| Measles, Mumps, and Rubella |
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 | | | | Disease Problems | | Contraindications and Precautions | | | | | Vaccine Recommendations | | Pregnancy and Postpartum Considerations | | | | | Administering Vaccines | | Vaccine Safe | | | | | Scheduling Vaccines | | Storage and Handling | | | | | For Healthcare Personnel | | | |
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| Disease Issues |
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| What is the current situation with measles, mumps, and rubella in the The states? |
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| 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 year since 1992; 73% of cases were associated with outbreaks amongst unvaccinated people in New York. These outbreaks were contained and stopped before the end of 2019. Betwixt Jan one and August 19, 2020, just 12 measles cases were reported by vii jurisdictions. Limited travel equally a effect of the COVID-19 pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the United States. CDC measles surveillance updates can be found at www.cdc.gov/measles/cases-outbreaks.html. |
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| Since the pre-vaccine era, there has been a more than 99% subtract in mumps cases in the United States. Withal, outbreaks still occasionally occur. In 2006, there was an outbreak affecting more than half dozen,584 people in the Us, 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 3,000 cases. Since 2015, numerous outbreaks take been reported across the US, in college campuses, prisons, and shut-knit communities, including a large outbreak in northwest Arkansas where most iii,000 cases were reported in 2016. These outbreaks have shown that when people with mumps have close contact with a lot of other people (such as among residential college students and families in shut-knit communities) mumps can spread fifty-fifty among vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A provisional total of iii,484 cases of mumps were reported to CDC in 2019. |
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| Rubella was alleged eliminated (the absenteeism of endemic transmission for 12 months or more) from the Us in 2004. Fewer than 10 cases (primarily import-related) accept been reported annually in the United states since elimination was declared. Rubella incidence in the United States has decreased by more than 99% from the pre-vaccine era. A provisional total of three cases of rubella, and no cases of congenital rubella syndrome, were reported in 2019. |
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| How serious are measles, mumps, and rubella? |
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| Measles can lead to serious complications and death, even with mod medical care. The 1989–1991 measles outbreak in the U.S. resulted in more than than 55,000 cases and more 100 deaths. In the Us, from 1987 to 2000, the most ordinarily reported complications associated with measles infection were pneumonia (6%), otitis media (seven%), and diarrhea (8%). For every one,000 reported measles cases in the U.s.a., approximately one case of encephalitis and two to 3 deaths resulted. The risk for expiry from measles or its complications is greater for infants, immature children, and adults than for older children and adolescents. |
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| Mumps nearly normally causes fever and parotitis. Up to 25% of persons with mumps take few or no symptoms. Complications of mumps include orchitis (inflammation of the testicle) and oophoritis (inflammation of the ovary). Other complications of mumps include pancreatitis, deafness, aseptic meningitis, and encephalitis. Mumps illness is typically milder, with fewer complications, in fully vaccinated case patients. |
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| Rubella is generally a mild illness with depression-grade fever, lymphadenopathy, and malaise. Up to 50% of rubella virus infections are subclinical. Complications can include thrombocytopenic purpura and encephalitis. Rubella virus is teratogenic and infection in a pregnant woman, especially during the first trimester can result in miscarriage, stillbirth, and birth defects including cataracts, hearing loss, mental retardation, and congenital eye defects. |
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| What are the signs and symptoms healthcare providers should look for in diagnosing measles? |
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| Healthcare providers should doubtable measles in patients with a delirious rash illness and the clinically uniform symptoms of cough, coryza (runny nose), and/or conjunctivitis (red, watery eyes). The illness begins with a prodrome of fever and angst earlier rash onset. A clinical case of measles is defined as an affliction characterized by |
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| • | | a generalized rash lasting 3 or more days, and | | | | | • | | a temperature of 101°F or higher (38.3°C or college), and | | | | | • | | cough, coryza, and/or conjunctivitis. | |
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| Koplik spots, a rash present on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from ane to 2 days before the measles rash appears to one to 2 days afterward. They announced as punctate blue-white spots on the brilliant red background of the buccal mucosa. Pictures of measles rash and Koplik spots tin exist plant at www.cdc.gov/measles/about/photos.html. |
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| Providers should be specially 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. |
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| Providers should immediately isolate and report suspected measles cases to their local wellness department and obtain specimens for measles testing, including viral specimens for confirmation and genotyping. Providers should also collect blood for serologic testing during the first clinical meet with a person who has suspected or probable measles. |
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| What should our dispensary do if we suspect a patient has measles? |
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| Measles is highly contagious. A person with measles is infectious up to 4 days before through 4 days after the day of rash onset. Patients with suspected measles should be isolated for 4 days afterward 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 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 throat swab (or nasopharyngeal swab) for viral confirmation. |
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| Measles is a nationally notifiable disease in the U.Due south.; healthcare providers should written report all cases of suspected measles to public health authorities immediately to help reduce the number of secondary cases. Exercise not wait for the results of laboratory testing to report clinically-suspected measles to the local health department. |
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| More data on measles affliction, diagnostic testing, and infection control tin be institute at www.cdc.gov/measles/hcp/alphabetize.html. |
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| How long does information technology take to show signs of measles, mumps, and rubella subsequently existence exposed? |
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| For measles, there is an average of 10 to 12 days from exposure to the appearance of the first symptom, which is usually fever. The measles rash doesn't usually announced until approximately 14 days later exposure (range: vii to 21 days), and the rash typically begins ii to 4 days after the fever begins. The incubation period of mumps averages 16 to xviii days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation catamenia of rubella is xiv days (range: 12 to 23 days). However, as noted higher up, upward to half of rubella virus infections crusade no symptoms. |
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| Vaccine Recommendations | Dorsum to top | |
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| What are the current recommendations for the use of MMR vaccine? |
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| The most recent comprehensive ACIP recommendations for the employ of MMR vaccine were published in 2013 and are available at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a second dose at age four through 6 years. The second dose of MMR can be given as early every bit iv weeks (28 days) later on the beginning dose and be counted every bit a valid dose if both doses were given subsequently the kid's kickoff birthday. The second dose is not a booster, but rather is intended to produce immunity in the small number of people who fail to answer to the first dose. |
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| Adults with no evidence of amnesty (bear witness of amnesty is defined as documented receipt of 1 dose [ii doses four weeks autonomously if high risk] of alive measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or nativity before 1957) should become one dose of MMR vaccine unless the adult is in a loftier-risk grouping. High-risk people need ii doses and include school-age children, healthcare personnel, international travelers, and students attending mail service-loftier school educational institutions. |
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| Live attenuated measles vaccine became bachelor in the U.S. in 1963. An ineffective, inactivated measles vaccine was also available 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 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 take a chance-appropriate with MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered completely vaccinated for their age or risk status. |
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| What is considered acceptable evidence of amnesty to measles? |
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| Acceptable presumptive testify of amnesty against measles includes at least one of the post-obit: |
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| • | | written documentation of adequate vaccination: | | | | | • | | laboratory evidence of immunity | | | | | • | | laboratory confirmation of measles (verbal history of measles does not count) | | | | | • | | nascency before 1957 | |
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| Although birth before 1957 is considered acceptable bear witness of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who practice not have other testify of immunity with 2 doses of MMR vaccine (minimum interval 28 days). |
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| During an outbreak of measles, healthcare facilities should recommend two doses of MMR vaccine at the advisable interval for unvaccinated healthcare personnel regardless of birth year if they lack laboratory prove of measles immunity. |
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| For which adults are 0, ane, or two doses of MMR vaccine recommended to prevent measles? |
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| Cypher, one, or two doses of MMR vaccine are needed for the adults described beneath. |
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| Naught doses: |
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| • | | adults born earlier 1957 except healthcare personnel* | | | | | • | | adults born 1957 or subsequently who are at low gamble (i.e., not an international traveler or healthcare worker, or person attending college or other post-high school educational establishment) and who have already received one or more documented doses of alive measles vaccine | | | | | • | | adults with laboratory evidence of immunity or laboratory confirmation of measles | | | | |
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| One dose of MMR vaccine: |
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| • | | adults born 1957 or later who are at low risk (i.east., non an international traveler, healthcare worker, or person attending college or other postal service-high school educational institution) and have no documented vaccination with live measles vaccine and no laboratory evidence of immunity or prior measles infection | | | | |
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| 2 doses of MMR vaccine: |
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| � | | high-risk adults without any prior documented live measles vaccination and no laboratory show of immunity or prior measles infection, including: | | | | |
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| 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-risk) or two (if loftier-risk) doses of MMR vaccine. |
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| * Healthcare personnel born before 1957 should be considered for MMR vaccination in the absence of an outbreak, only are recommended for MMR vaccination during outbreaks. |
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| Given the risk of outbreaks of measles in the U.S., should all healthcare personnel, including those born before 1957, have 2 doses of MMR vaccine? |
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| Although birth earlier 1957 is considered acceptable bear witness of measles amnesty for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born before 1957 who practise non have laboratory evidence of measles amnesty, laboratory confirmation of illness, or vaccination with two appropriately spaced doses of MMR vaccine. |
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| However, during a local outbreak of measles, all healthcare personnel, including those born before 1957, are recommended to have 2 doses of MMR vaccine at the advisable interval if they lack laboratory evidence of measles. |
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| Healthcare facilities should check with their land or local health section's immunization program for guidance. Access contact data here: world wide web.immunize.org/coordinators. |
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| If there is an outbreak in my area, tin can nosotros vaccinate children younger than 12 months? |
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| MMR can exist given to children as immature as 6 months of historic period who are at high adventure of exposure such as during international travel or a community outbreak. However, doses given BEFORE 12 months of historic period cannot be counted toward the two-dose series for MMR. |
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| How does being built-in before 1957 confer immunity to measles? |
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| 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 take had measles disease. Surveys suggest that 95% to 98% of those built-in before 1957 are allowed to measles. Persons born earlier 1957 can exist presumed to be immune. Nevertheless, if serologic testing indicates that the person is non immune, at to the lowest degree 1 dose of MMR should be administered. |
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| Why is a second dose of MMR necessary? |
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| Approximately seven% of people practice not develop measles immunity after the outset dose of vaccine. This occurs for a variety of reasons. The second dose is to provide another adventure to develop measles amnesty for people who did not respond to the first dose. About 97% of people develop amnesty to measles after two doses of measles-containing vaccine. |
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| Are at that place any situations where more than than 2 doses of MMR are recommended? |
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| There are two circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing historic period who have received ii doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive ane additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic bear witness of rubella immunity is not recommended. MMR should non be administered to a pregnant woman. |
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| In 2018, ACIP published guidance for MMR vaccination of people at increased gamble for acquiring mumps during an outbreak. People previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified past public wellness authorities as being office of a grouping 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 meliorate protection confronting mumps disease and related complications. More information virtually this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf. |
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| When is it appropriate to use MMR vaccine for measles post-exposure prophylaxis? |
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| MMR vaccine given within 72 hours of initial measles exposure can reduce the risk of getting ill or reduce the severity of symptoms. Another option for exposed, measles-susceptible individuals at high take a chance of complications who cannot be vaccinated is to requite immunoglobulin (IG) within six days of exposure. Exercise not administrate MMR vaccine and IG simultaneously, equally the IG invalidates the vaccine. |
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| Data on post-exposure prophylaxis for measles can be found in the 2013 ACIP guidance at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 24. |
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| Do whatever adults demand "booster" doses of MMR vaccine to forbid measles? |
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| No. Adults with evidence of immunity practice non need whatever further vaccines. No "booster" doses of MMR vaccine are recommended for either adults or children. They are considered to have life-long immunity once they have received the recommended number of MMR vaccine doses or have other testify of amnesty. |
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| Many people who were immature children in the 1960s exercise not have records indicating what type of measles vaccine they received in the mid-1960s. What measles vaccine was almost ofttimes given in that time menses? That guidance would assist many older people who would prefer not to be revaccinated. |
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| Both killed and live attenuated measles vaccines became available in 1963. Live adulterate vaccine was used more than often than killed vaccine. The killed vaccine was found to be non effective and people who received it should be revaccinated with live vaccine. Without a written tape, it is not possible to know what type of vaccine an individual may have received. So persons built-in during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles illness should receive at least ane dose of MMR. Some people at increased risk of exposure to measles (such equally healthcare professionals and international travelers) should receive 2 doses of MMR separated past at least 4 weeks. |
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| Do people who received MMR in the 1960s need to have their dose repeated? |
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| Not necessarily. People who have documentation of receiving alive measles vaccine in the 1960s do not need to exist revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown blazon should be revaccinated with at to the lowest degree one dose of alive 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 effective. People vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown blazon who are at loftier run a risk for mumps infection (such equally people who piece of work in a healthcare facility) should be considered for revaccination with two doses of MMR vaccine. |
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| I understand that ACIP changed its definition of evidence of immunity to measles, rubella, and mumps in 2013. Please explain. |
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| In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of illness as evidence of amnesty for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Medico diagnosis of affliction had non previously been accepted as testify of immunity for rubella. With the decrease in measles and mumps cases over the last 30 years, the validity of physician-diagnosed disease has become questionable. In addition, documenting history from md records is not a practical selection for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. |
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| Is there anything that can exist washed for unvaccinated people who have already been exposed to measles, mumps, or rubella? |
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| Measles vaccine, given as MMR, may be constructive if given within the first three days (72 hours) after exposure to measles. Immune globulin may be 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 not have evidence of mumps or rubella amnesty they should be vaccinated since not all exposures issue in infection. |
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| What are the current ACIP recommendations for utilize of immune globulin (IG) for measles, mumps, and rubella mail-exposure prophylaxis? |
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| In the 2013 revision of its MMR vaccine recommendations ACIP expanded the employ of mail service-exposure IG prophylaxis for measles. Intramuscular IG (IGIM) should 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 trunk weight; the maximum dose is fifteen mL. Alternatively, MMR vaccine can be given instead of IGIM to infants age half dozen through eleven months, if it can be given within 72 hours of exposure. |
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| Meaning women without prove of measles immunity who are exposed to measles should receive an intravenous IG (IGIV) dose of 400 mg/kg of body weight. Severely immunocompromised people, irrespective of evidence of measles immunity or vaccination, who have been exposed to measles should receive an IGIV dose of 400 mg/kg of body weight. |
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| For persons already receiving IGIV therapy, administration of at least 400 mg/kg body weight within 3 weeks before measles exposure should be sufficient to foreclose measles infection. For patients receiving subcutaneous immune globulin (IGSC) therapy, assistants of at least 200 mg/kg torso weight for 2 consecutive weeks before measles exposure should exist sufficient. |
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| Other people who do not accept evidence of measles immunity 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 accept intense, prolonged close contact (such equally household, child care, classroom, etc.). The maximum dose of IGIM is 15 mL. |
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| 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 not be used to control measles outbreaks. |
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| IG has not been shown to prevent mumps or rubella infection afterward exposure and is non recommended for that purpose. |
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| Nosotros often see college students who lack vaccination records, only 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? |
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| Single antigen vaccine is no longer available in the U.S.; the student should become the combined MMR vaccine. If a higher pupil or other person at increased take a chance of exposure cannot produce written documentation of either immunization or disease, and titers are negative, they should receive two doses of MMR. |
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| I have patients who claim to think receiving MMR vaccine but have no written record, or whose parents written report the patient has been vaccinated. Should I accept this equally evidence of vaccination? |
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| No. Cocky-reported doses and history of vaccination provided by a parent or other caregiver are non considered to be valid. Yous should only accept a written, dated record as testify of vaccination. |
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| Under what circumstances should adults be considered for testing for measles-specific antibody prior to getting vaccinated? |
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| Adults without evidence of immunity and no contraindications to MMR vaccine tin can be vaccinated without testing. Merely adults without evidence of amnesty might exist considered for testing for measles-specific IgG antibody, but testing is non needed prior to vaccination. |
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| CDC does not recommend measles antibody testing after MMR vaccination to verify the patient'due south immune response to vaccination. |
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| Two documented doses of MMR vaccine given on or after the first birthday and separated by at least 28 days is considered proof of measles immunity, co-ordinate to ACIP. Documentation of appropriate vaccination supersedes the results of serologic testing for measles, mumps, rubella, and varicella. |
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| A patient built-in in 1970 has a history of measles disease and is as well immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, but is concerned near the measles exposure take a chance. Should the patient receive the MMR vaccine? |
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| A history of having had measles is non 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 so MMR vaccine is contraindicated in this person. |
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| We have developed patients in our practise at high adventure for measles, including patients going back to college or preparing for international travel, who don't call back ever receiving MMR vaccine or having had measles affliction. How should we manage these patients? |
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| Y'all accept two options. You can test for immunity or y'all can but give 2 doses of MMR at to the lowest degree four weeks apart. There is no damage in giving MMR vaccine to a person who may already be immune to 1 or more of the vaccine viruses. If you lot or the patient opt for testing, and the tests signal the patient is not immune to one or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks apart. If any test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination because commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity. |
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| I accept a 45-yr-one-time patient who is traveling to Haiti for a mission trip. She doesn't recall ever getting an MMR booster (she didn't get to college and never worked in health care). She was rubella allowed when pregnant xx years ago. Her measles titer is negative. Would yous recommend an MMR booster? |
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| ACIP recommends 2 doses of MMR given at least 4 weeks apart for any adult built-in in 1957 or after who plans to travel internationally. There is no harm in giving MMR vaccine to a person who may already be immune to 1 or more than of the vaccine viruses. |
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| A patient who was born before 1957 and is non a healthcare worker wants to get the MMR vaccine earlier international travel. Does he need a dose of MMR? |
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| No, it is not considered necessary, only he may be vaccinated. Before implementation of the national measles vaccination plan in 1963, nearly every person caused measles earlier adulthood. So, this patient can be considered immune based on their birth year. Yet, MMR vaccine also may be given to whatever person born before 1957 who does not have a contraindication to MMR vaccination. |
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| Routine testing of patients born earlier 1957 for measles-specific antibody is not recommended past CDC. |
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| Nosotros have measles cases in our community. How can I best protect the young children in my practice? |
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| First of all, make sure all your patients are fully vaccinated according to the U.Due south. immunization schedule. |
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| In certain circumstances, MMR is recommended for infants historic period half dozen through 11 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 every bit a control measure during a U.Southward. measles outbreak. Consult your state health department to find out if this is recommended in your situation. Practice not count any dose of MMR vaccine as function of the 2-dose series if information technology is administered before a child'due south first birthday. Instead, repeat the dose when the kid is age 12 months. |
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| In the case of a local outbreak, you also 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 2d dose 4 weeks later (at the minimum interval) instead of waiting until historic period 4 through half-dozen years. |
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| Finally, recall that infants as well young for routine vaccination and people with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. Be sure to encourage all your patients and their family unit members to become vaccinated if they are not immune. |
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| During a mumps outbreak should we offer a third dose of MMR (MMR Two, Merck) to persons who have two prior documented doses of MMR? |
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| In contempo years, mumps outbreaks have occurred primarily in populations in institutional settings with close contact (such equally residential colleges) or in shut-knit social groups. The electric current routine recommendation for ii doses of MMR vaccine appears to exist sufficient for mumps control in the general population, but bereft for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 doses of MMR vaccine is high. |
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| 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 existence function of a group at increased take a chance for acquiring mumps considering of an outbreak should receive a 3rd dose of a mumps virus�containing vaccine to ameliorate protection against mumps disease and related complications. More information about this recommendation is available at world wide web.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf. |
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| In a measles outbreak, do children who take not had MMR vaccine pose a threat to vaccinated people? It is my understanding that vaccinated people can still contract measles. Am I right? |
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| Y'all are right that vaccinated people tin can withal 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 proficient match of circulating and vaccine viruses, and seventy% for acellular pertussis vaccines in the 3-v years after vaccination). More than data is available for each vaccine and disease at www.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines. |
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| Administering Vaccines | Dorsum to tiptop | |
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| Our dispensary has been giving MMR by the wrong road (IM rather than SC) for years. Should these doses be repeated? |
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| All live injected vaccines (MMR, varicella, and xanthous fever) are recommended to be given subcutaneously. All the same, intramuscular administration of whatsoever of these vaccines is not likely to decrease immunogenicity, and doses given IM exercise not need to be repeated. |
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| We oftentimes need to give MMR vaccine to big adults. Is a 25-gauge needle with a length of 5/8" sufficient for a subcutaneous injection? |
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| Yes. A 5/8" needle is recommended for subcutaneous injections for people of all sizes. |
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| MMRV was mistakenly given to a 31-year-old instead of MMR. Tin can this be considered a valid dose? |
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| Aye, however, this upshot is non 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. |
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| Scheduling Vaccines | Dorsum to top | |
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| How presently can we give the second dose of MMR vaccine to a child vaccinated at 12 months old? |
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| For routine vaccination, children without contraindications to MMR vaccine should receive two doses of MMR vaccine with the first dose at age 12–xv months former and the second dose at historic period 4–vi years erstwhile. The minimum interval is 28 days for dose ii. If y'all have an outbreak in your community or a child is traveling internationally, and so consider using the minimum interval instead of waiting until age 4–6 years old for dose two. |
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| Does the 4-twenty-four hours "grace period" apply to the minimum age for assistants of the first dose of MMR? What about the 28-24-hour interval minimum interval between doses of MMR? |
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| A dose of MMR vaccine administered upward to 4 days earlier the first altogether may exist counted every bit valid. However, school entry requirements in some states may mandate assistants on or after the first altogether. The four-24-hour interval "grace flow" should not be applied to the 28-day minimum interval between two doses of a alive parenteral vaccine. |
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| Can MMR be given on the same mean solar day as other live virus vaccines? |
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| Yes. However, if two parenteral or intranasal live vaccines (MMR, varicella, LAIV and/or yellow fever) are not administered on the same day, they should exist separated by an interval of at least 28 days. |
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| If you can give the 2d dose of MMR as early as 28 days after the first dose, why practice we routinely wait until kindergarten entry to requite the 2d dose? |
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| The second dose of MMR may be given as early on as 4 weeks later the start dose, and exist counted as a valid dose if both doses were given afterward the first birthday. The second dose is not a booster, but rather it is intended to produce immunity in the pocket-size number of people who fail to respond to the first dose. The risk of measles is college in school-age children than those of preschool historic period, so 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 kid will have an immunization visit for other school entry vaccines. |
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| What is the primeval historic period at which I can requite MMR to an baby who will be traveling internationally? Also, which countries pose a loftier chance to children for contracting measles? |
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| 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 The states. Earlier their departure from the United States, children age 6 through 11 months should receive i dose of MMR. The gamble for measles exposure can be loftier in loftier-, heart- and low-income countries. Consequently, CDC encourages all international travelers to exist 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 data on the worldwide measles situation, and on CDC's measles vaccination information for travelers, become to wwwnc.cdc.gov/travel. |
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| If nosotros give a child a dose of MMR vaccine at 6 months of historic period considering they are in a community with cases of measles, when should nosotros give the next dose? |
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| The next dose should be given at 12 months of age. The child will also need another dose at least 28 days later. For the child to be fully vaccinated, they need to have 2 doses of MMR vaccine given when the child is 12 months of age and older. A dose given at less than 12 months of historic period does non count as part of the MMR vaccine two-dose series. |
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| I have an eight-month-old patient who is traveling internationally. The infant needs to be protected from hepatitis A also equally measles, mumps, and rubella. The family is leaving in eleven days. Can I give hepatitis A IG and MMR vaccine simultaneously? |
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| No. IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in February 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants historic period 6 through eleven months traveling outside the United states of america when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this historic period group. Neither vaccine is counted every bit office of the child's 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. |
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| Tin can I give the 2d dose of MMR earlier than historic period 4 through half dozen years (the kindergarten entry dose) to young children traveling to areas of the earth where there are measles cases? |
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| Yes. The 2nd dose of MMR can be given a minimum of 28 days afterwards the beginning dose if necessary. |
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| If I give MMR to an infant traveler younger than historic period 1 year, volition that dose be considered valid for the U.S. immunization schedule? |
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| No. A measles-containing vaccine administered more than than 4 days before the offset birthday should non be counted every bit part of the series. MMR should exist repeated when the child is age 12 through 15 months (12 months if the child remains in an expanse where disease hazard is high). The 2d dose should exist administered at least 28 days after the first dose. |
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| Tin can I give a tuberculin pare test (TST) on the aforementioned day as a dose of MMR vaccine? |
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| Yes. A TST can be practical before or on the aforementioned day that MMR vaccine is given. However, if MMR vaccine is given on the previous solar day or earlier, the TST should be delayed for at least 28 days. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin exam because of balmy suppression of the immune arrangement. |
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| An 18-year-old college student says he had both measles and mumps diseases as a preschooler, but never had MMR vaccine. Is rubella vaccine recommended in such a situation? |
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| This educatee should receive 2 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 antibiotic, birth before 1957, or written documentation of vaccination. For rubella, only serologic evidence or documented vaccination should exist accepted every bit proof of immunity. Additionally, people built-in prior to 1957 may be considered immune to rubella unless they are women who accept the potential to go significant. |
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| When non 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. |
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| 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 non given on the same day should be separated past at least 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 thirty days if possible. Either interval is acceptable. |
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| For Healthcare Personnel | Back to top | |
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| What is the recommendation for MMR vaccine for healthcare personnel? |
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| ACIP recommends that all HCP born during or after 1957 have acceptable presumptive evidence of immunity to measles, mumps, and rubella, defined as documentation of ii 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 prove of measles, mumps, and/or rubella immunity or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated by at least 4 weeks for unvaccinated healthcare personnel regardless of birth twelvemonth who lack laboratory show of measles or mumps immunity or laboratory confirmation of illness. During outbreaks of rubella, healthcare facilities should recommend i dose of MMR for unvaccinated personnel regardless of birth twelvemonth who lack laboratory bear witness of rubella immunity or laboratory confirmation of infection or disease. |
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| Would you consider healthcare personnel with 2 documented doses of MMR vaccine to be allowed even if their serology for 1 or more of the antigens comes back negative? |
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| 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 historic period-appropriate vaccination supersedes the results of subsequent serologic testing. In dissimilarity, HCP who do not have documentation of MMR vaccination and whose serologic examination is interpreted as "indeterminate" or "equivocal" should be considered non immune and should receive 2 doses of MMR vaccine (minimum interval 28 days). ACIP does not recommend serologic testing subsequently vaccination. For more information, see ACIP's recommendations on the utilize of MMR vaccine at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 22. |
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| If a healthcare worker develops a rash and depression-grade fever after MMR vaccine, is s/he infectious? |
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| Approximately 5 to xv% of susceptible people who receive MMR vaccine will develop a low-course fever and/or mild rash 7 to 12 days after vaccination. However, the person is non infectious, and no special precautions ( such as exclusion from work) need to be taken. |
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| A 22-twelvemonth-one-time female is going to pharmacy school and the school wants her to have a second dose of MMR vaccine. She had the first 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 just not immune to rubella. Can I give her a 2nd dose of the MMR with her having measles after the kickoff dose? |
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| Yep, as a healthcare professional person, this person should go a 2d dose of MMR to ensure she is immune to rubella. There is no impairment in providing MMR to a person who is already immune to 1 or more of the components. If she developed measles just 1 day later on getting her kickoff MMR, she must take been exposed to the disease prior to vaccination. |
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| Contraindications and Precautions | Dorsum to elevation | |
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| What are the contraindications and precautions for MMR vaccine? |
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| Contraindications: |
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| • | | history of a severe (anaphylactic) reaction to whatsoever vaccine component (e.g., neomycin) or following a previous dose of MMR | | | | | • | | pregnancy | | | | | • | | severe immunosuppression from either disease or therapy | |
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| Precautions: |
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| • | | receipt of an antibody-containing claret product in the previous 3–11 months, depending on the blazon of claret product received. Come across www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Table 3-5 for more information on this issue | | | | | • | | moderate or severe acute affliction with or without fever | | | | | • | | history of thrombocytopenia or thrombocytopenic purpura | | | | | • | | Important details most the contraindications and precautions for MMR vaccine are in the current MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. | |
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| We have many patients who are immunocompromised and cannot get the MMR vaccine. How should we advise our patients? |
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| People with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage amid those around them. To help preclude the spread of measles virus, brand sure all your staff and patients who tin exist vaccinated are fully vaccinated co-ordinate to the U.S. immunization schedule. Also, encourage patients to remind their family members and other close contacts to get vaccinated if they are not immune. |
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| If patients who cannot get MMR vaccine are exposed to measles, CDC has guidelines for allowed globulin for post-exposure prophylaxis which can be constitute at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. |
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| We have a patient who has selective IgA deficiency. We likewise have patients with selective IgM deficiency. Tin can MMR or varicella vaccine be administered to these patients? |
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| 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 constructive. |
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| I take a patient who is traveling internationally and needs MMR vaccine. He recently received an injectable steroid. How long should he look before receiving MMR vaccine? |
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| In that location is no need to await a specific interval before giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, and and then at that place is no concern virtually rubber or efficacy of MMR. |
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| Tin can I requite MMR to a kid whose sibling is receiving chemotherapy for leukemia? |
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| Yes. MMR and varicella vaccines should be given to the salubrious household contacts of immunosuppressed children. |
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| We have a 40 lb vi-year-old patient who has been taking xv mg of methotrexate weekly for arthritis for 12 months. Can we give the child MMR and varicella vaccine based on this methotrexate dosage? |
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| Based on the weight and dosage provided (40 lbs and 15 mg/calendar week), the child is currently receiving more than 0.4 mg/kg/calendar week of methotrexate. This meets the Infectious Disease Society of America (IDSA) definition of loftier-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced. The 2013 IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/calendar week. For boosted details, run across the 2013 IDSA Clinical Do Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early on/2013/11/26/cid.cit684.full.pdf. |
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| Is it true that egg allergy is not considered a contraindication to MMR vaccine? |
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| Several studies take documented the safety of measles and mumps vaccine (which are grown in chick embryo tissue civilization) in children with astringent egg allergy. Neither the American Academy of Pediatrics nor ACIP consider egg allergy as a contraindication to MMR vaccine. ACIP recommends routine vaccination of egg-allergic children without the use of special protocols or desensitization procedures. |
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| Can I requite MMR to a breastfeeding female parent or to a breastfed infant? |
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| Yes. Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no risk to the infant existence breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the infant is asymptomatic. |
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| If a patient recently received a claret product, can he or she receive MMR vaccine? |
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| Yes, but there should be sufficient time betwixt the blood product and the MMR to reduce the take chances of interference. The interval depends on the blood product received. Encounter Table 3-five of ACIP's General Best Practice Guidelines for Immunization for more data, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html. |
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| Is information technology acceptable practise to administer MMR, Tdap, and flu vaccines to a postpartum mom at the same time as administering RhoGam? |
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| Aye. Receipt of RhoGam is not a reason to delay vaccination. For more information meet the ACIP General Best Practice Guidelines for Immunization, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html. |
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| Delight describe the electric current ACIP recommendations for the utilize of MMR vaccine in people who are infected with HIV. |
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| ACIP recommendations for vaccinating people with HIV infection were revised in 2013. The current recommendations are as follows: |
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| Administer ii doses of MMR vaccine to all HIV-infected people age 12 months and older who practise not accept evidence of electric current severe immunosuppression or current evidence of measles, rubella, and mumps immunity. To be regarded as non having evidence of current severe immunosuppression, a kid age 5 years or younger must have CD4 percentages of 15% or more than for 6 months or longer; a person older than 5 years must have CD4 percentages of 15% or more than and a CD4 lymphocyte count of 200 or more/mm3 for half dozen months or longer. If laboratory results country only one blazon of parameter (percent or counts) this is sufficient for vaccine decision-making. |
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| Administer the first dose at 12 through 15 months and the 2d dose to children age 4 through half-dozen years, or as early on as 28 days after the start dose. |
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| Unless they have acceptable current evidence of measles, mumps, and rubella amnesty, people with perinatal HIV infection who were vaccinated prior to institution of constructive antiretroviral therapy (ART) should receive ii appropriately spaced doses of MMR vaccine subsequently constructive Fine art has been established. Established constructive Fine art is defined every bit receiving Fine art for at least 6 months in combination with CD4 percentages of 15% or more than for 6 months or longer for children age 5 years or younger. People older than five years should take CD4 percentages of 15% or more and a CD4 lymphocyte count of 200 or more/mm3 for six months or longer. If laboratory results state only one type of parameter (percentages or counts) this is sufficient for vaccine decision-making. |
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| Pregnancy and Postpartum Considerations | Dorsum to top | |
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| What is the recommended length of time a woman should look after receiving rubella (MMR) vaccine before becoming significant? |
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| Although the MMR vaccine bundle insert recommends a 3-month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for 4 weeks. For details on this result, see ACIP's Control and Prevention of Rubella: Evaluation and Direction of Suspected Outbreaks, Rubella in Pregnant Women, and Surveillance for Congenital Rubella Syndrome. |
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| How should teenage girls and women of child-bearing age be screened for pregnancy before MMR vaccination? |
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| ACIP recommends that women of childbearing age exist asked if they are currently meaning or attempting to become significant. Vaccination should exist deferred for those who answer "yes." Those who answer "no" should be advised to avoid pregnancy for 4 weeks following vaccination. Pregnancy testing is not necessary. |
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| If a meaning adult female inadvertently receives MMR vaccine, how should she be brash? |
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| No specific activity needs to be taken other than to reassure the woman that no agin outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy is 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 hereafter. Detailed information almost MMR vaccination in pregnancy is included in the most recent MMR ACIP argument, available at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf. |
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| Nosotros require a pregnancy test for all our 7th graders earlier giving an MMR. Is this necessary? |
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| No. ACIP recommends that women of childbearing age be asked if they are currently significant or attempting to get significant. Vaccination should be deferred for those who answer "yes." Those who answer "no" should be brash to avoid pregnancy for one calendar month post-obit vaccination. |
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| Can nosotros give an MMR to a 15-month-old whose mother is 2 months pregnant? |
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| Yes. Measles, mumps, and rubella vaccine viruses are not transmitted from the vaccinated person, so MMR vaccination of a household contact does not pose a risk to a pregnant household member. |
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| If a woman's rubella test result shows she is "not immune" during a prenatal visit, but she has 2 documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum? |
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| In 2013, ACIP inverse its recommendation for this situation (run across www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages xviii–20). It is recommended that women of childbearing historic period who have received 1 or two doses of rubella-containing vaccine and have rubella serum IgG levels that are non clearly positive should be administered 1 additional dose of MMR vaccine (maximum of iii doses) and practise non need to exist retested for serologic evidence of rubella immunity. MMR should not be administered to a meaning woman. |
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| I have a female patient who has a non-immune rubella titer two months after her second MMR vaccination. Should she be revaccinated? If and then, should the titer again be checked to decide seroconversion? |
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| ACIP recommends that vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not conspicuously positive should exist administered one additional dose of MMR vaccine (maximum of three doses). Repeat serologic testing for evidence of rubella immunity is not recommended. Encounter www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–twenty, for more data on this issue. |
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| MMR vaccines should not exist administered to women known to exist pregnant or attempting to get pregnant. Considering of the theoretical risk to the fetus when the mother receives a live virus vaccine, women should be counseled to avoid condign meaning for 28 days after receipt of MMR vaccine. |
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| How before long afterwards commitment tin can MMR be given to the mother? |
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| MMR can be administered whatsoever time afterwards delivery. The vaccine should be administered to a woman who is susceptible to either measles, mumps, or rubella earlier hospital discharge, fifty-fifty if she has received RhoGam during the hospital stay, leaves in less than 24 hours, or is breastfeeding. |
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| Vaccine Safety | Back to elevation | |
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| Is in that location any testify that MMR or thimerosal causes autism? |
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| No. This outcome has been studied extensively, including a thorough review by the contained Institute of Medicine (IOM). The IOM issued a study in 2004 that concluded at that place is no evidence supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. For more than information on thimerosal and vaccines in general, visit www.cdc.gov/vaccinesafety/Concerns/thimerosal/alphabetize.html. |
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| A few parents are asking that their children receive dissever components of the MMR vaccine because they fear MMR may be linked to autism. What should I do? |
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| Merck no longer produces single antigen measles, mumps, and/or rubella vaccines for the U.S. market. Simply combined MMR is available. You should educate parents about the lack of association between MMR and autism. |
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| How probable is it for a person to develop arthritis from rubella vaccine? |
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| Arthralgia (joint pain) and transient arthritis (joint redness or swelling) following rubella vaccination occurs only in people who were susceptible to rubella at the time of vaccination. Joint symptoms are uncommon in children and in adult males. About 25% of not-immune post-pubertal women written report joint pain after receiving rubella vaccine, and well-nigh 10% to xxx% study arthritis-like signs and symptoms. |
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| When joint symptoms occur, they more often than not begin 1 to 3 weeks subsequently vaccination, usually are mild and not incapacitating, concluding about 2 days, and rarely recur. |
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| Is there whatever impairment in giving an actress dose of MMR to a child of age seven years whose record is lost and the mother is not sure nigh the final dose of MMR? |
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| In general, although information technology is not ideal, receiving extra doses of vaccine poses no medical problem. All the same, receiving excessive doses of tetanus toxoid (e.g., DTaP, DT, Tdap, or Td) tin increase the risk of a local adverse reaction. For details run across the Extra Doses of Vaccine Antigens department of the ACIP General All-time Do Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html. |
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| Vaccination providers oftentimes encounter people who do not have adequate documentation of vaccinations. Providers should just accept written, dated records every bit evidence of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should not exist accepted. An effort to locate missing records should be fabricated whenever possible by contacting previous healthcare providers, reviewing state or local immunization data systems, and searching for a personally held tape. |
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| If records cannot be located or will definitely not exist bachelor anywhere because of the patient's circumstances, children without adequate documentation should exist considered susceptible and should receive age-advisable vaccination. Serologic testing for immunity is an alternative to vaccination for certain antigens (due east.thousand., measles, rubella, hepatitis A, diphtheria, and tetanus). |
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| Storage and Treatment | Dorsum to top | |
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| How long can reconstituted MMR vaccine be stored in a refrigerator earlier it must exist discarded? |
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| The corporeality of time in which a dose of vaccine must be used after reconstitution varies past vaccine and is unremarkably outlined somewhere in the vaccine'south package insert. MMR must be used inside viii hours of reconstitution. MMRV must exist used within 30 minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff pedagogy piece that outlines the time allowed between reconstitution and use, equally stated in the packet inserts for a number of vaccines. Handout can be institute at the post-obit link: www.immunize.org/catg.d/p3040.pdf. |
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| How should MMR vaccine be stored? |
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| MMR may be stored either in the fridge at ii°C to 8°C (36°F to 46°F) or in the freezer at -50°C to -15°C (-58°F to +5°F). The diluent should non exist frozen and can exist stored in the refrigerator or at room temperature. |
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| If the MMR is combined with varicella vaccine as MMRV (ProQuad, Merck), it must be stored in the freezer at -50°C to -fifteen°C (-58°F to +5°F). |
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| A box of MMR vaccine (not reconstituted) was left at room temperature overnight. Tin I apply it? |
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| Unfortunately, serious errors in vaccine storage and handling like this occur too often. If yous doubtable that vaccine has been mishandled, you should store the vaccine as recommended, and then contact the manufacturer or state/local health department for guidance on its use. This is particularly important for live virus vaccines like MMR and varicella. |
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| In one case MMR vaccine has been reconstituted with diluent, how soon must it be used? |
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| 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. |
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| I misplaced the diluent for the MMR dose so I used normal saline instead. Is at that place whatsoever problem with doing this? |
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| Only the diluent supplied with the vaccine should be used to reconstitute any vaccine. Any vaccine reconstituted with the incorrect diluent should be repeated. |
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