If You Have Had Measles Before Can You Get Them Again

Measles, Mumps, and Rubella

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

Illness Issues

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

In 2019, a provisional total of 1,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a single yr since 1992; 73% of cases were associated with outbreaks among unvaccinated people in New York. These outbreaks were contained and stopped earlier the end of 2019. Between Jan ane and Baronial xix, 2020, just 12 measles cases were reported by seven jurisdictions. Limited travel equally a issue of the COVID-nineteen pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the U.s.a.. CDC measles surveillance updates can be found at www.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, there has been a more than than 99% subtract in mumps cases in the United States. However, outbreaks withal occasionally occur. In 2006, there was an outbreak affecting more than half-dozen,584 people in the United States, with many cases occurring on higher campuses. In 2009, an outbreak started in shut-knit religious communities and schools in the Northeast, resulting in more than than 3,000 cases. Since 2015, numerous outbreaks have been reported across the The states, in college campuses, prisons, and close-knit communities, including a large outbreak in northwest Arkansas where about 3,000 cases were reported in 2016. These outbreaks have shown that when people with mumps have close contact with a lot of other people (such every bit among residential college students and families in close-knit communities) mumps can spread even among vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A conditional 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 10 cases (primarily import-related) have been reported annually in the Usa since elimination was declared. Rubella incidence in the Us has decreased by more than 99% from the pre-vaccine era. A conditional full of 3 cases of rubella, and no cases of congenital rubella syndrome, were reported in 2019.

How serious are measles, mumps, and rubella?

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

Mumps most ordinarily causes fever and parotitis. Upwardly to 25% of persons with mumps accept 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 illness is typically milder, with fewer complications, in fully vaccinated case patients.

Rubella is generally a mild disease with low-class 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 significant adult female, particularly during the first trimester can effect in miscarriage, stillbirth, and birth defects including cataracts, hearing loss, mental retardation, and congenital heart defects.

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

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

• a generalized rash lasting 3 or more days, and • a temperature of 101°F or college (38.3°C or higher), and • cough, coryza, and/or conjunctivitis.

Koplik spots, a rash present on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from one to ii days before the measles rash appears to one to 2 days afterward. They announced as punctate blue-white spots on the bright ruddy background of the buccal mucosa. Pictures of measles rash and Koplik spots tin exist found at world wide web.cdc.gov/measles/nigh/photos.html.

Providers should be especially aware 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 section and obtain specimens for measles testing, including viral specimens for confirmation and genotyping. Providers should also collect blood for serologic testing during the offset clinical encounter with a person who has suspected or probable measles.

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

Measles is highly contagious. A person with measles is infectious upwards to iv days before through 4 days after the mean solar day of rash onset. Patients with suspected measles should exist isolated for 4 days after they develop a rash. Airborne precautions should exist followed in healthcare settings past all healthcare personnel. The preferred placement for patients who crave airborne precautions is in a single-patient airborne infection isolation room. Providers should immediately isolate and report suspected measles cases to their local wellness 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.S.; healthcare providers should report all cases of suspected measles to public wellness government immediately to help reduce the number of secondary cases. Do not wait for the results of laboratory testing to report clinically-suspected measles to the local wellness department.

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

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

For measles, there is an boilerplate of 10 to 12 days from exposure to the appearance of the offset symptom, which is ordinarily fever. The measles rash doesn't usually appear until approximately 14 days after exposure (range: 7 to 21 days), and the rash typically begins 2 to 4 days later on the fever begins. The incubation flow of mumps averages 16 to 18 days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation menstruation of rubella is 14 days (range: 12 to 23 days). However, as noted above, up to half of rubella virus infections cause no symptoms.

Vaccine Recommendations Back to acme

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

The near recent comprehensive ACIP recommendations for the utilise of MMR vaccine were published in 2013 and are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a second dose at historic period 4 through six years. The second dose of MMR can exist given as early equally 4 weeks (28 days) afterwards the kickoff dose and be counted every bit a valid dose if both doses were given after the child'southward first birthday. The second dose is not a booster, but rather is intended to produce immunity in the pocket-size number of people who fail to answer to the first dose.

Adults with no evidence of amnesty (prove of immunity is defined equally documented receipt of one dose [2 doses 4 weeks autonomously if high risk] of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or nativity earlier 1957) should get ane dose of MMR vaccine unless the adult is in a high-risk group. Loftier-take chances people need 2 doses and include school-age children, healthcare personnel, international travelers, and students attending post-high school educational institutions.

Alive attenuated measles vaccine became available in the U.South. in 1963. An ineffective, inactivated measles vaccine was likewise bachelor in the U.Due south. in 1963–1967. Combined MMR vaccine (MMRII, Merck) was licensed in 1971. For people who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine it was, or are sure information technology was inactivated measles vaccine, that dose should exist considered invalid and the patient revaccinated every bit age- and adventure-advisable with MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting tin can receive an boosted dose of MMR vaccine even if they are considered completely vaccinated for their age or risk condition.

What is considered adequate evidence of immunity to measles?

Acceptable presumptive prove of immunity against measles includes at least one of the following:

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

Although birth before 1957 is considered adequate testify of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do non accept other evidence of amnesty with 2 doses of MMR vaccine (minimum interval 28 days).

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

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

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

Zippo doses:

• adults born before 1957 except healthcare personnel* • adults born 1957 or later who are at depression risk (i.due east., not an international traveler or healthcare worker, or person attending college or other post-loftier school educational institution) and who have already received one or more documented doses of live measles vaccine • adults with laboratory bear witness of amnesty or laboratory confirmation of measles

1 dose of MMR vaccine:

• adults built-in 1957 or afterward who are at low risk (i.eastward., not an international traveler, healthcare worker, or person attending college or other post-loftier school educational institution) and have no documented vaccination with live measles vaccine and no laboratory testify of immunity or prior measles infection

Two doses of MMR vaccine:

� loftier-take chances adults without any prior documented alive measles vaccination and no laboratory testify 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 one (if low-gamble) or two (if high-hazard) doses of MMR vaccine.

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

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

Although nascency earlier 1957 is considered adequate evidence of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) built-in before 1957 who do not accept laboratory show of measles immunity, laboratory confirmation of disease, or vaccination with 2 appropriately spaced doses of MMR vaccine.

However, during a local outbreak of measles, all healthcare personnel, including those built-in earlier 1957, are recommended to accept ii doses of MMR vaccine at the appropriate interval if they lack laboratory evidence of measles.

Healthcare facilities should cheque with their country or local health department's immunization program for guidance. Access contact data here: www.immunize.org/coordinators.

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

MMR tin can be given to children as young equally vi months of age who are at high risk of exposure such equally during international travel or a customs outbreak. Nevertheless, doses given Earlier 12 months of historic period cannot exist counted toward the 2-dose series for MMR.

How does being born before 1957 confer immunity to measles?

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very probable to accept had measles disease. Surveys suggest that 95% to 98% of those born earlier 1957 are immune to measles. Persons born before 1957 can exist presumed to exist allowed. However, if serologic testing indicates that the person is not allowed, at least 1 dose of MMR should be administered.

Why is a second dose of MMR necessary?

Approximately vii% of people practise non develop measles immunity after the first dose of vaccine. This occurs for a variety of reasons. The second dose is to provide another take chances to develop measles amnesty for people who did non respond to the kickoff dose. About 97% of people develop amnesty to measles after 2 doses of measles-containing vaccine.

Are at that place 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 historic period who have received 2 doses of rubella-containing vaccine and accept rubella serum IgG levels that are not conspicuously positive should receive 1 additional dose of MMR vaccine (maximum of iii doses). Further testing for serologic bear witness of rubella immunity is not recommended. MMR should non exist administered to a significant adult female.

In 2018, ACIP published guidance for MMR vaccination of people at increased take a chance for acquiring mumps during an outbreak. People previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified by public health regime as beingness function 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 better protection against mumps disease and related complications. More information most this recommendation is bachelor at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

When is information technology appropriate to use MMR vaccine for measles mail-exposure prophylaxis?

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

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

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

No. Adults with evidence of immunity do non need any farther vaccines. No "booster" doses of MMR vaccine are recommended for either adults or children. They are considered to have life-long immunity once they have received the recommended number of MMR vaccine doses or accept other evidence of immunity.

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

Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more than often than killed vaccine. The killed vaccine was found to be non constructive and people who received it should exist revaccinated with alive vaccine. Without a written record, information technology is not possible to know what type of vaccine an individual may take received. So persons born during or later 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot certificate having been vaccinated or having laboratory-confirmed measles affliction should receive at least 1 dose of MMR. Some people at increased risk of exposure to measles (such equally 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 take documentation of receiving alive measles vaccine in the 1960s practice not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown blazon should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect people who may take received killed measles vaccine which was available 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 adventure for mumps infection (such equally people who work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

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

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of disease as bear witness of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease every bit evidence of immunity for measles and mumps. Physician 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 thirty years, the validity of physician-diagnosed illness has go questionable. In addition, documenting history from doctor records is not a practical option for most adults. The 2013 MMR ACIP recommendations are bachelor at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

Measles vaccine, given as MMR, may exist effective if given within the start 3 days (72 hours) afterward exposure to measles. Immune globulin may exist effective for as long as 6 days after exposure. Postexposure prophylaxis with MMR vaccine does not prevent or modify the clinical severity of mumps or rubella. However, if the exposed person does non accept evidence of mumps or rubella immunity they should be vaccinated since not all exposures consequence in infection.

What are the electric 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 utilise of mail-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 6 through 11 months, if it can be given inside 72 hours of exposure.

Pregnant women without evidence of measles amnesty 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, assistants of at least 400 mg/kg trunk weight inside 3 weeks earlier measles exposure should exist 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 consecutive weeks before measles exposure should be sufficient.

Other people who do non accept testify of measles immunity tin can receive an IGIM dose of 0.5 mL/kg of body weight. Give priority to people who were exposed to measles in settings where they have intense, prolonged close contact (such every bit household, child intendance, classroom, etc.). The maximum dose of IGIM is 15 mL.

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

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

We often run across college students who lack vaccination records, simply whose titer results bear witness they are non immune to some combination of measles, rubella, and/or mumps. What type of vaccine should these students receive?

Single antigen vaccine is no longer available in the U.S.; the student should get the combined MMR vaccine. If a college student or other person at increased run a 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 remember receiving MMR vaccine but accept no written record, or whose parents report the patient has been vaccinated. Should I have this as evidence of vaccination?

No. Self-reported doses and history of vaccination provided by a parent or other caregiver are non considered to be valid. You should only take a written, dated tape as bear witness 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 exist vaccinated without testing. Just 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 not recommend measles antibiotic testing later MMR vaccination to verify the patient'southward immune response to vaccination.

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

A patient born in 1970 has a history of measles disease and is likewise 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 test for measles-specific IgG will confirm that the person is immune and is non at risk of infection regardless of the multiple myeloma. Multiple myeloma is a hematologic cancer and is considered immunosuppressive and so MMR vaccine is contraindicated in this person.

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

Yous take 2 options. You can exam for amnesty or you can just requite two doses of MMR at to the lowest degree 4 weeks apart. There is no harm in giving MMR vaccine to a person who may already be allowed to 1 or more of the vaccine viruses. If you or the patient opt for testing, and the tests indicate the patient is non allowed to 1 or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks autonomously. If whatever examination results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination because commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity.

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

ACIP recommends 2 doses of MMR given at least four weeks apart for any adult born in 1957 or later who plans to travel internationally. In that location is no harm in giving MMR vaccine to a person who may already be immune to 1 or more of the vaccine viruses.

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

No, information technology is not considered necessary, but he may be vaccinated. Before implementation of the national measles vaccination plan in 1963, virtually every person caused measles earlier adulthood. So, this patient can exist considered allowed based on their birth year. However, MMR vaccine also may be given to whatever 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.

Nosotros have measles cases in our community. How can I all-time protect the immature children in my do?

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

In sure circumstances, MMR is recommended for infants age 6 through 11 months. Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants as immature equally age 6 months as a control mensurate during a U.S. measles outbreak. Consult your state health department to detect out if this is recommended in your situation. Practice not count any dose of MMR vaccine as part of the 2-dose serial if it is administered before a child's first birthday. Instead, repeat the dose when the kid is age 12 months.

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

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

During a mumps outbreak should we offer a tertiary dose of MMR (MMR II, Merck) to persons who accept ii prior documented doses of MMR?

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

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 ii doses of a mumps virus�containing vaccine who are identified past public health authorities as being part of a group at increased take a chance for acquiring mumps because of an outbreak should receive a tertiary dose of a mumps virus�containing vaccine to meliorate protection confronting mumps disease and related complications. More information about this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

In a measles outbreak, practice children who accept not had MMR vaccine pose a threat to vaccinated people? Information technology is my understanding that vaccinated people tin still contract measles. Am I right?

You are correct that vaccinated people tin still be infected with viruses or bacteria against which they are vaccinated. No vaccine is 100% effective. Vaccine effectiveness varies from greater than 95% (for diseases such every bit measles, rubella, and hepatitis B) to much lower (60% for influenza in years with a good match of circulating and vaccine viruses, and 70% for acellular pertussis vaccines in the 3-5 years after vaccination). More than data is available for each vaccine and disease at world wide web.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines.

Administering Vaccines Dorsum to acme

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

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

Nosotros often demand to give MMR vaccine to large adults. Is a 25-gauge needle with a length of 5/eight" sufficient for a subcutaneous injection?

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

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

Aye, all the same, this effect is not addressed in the 2010 MMRV ACIP recommendations. Although this is off-characterization utilise, 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 summit

How presently can we give the second dose of MMR vaccine to a child vaccinated at 12 months one-time?

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

Does the 4-twenty-four hour period "grace period" apply to the minimum age for administration of the first dose of MMR? What near the 28-day minimum interval between doses of MMR?

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

Tin can MMR be given on the same solar day every bit other live virus vaccines?

Yep. Yet, if two parenteral or intranasal live vaccines (MMR, varicella, LAIV and/or yellow fever) are not administered on the same twenty-four hours, they should be separated by an interval of at least 28 days.

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

The second dose of MMR may exist given as early as 4 weeks later the first dose, and be counted as a valid dose if both doses were given after the starting time birthday. The 2d dose is not a booster, but rather it is intended to produce immunity in the small number of people who neglect to respond to the first dose. The risk of measles is college in schoolhouse-age children than those of preschool age, then it is important to receive the second dose by school entry. It is also convenient to requite the second dose at this age, since the child volition have an immunization visit for other school entry vaccines.

What is the earliest historic period at which I can give MMR to an infant who will be traveling internationally? Also, which countries pose a high take chances 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 Usa, children age 6 through 11 months should receive 1 dose of MMR. The chance for measles exposure tin be high in high-, middle- and low-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to keep a re-create of their immunization records with them as they travel. For additional information on the worldwide measles state of affairs, and on CDC'southward measles vaccination information for travelers, go to wwwnc.cdc.gov/travel.

If we give a child a dose of MMR vaccine at vi 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 kid will as well need some other dose at least 28 days afterwards. For the child to be fully vaccinated, they need to have 2 doses of MMR vaccine given when the child is 12 months of historic period 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 accept an 8-calendar month-erstwhile patient who is traveling internationally. The babe needs to be protected from hepatitis A as well as measles, mumps, and rubella. The family unit is leaving in 11 days. Tin I give hepatitis A IG and MMR vaccine simultaneously?

No. IG may comprise antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in February 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age half-dozen through 11 months traveling outside the United States when protection confronting hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this historic period group. Neither vaccine is counted as function of the kid'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, folio 18.

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

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

If I give MMR to an infant traveler younger than age one yr, will 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 every bit function of the series. MMR should exist repeated when the child is age 12 through 15 months (12 months if the child remains in an area where disease adventure is loftier). The 2nd dose should be administered at least 28 days after the offset dose.

Can I requite a tuberculin skin test (TST) on the same day every bit a dose of MMR vaccine?

Yeah. A TST tin be applied earlier or on the same day that MMR vaccine is given. Nevertheless, if MMR vaccine is given on the previous day or earlier, the TST should be delayed for at least 28 days. Alive measles vaccine given prior to the awarding of a TST tin reduce the reactivity of the skin test considering of mild suppression of the immune system.

An eighteen-year-one-time college educatee 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 educatee should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is not acceptable as proof of immunity. Acceptable evidence of measles and mumps immunity includes a positive serologic test for antibody, nativity before 1957, or written documentation of vaccination. For rubella, but serologic evidence or documented vaccination should be accepted as proof of immunity. Additionally, people born prior to 1957 may be considered immune 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 four weeks (28 days) or thirty days? I have seen the yellowish fever and live virus vaccine recommendations published both ways.

The General Best Practice Guidelines for Immunization (encounter www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html) makes the generic recommendation that live parenterally or nasally administered vaccines non given on the same day should be separated by at to the lowest degree 28 days. The CDC travel health website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should exist separated by at least 30 days if possible. Either interval is acceptable.

For Healthcare Personnel Back to top

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP born during or after 1957 take adequate presumptive show of immunity to measles, mumps, and rubella, defined as documentation of two doses of measles and mumps vaccine and at least i dose of rubella vaccine, laboratory show of immunity, or laboratory confirmation of disease. Further, ACIP recommends that healthcare facilities should consider vaccination of all unvaccinated healthcare personnel who were built-in before 1957 and who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of illness. During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated by at least four weeks for unvaccinated healthcare personnel regardless of nascency twelvemonth who lack laboratory prove of measles or mumps immunity or laboratory confirmation of disease. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of birth year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease.

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

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

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

Approximately v to fifteen% of susceptible people who receive MMR vaccine volition develop a low-form fever and/or balmy rash 7 to 12 days after vaccination. However, the person is not infectious, and no special precautions ( such as exclusion from work) need to be taken.

A 22-year-onetime female person is going to chemist's shop school and the school wants her to accept a 2d dose of MMR vaccine. She had the showtime dose as a kid and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is allowed to mumps and measles but not immune to rubella. Can I give her a 2d dose of the MMR with her having measles after the offset dose?

Aye, as a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. There 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 one 24-hour interval after getting her first MMR, she must have been exposed to the disease prior to vaccination.

Contraindications and Precautions Back to top

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

• receipt of an antibody-containing blood product in the previous iii–11 months, depending on the type of blood product received. Meet www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Tabular array 3-v for more data on this issue • moderate or severe acute illness with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Important details about the contraindications and precautions for MMR vaccine are in the current MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

People with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage amidst those around them. To assistance forestall the spread of measles virus, make sure all your staff and patients who tin can be vaccinated are fully vaccinated according to the U.S. immunization schedule. Also, encourage patients to remind their family members and other close contacts to become vaccinated if they are not allowed.

If patients who cannot get MMR vaccine are exposed to measles, CDC has guidelines for allowed globulin for post-exposure prophylaxis which can be found at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

We have a patient who has selective IgA deficiency. We also have patients with selective IgM deficiency. 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 probable effective.

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

There is no demand to wait a specific interval earlier giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, and so there is no concern about safety or efficacy of MMR.

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

Aye. MMR and varicella vaccines should be given to the good for you household contacts of immunosuppressed children.

Nosotros have a 40 lb six-year-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Tin we requite the child MMR and varicella vaccine based on this methotrexate dosage?

Based on the weight and dosage provided (xl lbs and 15 mg/week), the child is currently receiving more 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 fourth dimension equally the methotrexate dosage can exist reduced. The 2013 IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/week. For additional details, see the 2013 IDSA Clinical Exercise Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/11/26/cid.cit684.full.pdf.

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

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

Tin can I give MMR to a breastfeeding mother or to a breastfed infant?

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

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

Yeah, but in that location should be sufficient fourth dimension between the blood production and the MMR to reduce the chance of interference. The interval depends on the blood product received. See Table 3-5 of ACIP's Full general Best Do Guidelines for Immunization for more data, available at www.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 time as administering RhoGam?

Yes. Receipt of RhoGam is not a reason to delay vaccination. For more information see the ACIP General All-time Do Guidelines for Immunization, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

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

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

Administer ii doses of MMR vaccine to all HIV-infected people historic period 12 months and older who do not take evidence of current severe immunosuppression or current bear witness of measles, rubella, and mumps amnesty. To be regarded as non having bear witness of current severe immunosuppression, a child age 5 years or younger must accept CD4 percentages of 15% or more for vi months or longer; a person older than 5 years must accept CD4 percentages of xv% or more and a CD4 lymphocyte count of 200 or more/mm3 for six months or longer. If laboratory results state only one blazon of parameter (percent or counts) this is sufficient for vaccine decision-making.

Administer the get-go dose at 12 through 15 months and the 2d dose to children historic period 4 through 6 years, or as early as 28 days after the first dose.

Unless they have adequate current show of measles, mumps, and rubella immunity, people with perinatal HIV infection who were vaccinated prior to establishment of constructive antiretroviral therapy (Art) should receive 2 appropriately spaced doses of MMR vaccine after effective ART has been established. Established effective ART is divers as receiving Art for at to the lowest degree six months in combination with CD4 percentages of xv% or more for 6 months or longer for children age 5 years or younger. People older than 5 years should have CD4 percentages of 15% or more and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results state but i type of parameter (percentages or counts) this is sufficient for vaccine controlling.

Pregnancy and Postpartum Considerations Back to elevation

What is the recommended length of fourth dimension a woman should wait after receiving rubella (MMR) vaccine before becoming meaning?

Although the MMR vaccine package insert recommends a 3-month deferral of pregnancy later MMR vaccination, ACIP recommends deferral of pregnancy for iv weeks. For details on this issue, encounter ACIP'southward Control and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella in Meaning 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 exist asked if they are currently pregnant or attempting to become pregnant. Vaccination should be deferred for those who respond "yes." Those who reply "no" should be advised to avoid pregnancy for 4 weeks following vaccination. Pregnancy testing is not necessary.

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

No specific activity needs to be taken other than to reassure the woman that no adverse outcomes are expected as a effect of this vaccination. MMR vaccination during pregnancy is non a reason to terminate the pregnancy. Y'all should consult with others in your healthcare setting to identify ways to prevent such vaccination errors in the futurity. Detailed information most MMR vaccination in pregnancy is included in the near recent MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

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

Tin we give an MMR to a xv-month-old whose female parent is 2 months significant?

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

If a woman's rubella exam result shows she is "non allowed" during a prenatal visit, but she has 2 documented doses of MMR vaccine, does she need a 3rd dose of MMR vaccine postpartum?

In 2013, ACIP inverse its recommendation for this situation (encounter www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20). It is recommended that women of childbearing age who have received 1 or ii doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered 1 boosted dose of MMR vaccine (maximum of 3 doses) and do not demand to be retested for serologic evidence of rubella immunity. MMR should not exist administered to a pregnant woman.

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

ACIP recommends that vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and accept a rubella serum IgG levels that is non clearly positive should be administered i boosted dose of MMR vaccine (maximum of three doses). Echo serologic testing for show of rubella immunity is non recommended. Run across www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages eighteen–twenty, for more information on this issue.

MMR vaccines should not be administered to women known to be pregnant 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 meaning for 28 days after receipt of MMR vaccine.

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

MMR tin can be administered any time later on commitment. The vaccine should be administered to a adult female who is susceptible to either measles, mumps, or rubella before infirmary discharge, even if she has received RhoGam during the hospital stay, leaves in less than 24 hours, or is breastfeeding.

Vaccine Safe Back to pinnacle

Is at that place any evidence that MMR or thimerosal causes autism?

No. This issue has been studied extensively, including a thorough review past 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 development of autism. For more data on thimerosal and vaccines in general, visit www.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

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

Merck no longer produces single antigen measles, mumps, and/or rubella vaccines for the U.S. market. Simply combined MMR is bachelor. You should educate parents almost the lack of association betwixt MMR and autism.

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

Arthralgia (joint pain) and transient arthritis (joint redness or swelling) following rubella vaccination occurs just in people who were susceptible to rubella at the fourth dimension of vaccination. Joint symptoms are uncommon in children and in adult males. About 25% of not-allowed post-pubertal women written report joint pain afterward receiving rubella vaccine, and about 10% to 30% written report arthritis-like signs and symptoms.

When joint symptoms occur, they generally begin ane to three weeks subsequently vaccination, usually are mild and non incapacitating, last about 2 days, and rarely recur.

Is there any harm in giving an extra dose of MMR to a child of historic period 7 years whose record is lost and the female parent is not certain about the last dose of MMR?

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

Vaccination providers oft encounter people who do not have acceptable documentation of vaccinations. Providers should merely accept written, dated records equally prove of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should non 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 record.

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

Storage and Handling Dorsum to top

How long can reconstituted MMR vaccine be stored in a fridge before it must be discarded?

The amount of time in which a dose of vaccine must exist used after reconstitution varies by vaccine and is usually outlined somewhere in the vaccine's package insert. MMR must be used within eight hours of reconstitution. MMRV must be used within xxx minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff education slice that outlines the time immune betwixt reconstitution and use, as stated in the bundle inserts for a number of vaccines. Handout can be found at the post-obit link: www.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine exist stored?

MMR may exist stored either in the refrigerator at two°C to eight°C (36°F to 46°F) or in the freezer at -50°C to -15°C (-58°F to +5°F). The diluent should non be frozen and can be stored in the refrigerator or at room temperature.

If the MMR is combined with varicella vaccine as MMRV (ProQuad, Merck), it must 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 employ information technology?

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

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

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

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

Only the diluent supplied with the vaccine should be used to reconstitute any vaccine. Any vaccine reconstituted with the wrong diluent should be repeated.

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

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