If I Had Measles Can I Get Them Again

Measles, Mumps, and Rubella

Illness Bug Contraindications and Precautions Vaccine Recommendations Pregnancy and Postpartum Considerations Administering Vaccines Vaccine Condom Scheduling Vaccines Storage and Treatment For Healthcare Personnel

Disease Issues

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

In 2019, a provisional total of 1,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a single year since 1992; 73% of cases were associated with outbreaks amongst unvaccinated people in New York. These outbreaks were contained and stopped before the end of 2019. Between January 1 and August nineteen, 2020, just 12 measles cases were reported by 7 jurisdictions. Express travel every bit a outcome of the COVID-19 pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the United states of america. CDC measles surveillance updates can be plant at www.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, at that place has been a more than than 99% decrease in mumps cases in the United States. However, outbreaks still occasionally occur. In 2006, there was an outbreak affecting more than than six,584 people in the United States, with many cases occurring on college campuses. In 2009, an outbreak started in shut-knit religious communities and schools in the Northeast, resulting in more than 3,000 cases. Since 2015, numerous outbreaks have been reported across the US, 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 equally among residential college students and families in shut-knit communities) mumps can spread even among vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A provisional total of iii,484 cases of mumps were reported to CDC in 2019.

Rubella was alleged eliminated (the absence of endemic manual for 12 months or more than) from the United states in 2004. Fewer than 10 cases (primarily import-related) take 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 3 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 death, 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 Us, from 1987 to 2000, the well-nigh commonly reported complications associated with measles infection were pneumonia (6%), otitis media (seven%), and diarrhea (8%). For every i,000 reported measles cases in the United States, approximately one instance of encephalitis and two to 3 deaths resulted. The adventure for decease 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 take few or no symptoms. Complications of mumps include orchitis (inflammation of the testicle) and oophoritis (inflammation of the ovary). Other complications of mumps include pancreatitis, deafness, aseptic meningitis, and encephalitis. Mumps illness is typically milder, with fewer complications, in fully vaccinated case patients.

Rubella is generally a mild illness with low-grade fever, lymphadenopathy, and malaise. Up to 50% of rubella virus infections are subclinical. Complications tin include thrombocytopenic purpura and encephalitis. Rubella virus is teratogenic and infection in a significant woman, particularly during the beginning trimester tin result in miscarriage, stillbirth, and birth defects including cataracts, hearing loss, mental retardation, and congenital eye defects.

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

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

• a generalized rash lasting 3 or more than 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 ane to two days before the measles rash appears to ane to two days afterward. They appear equally punctate blueish-white spots on the bright cherry background of the buccal mucosa. Pictures of measles rash and Koplik spots can be found at www.cdc.gov/measles/about/photos.html.

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

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

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

Measles is highly contagious. A person with measles is infectious up to 4 days before through 4 days later the day of rash onset. Patients with suspected measles should be isolated for 4 days later they develop a rash. Airborne precautions should exist followed in healthcare settings by all healthcare personnel. The preferred placement for patients who require airborne precautions is in a unmarried-patient airborne infection isolation room. Providers should immediately isolate and study suspected measles cases to their local wellness section 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.S.; healthcare providers should report all cases of suspected measles to public wellness authorities immediately to assist reduce the number of secondary cases. Practise not await for the results of laboratory testing to report clinically-suspected measles to the local health department.

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

How long does it take to testify signs of measles, mumps, and rubella subsequently being exposed?

For measles, there is an average of ten to 12 days from exposure to the appearance of the first symptom, which is usually fever. The measles rash doesn't usually appear until approximately 14 days after exposure (range: 7 to 21 days), and the rash typically begins ii to 4 days subsequently the fever begins. The incubation period of mumps averages xvi to xviii days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation flow of rubella is 14 days (range: 12 to 23 days). However, every bit noted above, upward to half of rubella virus infections crusade no symptoms.

Vaccine Recommendations Back to top

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

The most recent comprehensive ACIP recommendations for the employ of MMR vaccine were published in 2013 and are bachelor at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at historic period 12 through 15 months, with a 2nd dose at age 4 through 6 years. The second dose of MMR can be given every bit early every bit iv weeks (28 days) subsequently the commencement dose and be counted equally a valid dose if both doses were given after the child's first altogether. The second dose is not a booster, only rather is intended to produce immunity in the small number of people who fail to respond to the offset dose.

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

Live attenuated measles vaccine became available in the U.Due south. in 1963. An ineffective, inactivated measles vaccine was as well 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 blazon of vaccine information technology was, or are sure information technology was inactivated measles vaccine, that dose should be considered invalid and the patient revaccinated as age- and risk-appropriate with MMR vaccine. At the discretion of the country public health section, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered completely vaccinated for their age or risk status.

What is considered adequate prove of immunity to measles?

Acceptable presumptive evidence of immunity confronting measles includes at to the lowest degree one of the following:

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

Although nascency before 1957 is considered acceptable testify of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who do not have other evidence of immunity with ii 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 twelvemonth 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, one, or two doses of MMR vaccine are needed for the adults described below.

Naught doses:

• adults built-in earlier 1957 except healthcare personnel* • adults born 1957 or afterwards who are at depression gamble (i.e., non an international traveler or healthcare worker, or person attending college or other mail service-high school educational institution) and who have already received ane or more than documented doses of live measles vaccine • adults with laboratory evidence of immunity or laboratory confirmation of measles

One dose of MMR vaccine:

• adults built-in 1957 or later who are at low gamble (i.e., non an international traveler, healthcare worker, or person attending college or other post-high school educational institution) and have no documented vaccination with live measles vaccine and no laboratory evidence of immunity or prior measles infection

Two doses of MMR vaccine:

� high-risk adults without any prior documented live measles vaccination and no laboratory evidence 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 it was, or are sure it was inactivated measles vaccine, should be revaccinated with either one (if depression-risk) or two (if high-risk) doses of MMR vaccine.

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

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

Although birth before 1957 is considered acceptable testify of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born before 1957 who practise not have laboratory show of measles immunity, laboratory confirmation of disease, or vaccination with 2 appropriately spaced doses of MMR vaccine.

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

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

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

MMR can be given to children as young equally 6 months of historic period who are at high take chances of exposure such as during international travel or a community outbreak. Even so, doses given BEFORE 12 months of age cannot be counted toward the 2-dose series for MMR.

How does being built-in earlier 1957 confer immunity to measles?

People built-in before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a effect, these people are very probable to have had measles affliction. 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. Still, if serologic testing indicates that the person is non allowed, at least 1 dose of MMR should be administered.

Why is a second dose of MMR necessary?

Approximately 7% of people exercise not develop measles immunity afterward the first dose of vaccine. This occurs for a variety of reasons. The 2d dose is to provide some other chance to develop measles immunity for people who did non respond to the beginning dose. About 97% of people develop immunity to measles after two doses of measles-containing vaccine.

Are there any situations where more than than ii 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 conspicuously positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Farther testing for serologic testify of rubella amnesty is not recommended. MMR should not be administered to a pregnant woman.

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 health authorities every bit being function of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus�containing vaccine (MMR or MMRV) to improve protection confronting mumps affliction and related complications. More information virtually this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

When is information technology appropriate to apply MMR vaccine for measles post-exposure prophylaxis?

MMR vaccine given within 72 hours of initial measles exposure can reduce the risk of getting sick or reduce the severity of symptoms. Another option for exposed, measles-susceptible individuals at high take a chance of complications who cannot be vaccinated is to requite immunoglobulin (IG) within vi days of exposure. Exercise not administer MMR vaccine and IG simultaneously, as the IG invalidates the vaccine.

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

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

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

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

Both killed and alive adulterate measles vaccines became bachelor in 1963. Live attenuated vaccine was used more oftentimes than killed vaccine. The killed vaccine was found to exist not effective and people who received it should be revaccinated with live vaccine. Without a written record, it is not possible to know what blazon of vaccine an individual may take received. So persons built-in during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot certificate having been vaccinated or having laboratory-confirmed measles disease should receive at least 1 dose of MMR. Some people at increased risk of exposure to measles (such every bit healthcare professionals and international travelers) should receive 2 doses of MMR separated by at to the lowest degree 4 weeks.

Exercise people who received MMR in the 1960s need to take their dose repeated?

Not necessarily. People who take documentation of receiving live measles vaccine in the 1960s do not demand 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 to the lowest degree one dose of live adulterate 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 risk for mumps infection (such as people who work in a healthcare facility) should exist 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 every bit bear witness of amnesty for measles, mumps, and rubella. ACIP removed physician diagnosis of affliction as evidence of immunity for measles and mumps. Dr. diagnosis of illness had non previously been accepted equally prove of amnesty for rubella. With the decrease in measles and mumps cases over the final 30 years, the validity of md-diagnosed disease has become questionable. In addition, documenting history from physician records is not a practical option for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

Measles vaccine, given every bit MMR, may exist constructive if given within the kickoff 3 days (72 hours) after exposure to measles. Allowed globulin may exist effective for every bit long every bit 6 days afterwards exposure. Postexposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella. However, if the exposed person does not take evidence of mumps or rubella immunity they should be vaccinated since not all exposures effect 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 use of post-exposure IG prophylaxis for measles. Intramuscular IG (IGIM) should exist administered to all infants younger than 12 months who accept been exposed to measles. The dose of IGIM is 0.5 mL/kg of body weight; the maximum dose is 15 mL. Alternatively, MMR vaccine can be given instead of IGIM to infants age 6 through 11 months, if information technology can exist given within 72 hours of exposure.

Meaning 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, administration of at least 400 mg/kg trunk weight within 3 weeks earlier measles exposure should be sufficient to preclude measles infection. For patients receiving subcutaneous immune globulin (IGSC) therapy, administration of at least 200 mg/kg body weight for 2 sequent weeks before measles exposure should be sufficient.

Other people who do not have evidence of measles immunity can receive an IGIM dose of 0.5 mL/kg of torso weight. Requite priority to people who were exposed to measles in settings where they have intense, prolonged close contact (such equally household, kid intendance, classroom, etc.). The maximum dose of IGIM is fifteen mL.

IG is not indicated for persons who have received ane 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 preclude mumps or rubella infection after exposure and is not recommended for that purpose.

We often run into higher students who lack vaccination records, merely whose titer results bear witness 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 bachelor in the U.S.; the student 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 ii doses of MMR.

I accept patients who claim to recall receiving MMR vaccine but have no written record, or whose parents written report the patient has been vaccinated. Should I accept this every bit evidence of vaccination?

No. Self-reported doses and history of vaccination provided by a parent or other caregiver are not considered to be valid. You should but accept a written, dated record as testify of vaccination.

Nether what circumstances should adults be considered for testing for measles-specific antibody prior to getting vaccinated?

Adults without evidence of immunity and no contraindications to MMR vaccine tin be vaccinated without testing. Just adults without bear witness of immunity might be considered for testing for measles-specific IgG antibiotic, but testing is not needed prior to vaccination.

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

2 documented doses of MMR vaccine given on or after the starting time birthday and separated by at least 28 days is considered proof of measles amnesty, co-ordinate to ACIP. Documentation of appropriate vaccination supersedes the results of serologic testing for measles, mumps, rubella, and varicella.

A patient born in 1970 has a history of measles disease and is also immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, simply is concerned near the measles exposure take a 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 test for measles-specific IgG will confirm that the person is allowed and is not at chance of infection regardless of the multiple myeloma. Multiple myeloma is a hematologic cancer and is considered immunosuppressive then MMR vaccine is contraindicated in this person.

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

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

I accept a 45-year-former 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 allowed when pregnant 20 years ago. Her measles titer is negative. Would yous recommend an MMR booster?

ACIP recommends 2 doses of MMR given at least four weeks autonomously for any developed built-in in 1957 or later who plans to travel internationally. There is no impairment in giving MMR vaccine to a person who may already be immune to one or more than of the vaccine viruses.

A patient who was born before 1957 and is non a healthcare worker wants to become the MMR vaccine before international travel. Does he need a dose of MMR?

No, it is not considered necessary, but he may be vaccinated. Before implementation of the national measles vaccination program in 1963, well-nigh every person acquired measles before adulthood. So, this patient can be considered allowed based on their birth year. However, MMR vaccine also may be given to any 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.

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

First of all, brand sure all your patients are fully vaccinated co-ordinate to the U.Due south. immunization schedule.

In certain circumstances, MMR is recommended for infants age 6 through 11 months. Give infants this age a dose of MMR earlier international travel. In addition, consider measles vaccination for infants as young as age half-dozen months as a control measure during a U.Southward. measles outbreak. Consult your state health department to find out if this is recommended in your situation. Do not count any dose of MMR vaccine as part of the 2-dose serial if information technology is administered earlier a kid's first birthday. Instead, repeat the dose when the kid is age 12 months.

In the case of a local outbreak, you as well might consider vaccinating children historic period 12 months and older at the minimum age (12 months, instead of 12 through xv months) and giving the second dose 4 weeks afterward (at the minimum interval) instead of waiting until age four 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 amongst those effectually them. Be sure to encourage all your patients and their family members to get vaccinated if they are not immune.

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

In recent 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 2 doses of MMR vaccine appears to be sufficient for mumps control in the general population, only insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with two doses of MMR vaccine is high.

In January 2018, the Informational 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 health government equally being office of a grouping at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus�containing vaccine 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.

In a measles outbreak, practise children who take not 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 as measles, rubella, and hepatitis B) to much lower (60% for flu in years with a good match of circulating and vaccine viruses, and 70% for acellular pertussis vaccines in the iii-5 years after vaccination). More information is available for each vaccine and disease at www.cdc.gov/vaccines/vpd-vac/default.htm and world wide web.immunize.org/vaccines.

Administering Vaccines Back to top

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

All alive injected vaccines (MMR, varicella, and xanthous 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 practice not need to exist repeated.

Nosotros often need to give MMR vaccine to big adults. Is a 25-guess needle with a length of 5/eight" 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-former instead of MMR. Can this exist considered a valid dose?

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

Scheduling Vaccines Back to top

How soon can we give the second dose of MMR vaccine to a kid vaccinated at 12 months old?

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

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

A dose of MMR vaccine administered up to iv days before the showtime birthday may be counted as valid. Even so, schoolhouse entry requirements in some states may mandate administration on or after the first altogether. The 4-day "grace flow" should not be applied to the 28-day minimum interval between two doses of a live parenteral vaccine.

Tin MMR be given on the aforementioned twenty-four hour period as other live virus vaccines?

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

If you can give the 2nd dose of MMR as early equally 28 days afterward the first dose, why do nosotros routinely wait until kindergarten entry to give the second dose?

The 2nd dose of MMR may be given as early on as iv weeks afterwards the first dose, and exist counted as a valid dose if both doses were given after the get-go birthday. The 2nd dose is not a booster, but rather it is intended to produce immunity in the modest number of people who fail to respond to the offset dose. The gamble of measles is higher in school-age children than those of preschool historic period, then it is important to receive the second dose past school entry. It is also convenient to give the 2d dose at this age, since the kid will accept an immunization visit for other school entry vaccines.

What is the earliest 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 alive away should be vaccinated at an earlier age than that recommended for children who reside in the United States. Before their deviation from the United States, children historic period vi through 11 months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, middle- and low-income countries. Consequently, CDC encourages all international travelers to be upwardly to date on their immunizations regardless of their travel destination and to go on a copy of their immunization records with them as they travel. For boosted information on the worldwide measles situation, and on CDC's measles vaccination information for travelers, become to wwwnc.cdc.gov/travel.

If we give 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 nosotros give the side by side dose?

The next dose should exist given at 12 months of age. The child will likewise need another dose at least 28 days later. For the kid 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 as part of the MMR vaccine two-dose series.

I have an eight-month-old patient who is traveling internationally. The infant needs to exist protected from hepatitis A as well every bit measles, mumps, and rubella. The family is leaving in 11 days. Tin I requite 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 2022 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age 6 through 11 months traveling outside 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 function of the kid'southward routine vaccination series. For details of this recommendation, see the CDC ACIP recommendations for the prevention and control of hepatitis A at world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page xviii.

Tin I give the second dose of MMR before than age four through vi years (the kindergarten entry dose) to young children traveling to areas of the world where in that location are measles cases?

Yes. The 2d dose of MMR tin be given a minimum of 28 days afterward the first dose if necessary.

If I requite MMR to an infant traveler younger than age 1 twelvemonth, will that dose be considered valid for the U.S. immunization schedule?

No. A measles-containing vaccine administered more than 4 days before the first birthday should not be counted 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 surface area where illness risk is high). The second dose should be administered at least 28 days after the beginning dose.

Tin I requite a tuberculin skin test (TST) on the same 24-hour interval equally a dose of MMR vaccine?

Yes. A TST can exist applied before or on the same solar 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 28 days. Live measles vaccine given prior to the application of a TST tin can reduce the reactivity of the skin test because of mild suppression of the allowed system.

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

This student should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is non acceptable equally proof of immunity. Acceptable evidence of measles and mumps immunity includes a positive serologic test for antibiotic, nativity before 1957, or written documentation of vaccination. For rubella, only serologic bear witness or documented vaccination should be accepted as proof of immunity. Additionally, people built-in prior to 1957 may exist considered immune to rubella unless they are women who have the potential to become pregnant.

When non given on the same twenty-four hours, is the interval between yellow fever and MMR vaccines four weeks (28 days) or 30 days? I have seen the yellow fever and live virus vaccine recommendations published both ways.

The General Best Practice Guidelines for Immunization (see world wide web.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 exist separated by at to the lowest degree 28 days. The CDC travel health website recommends that xanthous fever vaccine and other parenteral or nasal live vaccines should be separated by at least thirty days if possible. Either interval is acceptable.

For Healthcare Personnel Back to summit

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP born during or afterward 1957 have adequate presumptive prove of immunity to measles, mumps, and rubella, defined every bit documentation of 2 doses of measles and mumps vaccine and at least one dose of rubella vaccine, laboratory evidence of immunity, or laboratory confirmation of disease. Further, ACIP recommends that healthcare facilities should consider vaccination of all unvaccinated healthcare personnel who were born before 1957 and who lack laboratory evidence of measles, mumps, and/or rubella immunity or laboratory confirmation of affliction. 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 immunity or laboratory confirmation of disease. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of nativity twelvemonth who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease.

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

Yeah. Healthcare personnel (HCP) with two 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-appropriate vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who practice non have documentation of MMR vaccination and whose serologic test is interpreted equally "indeterminate" or "equivocal" should be considered not immune and should receive two doses of MMR vaccine (minimum interval 28 days). ACIP does not recommend serologic testing afterwards vaccination. For more than information, see ACIP's recommendations on the use of MMR vaccine at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, folio 22.

If a healthcare worker develops a rash and low-grade fever later MMR vaccine, is southward/he infectious?

Approximately 5 to fifteen% of susceptible people who receive MMR vaccine will develop a low-grade fever and/or mild rash 7 to 12 days after vaccination. Nonetheless, the person is not infectious, and no special precautions ( such as exclusion from work) need to exist taken.

A 22-year-former female is going to chemist's school and the school wants her to have a second dose of MMR vaccine. She had the outset dose equally a child and developed measles within 24 hours of receiving the vaccine. Contempo serologic testing showed she is allowed to mumps and measles only not immune to rubella. Can I requite her a second dose of the MMR with her having measles after the first dose?

Yeah, every bit a healthcare professional person, this person should get a second dose of MMR to ensure she is allowed to rubella. At that place is no impairment in providing MMR to a person who is already immune to 1 or more than of the components. If she developed measles only one solar day later on getting her start MMR, she must have been exposed to the affliction prior to vaccination.

Contraindications and Precautions Back to acme

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

• receipt of an antibody-containing blood product in the previous three–eleven months, depending on the type of claret product received. Run into www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Tabular array 3-5 for more data on this issue • moderate or severe acute illness with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Of import details about 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.

Nosotros accept many patients who are immunocompromised and cannot go the MMR vaccine. How should we suggest our patients?

People with medical weather 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 be vaccinated are fully vaccinated according to the U.South. immunization schedule. Also, encourage patients to remind their family members and other shut contacts to get vaccinated if they are not allowed.

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

We have a patient who has selective IgA deficiency. We also take patients with selective IgM deficiency. Can MMR or varicella vaccine be 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 allowed 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 await before receiving MMR vaccine?

At that place is no need to look a specific interval before giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, and and then there is no concern well-nigh safety or efficacy of MMR.

Can I requite MMR to a child 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 xl lb half-dozen-yr-one-time patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can 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.four mg/kg/week of methotrexate. This meets the Infectious Illness Social club of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced. The 2013 IDSA definition of depression-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/week. For boosted details, meet the 2013 IDSA Clinical Practice Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/xi/26/cid.cit684.total.pdf.

Is it true that egg allergy is non considered a contraindication to MMR vaccine?

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

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

Yes. Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no risk to the infant being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may 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 fourth dimension between the blood production and the MMR to reduce the run a risk of interference. The interval depends on the blood product received. Come across Table 3-five of ACIP's Full general Best Do Guidelines for Immunization for more data, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Is it acceptable practice to administer MMR, Tdap, and flu vaccines to a postpartum mom at the same fourth dimension every bit administering RhoGam?

Yep. Receipt of RhoGam is not a reason to delay vaccination. For more information see the ACIP General Best Practise Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

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

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

Administrate ii doses of MMR vaccine to all HIV-infected people historic period 12 months and older who do not have prove of current severe immunosuppression or electric current testify 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 xv% or more for six months or longer; a person older than 5 years must have CD4 percentages of xv% or more and a CD4 lymphocyte count of 200 or more/mm3 for six months or longer. If laboratory results state only one type of parameter (percentage or counts) this is sufficient for vaccine controlling.

Administer the commencement dose at 12 through 15 months and the second dose to children age 4 through half dozen years, or equally early on as 28 days after the offset dose.

Unless they have adequate current evidence of measles, mumps, and rubella immunity, people with perinatal HIV infection who were vaccinated prior to establishment of constructive antiretroviral therapy (ART) should receive ii accordingly spaced doses of MMR vaccine after effective ART has been established. Established effective Fine art is divers every bit receiving Art for at least vi months in combination with CD4 percentages of xv% or more for six months or longer for children age 5 years or younger. People older than 5 years should have CD4 percentages of fifteen% or more and a CD4 lymphocyte count of 200 or more than/mm3 for 6 months or longer. If laboratory results country only one type of parameter (percentages or counts) this is sufficient for vaccine conclusion-making.

Pregnancy and Postpartum Considerations Back to top

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

Although the MMR vaccine package insert recommends a 3-calendar month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for four weeks. For details on this issue, see ACIP's 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 child-bearing age exist screened for pregnancy earlier MMR vaccination?

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 "aye." Those who reply "no" should exist advised to avoid pregnancy for 4 weeks post-obit vaccination. Pregnancy testing is non necessary.

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

No specific action needs to be taken other than to reassure the woman that no adverse outcomes are expected every bit a result of this vaccination. MMR vaccination during pregnancy is not a reason to terminate the pregnancy. You lot should consult with others in your healthcare setting to place ways to prevent such vaccination errors in the hereafter. Detailed data about MMR vaccination in pregnancy is included in the nigh recent MMR ACIP argument, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

We require a pregnancy exam for all our seventh graders earlier giving an MMR. Is this necessary?

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

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

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

If a woman'southward rubella examination result shows she is "not immune" during a prenatal visit, simply she has 2 documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum?

In 2013, ACIP changed its recommendation for this situation (see www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20). It is recommended that women of childbearing historic period who have received 1 or two doses of rubella-containing vaccine and accept rubella serum IgG levels that are not clearly positive should be administered ane additional dose of MMR vaccine (maximum of 3 doses) and do non demand to be retested for serologic prove of rubella amnesty. MMR should not be administered to a meaning woman.

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

ACIP recommends that vaccinated women of childbearing historic period who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should be administered i additional dose of MMR vaccine (maximum of 3 doses). Echo serologic testing for evidence of rubella immunity is non recommended. Meet www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20, for more information on this issue.

MMR vaccines should not be administered to women known to exist pregnant or attempting to become significant. Because of the theoretical risk to the fetus when the female parent receives a live virus vaccine, women should exist counseled to avoid condign significant for 28 days afterward receipt of MMR vaccine.

How soon afterward delivery can MMR exist given to the female parent?

MMR tin be administered whatsoever fourth dimension afterward commitment. The vaccine should exist administered to a woman who is susceptible to either measles, mumps, or rubella before infirmary belch, even 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 whatsoever prove that MMR or thimerosal causes autism?

No. This consequence has been studied extensively, including a thorough review by the contained Institute of Medicine (IOM). The IOM issued a written report in 2004 that concluded there is no evidence supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. For more information on thimerosal and vaccines in general, visit www.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

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

Merck no longer produces unmarried antigen measles, mumps, and/or rubella vaccines for the U.S. market. Simply combined MMR is available. You lot should educate parents virtually 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 (articulation redness or swelling) following 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. Nigh 25% of non-immune post-pubertal women report joint pain after receiving rubella vaccine, and nigh ten% to 30% report arthritis-similar signs and symptoms.

When joint symptoms occur, they more often than not brainstorm 1 to three weeks after vaccination, commonly are mild and not incapacitating, last well-nigh two days, and rarely recur.

Is there whatsoever harm in giving an extra dose of MMR to a kid of historic period seven years whose record is lost and the mother is not sure virtually the last dose of MMR?

In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem. Even so, receiving excessive doses of tetanus toxoid (due east.yard., DTaP, DT, Tdap, or Td) tin increase the risk of a local adverse reaction. For details see the Extra Doses of Vaccine Antigens section of the ACIP General Best Do Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

Vaccination providers often come across people who do not have adequate documentation of vaccinations. Providers should only have written, dated records as prove 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 endeavor to locate missing records should exist made whenever possible by contacting previous healthcare providers, reviewing country or local immunization data systems, and searching for a personally held record.

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

Storage and Treatment Back to superlative

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

The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is ordinarily outlined somewhere in the vaccine's parcel insert. MMR must be used within viii hours of reconstitution. MMRV must be used within xxx minutes; other vaccines must exist used immediately. The Immunization Action Coalition has a staff education slice that outlines the time allowed betwixt reconstitution and utilise, equally stated in the bundle inserts for a number of vaccines. Handout can exist plant at the following link: www.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine be stored?

MMR may be stored either in the refrigerator at 2°C to 8°C (36°F to 46°F) or in the freezer at -50°C to -15°C (-58°F to +five°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), it must be stored in the freezer at -50°C to -15°C (-58°F to +5°F).

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

Unfortunately, serious errors in vaccine storage and handling like this occur too often. If y'all doubtable that vaccine has been mishandled, yous should store the vaccine as recommended, then contact the manufacturer or state/local health department for guidance on its utilise. This is specially important for live virus vaccines similar MMR and varicella.

One time MMR vaccine has been reconstituted with diluent, how presently must it be used?

It is preferable to administer MMR immediately after reconstitution. If reconstituted MMR is not used within eight hours, it must be 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 there whatsoever problem with doing this?

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

Dorsum to tiptop

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

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