If Youve Had Measles Before Can You Get It Again

Measles, Mumps, and Rubella

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

Disease Problems

What is the current state of affairs with measles, mumps, and rubella in the Usa?

In 2019, a provisional full of i,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 amid unvaccinated people in New York. These outbreaks were contained and stopped before the stop of 2019. Between January one and August 19, 2020, merely 12 measles cases were reported by 7 jurisdictions. Limited travel every bit a effect of the COVID-19 pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the U.s.a.. CDC measles surveillance updates can be establish at www.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, there has been a more than 99% decrease in mumps cases in the United States. All the same, outbreaks nonetheless occasionally occur. In 2006, there was an outbreak affecting more than than half-dozen,584 people in the United States, with many cases occurring on higher campuses. In 2009, an outbreak started in close-knit religious communities and schools in the Northeast, resulting in more iii,000 cases. Since 2015, numerous outbreaks have been reported beyond the Us, in higher campuses, prisons, and shut-knit communities, including a large outbreak in northwest Arkansas where almost three,000 cases were reported in 2016. These outbreaks have shown that when people with mumps accept shut contact with a lot of other people (such as among residential college students and families in close-knit communities) mumps tin can spread fifty-fifty among vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A conditional full of iii,484 cases of mumps were reported to CDC in 2019.

Rubella was declared eliminated (the absenteeism of endemic manual for 12 months or more) from the U.s.a. in 2004. Fewer than x cases (primarily import-related) take been reported annually in the Us since elimination was alleged. Rubella incidence in the United states of america has decreased past 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 tin can lead to serious complications and expiry, even with modern medical care. The 1989–1991 measles outbreak in the U.S. resulted in more than than 55,000 cases and more than than 100 deaths. In the United States, from 1987 to 2000, the nearly commonly reported complications associated with measles infection were pneumonia (6%), otitis media (7%), and diarrhea (viii%). For every 1,000 reported measles cases in the United States, approximately one case of encephalitis and 2 to three deaths resulted. The risk for expiry from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

Mumps most commonly causes fever and parotitis. Up 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 more often than not a mild illness with low-grade fever, lymphadenopathy, and malaise. Upward 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, particularly during the start trimester can result in miscarriage, stillbirth, and nascence defects including cataracts, hearing loss, mental retardation, and built heart defects.

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

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

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

Koplik spots, a rash present on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from i to two days earlier the measles rash appears to one to 2 days later on. They appear every bit punctate blue-white spots on the bright red background of the buccal mucosa. Pictures of measles rash and Koplik spots can be found at world wide web.cdc.gov/measles/about/photos.html.

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

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

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

Measles is highly contagious. A person with measles is infectious upwardly to 4 days before through 4 days after the day of rash onset. Patients with suspected measles should be isolated for four days after they develop a rash. Airborne precautions should be followed in healthcare settings by all healthcare personnel. The preferred placement for patients who require airborne precautions is in a single-patient airborne infection isolation room. Providers should immediately isolate and report suspected measles cases to their local health department and obtain specimens for measles testing, including serum sample for measles serologic testing and a throat swab (or nasopharyngeal swab) for viral confirmation.

Measles is a nationally notifiable disease in the U.Due south.; healthcare providers should report all cases of suspected measles to public wellness authorities 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 health department.

More data on measles affliction, diagnostic testing, and infection control can be institute at www.cdc.gov/measles/hcp/index.html.

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

For measles, there is an average of 10 to 12 days from exposure to the advent of the first symptom, which is usually fever. The measles rash doesn't unremarkably appear until approximately 14 days after exposure (range: 7 to 21 days), and the rash typically begins two to 4 days after the fever begins. The incubation period of mumps averages 16 to eighteen days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation period of rubella is 14 days (range: 12 to 23 days). Even so, equally noted above, up to half of rubella virus infections crusade no symptoms.

Vaccine Recommendations Dorsum to top

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

The most recent comprehensive ACIP recommendations for the use 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 fifteen months, with a 2nd dose at historic period 4 through vi years. The second dose of MMR tin exist given every bit early on every bit 4 weeks (28 days) after the first dose and be counted as a valid dose if both doses were given subsequently the kid's first altogether. The 2d dose is not a booster, only rather is intended to produce immunity in the small number of people who fail to respond to the start dose.

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

Live adulterate measles vaccine became available in the U.Due south. in 1963. An ineffective, inactivated measles vaccine was too bachelor in the U.South. in 1963–1967. Combined MMR vaccine (MMRII, Merck) was licensed in 1971. For people who previously received a dose of measles vaccine in 1963–1967 and are unsure which blazon of vaccine information technology was, or are sure it was inactivated measles vaccine, that dose should be considered invalid and the patient revaccinated as age- and chance-appropriate with MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting tin receive an additional dose of MMR vaccine fifty-fifty if they are considered completely vaccinated for their age or risk status.

What is considered acceptable bear witness of immunity to measles?

Acceptable presumptive testify of amnesty confronting measles includes at least one of the following:

• written documentation of adequate vaccination: • laboratory evidence of immunity • laboratory confirmation of measles (verbal history of measles does non count) • birth before 1957

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

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

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

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

Zero doses:

• adults built-in before 1957 except healthcare personnel* • adults born 1957 or afterward who are at low adventure (i.e., not an international traveler or healthcare worker, or person attention higher or other post-loftier schoolhouse educational establishment) and who take already received one or more documented doses of alive measles vaccine • adults with laboratory evidence of immunity or laboratory confirmation of measles

Ane dose of MMR vaccine:

• adults born 1957 or afterward who are at depression risk (i.due east., not an international traveler, healthcare worker, or person attention college or other post-high school educational institution) and have no documented vaccination with live measles vaccine and no laboratory evidence of amnesty or prior measles infection

Two doses of MMR vaccine:

� high-risk adults without whatever prior documented live 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 sure it was inactivated measles vaccine, should exist revaccinated with either one (if low-risk) or two (if high-risk) doses of MMR vaccine.

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

Given the risk of outbreaks of measles in the U.Due south., should all healthcare personnel, including those built-in earlier 1957, have 2 doses of MMR vaccine?

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

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

Healthcare facilities should cheque with their land or local wellness department's immunization plan for guidance. Access contact information here: www.immunize.org/coordinators.

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

MMR can be given to children as young as vi months of age who are at loftier risk of exposure such as during international travel or a community outbreak. However, doses given Earlier 12 months of historic period cannot exist counted toward the ii-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 consequence, these people are very likely to have had measles affliction. Surveys suggest that 95% to 98% of those born earlier 1957 are immune to measles. Persons built-in before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least one dose of MMR should be administered.

Why is a second dose of MMR necessary?

Approximately vii% of people do not develop measles immunity after the first dose of vaccine. This occurs for a multifariousness of reasons. The second dose is to provide another chance to develop measles immunity for people who did non respond to the first dose. About 97% of people develop immunity to measles later on two doses of measles-containing vaccine.

Are at that place whatever situations where more than two doses of MMR are recommended?

There are two circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing age who have received 2 doses of rubella-containing vaccine and take rubella serum IgG levels that are not conspicuously positive should receive i additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. MMR should not be administered to a pregnant woman.

In 2018, ACIP published guidance for MMR vaccination of people at increased adventure for acquiring mumps during an outbreak. People previously vaccinated with two doses of a mumps virus�containing vaccine who are identified past public health government every bit being office of a group or population at increased take a chance for acquiring mumps considering 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 about this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

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

MMR vaccine given inside 72 hours of initial measles exposure tin reduce the adventure of getting sick or reduce the severity of symptoms. Another option for exposed, measles-susceptible individuals at high adventure of complications who cannot be vaccinated is to give immunoglobulin (IG) within vi days of exposure. Do not administer MMR vaccine and IG simultaneously, equally the IG invalidates the vaccine.

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

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

No. Adults with evidence of amnesty do not need any further vaccines. No "booster" doses of MMR vaccine are recommended for either adults or children. They are considered to accept life-long amnesty once they take received the recommended number of MMR vaccine doses or have other evidence of immunity.

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 nearly frequently given in that fourth dimension menstruation? That guidance would help many older people who would prefer not to exist revaccinated.

Both killed and alive 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 not constructive and people who received it should exist revaccinated with live vaccine. Without a written record, information technology is not possible to know what blazon of vaccine an individual may take received. And then persons born during or later 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles disease should receive at to the lowest degree 1 dose of MMR. Some people at increased adventure of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least four weeks.

Do people who received MMR in the 1960s need to accept their dose repeated?

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

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

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of disease as show of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Doctor diagnosis of disease 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 go questionable. In addition, documenting history from physician records is non a applied option for virtually adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

Measles vaccine, given as MMR, may exist effective if given inside the showtime 3 days (72 hours) after exposure to measles. Immune globulin may be effective for as long as half-dozen days after exposure. Postexposure prophylaxis with MMR vaccine does not prevent or modify the clinical severity of mumps or rubella. Yet, if the exposed person does non have evidence of mumps or rubella amnesty they should be vaccinated since non all exposures event in infection.

What are the current ACIP recommendations for use of immune globulin (IG) for measles, mumps, and rubella post-exposure prophylaxis?

In the 2013 revision of its MMR vaccine recommendations ACIP expanded the 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 tin exist given instead of IGIM to infants age 6 through 11 months, if it tin can be given within 72 hours of exposure.

Pregnant women without prove 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 bear witness 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 within 3 weeks before measles exposure should exist sufficient to prevent measles infection. For patients receiving subcutaneous allowed globulin (IGSC) therapy, administration of at to the lowest degree 200 mg/kg body weight for ii consecutive weeks before measles exposure should be sufficient.

Other people who do non have testify of measles immunity can receive an IGIM dose of 0.v mL/kg of torso weight. Give priority to people who were exposed to measles in settings where they take intense, prolonged shut contact (such every bit household, child care, classroom, etc.). The maximum dose of IGIM is 15 mL.

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

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

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

Single antigen vaccine is no longer available in the U.S.; the student should get the combined MMR vaccine. If a higher student or other person at increased hazard of exposure cannot produce written documentation of either immunization or disease, and titers are negative, they should receive two doses of MMR.

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

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

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

Adults without evidence of immunity and no contraindications to MMR vaccine can be vaccinated without testing. Merely adults without prove of amnesty might exist considered for testing for measles-specific IgG antibody, simply testing is non needed prior to vaccination.

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

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

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

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

Nosotros have developed patients in our exercise at high risk for measles, including patients going back to college or preparing for international travel, who don't retrieve e'er receiving MMR vaccine or having had measles disease. How should we manage these patients?

You have two options. You can examination for immunity or you lot tin can just give 2 doses of MMR at to the lowest degree four weeks apart. There is no harm in giving MMR vaccine to a person who may already exist immune 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 one or more of the vaccine components, requite your patient 2 doses of MMR at least 4 weeks apart. If whatsoever test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination because commercial tests may non exist sensitive enough to reliably find vaccine-induced amnesty.

I have a 45-year-sometime patient who is traveling to Haiti for a mission trip. She doesn't recall ever getting an MMR booster (she didn't go to college and never worked in health care). She was rubella immune when pregnant 20 years ago. Her measles titer is negative. Would you recommend an MMR booster?

ACIP recommends 2 doses of MMR given at least 4 weeks apart for whatsoever adult built-in in 1957 or later who plans to travel internationally. There is no harm in giving MMR vaccine to a person who may already be allowed to i or more of the vaccine viruses.

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

No, it is not considered necessary, but he may be vaccinated. Before implementation of the national measles vaccination plan in 1963, nearly every person acquired measles before machismo. And so, this patient can be considered allowed based on their birth yr. Notwithstanding, MMR vaccine too may be given to whatsoever person born before 1957 who does not have a contraindication to MMR vaccination.

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

We have measles cases in our community. How can I all-time protect the young children in my practice?

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

In certain circumstances, MMR is recommended for infants age half-dozen through 11 months. Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants as immature as age 6 months every bit a control measure during a U.S. measles outbreak. Consult your state health department to find out if this is recommended in your situation. Exercise not count whatever dose of MMR vaccine every bit office of the two-dose series if it is administered earlier a child's first birthday. Instead, repeat the dose when the child is historic period 12 months.

In the example of a local outbreak, you also 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 after (at the minimum interval) instead of waiting until age 4 through 6 years.

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

During a mumps outbreak should nosotros offer a tertiary dose of MMR (MMR Ii, Merck) to persons who have two prior documented doses of MMR?

In contempo years, mumps outbreaks have occurred primarily in populations in institutional settings with shut contact (such as residential colleges) or in shut-knit social groups. The current routine recommendation for two doses of MMR vaccine appears to be sufficient for mumps control in the general population, simply insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 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 take a chance for acquiring mumps during an outbreak. Persons previously vaccinated with ii doses of a mumps virus�containing vaccine who are identified by public health government equally being function of a grouping at increased risk for acquiring mumps because of an outbreak should receive a tertiary dose of a mumps virus�containing vaccine to improve protection against mumps illness and related complications. More information nigh this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

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

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

Administering Vaccines Dorsum to top

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

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

Nosotros often need to give MMR vaccine to large adults. Is a 25-gauge needle with a length of 5/8" sufficient for a subcutaneous injection?

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

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

Yep, however, this outcome is not addressed in the 2010 MMRV ACIP recommendations. Although this is off-label utilize, CDC recommends that when a dose of MMRV is inadvertently given to a patient historic period thirteen years and older, it may exist counted towards completion of the MMR and varicella vaccine series and does non need to be repeated.

Scheduling Vaccines Dorsum to top

How shortly can we give the 2d dose of MMR vaccine to a child vaccinated at 12 months old?

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

Does the 4-mean solar day "grace period" employ to the minimum age for administration of the first dose of MMR? What about the 28-day minimum interval betwixt doses of MMR?

A dose of MMR vaccine administered up to 4 days before the first birthday may be counted as valid. However, school entry requirements in some states may mandate assistants on or after the start birthday. The four-mean solar day "grace period" should non be applied to the 28-day minimum interval between 2 doses of a alive parenteral vaccine.

Tin can MMR exist given on the same day as other alive virus vaccines?

Yes. Yet, if two parenteral or intranasal live vaccines (MMR, varicella, LAIV and/or yellow fever) are non administered on the same day, they should be separated by an interval of at to the lowest degree 28 days.

If you tin can give the second dose of MMR as early as 28 days later the beginning dose, why practise we routinely expect until kindergarten entry to give the second dose?

The second dose of MMR may exist given as early as four weeks later on the kickoff dose, and be counted equally a valid dose if both doses were given after the first birthday. The 2nd dose is non a booster, only rather information technology is intended to produce immunity in the small number of people who fail to answer to the first dose. The risk of measles is college in school-historic period children than those of preschool age, so it is of import to receive the second dose by school entry. Information technology is also convenient to requite the 2d dose at this age, since the child will accept an immunization visit for other school entry vaccines.

What is the earliest age at which I can give MMR to an baby who volition be traveling internationally? Likewise, which countries pose a high risk to children for contracting measles?

ACIP recommends that children who travel or live away should exist vaccinated at an earlier age than that recommended for children who reside in the United States. Earlier their departure from the United States, children age 6 through 11 months should receive one dose of MMR. The risk for measles exposure tin exist high in high-, middle- and depression-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 copy of their immunization records with them every bit they travel. For additional information on the worldwide measles situation, and on CDC's measles vaccination information for travelers, go to wwwnc.cdc.gov/travel.

If we requite a child a dose of MMR vaccine at half dozen months of age because they are in a community with cases of measles, when should we give the adjacent dose?

The side by side dose should be given at 12 months of age. The kid will besides demand 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 age does not count every bit role of the MMR vaccine two-dose series.

I accept an 8-calendar month-former patient who is traveling internationally. The infant needs to exist protected from hepatitis A besides every bit measles, mumps, and rubella. The family unit is leaving in xi days. Can I give hepatitis A IG and MMR vaccine simultaneously?

No. IG may 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 6 through xi months traveling exterior the United States when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this historic period group. Neither vaccine is counted as part of the child's routine vaccination series. For details of this recommendation, meet the CDC ACIP recommendations for the prevention and command of hepatitis A at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page 18.

Can I requite the second dose of MMR earlier than age 4 through 6 years (the kindergarten entry dose) to young children traveling to areas of the world where there are measles cases?

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

If I requite MMR to an infant traveler younger than age 1 year, will that dose exist 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 as 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 illness take a chance is high). The 2d dose should exist administered at least 28 days after the offset dose.

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

Yeah. A TST can be applied earlier or on the aforementioned day that MMR vaccine is given. Yet, if MMR vaccine is given on the previous 24-hour interval 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 peel test because of mild suppression of the immune system.

An 18-yr-onetime college student says he had both measles and mumps diseases as a preschooler, but never had MMR vaccine. Is rubella vaccine recommended in such a situation?

This student should receive two doses of MMR, separated past at to the lowest degree 28 days. A personal history of measles and mumps is non adequate as proof of immunity. Acceptable prove of measles and mumps amnesty includes a positive serologic test for antibody, birth before 1957, or written documentation of vaccination. For rubella, just serologic evidence or documented vaccination should be accepted as proof of immunity. Additionally, people born prior to 1957 may be considered allowed to rubella unless they are women who have the potential to become pregnant.

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

The General Best Practice Guidelines for Immunization (see www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html) makes the generic recommendation that live parenterally or nasally administered vaccines not given on the same twenty-four hour period 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 be separated by at least xxx days if possible. Either interval is acceptable.

For Healthcare Personnel Back to peak

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP born during or after 1957 take acceptable presumptive evidence of immunity to measles, mumps, and rubella, defined equally documentation of two doses of measles and mumps vaccine and at least one dose of rubella vaccine, laboratory prove of immunity, or laboratory confirmation of disease. Further, ACIP recommends that healthcare facilities should consider vaccination of all unvaccinated healthcare personnel who were born before 1957 and who lack laboratory evidence of measles, mumps, and/or rubella amnesty or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated by at least 4 weeks for unvaccinated healthcare personnel regardless of nascency year who lack laboratory evidence of measles or mumps amnesty or laboratory confirmation of affliction. During outbreaks of rubella, healthcare facilities should recommend ane dose of MMR for unvaccinated personnel regardless of nascence twelvemonth who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease.

Would you consider healthcare personnel with ii documented doses of MMR vaccine to exist allowed even if their serology for 1 or more of the antigens comes back negative?

Aye. Healthcare personnel (HCP) with ii documented doses of MMR vaccine are considered to exist immune regardless of the results of a subsequent serologic test for measles, mumps, or rubella. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who do not have documentation of MMR vaccination and whose serologic test is interpreted as "indeterminate" or "equivocal" should 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, run into ACIP'southward recommendations on the utilize 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 after MMR vaccine, is s/he infectious?

Approximately five to fifteen% of susceptible people who receive MMR vaccine will develop a depression-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.

A 22-twelvemonth-sometime female is going to pharmacy school and the school wants her to have a second dose of MMR vaccine. She had the get-go dose every bit a kid and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles simply not immune to rubella. Can I give her a 2d dose of the MMR with her having measles afterward the first dose?

Aye, as a healthcare professional, this person should get a second dose of MMR to ensure she is allowed to rubella. There is no harm in providing MMR to a person who is already immune to i or more of the components. If she developed measles only ane 24-hour interval afterward getting her get-go MMR, she must have been exposed to the disease prior to vaccination.

Contraindications and Precautions Dorsum to acme

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

• receipt of an antibody-containing blood product in the previous 3–11 months, depending on the type of blood product received. See www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Table three-5 for more than information on this issue • moderate or severe acute illness with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Important details near the contraindications and precautions for MMR vaccine are in the electric current MMR ACIP argument, available at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

We take many patients who are immunocompromised and cannot go the MMR vaccine. How should we advise our patients?

People with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. To help prevent the spread of measles virus, brand sure all your staff and patients who can exist vaccinated are fully vaccinated according to the U.S. immunization schedule. Also, encourage patients to remind their family unit members and other close contacts to get vaccinated if they are not immune.

If patients who cannot become MMR vaccine are exposed to measles, CDC has guidelines for immune globulin for post-exposure prophylaxis which can be establish at www.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?

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

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

In that location is no need to await a specific interval before giving MMR. Injectable steroids are non considered immunosuppressive for the purpose of vaccination decisions, and so there is no concern about prophylactic or efficacy of MMR.

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

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

Nosotros have a 40 lb six-twelvemonth-quondam patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can nosotros give the kid MMR and varicella vaccine based on this methotrexate dosage?

Based on the weight and dosage provided (40 lbs and fifteen mg/week), the child is currently receiving more than 0.4 mg/kg/week of methotrexate. This meets the Communicable diseases Society of America (IDSA) definition of loftier-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time equally the methotrexate dosage can be reduced. The 2013 IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0.four mg/kg/calendar week. For additional details, see the 2013 IDSA Clinical Exercise Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early on/2013/11/26/cid.cit684.total.pdf.

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

Several studies have documented the safety of measles and mumps vaccine (which are grown in chick embryo tissue culture) in children with astringent 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 I give MMR to a breastfeeding mother or to a breastfed infant?

Yes. Breastfeeding does non 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 chest milk, the infection in the infant is asymptomatic.

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

Yes, but there should be sufficient time between the blood product and the MMR to reduce the chance of interference. The interval depends on the blood product received. See Table 3-five of ACIP's 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 do to administrate MMR, Tdap, and influenza vaccines to a postpartum mom at the same time as administering RhoGam?

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

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

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

Administer 2 doses of MMR vaccine to all HIV-infected people historic period 12 months and older who do not accept evidence of current astringent immunosuppression or current evidence of measles, rubella, and mumps immunity. To be regarded as not having prove of current severe immunosuppression, a child age 5 years or younger must have CD4 percentages of 15% or more for half-dozen months or longer; a person older than five years must have CD4 percentages of xv% or more than and a CD4 lymphocyte count of 200 or more than/mm3 for 6 months or longer. If laboratory results state only 1 type of parameter (percentage or counts) this is sufficient for vaccine decision-making.

Administer the beginning dose at 12 through xv months and the second dose to children age iv through six years, or as early as 28 days after the offset dose.

Unless they accept acceptable current bear witness of measles, mumps, and rubella amnesty, people with perinatal HIV infection who were vaccinated prior to establishment of constructive antiretroviral therapy (ART) should receive 2 accordingly spaced doses of MMR vaccine afterwards constructive Art has been established. Established effective ART is defined as receiving ART for at to the lowest degree 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 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 only ane type of parameter (percentages or counts) this is sufficient for vaccine determination-making.

Pregnancy and Postpartum Considerations Dorsum to elevation

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

Although the MMR vaccine bundle insert recommends a 3-month deferral of pregnancy later MMR vaccination, ACIP recommends deferral of pregnancy for four weeks. For details on this result, come across ACIP'south Control and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella in Pregnant Women, and Surveillance for Congenital Rubella Syndrome.

How should teenage girls and women of changeable age exist screened for pregnancy earlier MMR vaccination?

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

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

No specific action needs to exist taken other than to reassure the woman that no adverse outcomes are expected as a event of this vaccination. MMR vaccination during pregnancy is not a reason to terminate the pregnancy. You should consult with others in your healthcare setting to place ways to preclude such vaccination errors in the hereafter. Detailed information virtually MMR vaccination in pregnancy is included in the nearly recent MMR ACIP statement, bachelor at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

No. 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 answer "aye." Those who answer "no" should be advised to avert pregnancy for one month post-obit vaccination.

Can nosotros give an MMR to a 15-month-erstwhile whose mother is 2 months pregnant?

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

If a adult female'south rubella test issue shows she is "non immune" during a prenatal visit, but she has 2 documented doses of MMR vaccine, does she need a tertiary dose of MMR vaccine postpartum?

In 2013, ACIP changed its recommendation for this situation (meet www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20). Information technology is recommended that women of childbearing age who have received one or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered 1 additional dose of MMR vaccine (maximum of 3 doses) and do not need to be retested for serologic evidence of rubella immunity. MMR should not be administered to a pregnant woman.

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

ACIP recommends that vaccinated women of childbearing age who accept received one or 2 doses of rubella-containing vaccine and have a rubella serum IgG levels that is not conspicuously positive should exist administered ane additional dose of MMR vaccine (maximum of three doses). Repeat serologic testing for evidence of rubella immunity is non recommended. Run into www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–twenty, for more information on this issue.

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

How soon later delivery tin can MMR be given to the mother?

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

Vaccine Safe Back to top

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

No. This issue has been studied extensively, including a thorough review by the independent Constitute of Medicine (IOM). The IOM issued a study in 2004 that ended there is no prove supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. For more than information on thimerosal and vaccines in full general, visit www.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

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

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

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

Arthralgia (joint hurting) and transient arthritis (joint redness or swelling) post-obit rubella vaccination occurs only 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-immune mail service-pubertal women report joint pain later on receiving rubella vaccine, and nigh 10% to 30% report arthritis-like signs and symptoms.

When articulation symptoms occur, they by and large begin 1 to 3 weeks subsequently vaccination, usually are mild and non incapacitating, concluding about 2 days, and rarely recur.

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

In general, although information technology is not ideal, receiving extra doses of vaccine poses no medical problem. However, receiving excessive doses of tetanus toxoid (e.g., DTaP, DT, Tdap, or Td) tin increase the gamble of a local adverse reaction. For details come across the Extra Doses of Vaccine Antigens department of the ACIP General Best Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Vaccination providers frequently run across people who do not accept adequate documentation of vaccinations. Providers should only accept written, dated records as testify of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should not be accustomed. An attempt to locate missing records should be fabricated whenever possible by contacting previous healthcare providers, reviewing state or local immunization information systems, and searching for a personally held record.

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

Storage and Handling Dorsum to top

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

The amount of time in which a dose of vaccine must exist used subsequently reconstitution varies by vaccine and is usually outlined somewhere in the vaccine's parcel insert. MMR must be used within 8 hours of reconstitution. MMRV must be used inside thirty minutes; other vaccines must exist used immediately. The Immunization Action Coalition has a staff education slice that outlines the fourth dimension allowed betwixt reconstitution and use, as stated in the package inserts for a number of vaccines. Handout tin be plant at the following link: world wide web.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine be stored?

MMR may exist stored either in the refrigerator at 2°C to 8°C (36°F to 46°F) or in the freezer at -fifty°C to -15°C (-58°F to +5°F). The diluent should not 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), information technology must be stored in the freezer at -l°C to -15°C (-58°F to +five°F).

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

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

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

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

I misplaced the diluent for the MMR dose so I used normal saline instead. Is in that location whatever problem with doing this?

Only the diluent supplied with the vaccine should be used to reconstitute whatsoever 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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