Can a Person Who Had Measles Get Them Again

Measles, Mumps, and Rubella

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

Affliction Issues

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

In 2019, a provisional total of i,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a single twelvemonth since 1992; 73% of cases were associated with outbreaks among unvaccinated people in New York. These outbreaks were independent and stopped before the end of 2019. Between January 1 and August 19, 2020, just 12 measles cases were reported by 7 jurisdictions. Express travel as a result 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 tin be found at www.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, there has been a more 99% decrease in mumps cases in the United States. Notwithstanding, outbreaks withal occasionally occur. In 2006, there was an outbreak affecting more than 6,584 people in the United States, with many cases occurring on college campuses. In 2009, an outbreak started in close-knit religious communities and schools in the Northeast, resulting in more than 3,000 cases. Since 2015, numerous outbreaks have been reported across the United states, in college campuses, prisons, and close-knit communities, including a large outbreak in northwest Arkansas where almost 3,000 cases were reported in 2016. These outbreaks have shown that when people with mumps have close contact with a lot of other people (such every bit among residential college students and families in close-knit communities) mumps can spread fifty-fifty amidst vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A provisional total of 3,484 cases of mumps were reported to CDC in 2019.

Rubella was declared eliminated (the absence of owned transmission for 12 months or more) from the United States in 2004. Fewer than ten cases (primarily import-related) have 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 full of iii cases of rubella, and no cases of congenital rubella syndrome, were reported in 2019.

How serious are measles, mumps, and rubella?

Measles can lead to serious complications and expiry, even with modern medical care. The 1989–1991 measles outbreak in the U.Due south. resulted in more than 55,000 cases and more than 100 deaths. In the U.s.a., from 1987 to 2000, the near commonly reported complications associated with measles infection were pneumonia (half dozen%), otitis media (7%), and diarrhea (viii%). For every 1,000 reported measles cases in the United states, approximately one case of encephalitis and two to iii deaths resulted. The adventure for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

Mumps most usually causes fever and parotitis. Upwards 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 affliction is typically milder, with fewer complications, in fully vaccinated case patients.

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

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

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

• a generalized rash lasting 3 or more than days, and • a temperature of 101°F or higher (38.three°C or higher), and • cough, coryza, and/or conjunctivitis.

Koplik spots, a rash nowadays on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from 1 to ii days earlier the measles rash appears to one to 2 days subsequently. They announced as punctate blue-white spots on the bright blood-red background of the buccal mucosa. Pictures of measles rash and Koplik spots can be plant at www.cdc.gov/measles/about/photos.html.

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

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

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

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

Measles is a nationally notifiable illness in the U.South.; healthcare providers should written report all cases of suspected measles to public health authorities immediately to assist 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 than information on measles disease, diagnostic testing, and infection command can be constitute at www.cdc.gov/measles/hcp/index.html.

How long does information technology take to show signs of measles, mumps, and rubella after being exposed?

For measles, there is an average of 10 to 12 days from exposure to the appearance of the first symptom, which is ordinarily fever. The measles rash doesn't usually announced until approximately fourteen days after exposure (range: 7 to 21 days), and the rash typically begins 2 to 4 days after the fever begins. The incubation period of mumps averages 16 to 18 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 in a higher place, up to half of rubella virus infections cause no symptoms.

Vaccine Recommendations Dorsum to top

What are the 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 world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at age 12 through fifteen months, with a 2d dose at age 4 through 6 years. The second dose of MMR tin can be given as early on as 4 weeks (28 days) after the start dose and be counted as a valid dose if both doses were given after the child's first birthday. The second dose is not a booster, but rather is intended to produce amnesty in the modest number of people who fail to respond to the first dose.

Adults with no evidence of immunity (show of immunity is divers equally documented receipt of 1 dose [2 doses 4 weeks apart if loftier risk] of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or nativity before 1957) should get i dose of MMR vaccine unless the adult is in a high-risk group. Loftier-chance people need 2 doses and include schoolhouse-historic period children, healthcare personnel, international travelers, and students attending post-high school educational institutions.

Alive adulterate measles vaccine became available in the U.Due south. in 1963. An ineffective, inactivated measles vaccine was also available in the U.S. in 1963–1967. Combined MMR vaccine (MMRII, Merck) was licensed in 1971. For people who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine it was, or are sure it was inactivated measles vaccine, that dose should be considered invalid and the patient revaccinated equally age- and run a risk-appropriate with MMR vaccine. At the discretion of the land public health department, anyone exposed to measles in an outbreak setting can receive an boosted dose of MMR vaccine fifty-fifty if they are considered completely vaccinated for their age or risk status.

What is considered acceptable testify of immunity to measles?

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

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

Although birth earlier 1957 is considered adequate show of measles amnesty, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who practise not have other evidence of immunity with 2 doses of MMR vaccine (minimum interval 28 days).

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

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

Zip, one, or two doses of MMR vaccine are needed for the adults described beneath.

Zero doses:

• adults born before 1957 except healthcare personnel* • adults born 1957 or later who are at low take a chance (i.eastward., not an international traveler or healthcare worker, or person attending college or other mail-high school educational establishment) and who have already received i or more documented doses of alive measles vaccine • adults with laboratory evidence of immunity or laboratory confirmation of measles

One dose of MMR vaccine:

• adults born 1957 or later who are at low risk (i.e., not an international traveler, healthcare worker, or person attention college or other mail service-high school educational institution) and have no documented vaccination with alive measles vaccine and no laboratory testify of amnesty or prior measles infection

Two doses of MMR vaccine:

� high-run a risk adults without whatsoever prior documented live measles vaccination and no laboratory show of immunity or prior measles infection, including:

Persons who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine information technology was, or are sure it was inactivated measles vaccine, should exist revaccinated with either ane (if low-risk) or two (if high-adventure) doses of MMR vaccine.

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

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

Although birth earlier 1957 is considered acceptable evidence of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) built-in earlier 1957 who exercise non take laboratory evidence of measles amnesty, laboratory confirmation of disease, or vaccination with 2 accordingly spaced doses of MMR vaccine.

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

Healthcare facilities should check with their state or local health 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 6 months of historic period who are at loftier risk of exposure such every bit during international travel or a community outbreak. However, doses given Earlier 12 months of age cannot exist counted toward the 2-dose series for MMR.

How does being born before 1957 confer immunity to measles?

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to take had measles disease. Surveys suggest that 95% to 98% of those built-in before 1957 are immune to measles. Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is non immune, at least 1 dose of MMR should be administered.

Why is a second dose of MMR necessary?

Approximately 7% of people do not develop measles immunity after the first dose of vaccine. This occurs for a variety of reasons. The 2d dose is to provide another take chances to develop measles immunity for people who did not respond to the first dose. Well-nigh 97% of people develop amnesty to measles after ii doses of measles-containing vaccine.

Are there 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 accept received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive 1 boosted dose of MMR vaccine (maximum of 3 doses). Farther testing for serologic evidence of rubella amnesty is not recommended. MMR should not be administered to a pregnant adult female.

In 2018, ACIP published guidance for MMR vaccination of people at increased risk for acquiring mumps during an outbreak. People previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified by public wellness authorities as being part of a group or population at increased chance for acquiring mumps because of an outbreak should receive a third dose of a mumps virus�containing vaccine (MMR or MMRV) to amend protection against mumps affliction and related complications. More information about this recommendation is bachelor at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

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

MMR vaccine given within 72 hours of initial measles exposure can reduce the chance of getting sick or reduce the severity of symptoms. Another choice for exposed, measles-susceptible individuals at high risk of complications who cannot exist vaccinated is to give immunoglobulin (IG) within six days of exposure. Practise not administer MMR vaccine and IG simultaneously, as the IG invalidates the vaccine.

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

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

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

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 most frequently given in that time menstruation? That guidance would assist many older people who would prefer not to be revaccinated.

Both killed and live adulterate measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. The killed vaccine was found to be not constructive and people who received it should be revaccinated with alive vaccine. Without a written tape, it is not possible to know what blazon of vaccine an individual may accept received. So persons born during or afterward 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 one dose of MMR. Some people at increased take chances of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least 4 weeks.

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

Non necessarily. People who accept documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should exist revaccinated with at to the lowest degree ane 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 type who are at loftier chance for mumps infection (such as people who piece of work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

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

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

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

Measles vaccine, given as MMR, 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 later exposure. Postexposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella. Even so, if the exposed person does not accept show of mumps or rubella amnesty they should be vaccinated since not all exposures outcome in infection.

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

In the 2013 revision of its MMR vaccine recommendations ACIP expanded the employ of post-exposure IG prophylaxis for measles. Intramuscular IG (IGIM) should be administered to all infants younger than 12 months who have been exposed to measles. The dose of IGIM is 0.5 mL/kg of body weight; the maximum dose is 15 mL. Alternatively, MMR vaccine can be given instead of IGIM to infants age half dozen through xi months, if information technology can be given within 72 hours of exposure.

Pregnant women without evidence 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.

For persons already receiving IGIV therapy, assistants of at least 400 mg/kg body weight inside three weeks earlier measles exposure should exist sufficient to forbid measles infection. For patients receiving subcutaneous immune globulin (IGSC) therapy, administration of at least 200 mg/kg trunk weight for 2 consecutive weeks earlier measles exposure should be sufficient.

Other people who exercise non 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 have intense, prolonged close contact (such as household, child intendance, classroom, etc.). The maximum dose of IGIM is 15 mL.

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

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

We often meet higher students who lack vaccination records, simply whose titer results testify 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.Southward.; the educatee should get the combined MMR vaccine. If a college educatee or other person at increased risk of exposure cannot produce written documentation of either immunization or affliction, and titers are negative, they should receive two doses of MMR.

I take patients who merits to call back receiving MMR vaccine but have no written record, or whose parents report the patient has been vaccinated. Should I accept this equally evidence of vaccination?

No. Self-reported doses and history of vaccination provided by a parent or other caregiver are non considered to be valid. Yous should merely accept a written, dated tape as evidence of vaccination.

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

Adults without evidence of amnesty and no contraindications to MMR vaccine can be vaccinated without testing. Only adults without testify of amnesty might be considered for testing for measles-specific IgG antibody, but testing is not needed prior to vaccination.

CDC does not recommend measles antibody testing after MMR vaccination to verify the patient'south immune response to vaccination.

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, according to ACIP. Documentation of advisable vaccination supersedes the results of serologic testing for measles, mumps, rubella, and varicella.

A patient built-in in 1970 has a history of measles disease and is also immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, simply is concerned about the measles exposure risk. Should the patient receive the MMR vaccine?

A history of having had measles is non sufficient evidence of measles immunity. A positive serologic exam for measles-specific IgG will confirm that the person is immune and is not 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.

We 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 remember ever receiving MMR vaccine or having had measles disease. How should we manage these patients?

Yous accept two options. You lot tin test for immunity or you can but give 2 doses of MMR at least 4 weeks apart. There is no harm in giving MMR vaccine to a person who may already be allowed to ane or more of the vaccine viruses. If y'all or the patient opt for testing, and the tests indicate the patient is not allowed to one or more of the vaccine components, give your patient ii doses of MMR at least 4 weeks apart. If whatever test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing subsequently vaccination because commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity.

I have a 45-year-quondam patient who is traveling to Haiti for a mission trip. She doesn't remember ever getting an MMR booster (she didn't go to college and never worked in wellness care). She was rubella immune when pregnant 20 years agone. 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 developed born in 1957 or afterward who plans to travel internationally. There is no harm in giving MMR vaccine to a person who may already exist allowed to one or more of the vaccine viruses.

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?

No, it is not considered necessary, but he may be vaccinated. Earlier implementation of the national measles vaccination program in 1963, virtually every person acquired measles before adulthood. And then, this patient tin can be considered immune based on their nascence twelvemonth. Notwithstanding, MMR vaccine likewise may be given to whatever person born before 1957 who does not have a contraindication to MMR vaccination.

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

Nosotros have measles cases in our community. How tin can I best protect the young children in my practice?

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

In certain circumstances, MMR is recommended for infants age 6 through eleven months. Give infants this age a dose of MMR earlier international travel. In improver, consider measles vaccination for infants as young every bit age 6 months as a control measure during a U.South. 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 part of the 2-dose serial if it is administered earlier a child'southward first birthday. Instead, repeat the dose when the kid is age 12 months.

In the example of a local outbreak, you also might consider vaccinating children historic period 12 months and older at the minimum historic period (12 months, instead of 12 through fifteen months) and giving the 2d dose 4 weeks later (at the minimum interval) instead of waiting until age iv through six 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 amongst those effectually them. Exist certain to encourage all your patients and their family unit members to become vaccinated if they are not immune.

During a mumps outbreak should we offer a third dose of MMR (MMR II, Merck) to persons who have 2 prior documented doses of MMR?

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

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 two doses of a mumps virus�containing vaccine who are identified by public wellness authorities as existence role of a group at increased hazard for acquiring mumps considering of an outbreak should receive a 3rd dose of a mumps virus�containing vaccine to improve protection against mumps disease and related complications. More information virtually this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

In a measles outbreak, exercise children who have non had MMR vaccine pose a threat to vaccinated people? It is my agreement that vaccinated people can notwithstanding contract measles. Am I right?

You are correct that vaccinated people can still be infected with viruses or leaner confronting which they are vaccinated. No vaccine is 100% effective. Vaccine effectiveness varies from greater than 95% (for diseases such as measles, rubella, and hepatitis B) to much lower (threescore% for influenza in years with a practiced friction match of circulating and vaccine viruses, and seventy% for acellular pertussis vaccines in the 3-5 years after vaccination). More than information is available for each vaccine and affliction at www.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines.

Administering Vaccines Dorsum to height

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

All live injected vaccines (MMR, varicella, and yellow fever) are recommended to be given subcutaneously. However, intramuscular assistants of any of these vaccines is not likely to decrease immunogenicity, and doses given IM do not need to be 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-twelvemonth-old instead of MMR. Can this be considered a valid dose?

Yeah, still, this issue is not addressed in the 2010 MMRV ACIP recommendations. Although this is off-label use, CDC recommends that when a dose of MMRV is inadvertently given to a patient age 13 years and older, information technology may be counted towards completion of the MMR and varicella vaccine series and does not need to be repeated.

Scheduling Vaccines Back to pinnacle

How presently tin we requite the 2d dose of MMR vaccine to a child vaccinated at 12 months one-time?

For routine vaccination, children without contraindications to MMR vaccine should receive two doses of MMR vaccine with the first dose at age 12–fifteen months old and the second dose at historic period 4–six years erstwhile. The minimum interval is 28 days for dose ii. If y'all accept an outbreak in your community or a child is traveling internationally, so consider using the minimum interval instead of waiting until historic period four–6 years one-time for dose 2.

Does the iv-twenty-four hour period "grace period" use to the minimum age for assistants of the outset dose of MMR? What about the 28-day minimum interval between doses of MMR?

A dose of MMR vaccine administered up to 4 days before the first birthday may be counted as valid. However, schoolhouse entry requirements in some states may mandate administration on or after the first birthday. The 4-24-hour interval "grace flow" should not exist practical to the 28-day minimum interval between 2 doses of a live parenteral vaccine.

Can MMR exist given on the same day every bit other live virus vaccines?

Yes. Notwithstanding, if ii parenteral or intranasal alive vaccines (MMR, varicella, LAIV and/or yellowish fever) are not administered on the aforementioned twenty-four hour period, they should exist separated by an interval of at least 28 days.

If yous tin can give the second dose of MMR as early as 28 days afterwards the get-go dose, why do we routinely wait until kindergarten entry to requite the second dose?

The second dose of MMR may be given every bit early on equally 4 weeks afterwards the starting time dose, and exist counted as a valid dose if both doses were given after the outset altogether. The second dose is non a booster, only rather it is intended to produce immunity in the minor number of people who neglect to respond to the beginning dose. The take chances of measles is higher in schoolhouse-age children than those of preschool age, and then it is important to receive the 2d dose past school entry. It is also convenient to give the second dose at this age, since the child volition take an immunization visit for other school entry vaccines.

What is the primeval age at which I can requite MMR to an infant who will be traveling internationally? Also, which countries pose a high risk to children for contracting measles?

ACIP recommends that children who travel or live abroad should be vaccinated at an before historic period than that recommended for children who reside in the United States. Before their departure from the The states, children age six through 11 months should receive 1 dose of MMR. The risk for measles exposure can exist high in high-, heart- and depression-income countries. Consequently, CDC encourages all international travelers to be up to appointment on their immunizations regardless of their travel destination and to keep a re-create of their immunization records with them every bit they travel. For additional information on the worldwide measles state of affairs, and on CDC'due south measles vaccination information for travelers, get to wwwnc.cdc.gov/travel.

If we 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 we requite the adjacent dose?

The adjacent dose should be given at 12 months of age. The child will likewise 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 age does non count as part of the MMR vaccine two-dose series.

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

No. IG may 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 exist administered to infants age half dozen through 11 months traveling exterior the Us when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this historic period grouping. Neither vaccine is counted equally part of the child's routine vaccination serial. 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 eighteen.

Can I give the second dose of MMR earlier than age 4 through 6 years (the kindergarten entry dose) to young children traveling to areas of the globe where at that place are measles cases?

Yes. The 2nd dose of MMR can be given a minimum of 28 days subsequently the first dose if necessary.

If I give MMR to an baby 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 be repeated when the child is age 12 through 15 months (12 months if the child remains in an expanse where disease gamble is high). The second dose should be administered at least 28 days after the commencement dose.

Can I give a tuberculin pare test (TST) on the aforementioned 24-hour interval every bit a dose of MMR vaccine?

Aye. A TST tin be practical before or on the same twenty-four hours that MMR vaccine is given. Nonetheless, if MMR vaccine is given on the previous day or before, 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 test because of mild suppression of the immune system.

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

This student should receive ii doses of MMR, separated by at least 28 days. A personal history of measles and mumps is not acceptable as proof of immunity. Acceptable bear witness of measles and mumps amnesty includes a positive serologic test for antibody, birth before 1957, or written documentation of vaccination. For rubella, just serologic prove or documented vaccination should be accustomed equally 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 non given on the same 24-hour interval, is the interval between yellowish fever and MMR vaccines 4 weeks (28 days) or 30 days? I have seen the xanthous 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 non given on the same day should be separated past at to the lowest degree 28 days. The CDC travel health website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated by at least thirty days if possible. Either interval is adequate.

For Healthcare Personnel Dorsum to top

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP born during or afterward 1957 have adequate presumptive bear witness of immunity to measles, mumps, and rubella, defined as documentation of two doses of measles and mumps vaccine and at least i dose of rubella vaccine, laboratory evidence of immunity, or laboratory confirmation of affliction. Farther, ACIP recommends that healthcare facilities should consider vaccination of all unvaccinated healthcare personnel who were built-in earlier 1957 and who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend two doses of MMR separated by at to the lowest degree 4 weeks for unvaccinated healthcare personnel regardless of birth yr who lack laboratory bear witness of measles or mumps immunity or laboratory confirmation of disease. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of birth year who lack laboratory show of rubella immunity or laboratory confirmation of infection or illness.

Would you consider healthcare personnel with 2 documented doses of MMR vaccine to be immune even if their serology for 1 or more than of the antigens comes back negative?

Yes. Healthcare personnel (HCP) with ii documented doses of MMR vaccine are considered to be allowed regardless of the results of a subsequent serologic examination for measles, mumps, or rubella. Documented age-advisable vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who do not accept documentation of MMR vaccination and whose serologic test is interpreted as "indeterminate" or "equivocal" should be considered not immune and should receive ii doses of MMR vaccine (minimum interval 28 days). ACIP does not recommend serologic testing after vaccination. For more than information, see ACIP's recommendations on the use of MMR vaccine at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 22.

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

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

A 22-year-old female is going to pharmacy schoolhouse and the school wants her to have a second dose of MMR vaccine. She had the first dose every bit a child and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles but non immune to rubella. Can I give her a second dose of the MMR with her having measles afterward the first dose?

Yes, every bit a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. In that location is no harm in providing MMR to a person who is already immune to ane or more of the components. If she developed measles just one day after getting her first MMR, she must accept been exposed to the disease prior to vaccination.

Contraindications and Precautions Back to top

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

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

We take many patients who are immunocompromised and cannot become 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, make certain all your staff and patients who can exist vaccinated are fully vaccinated according to the U.S. immunization schedule. As well, encourage patients to remind their family members and other close contacts to go vaccinated if they are not allowed.

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

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

There 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, only 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 wait before receiving MMR vaccine?

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

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

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

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

Based on the weight and dosage provided (40 lbs and xv mg/week), the child is currently receiving more than 0.4 mg/kg/calendar week of methotrexate. This meets the Infectious Illness Guild of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such fourth dimension as 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, come across the 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early on/2013/xi/26/cid.cit684.total.pdf.

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

Several studies accept documented the safety of measles and mumps vaccine (which are grown in chick embryo tissue civilisation) in children with 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.

Can I give MMR to a breastfeeding mother or to a breastfed infant?

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

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

Yes, but there should be sufficient time between the claret product and the MMR to reduce the chance of interference. The interval depends on the claret product received. Meet Table 3-v of ACIP's Full general Best Practice Guidelines for Immunization for more information, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Is it acceptable exercise to administrate MMR, Tdap, and influenza vaccines to a postpartum mom at the aforementioned time as administering RhoGam?

Aye. Receipt of RhoGam is not a reason to delay vaccination. For more data see the ACIP General All-time Exercise Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

Please depict the electric current ACIP recommendations for the apply 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 age 12 months and older who do not have evidence of current severe immunosuppression or electric current evidence of measles, rubella, and mumps immunity. To be regarded as not having testify of current severe immunosuppression, a child historic period v years or younger must take CD4 percentages of 15% or more for vi months or longer; a person older than 5 years must take CD4 percentages of xv% or more and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results land simply i blazon of parameter (percent or counts) this is sufficient for vaccine decision-making.

Administer the first dose at 12 through 15 months and the 2nd dose to children age 4 through 6 years, or as early as 28 days later the outset dose.

Unless they take adequate current evidence of measles, mumps, and rubella immunity, people with perinatal HIV infection who were vaccinated prior to establishment of effective antiretroviral therapy (ART) should receive two accordingly spaced doses of MMR vaccine after 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 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 than and a CD4 lymphocyte count of 200 or more/mm3 for six months or longer. If laboratory results state only ane type of parameter (percentages or counts) this is sufficient for vaccine decision-making.

Pregnancy and Postpartum Considerations Back to top

What is the recommended length of time a woman should look afterwards receiving rubella (MMR) vaccine before becoming pregnant?

Although the MMR vaccine package insert recommends a 3-month deferral of pregnancy afterwards MMR vaccination, ACIP recommends deferral of pregnancy for 4 weeks. For details on this consequence, run into ACIP'southward 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 historic period exist screened for pregnancy before MMR vaccination?

ACIP recommends that women of childbearing age exist asked if they are currently significant or attempting to go pregnant. Vaccination should exist deferred for those who answer "yes." Those who respond "no" should be brash to avoid pregnancy for 4 weeks following vaccination. Pregnancy testing is not necessary.

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

No specific action needs to exist taken other than to reassure the adult female that no adverse outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy is not a reason to cease the pregnancy. Yous should consult with others in your healthcare setting to identify ways to forestall such vaccination errors in the futurity. Detailed data nearly MMR vaccination in pregnancy is included in the most recent MMR ACIP statement, bachelor at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

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

Tin can we requite an MMR to a 15-month-onetime whose mother is 2 months meaning?

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

If a woman'south rubella test issue shows she is "non immune" during a prenatal visit, just she has 2 documented doses of MMR vaccine, does she demand a third dose of MMR vaccine postpartum?

In 2013, ACIP changed its recommendation for this state of affairs (see www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20). It is recommended that women of childbearing age who accept received 1 or 2 doses of rubella-containing vaccine and take rubella serum IgG levels that are not conspicuously positive should exist administered 1 boosted dose of MMR vaccine (maximum of iii doses) and do not need to be retested for serologic testify of rubella immunity. MMR should not exist administered to a pregnant woman.

I have a female patient who has a non-immune rubella titer ii months after her second MMR vaccination. Should she be revaccinated? If so, should the titer over again exist checked to determine seroconversion?

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

MMR vaccines should not exist administered to women known to be meaning or attempting to become pregnant. Because of the theoretical gamble to the fetus when the mother receives a live virus vaccine, women should exist counseled to avoid becoming meaning for 28 days after receipt of MMR vaccine.

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

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

Vaccine Safety Back to top

Is there any evidence that MMR or thimerosal causes autism?

No. This effect has been studied extensively, including a thorough review by the independent Institute of Medicine (IOM). The IOM issued a written report in 2004 that concluded at that place is no evidence supporting an association betwixt MMR vaccine or thimerosal-containing vaccines and the evolution of autism. For more information on thimerosal and vaccines in general, visit world wide web.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

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

Merck no longer produces single antigen measles, mumps, and/or rubella vaccines for the U.Southward. marketplace. Only combined MMR is available. You should educate parents nearly the lack of association between MMR and autism.

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

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 non-immune postal service-pubertal women report joint pain after receiving rubella vaccine, and about 10% to 30% report arthritis-like signs and symptoms.

When joint symptoms occur, they by and large brainstorm 1 to 3 weeks after vaccination, usually are mild and not incapacitating, last about two days, and rarely recur.

Is there any impairment in giving an extra dose of MMR to a child of age seven years whose record is lost and the mother is non sure about the concluding dose of MMR?

In general, although information technology is non platonic, receiving extra doses of vaccine poses no medical problem. However, receiving excessive doses of tetanus toxoid (e.chiliad., DTaP, DT, Tdap, or Td) tin increment the risk of a local adverse reaction. For details see the Extra Doses of Vaccine Antigens section of the ACIP General All-time Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Vaccination providers frequently see people who do not have acceptable documentation of vaccinations. Providers should simply 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 be accustomed. An attempt to locate missing records should be made whenever possible past contacting previous healthcare providers, reviewing land or local immunization data systems, and searching for a personally held record.

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

Storage and Handling Back to top

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

The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is unremarkably outlined somewhere in the vaccine's package insert. MMR must be used within 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must exist used immediately. The Immunization Action Coalition has a staff pedagogy slice that outlines the time allowed betwixt reconstitution and use, every bit stated in the package inserts for a number of vaccines. Handout can be constitute at the following link: world wide web.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine be stored?

MMR may be stored either in the refrigerator at 2°C to viii°C (36°F to 46°F) or in the freezer at -50°C to -xv°C (-58°F to +5°F). The diluent should not be frozen and can be stored in the fridge or at room temperature.

If the MMR is combined with varicella vaccine as MMRV (ProQuad, Merck), it must exist stored in the freezer at -fifty°C to -15°C (-58°F to +5°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 handling like this occur too frequently. If you doubtable that vaccine has been mishandled, y'all should store the vaccine equally recommended, then contact the manufacturer or land/local health department for guidance on its utilise. This is particularly important for live virus vaccines like MMR and varicella.

One time MMR vaccine has been reconstituted with diluent, how shortly must information technology exist used?

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

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

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

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

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