of Pediatrics nor ACIP consider egg allergy equally a contraindication to MMR vaccine. ACIP recommends routine vaccination of egg-allergic children without the use 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 being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may exist transmitted via breast milk, the infection in the babe is asymptomatic.

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

Yes, but there should be sufficient fourth dimension between the blood product and the MMR to reduce the run a risk of interference. The interval depends on the blood product received. Come across Tabular array 3-5 of ACIP'due south General Best Practice Guidelines for Immunization for more information, bachelor at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

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

Yes. Receipt of RhoGam is non a reason to delay vaccination. For more information see the ACIP General Best Practice Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Delight depict 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 current recommendations are as follows:

Administer two doses of MMR vaccine to all HIV-infected people age 12 months and older who exercise not take testify of current astringent immunosuppression or electric current evidence of measles, rubella, and mumps amnesty. To be regarded as non having evidence of current severe immunosuppression, a child age 5 years or younger must have CD4 percentages of fifteen% or more for 6 months or longer; a person older than v years must take CD4 percentages of xv% or more and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results state only one type of parameter (pct or counts) this is sufficient for vaccine decision-making.

Administer the starting time dose at 12 through 15 months and the second dose to children age 4 through 6 years, or equally early every bit 28 days after the first dose.

Unless they have acceptable current bear witness of measles, mumps, and rubella immunity, people with perinatal HIV infection who were vaccinated prior to establishment of effective antiretroviral therapy (Fine art) should receive 2 appropriately spaced doses of MMR vaccine afterward constructive ART has been established. Established constructive Fine art is defined equally receiving Art for at least 6 months in combination with CD4 percentages of 15% or more for 6 months or longer for children age 5 years or younger. People older than five years should accept CD4 percentages of 15% or more and a CD4 lymphocyte count of 200 or more than/mm3 for 6 months or longer. If laboratory results state only i type of parameter (percentages or counts) this is sufficient for vaccine controlling.

Pregnancy and Postpartum Considerations Back to top

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

Although the MMR vaccine package insert recommends a three-month deferral of pregnancy later on MMR vaccination, ACIP recommends deferral of pregnancy for 4 weeks. For details on this issue, run into ACIP'south Control and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella in Significant Women, and Surveillance for Congenital Rubella Syndrome.

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

ACIP recommends that women of childbearing age be asked if they are currently pregnant or attempting to get significant. Vaccination should exist deferred for those who answer "yes." Those who answer "no" should exist advised to avoid pregnancy for iv 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 adverse outcomes are expected equally a outcome of this vaccination. MMR vaccination during pregnancy is not a reason to finish the pregnancy. You should consult with others in your healthcare setting to identify means to prevent such vaccination errors in the future. Detailed information most MMR vaccination in pregnancy is included in the most contempo MMR ACIP statement, bachelor 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 pregnant or attempting to become pregnant. Vaccination should be deferred for those who answer "yes." Those who answer "no" should be advised to avoid pregnancy for i month following vaccination.

Can nosotros requite an MMR to a 15-month-erstwhile whose female parent is ii months pregnant?

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 fellow member.

If a woman'south rubella test result shows she is "non immune" during a prenatal visit, but she has ii documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum?

In 2013, ACIP changed its recommendation for this situation (meet world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages xviii–20). Information technology is recommended that women of childbearing age who have received 1 or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are non clearly positive should be administered i additional dose of MMR vaccine (maximum of iii doses) and practice not need to be retested for serologic evidence of rubella immunity. MMR should not exist administered to a pregnant woman.

I have a female person patient who has a non-immune rubella titer two months afterward her 2d MMR vaccination. Should she be revaccinated? If so, should the titer again be checked to make up one's mind seroconversion?

ACIP recommends that vaccinated women of childbearing age who accept received one or two doses of rubella-containing vaccine and take a rubella serum IgG levels that is non clearly 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. Run into 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 meaning or attempting to become pregnant. Because of the theoretical adventure to the fetus when the mother receives a live virus vaccine, women should be counseled to avoid becoming significant for 28 days after receipt of MMR vaccine.

How soon after commitment tin MMR be given to the mother?

MMR tin exist administered whatsoever fourth dimension after delivery. The vaccine should be administered to a adult female who is susceptible to either measles, mumps, or rubella before hospital belch, even if she has received RhoGam during the infirmary stay, leaves in less than 24 hours, or is breastfeeding.

Vaccine Safety Back to tiptop

Is there any evidence that MMR or thimerosal causes autism?

No. This result has been studied extensively, including a thorough review by the independent 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 evolution of autism. For more information on thimerosal and vaccines in general, visit world wide web.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

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

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

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

Arthralgia (joint pain) and transient arthritis (joint redness or swelling) post-obit rubella vaccination occurs only in people who were susceptible to rubella at the time of vaccination. Joint symptoms are uncommon in children and in adult males. About 25% of non-immune mail service-pubertal women study articulation hurting subsequently receiving rubella vaccine, and well-nigh 10% to xxx% report arthritis-similar signs and symptoms.

When joint symptoms occur, they more often than not begin 1 to iii weeks afterward vaccination, usually are mild and not incapacitating, terminal well-nigh 2 days, and rarely recur.

Is at that place any damage in giving an extra dose of MMR to a child of age seven years whose record is lost and the female parent is not sure virtually the concluding dose of MMR?

In general, although it is non ideal, receiving extra doses of vaccine poses no medical problem. However, receiving excessive doses of tetanus toxoid (east.one thousand., DTaP, DT, Tdap, or Td) can increment the risk of a local adverse reaction. For details encounter the Extra Doses of Vaccine Antigens section of the ACIP General Best Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

Vaccination providers ofttimes encounter people who do non have adequate documentation of vaccinations. Providers should only accept written, dated records as evidence of vaccination. With the exception of flu vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should not exist accepted. An attempt to locate missing records should be made whenever possible by contacting previous healthcare providers, reviewing state or local immunization data systems, and searching for a personally held tape.

If records cannot exist located or will definitely not exist bachelor anywhere because of the patient's circumstances, children without adequate documentation should exist considered susceptible and should receive historic period-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 tiptop

How long tin reconstituted MMR vaccine exist stored in a refrigerator before it must be discarded?

The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is usually outlined somewhere in the vaccine's packet insert. MMR must exist used within 8 hours of reconstitution. MMRV must exist used inside 30 minutes; other vaccines must be used immediately. The Immunization Activity Coalition has a staff education piece that outlines the time allowed between reconstitution and use, as stated in the package inserts for a number of vaccines. Handout can be establish at the post-obit link: world wide web.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine be stored?

MMR may be stored either in the fridge at 2°C to 8°C (36°F to 46°F) or in the freezer at -50°C to -fifteen°C (-58°F to +v°F). The diluent should not be frozen and tin can be stored in the refrigerator or at room temperature.

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

A box of MMR vaccine (not reconstituted) was left at room temperature overnight. Can I utilize it?

Unfortunately, serious errors in vaccine storage and handling like this occur besides oft. If you lot doubtable 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 utilise. This is especially important for live virus vaccines like MMR and varicella.

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

It is preferable to administer MMR immediately afterwards reconstitution. If reconstituted MMR is not used inside 8 hours, information technology 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 any problem with doing this?

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

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

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