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For whom is MMR vaccination recommended? |
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| The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination for the following groups of persons: |
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all children, beginning
at age 12-15 months |
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adults born in 1957 or
later without documentation of vaccination |
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healthcare workers, who lack
evidence of immunity, regardless of age |
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non-pregnant women of childbearing
age without evidence of immunity to rubella |
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| For whom should second doses of MMR be given? |
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| All children and adolescents should receive 2 doses, given no less than 4 weeks apart. Most children vaccinated at 12-15 months should receive the second dose at age 4-6 years. All older children and adolescents should receive the second dose at the next available opportunity, as long as there has been a 4 week interval since the previous dose. |
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| ACIP recommends a second dose of MMR for
any adult born during 1957 or later who: |
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is a student in a post-secondary educational institution |
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is a healthcare worker |
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plans to travel internationally |
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is exposed to measles in an outbreak setting |
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was previously vaccinated with killed measles vaccine |
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was vaccinated with an unknown type of measles vaccine during 1963-1967 |
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| ACIP also recommends a second dose of
MMR vaccine to healthcare workers exposed to measles or mumps in an
outbreak setting, regardless of age. |
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| Why is a second dose of MMR necessary? |
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| Between 2% and 5% of persons do not develop measles immunity after the first dose of vaccine. This occurs for a variety of reasons. The second dose is to provide another chance to develop measles immunity for persons who did not respond to the first dose. |
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| Do people who received MMR in the 1960s need to have their dose repeated? |
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| Not necessarily. Persons who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated. Persons 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 persons who may have received killed measles vaccine which was available in 1963-1967 and was not effective. |
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| Is there anything that can be done for unvaccinated people who have already been exposed to measles? |
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| Measles vaccine may be effective if given within the first 3 days (72 hours) after exposure to measles. Immune globulin may be effective for as long as 6 days after exposure. More information on post-exposure prophylaxis for measles is available in the recommendations from the ACIP -- "MMR -- Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome and Control of Mumps" (see www.cdc.gov/vaccines/pubs/acip-list.htm). |
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| We often see college students 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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| Although single antigen vaccine is sometimes available, it may be more practical to advise the student to get the combined MMR vaccine. If a person 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 adult patients going back to college that must show proof of MMR vaccine and are unable to retrieve their immunization records. What are my options? |
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| Depending on the requirements of the college, your options are likely to either vaccinate or to perform serologic testing for all the antigens for which documented immunity is required. There is no evidence that adverse reactions are increased when MMR is given to a person who is already immune to one or more of the components of the vaccine. |
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| Can MMR be given on the same day as other live virus vaccines (e.g., varicella)? |
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| Yes. However, if two live vaccines (e.g., MMR and varicella) are not administered on the same day, they should be separated by an interval of at least 28 days. |
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| If you can give the second dose of MMR as early as 28 days after the first dose, why do we routinely wait until kindergarten entry to give the second dose? |
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| The second dose of MMR may be given as early as a month after the first dose, and be counted as a valid dose if both doses were given after the first birthday. The second dose is not a booster, but rather it is intended to produce immunity in the small number of persons who fail to respond to the first dose. The risk of measles is higher in school-age children than those of preschool age, so it is important to receive the second dose by school entry. It is also convenient to give the second dose at this age, since the child will have an immunization visit for other school entry vaccines. |
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| What is the earliest age at which I
can give MMR to an infant who will be traveling internationally? Also,
which countries pose a high risk 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 United States. Before their
departure from the United States, children age 6 through 11 months
should receive 1 dose of monovalent measles vaccine (if available) or
MMR. The risk for measles exposure can be high in both developed and
developing 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 as they travel. For continually updated information onthe
worldwide measles situation, and on CDC's measles vaccination
information for travelers, go to
wwwn.cdc.gov/travel/content/in-the-news/measles.aspx. |
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| Can I give the second dose of MMR
earlier than age 4 through 6 years (i.e., the kindergarten entry dose)
to young children traveling to areas of the world where there are
measles cases? |
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| Yes. The second dose of MMR can be given
a minimum of 28 days after the first dose if necessary. |
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| If I give MMR to an infant traveler
younger than age 1 year, will that dose be considered valid for the U.S.
immunization schedule? |
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| No. A measles-containing vaccine
administered before the first birthday should not be counted as part of
the series. MMR should be repeated when the child is age 12 to 15 months
of age (12 months if the child remains in an area where disease risk is
high). The second dose should be administered at least 28 days after the
first dose. |
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| Would you consider a person with 2
documented doses of MMR vaccine to be immune even if their serology for
1 or more of the antigens comes back negative? |
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| There is no ACIP recommendation for this
situation. A negative serology would more likely be the result of an
insensitive test than of a true vaccine failure. No more doses are
necessary. |
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| Can I give a tuberculin skin test (TST) on the same day as a dose of MMR vaccine? |
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A TST can be applied before or on the same day that MMR vaccine is given. However, if MMR vaccine is given on the previous day or earlier, the TST should be delayed for at least one month. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin test because of mild suppression of the immune system. |
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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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| Actually, this student should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is NOT acceptable as proof of immunity. Acceptable evidence of measles and mumps immunity includes a positive serologic test for antibody, physician diagnosis of disease, birth before 1957, or written documentation of vaccination. For rubella, only serologic evidence or documented vaccination should be accepted as proof of immunity. Additionally, persons born prior to 1957 may be considered immune to rubella unless they are women who have the potential to become pregnant. |
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| What is the recommendation for MMR
vaccine for healthcare personnel? |
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In June of 2009, ACIP strengthened its
recommendations for MMR requirements for healthcare personnel (HCP). The
Healthcare Infection Control Practices Advisory Committee (HICPAC) endorsed the
changes. In summary, ACIP recommends that all HCP born during or after 1957 have
adequate presumptive evidence of immunity to measles, mumps, and rubella,
defined as documentation of two doses of measles and mumps vaccine and at least
one dose of rubella vaccine, laboratory evidence of immunity, or laboratory
confirmation of disease. Further, ACIP recommends that, during an outbreak of
measles, mumps, or rubella, healthcare facilities should recommend vaccination
of all healthcare personnel who were born before 1957 and who lack laboratory
evidence of measles, mumps, and/or rubella immunity or laboratory confirmation
of disease with two doses of MMR vaccine (for measles and mumps) and one dose of
MMR vaccine (for rubella), and should consider recommending the same during
routine circumstances. |
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If a healthcare worker develops a rash and low-grade fever after MMR vaccine, is s/he infectious? |
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| Approximately 5-15% of susceptible persons who receive MMR vaccine will develop a low-grade fever and/or mild rash 7-12 days after vaccination. However, the person is not infectious, and no special precautions (e.g., exclusion from work) need to be taken. |
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| Contraindications and precautions for MMR vaccine |
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| Can I give MMR to a child whose sibling is receiving chemotherapy for leukemia? |
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| Yes. MMR and varicella vaccines should be given to the healthy household contacts of immunosuppressed children. |
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| Is it true that egg allergy is no longer considered a contraindication to MMR vaccine? |
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| Several studies have documented the safety of measles and mumps vaccine (which are grown in chick embryo tissue culture) in children with severe egg allergy. Neither the AAP's "Red Book" Committee 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 give MMR to a breastfeeding mother 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 being 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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| What is the recommended length of time a woman should wait after receiving rubella (or MMR) vaccine before becoming pregnant? |
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| Four weeks. |
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| We require a pregnancy test for all our 7th graders before giving an MMR. Is this necessary? |
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| No. ACIP recommends that women of childbearing age be asked if they are currently pregnant or attempting to become pregnant. Vaccination should be deferred for those who answer "yes." Those who answer "no" should be advised to avoid pregnancy for one month following vaccination. |
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| Can we 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 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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| CDC does not routinely recommend more
than 2 doses of MMR vaccine. A negative serology after 2 documented
doses probably represents a false negative (i.e., antibody titer too low
to detect with commercial tests). If a person is found to have a
negative serology after 2 documented doses of MMR, it is best to stop
testing for rubella. CDC's recommendations for the use of MMR vaccine
can be accessed at
www.cdc.gov/mmwr/PDF/rr/rr4708.pdf |
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| How soon after delivery can MMR be given? |
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| MMR can be administered any time after delivery. The vaccine should be administered to a woman who is susceptible to either measles, mumps, or rubella before hospital discharge, even if she has received RhoGam during the hospital stay, leaves in less than 24 hours, or is breastfeeding. |
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| Is there any evidence that MMR or thimerosal causes autism? |
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| No. This issue has been studied extensively in recent years, including a thorough review by the independent Institute of Medicine (IOM). The IOM issued a report in 2004 that concluded there is no evidence supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. To access the IOM committee minutes, as well as the executive summaries and full reports, go to www.iom.edu/CMS/3793/4705.aspx To obtain more information on thimerosal and vaccines in general, visit www.immunize.org/safety/thimerosal.htm |
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| A few parents are asking that their children receive separate components of the MMR vaccine because they fear MMR may be linked to autism. What should I do? |
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| You should educate parents about the lack of association between MMR and autism. If a parent still insists on separating the vaccine components, Merck has limited supplies of separate measles, mumps, and rubella vaccine available. It is preferable to administer separate components of MMR rather than not administer any measles, mumps, or rubella vaccines. |
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| Editor's note: IAC has developed a web page for parents titled "Does MMR vaccine cause autism? Examine the evidence." IAC encourages you to make and distribute copies of this web page. Find it at www.immunize.org/mmrautism |
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| How likely 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 persons who were susceptible to rubella at the time of vaccination. Joint symptoms are uncommon in children and in adult males. About 25% of post-pubertal women report joint pain after receiving rubella vaccine, and about 10% report arthritis-like signs and symptoms. |
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| When joint symptoms occur, they generally begin 1-3 weeks after vaccination, persist for one day to 3 weeks, and rarely recur. Chronic joint symptoms attributable to rubella vaccine are very rare, if they occur at all. |
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| Our clinic has given MMR by the wrong route (IM rather than SC) for years. Should these doses be repeated? |
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| All live injected vaccines (MMR, varicella, and yellow fever) are recommended to be given subcutaneously. However, intramuscular administration of any of these vaccines is not likely to decrease immunogenicity, and doses given IM do not need to be repeated. |
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| We 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? |
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| Yes. A 5/8" needle is recommended for subcutaneous injections for people of all sizes. |
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| Can single antigen preparations for measles and rubella vaccines be mixed together? We have MMR vaccine and single antigen vaccines for those who only need one. |
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| Absolutely not. Vaccines should never be mixed except when specifically approved by the FDA. Also, ACIP recommends use of combined MMR whenever one or more of the antigens are indicated, so there is little need to stock single antigen vaccines. |
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| How should MMR vaccine be stored? |
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| MMR may be stored either in the refrigerator at 35-46°F (2-8°C) or in the freezer. The diluent, however, should not be frozen and can be stored in the refrigerator or at room temperature. If the MMR is combined with varicella vaccine as ProQuad by Merck, it must be stored at an average temperature of 5°F (-15°C) or colder (like varicella vaccine). |
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| A box of MMR vaccine (undiluted) was left at room temperature for 3 hours. Can I use it? |
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| Unfortunately, serious errors in vaccine storage and handling occur too often. If you suspect that vaccine has been mishandled, you should contact the manufacturer or state/local health department for guidance on its use. This is particularly important for labile live virus vaccines like MMR and varicella. |
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| Once 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 be left at room temperature. |
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| I misplaced the diluent for the MMR dose so I used sterile water instead. Is there any problem with doing this? |
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| Only the diluent supplied with the vaccine should be used to reconstitute any vaccine. |
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| Reviewed on 11/09 |
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