If You Have Had Measels Can You Get It Again?

Measles, Mumps, and Rubella

Disease Bug Contraindications and Precautions Vaccine Recommendations Pregnancy and Postpartum Considerations Administering Vaccines Vaccine Rubber Scheduling Vaccines Storage and Treatment For Healthcare Personnel

Illness Issues

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

In 2019, a provisional full of 1,242 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 amid unvaccinated people in New York. These outbreaks were contained and stopped earlier the end of 2019. Between January ane and August xix, 2020, simply 12 measles cases were reported by 7 jurisdictions. Limited travel equally a effect of the COVID-xix pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the United States. CDC measles surveillance updates tin can be found at www.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, there has been a more than 99% decrease in mumps cases in the United States. Nevertheless, outbreaks still occasionally occur. In 2006, in that location was an outbreak affecting more than 6,584 people in the United States, with many cases occurring on higher 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 take been reported across the US, in college campuses, prisons, and close-knit communities, including a big outbreak in northwest Arkansas where almost 3,000 cases were reported in 2016. These outbreaks take 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 fifty-fifty among vaccinated people. Still, outbreaks are much larger in areas where vaccine coverage rates are lower. A conditional total of 3,484 cases of mumps were reported to CDC in 2019.

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

How serious are measles, mumps, and rubella?

Measles can atomic number 82 to serious complications and death, fifty-fifty with modern medical care. The 1989–1991 measles outbreak in the U.S. resulted in more than 55,000 cases and more than 100 deaths. In the U.s., from 1987 to 2000, the virtually usually reported complications associated with measles infection were pneumonia (6%), otitis media (7%), and diarrhea (8%). For every 1,000 reported measles cases in the United States, approximately one case of encephalitis and 2 to three deaths resulted. The take chances for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

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

Rubella is generally a mild illness with depression-form fever, lymphadenopathy, and malaise. Up to fifty% of rubella virus infections are subclinical. Complications can include thrombocytopenic purpura and encephalitis. Rubella virus is teratogenic and infection in a meaning woman, peculiarly during the first trimester tin result in miscarriage, stillbirth, and birth defects including cataracts, hearing loss, mental retardation, and built heart defects.

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

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

• a generalized rash lasting iii 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 one to 2 days before the measles rash appears to i to two days later on. They appear as punctate blueish-white spots on the bright red groundwork of the buccal mucosa. Pictures of measles rash and Koplik spots can be constitute at www.cdc.gov/measles/about/photos.html.

Providers should exist peculiarly enlightened of the possibility of measles in people with fever and rash who have recently traveled abroad or who have had contact with international travelers.

Providers should immediately isolate and 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 too collect claret for serologic testing during the start clinical encounter with a person who has suspected or probable measles.

What should our dispensary do 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 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 unmarried-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 disease in the U.Southward.; healthcare providers should study all cases of suspected measles to public health authorities immediately to assistance reduce the number of secondary cases. Do not wait for the results of laboratory testing to study clinically-suspected measles to the local health department.

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

How long does it take to show signs of measles, mumps, and rubella later on being exposed?

For measles, at that place is an average of 10 to 12 days from exposure to the appearance of the beginning symptom, which is normally fever. The measles rash doesn't usually announced until approximately 14 days after exposure (range: 7 to 21 days), and the rash typically begins ii to 4 days after the fever begins. The incubation menstruum of mumps averages xvi to xviii days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation menstruum of rubella is 14 days (range: 12 to 23 days). Yet, as noted above, upwards to half of rubella virus infections crusade no symptoms.

Vaccine Recommendations Dorsum to top

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

The most recent comprehensive ACIP recommendations for the apply of MMR vaccine were published in 2013 and are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at historic period 12 through 15 months, with a second dose at historic period four through 6 years. The 2nd dose of MMR tin can be given equally early on as four weeks (28 days) after the start dose and exist counted equally a valid dose if both doses were given afterward the child'southward starting time birthday. The second dose is non a booster, but rather is intended to produce immunity in the small number of people who fail to respond to the first dose.

Adults with no show of immunity (evidence of amnesty is defined as documented receipt of one dose [2 doses 4 weeks autonomously if high risk] of alive measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or nascency earlier 1957) should become 1 dose of MMR vaccine unless the adult is in a high-chance grouping. Loftier-risk people need two doses and include schoolhouse-age children, healthcare personnel, international travelers, and students attention post-high school educational institutions.

Live attenuated measles vaccine became available in the U.Southward. in 1963. An ineffective, inactivated measles vaccine was besides available in the U.S. in 1963–1967. Combined MMR vaccine (MMRII, Merck) was licensed in 1971. For people who previously received a dose of measles vaccine in 1963–1967 and are unsure which blazon of vaccine it was, or are sure it was inactivated measles vaccine, that dose should be considered invalid and the patient revaccinated as historic period- and risk-appropriate with MMR vaccine. At the discretion of the state public wellness department, anyone exposed to measles in an outbreak setting tin can receive an additional dose of MMR vaccine fifty-fifty if they are considered completely vaccinated for their age or gamble condition.

What is considered acceptable evidence of amnesty to measles?

Acceptable presumptive evidence of immunity confronting measles includes at least one of the post-obit:

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

Although birth before 1957 is considered acceptable show of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do not have other testify of immunity 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 nativity year if they lack laboratory evidence of measles immunity.

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

Zero, 1, or two doses of MMR vaccine are needed for the adults described below.

Zero doses:

• adults built-in before 1957 except healthcare personnel* • adults built-in 1957 or later who are at low risk (i.e., not an international traveler or healthcare worker, or person attention higher or other post-loftier school educational institution) and who have already received one or more documented doses of live measles vaccine • adults with laboratory show of immunity or laboratory confirmation of measles

Ane dose of MMR vaccine:

• adults born 1957 or later on who are at low gamble (i.e., not an international traveler, healthcare worker, or person attending college or other post-high schoolhouse educational institution) and have no documented vaccination with alive measles vaccine and no laboratory evidence of amnesty or prior measles infection

2 doses of MMR vaccine:

� high-risk adults without any prior documented alive 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 it was, or are certain it was inactivated measles vaccine, should be revaccinated with either ane (if low-risk) or two (if high-risk) doses of MMR vaccine.

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

Given the take a chance of outbreaks of measles in the U.S., should all healthcare personnel, including those born earlier 1957, take ii doses of MMR vaccine?

Although birth before 1957 is considered acceptable testify of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) built-in earlier 1957 who do not have laboratory bear witness of measles immunity, laboratory confirmation of disease, or vaccination with 2 appropriately spaced doses of MMR vaccine.

Yet, during a local outbreak of measles, all healthcare personnel, including those born before 1957, are recommended to have ii doses of MMR vaccine at the appropriate interval if they lack laboratory testify of measles.

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

If at that place is an outbreak in my area, tin can nosotros vaccinate children younger than 12 months?

MMR can be given to children as young as six months of historic period who are at high take chances of exposure such as during international travel or a community outbreak. However, doses given Before 12 months of historic period cannot exist counted toward the ii-dose series for MMR.

How does existence born before 1957 confer immunity to measles?

People built-in 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 likely to take had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons built-in before 1957 can exist presumed to be immune. However, if serologic testing indicates that the person is non immune, at least 1 dose of MMR should be administered.

Why is a 2nd dose of MMR necessary?

Approximately 7% of people practise not develop measles amnesty later the first dose of vaccine. This occurs for a variety of reasons. The 2nd dose is to provide some other take chances to develop measles amnesty for people who did not respond to the beginning dose. About 97% of people develop immunity to measles afterwards two doses of measles-containing vaccine.

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

There are ii circumstances when a 3rd dose of MMR is recommended. ACIP recommends that women of childbearing age who have received 2 doses of rubella-containing vaccine and accept rubella serum IgG levels that are not clearly positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Farther testing for serologic evidence of rubella immunity is not recommended. MMR should not exist administered to a significant adult female.

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

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

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

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

Do whatsoever adults demand "booster" doses of MMR vaccine to forestall measles?

No. Adults with bear witness of immunity exercise not need any farther vaccines. No "booster" doses of MMR vaccine are recommended for either adults or children. They are considered to take life-long immunity one time they accept received the recommended number of MMR vaccine doses or take other evidence of immunity.

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

Both killed and live adulterate measles vaccines became bachelor in 1963. Alive attenuated vaccine was used more than often than killed vaccine. The killed vaccine was plant to exist not effective and people who received information technology should exist revaccinated with live vaccine. Without a written record, information technology is not possible to know what type of vaccine an individual may have received. So persons born during or afterward 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot certificate having been vaccinated or having laboratory-confirmed measles illness should receive at to the lowest degree 1 dose of MMR. Some people at increased risk of exposure to measles (such as healthcare professionals and international travelers) should receive two doses of MMR separated past at least 4 weeks.

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

Not necessarily. People who accept documentation of receiving live measles vaccine in the 1960s do non need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least ane dose of live attenuated measles vaccine. This recommendation is intended to protect people who may have received killed measles vaccine which was available in the United States in 1963 through 1967 and was not constructive. People vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high take a chance 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. Delight explain.

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of disease as evidence of immunity for measles, mumps, and rubella. ACIP removed dr. diagnosis of disease every bit show of immunity for measles and mumps. Physician diagnosis of disease had not previously been accepted as evidence of amnesty for rubella. With the decrease in measles and mumps cases over the last 30 years, the validity of doctor-diagnosed disease has become questionable. In addition, documenting history from doctor records is not a practical option for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

Measles vaccine, given every bit MMR, may be constructive if given within the first 3 days (72 hours) subsequently exposure to measles. Immune globulin may be effective for as long as 6 days afterwards exposure. Postexposure prophylaxis with MMR vaccine does not prevent or change the clinical severity of mumps or rubella. However, if the exposed person does not take show of mumps or rubella amnesty 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 take 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 be given instead of IGIM to infants age 6 through 11 months, if it tin can exist given within 72 hours of exposure.

Pregnant women without prove 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 amnesty or vaccination, who have been exposed to measles should receive an IGIV dose of 400 mg/kg of body weight.

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

Other people who do not have bear witness of measles amnesty tin receive an IGIM dose of 0.v mL/kg of body weight. Give priority to people who were exposed to measles in settings where they accept intense, prolonged shut contact (such as household, kid care, classroom, etc.). The maximum dose of IGIM is fifteen mL.

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

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

We oftentimes encounter 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 bachelor in the U.Southward.; the student should get the combined MMR vaccine. If a college pupil 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 have patients who claim to call back receiving MMR vaccine just have no written record, 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 accept 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 testify of immunity and no contraindications to MMR vaccine can exist vaccinated without testing. Simply adults without evidence of immunity 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 later on MMR vaccination to verify the patient's immune response to vaccination.

Two documented doses of MMR vaccine given on or after the first altogether and separated by at to the lowest degree 28 days is considered proof of measles amnesty, co-ordinate 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 besides immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, just 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 exam for measles-specific IgG will confirm that the person is allowed and is not at take chances 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.

Nosotros have adult patients in our practice at high risk for measles, including patients going back to higher or preparing for international travel, who don't recall ever receiving MMR vaccine or having had measles disease. How should we manage these patients?

You accept two options. You tin test for immunity or yous tin can just requite ii doses of MMR at least iv weeks apart. At that place is no impairment 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 indicate the patient is not allowed to one or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks autonomously. If any examination results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination because commercial tests may not exist sensitive plenty to reliably detect vaccine-induced immunity.

I take a 45-yr-old patient who is traveling to Haiti for a mission trip. She doesn't recall ever getting an MMR booster (she didn't go to college and never worked in health care). She was rubella immune when pregnant xx years ago. Her measles titer is negative. Would you recommend an MMR booster?

ACIP recommends 2 doses of MMR given at least 4 weeks apart for any adult built-in in 1957 or later who plans to travel internationally. At that place is no harm in giving MMR vaccine to a person who may already exist immune to one or more than of the vaccine viruses.

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

No, information technology is not considered necessary, but he may exist vaccinated. Before implementation of the national measles vaccination program in 1963, virtually every person caused measles before adulthood. So, this patient tin can be considered immune based on their nascence twelvemonth. Still, MMR vaccine also may be given to any person born before 1957 who does not have a contraindication to MMR vaccination.

Routine testing of patients born 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?

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

In sure circumstances, MMR is recommended for infants age vi 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 6 months as a control measure during a U.Southward. measles outbreak. Consult your state health department to find out if this is recommended in your situation. Do non count any dose of MMR vaccine as part of the 2-dose series if it is administered before a kid's first birthday. Instead, repeat the dose when the kid is age 12 months.

In the case of a local outbreak, you too might consider vaccinating children historic period 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age four through half-dozen years.

Finally, remember 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 get vaccinated if they are not allowed.

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

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

In Jan 2018, the Advisory Committee on Immunization Practices (ACIP) published new guidance for MMR vaccination of persons at increased hazard for acquiring mumps during an outbreak. Persons previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified past public health authorities as existence part of a group at increased risk for acquiring mumps considering of an outbreak should receive a tertiary dose of a mumps virus�containing vaccine to improve protection against mumps disease 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, exercise children who have non had MMR vaccine pose a threat to vaccinated people? It is my understanding that vaccinated people tin still contract measles. Am I correct?

You are right that vaccinated people tin still be infected with viruses or bacteria against which they are vaccinated. No vaccine is 100% effective. Vaccine effectiveness varies from greater than 95% (for diseases such as measles, rubella, and hepatitis B) to much lower (sixty% for influenza in years with a good lucifer of circulating and vaccine viruses, and 70% for acellular pertussis vaccines in the 3-5 years later vaccination). More information is available for each vaccine and disease at world wide web.cdc.gov/vaccines/vpd-vac/default.htm and world wide web.immunize.org/vaccines.

Administering Vaccines Back to top

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

All live injected vaccines (MMR, varicella, and yellowish fever) are recommended to be given subcutaneously. Notwithstanding, intramuscular administration of whatever of these vaccines is not likely to subtract immunogenicity, and doses given IM practise not demand to be repeated.

Nosotros often demand to requite MMR vaccine to large adults. Is a 25-gauge needle with a length of 5/8" 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-twelvemonth-old instead of MMR. Tin can this exist considered a valid dose?

Yes, however, this issue is not addressed in the 2010 MMRV ACIP recommendations. Although this is off-label apply, CDC recommends that when a dose of MMRV is inadvertently given to a patient age 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 top

How soon can we requite the second dose of MMR vaccine to a child vaccinated at 12 months former?

For routine vaccination, children without contraindications to MMR vaccine should receive two doses of MMR vaccine with the first dose at age 12–15 months old and the 2nd dose at historic period 4–6 years former. The minimum interval is 28 days for dose two. If you have 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 4-day "grace period" utilize to the minimum historic period for assistants of the first dose of MMR? What about the 28-day minimum interval between doses of MMR?

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

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

Yes. However, if 2 parenteral or intranasal alive vaccines (MMR, varicella, LAIV and/or yellow fever) are non administered on the same twenty-four hour period, they should be separated by an interval of at least 28 days.

If yous tin give the second dose of MMR as early equally 28 days afterwards the first dose, why do we routinely wait until kindergarten entry to give the 2nd dose?

The second dose of MMR may be given equally early as iv weeks afterwards the commencement dose, and be counted as a valid dose if both doses were given after the offset altogether. The second dose is not a booster, but rather it is intended to produce amnesty in the small number of people who fail to respond to the first dose. The risk of measles is higher in school-historic period 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 kid will have an immunization visit for other school entry vaccines.

What is the primeval age at which I tin give MMR to an babe 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 before historic period than that recommended for children who reside in the United States. Before their departure from the United States, children historic period vi through eleven months should receive one dose of MMR. The take chances for measles exposure can be high in high-, heart- and low-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to proceed a copy of their immunization records with them as they travel. For additional information on the worldwide measles state of affairs, and on CDC's measles vaccination information for travelers, go to wwwnc.cdc.gov/travel.

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

The adjacent dose should be given at 12 months of age. The child volition besides demand some other dose at to the lowest degree 28 days subsequently. For the child 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 part of the MMR vaccine two-dose series.

I have an 8-calendar month-sometime patient who is traveling internationally. The baby needs to be protected from hepatitis A besides equally measles, mumps, and rubella. The family is leaving in 11 days. Tin I give hepatitis A IG and MMR vaccine simultaneously?

No. IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in Feb 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age six through xi months traveling outside the United States when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this age group. Neither vaccine is counted as role of the kid'southward routine vaccination series. For details of this recommendation, see the CDC ACIP recommendations for the prevention and control of hepatitis A at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page 18.

Tin can I give the second dose of MMR earlier than age 4 through vi years (the kindergarten entry dose) to young children traveling to areas of the earth where there are measles cases?

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

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

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

Can I give a tuberculin skin exam (TST) on the same twenty-four hours as a dose of MMR vaccine?

Yes. A TST can exist applied before or on the same day that MMR vaccine is given. Nonetheless, if MMR vaccine is given on the previous twenty-four hours or earlier, the TST should exist delayed for at to the lowest degree 28 days. Live measles vaccine given prior to the awarding of a TST can reduce the reactivity of the peel test because of mild suppression of the immune arrangement.

An 18-year-old college educatee says he had both measles and mumps diseases every bit a preschooler, but never had MMR vaccine. Is rubella vaccine recommended in such a situation?

This student should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is not acceptable every bit proof of immunity. Adequate evidence of measles and mumps immunity includes a positive serologic examination for antibody, nascence earlier 1957, or written documentation of vaccination. For rubella, merely serologic prove or documented vaccination should exist accepted as proof of amnesty. Additionally, people born prior to 1957 may be considered allowed to rubella unless they are women who have the potential to become pregnant.

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

The General All-time Practice 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 be separated by 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 30 days if possible. Either interval is adequate.

For Healthcare Personnel Dorsum to peak

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP born during or after 1957 have acceptable presumptive testify 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 immunity or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated past at least 4 weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory evidence of measles or mumps immunity or laboratory confirmation of affliction. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of nascency year who lack laboratory testify of rubella immunity or laboratory confirmation of infection or illness.

Would yous 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 back negative?

Yep. Healthcare personnel (HCP) with 2 documented doses of MMR vaccine are considered to be immune regardless of the results of a subsequent serologic exam for measles, mumps, or rubella. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who do not have documentation of MMR vaccination and whose serologic test 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 afterward vaccination. For more information, see ACIP'southward recommendations on the utilize of MMR vaccine at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, folio 22.

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

Approximately 5 to 15% of susceptible people who receive MMR vaccine will develop a low-grade fever and/or mild rash seven to 12 days after vaccination. However, the person is not infectious, and no special precautions ( such as exclusion from work) demand to be taken.

A 22-year-old female is going to pharmacy school and the school wants her to have a 2d dose of MMR vaccine. She had the showtime dose equally a child and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles but not allowed to rubella. Can I give her a 2d dose of the MMR with her having measles after the first dose?

Yes, as a healthcare professional, this person should get a 2d dose of MMR to ensure she is immune to rubella. In that location is no harm in providing MMR to a person who is already immune to one or more than of the components. If she developed measles only 1 24-hour interval later on getting her first MMR, she must accept been exposed to the disease prior to vaccination.

Contraindications and Precautions Back to height

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

• receipt of an antibody-containing claret product in the previous 3–eleven months, depending on the blazon of blood product received. See www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Table 3-5 for more than information on this result • moderate or severe acute affliction with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Of import details virtually the contraindications and precautions for MMR vaccine are in the current MMR ACIP argument, 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 advise our patients?

People with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage amongst those around them. To help prevent the spread of measles virus, brand 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 unit members and other close contacts to get vaccinated if they are non allowed.

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

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

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

There is no need to wait a specific interval before giving MMR. Injectable steroids are non considered immunosuppressive for the purpose of vaccination decisions, so at that place is no concern most condom or efficacy of MMR.

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

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

Nosotros have a 40 lb half-dozen-year-one-time patient who has been taking fifteen 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 than 0.4 mg/kg/week of methotrexate. This meets the Infectious Affliction Society of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time every bit the methotrexate dosage can exist reduced. The 2013 IDSA definition of depression-level immunosuppression for methotrexate is a dosage of less than 0.four mg/kg/week. For additional details, see the 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/11/26/cid.cit684.full.pdf.

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

Several studies accept 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 equally a contraindication to MMR vaccine. ACIP recommends routine vaccination of egg-allergic children without the employ of special protocols or desensitization procedures.

Can I give MMR to a breastfeeding female parent or to a breastfed baby?

Aye. Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a adult female who is breastfeeding poses no risk to the infant being breastfed. Although information technology is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the infant is asymptomatic.

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

Yes, merely there should be sufficient fourth dimension between the blood production and the MMR to reduce the chance of interference. The interval depends on the blood production received. See Table 3-5 of ACIP'due south Full general Best Practice Guidelines for Immunization for more information, bachelor at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Is it acceptable practice to administrate 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 than information see the ACIP General Best Practice Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Please 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 do not have evidence of current astringent immunosuppression or electric current evidence of measles, rubella, and mumps immunity. To be regarded as not having testify of current severe immunosuppression, a kid age 5 years or younger must accept CD4 percentages of 15% or more for 6 months or longer; a person older than five years must have CD4 percentages of 15% or more than and a CD4 lymphocyte count of 200 or more than/mm3 for 6 months or longer. If laboratory results state only ane blazon of parameter (per centum or counts) this is sufficient for vaccine decision-making.

Administer the first dose at 12 through 15 months and the second dose to children age four through six years, or equally early on as 28 days after the offset dose.

Unless they have adequate electric current bear witness of measles, mumps, and rubella immunity, people with perinatal HIV infection who were vaccinated prior to establishment of effective antiretroviral therapy (Art) should receive 2 appropriately spaced doses of MMR vaccine later effective ART has been established. Established effective ART is defined every bit receiving ART for at least vi months in combination with CD4 percentages of 15% or more for six months or longer for children age 5 years or younger. People older than v years should accept CD4 percentages of xv% or more and a CD4 lymphocyte count of 200 or more than/mm3 for 6 months or longer. If laboratory results state simply one blazon of parameter (percentages or counts) this is sufficient for vaccine controlling.

Pregnancy and Postpartum Considerations Dorsum to superlative

What is the recommended length of fourth dimension a adult female should wait afterward receiving rubella (MMR) vaccine before becoming significant?

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

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

ACIP recommends that women of childbearing historic period be asked if they are currently pregnant or attempting to go pregnant. Vaccination should be deferred for those who answer "yes." Those who answer "no" should exist advised to avoid pregnancy for four weeks post-obit vaccination. Pregnancy testing is not necessary.

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

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

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

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

Can we give an MMR to a fifteen-calendar month-old whose mother is 2 months pregnant?

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

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

In 2013, ACIP inverse its recommendation for this situation (see world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–xx). It is recommended that women of childbearing historic period who have received 1 or 2 doses of rubella-containing vaccine and take rubella serum IgG levels that are not conspicuously positive should be administered 1 additional dose of MMR vaccine (maximum of 3 doses) and do not need to be retested for serologic evidence of rubella immunity. MMR should not be administered to a meaning woman.

I have a female patient who has a not-immune rubella titer two months after her 2d MMR vaccination. Should she be revaccinated? If and so, should the titer again be checked to determine seroconversion?

ACIP recommends that vaccinated women of childbearing historic period who accept received ane or ii doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should exist administered one additional dose of MMR vaccine (maximum of iii doses). Echo serologic testing for evidence of rubella immunity is not recommended. Encounter www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20, for more information on this issue.

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

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

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

Vaccine Safety Back to meridian

Is there any evidence that MMR or thimerosal causes autism?

No. This consequence has been studied extensively, including a thorough review past the independent Institute of Medicine (IOM). The IOM issued a study in 2004 that concluded there is no prove supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. For more than information on thimerosal and vaccines in full 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 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.South. market. Only combined MMR is available. Y'all should brainwash parents virtually the lack of association between MMR and autism.

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

Arthralgia (articulation pain) and transient arthritis (joint redness or swelling) following rubella vaccination occurs only in people who were susceptible to rubella at the fourth dimension of vaccination. Articulation symptoms are uncommon in children and in adult males. Well-nigh 25% of non-immune post-pubertal women report articulation pain after receiving rubella vaccine, and about x% to 30% report arthritis-like signs and symptoms.

When articulation symptoms occur, they mostly begin 1 to iii weeks subsequently vaccination, usually are mild and not incapacitating, final most two days, and rarely recur.

Is there any harm in giving an extra dose of MMR to a child of age 7 years whose record is lost and the mother is not sure about the last dose of MMR?

In general, although it is not platonic, receiving extra doses of vaccine poses no medical problem. Nevertheless, receiving excessive doses of tetanus toxoid (e.one thousand., DTaP, DT, Tdap, or Td) tin can increment the gamble of a local adverse reaction. For details meet the Extra Doses of Vaccine Antigens section of the ACIP General All-time Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Vaccination providers ofttimes encounter people who do not have adequate documentation of vaccinations. Providers should merely 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 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 record.

If records cannot exist located or will definitely non be available anywhere because of the patient'south circumstances, children without adequate documentation should be considered susceptible and should receive age-advisable vaccination. Serologic testing for immunity is an culling to vaccination for sure antigens (e.thousand., measles, rubella, hepatitis A, diphtheria, and tetanus).

Storage and Handling Back to top

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

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

How should MMR vaccine exist stored?

MMR may be stored either in the refrigerator at 2°C to viii°C (36°F to 46°F) or in the freezer at -50°C to -xv°C (-58°F to +5°F). The diluent should non be frozen and tin be stored in the refrigerator or at room temperature.

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

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

Unfortunately, serious errors in vaccine storage and treatment similar this occur besides ofttimes. If you lot doubtable that vaccine has been mishandled, you should shop the vaccine as recommended, then contact the manufacturer or land/local health department for guidance on its use. This is particularly important for live virus vaccines like MMR and varicella.

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

It is preferable to administer MMR immediately after reconstitution. If reconstituted MMR is not used inside 8 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 and so I used normal saline instead. Is there any problem with doing this?

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

Back to height

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

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