I Got Vaccine but Still Got the Mumps Can I Get It Again

Measles, Mumps, and Rubella

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

Illness Problems

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

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 year since 1992; 73% of cases were associated with outbreaks amongst unvaccinated people in New York. These outbreaks were independent and stopped before the terminate of 2019. Between Jan 1 and August 19, 2020, merely 12 measles cases were reported by 7 jurisdictions. Limited travel as a event of the COVID-19 pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the The states. CDC measles surveillance updates can be found at www.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, there has been a more than than 99% decrease in mumps cases in the United States. However, outbreaks all the same occasionally occur. In 2006, at that place was an outbreak affecting more than 6,584 people in the United states of america, 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 beyond the US, in college campuses, prisons, and close-knit communities, including a large outbreak in northwest Arkansas where nearly iii,000 cases were reported in 2016. These outbreaks have shown that when people with mumps have close contact with a lot of other people (such equally among residential higher students and families in shut-knit communities) mumps can spread fifty-fifty among vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A provisional total of iii,484 cases of mumps were reported to CDC in 2019.

Rubella was declared eliminated (the absence of endemic manual for 12 months or more) from the Usa in 2004. Fewer than 10 cases (primarily import-related) take been reported annually in the United states of america since elimination was alleged. Rubella incidence in the United states of america has decreased by more than 99% from the pre-vaccine era. A provisional total of 3 cases of rubella, and no cases of built rubella syndrome, were reported in 2019.

How serious are measles, mumps, and rubella?

Measles tin lead to serious complications and death, fifty-fifty with modern medical care. The 1989–1991 measles outbreak in the U.Due south. resulted in more than than 55,000 cases and more 100 deaths. In the Us, from 1987 to 2000, the most unremarkably reported complications associated with measles infection were pneumonia (6%), otitis media (vii%), and diarrhea (8%). For every 1,000 reported measles cases in the The states, approximately one case of encephalitis and two to three deaths resulted. The take chances for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

Mumps well-nigh commonly causes fever and parotitis. Up to 25% of persons with mumps accept few or no symptoms. Complications of mumps include orchitis (inflammation of the testicle) and oophoritis (inflammation of the ovary). Other complications of mumps include pancreatitis, deafness, hygienic meningitis, and encephalitis. Mumps illness is typically milder, with fewer complications, in fully vaccinated case patients.

Rubella is generally a mild illness with depression-grade fever, lymphadenopathy, and malaise. Upward to 50% of rubella virus infections are subclinical. Complications tin can include thrombocytopenic purpura and encephalitis. Rubella virus is teratogenic and infection in a meaning adult female, especially during the start trimester can result in miscarriage, stillbirth, and birth defects including cataracts, hearing loss, mental retardation, and congenital heart defects.

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

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

• a generalized rash lasting iii or more than days, and • a temperature of 101°F or higher (38.3°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 ane to ii days before the measles rash appears to ane to ii days afterward. They appear as punctate blue-white spots on the bright ruddy background of the buccal mucosa. Pictures of measles rash and Koplik spots tin can be found at www.cdc.gov/measles/about/photos.html.

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

Providers should immediately isolate and study suspected measles cases to their local health department and obtain specimens for measles testing, including viral specimens for confirmation and genotyping. Providers should also collect blood for serologic testing during the commencement clinical see 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 upward to four days before through 4 days after the day of rash onset. Patients with suspected measles should be isolated for four days after they develop a rash. Airborne precautions should be followed in healthcare settings past 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 written report suspected measles cases to their local health department and obtain specimens for measles testing, including serum sample for measles serologic testing and a throat swab (or nasopharyngeal swab) for viral confirmation.

Measles is a nationally notifiable disease in the U.Southward.; healthcare providers should report all cases of suspected measles to public health regime immediately to help reduce the number of secondary cases. Do not await for the results of laboratory testing to report clinically-suspected measles to the local wellness department.

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

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

For measles, there is an average of ten to 12 days from exposure to the appearance of the first symptom, which is normally fever. The measles rash doesn't commonly appear until approximately 14 days after exposure (range: 7 to 21 days), and the rash typically begins ii to 4 days later on the fever begins. The incubation period of mumps averages sixteen to 18 days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation menses of rubella is xiv days (range: 12 to 23 days). However, every bit noted to a higher place, upwardly to one-half of rubella virus infections cause no symptoms.

Vaccine Recommendations Back to tiptop

What are the current recommendations for the employ of MMR vaccine?

The nigh recent comprehensive ACIP recommendations for the use of MMR vaccine were published in 2013 and are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a second dose at age 4 through half dozen years. The second dose of MMR can exist given as early as 4 weeks (28 days) after the showtime dose and exist counted as a valid dose if both doses were given after the kid'due south first birthday. The second dose is not a booster, but rather is intended to produce immunity in the small number of people who fail to respond to the first dose.

Adults with no prove of immunity (testify of immunity is defined equally documented receipt of 1 dose [2 doses iv weeks autonomously if high risk] of live measles virus-containing vaccine, laboratory evidence of amnesty or laboratory confirmation of illness, or nascence before 1957) should get 1 dose of MMR vaccine unless the adult is in a high-take a chance group. High-run a risk people need two doses and include school-historic period children, healthcare personnel, international travelers, and students attending post-high school educational institutions.

Live attenuated measles vaccine became available in the U.S. in 1963. An ineffective, inactivated measles vaccine was also bachelor in the U.Southward. in 1963–1967. Combined MMR vaccine (MMRII, Merck) was licensed in 1971. For people who previously received a dose of measles vaccine in 1963–1967 and are unsure which blazon of vaccine it was, or are certain it was inactivated measles vaccine, that dose should exist considered invalid and the patient revaccinated as age- and take a chance-appropriate with MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered completely vaccinated for their age or risk status.

What is considered acceptable prove of immunity to measles?

Adequate presumptive show of immunity against measles includes at least ane of the post-obit:

• written documentation of adequate vaccination: • laboratory evidence of immunity • laboratory confirmation of measles (verbal history of measles does not count) • nascency before 1957

Although birth earlier 1957 is considered acceptable bear witness of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who practice not have other show 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 nativity year if they lack laboratory evidence of measles immunity.

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

Zero, one, or two doses of MMR vaccine are needed for the adults described below.

Zero doses:

• adults born before 1957 except healthcare personnel* • adults born 1957 or subsequently who are at low risk (i.e., non an international traveler or healthcare worker, or person attending college or other post-high school educational institution) and who accept already received one or more than documented doses of live measles vaccine • adults with laboratory evidence of immunity or laboratory confirmation of measles

Ane dose of MMR vaccine:

• adults born 1957 or later who are at depression hazard (i.e., not an international traveler, healthcare worker, or person attending college or other mail-loftier 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 alive 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 low-gamble) or ii (if loftier-risk) doses of MMR vaccine.

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

Given the gamble of outbreaks of measles in the U.S., should all healthcare personnel, including those born before 1957, have 2 doses of MMR vaccine?

Although nascency before 1957 is considered adequate evidence of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) built-in before 1957 who do not take laboratory evidence of measles immunity, laboratory confirmation of disease, or vaccination with 2 accordingly spaced doses of MMR vaccine.

Yet, during a local outbreak of measles, all healthcare personnel, including those born before 1957, are recommended to have 2 doses of MMR vaccine at the appropriate interval if they lack laboratory prove of measles.

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

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

MMR tin be given to children as young as 6 months of age who are at loftier gamble of exposure such as during international travel or a community outbreak. Still, doses given Earlier 12 months of historic period cannot be counted toward the ii-dose series for MMR.

How does being born before 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 likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons born earlier 1957 can be presumed to be allowed. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should exist administered.

Why is a second dose of MMR necessary?

Approximately 7% of people do non develop measles immunity after the kickoff dose of vaccine. This occurs for a variety of reasons. The second dose is to provide another adventure to develop measles amnesty for people who did not respond to the showtime dose. About 97% of people develop immunity to measles afterwards two doses of measles-containing vaccine.

Are there whatsoever situations where more than 2 doses of MMR are recommended?

In that location are ii circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing age who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive i additional dose of MMR vaccine (maximum of 3 doses). Farther testing for serologic bear witness of rubella amnesty is non recommended. MMR should not be administered to a pregnant woman.

In 2018, ACIP published guidance for MMR vaccination of people at increased take chances for acquiring mumps during an outbreak. People previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified past public health regime as being role 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 amend protection against mumps disease and related complications. More information about this recommendation is bachelor at world wide web.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

When is it appropriate to use MMR vaccine for measles mail service-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 loftier hazard 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 post-exposure prophylaxis for measles tin be constitute 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 forbid measles?

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

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

Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. The killed vaccine was found to exist not effective and people who received it should exist revaccinated with live vaccine. Without a written record, information technology is not possible to know what type of vaccine an private may have received. So persons born during or afterwards 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles disease should receive at to the lowest degree 1 dose of MMR. Some people at increased risk of exposure to measles (such every bit healthcare professionals and international travelers) should receive ii doses of MMR separated past at least iv weeks.

Do people who received MMR in the 1960s demand to take their dose repeated?

Not necessarily. People who accept documentation of receiving live measles vaccine in the 1960s practise non demand 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 i dose of live attenuated measles vaccine. This recommendation is intended to protect people who may accept received killed measles vaccine which was available in the United states of america in 1963 through 1967 and was not constructive. People vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such equally people who work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

I empathize that ACIP inverse its definition of evidence of amnesty to measles, rubella, and mumps in 2013. Please explain.

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of illness equally prove of immunity for measles, mumps, and rubella. ACIP removed doc diagnosis of disease every bit show of amnesty for measles and mumps. Physician diagnosis of illness had not previously been accustomed every bit evidence of amnesty for rubella. With the decrease in measles and mumps cases over the last 30 years, the validity of doc-diagnosed affliction has become questionable. In addition, documenting history from md records is not a practical choice for most adults. The 2013 MMR ACIP recommendations are bachelor at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Is in that location annihilation that can be done for unvaccinated people who accept already been exposed to measles, mumps, or rubella?

Measles vaccine, given as MMR, may be constructive if given within the get-go 3 days (72 hours) after exposure to measles. Immune globulin may be effective for as long every bit 6 days afterward exposure. Postexposure prophylaxis with MMR vaccine does non prevent or alter the clinical severity of mumps or rubella. Yet, if the exposed person does not have bear witness of mumps or rubella immunity they should be vaccinated since non all exposures result in infection.

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

In the 2013 revision of its MMR vaccine recommendations ACIP expanded the apply of mail service-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.five mL/kg of body weight; the maximum dose is 15 mL. Alternatively, MMR vaccine can exist given instead of IGIM to infants age six through 11 months, if it can be given inside 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 accept 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 within 3 weeks before measles exposure should be sufficient to prevent measles infection. For patients receiving subcutaneous immune globulin (IGSC) therapy, assistants of at least 200 mg/kg trunk weight for 2 consecutive weeks before measles exposure should exist sufficient.

Other people who exercise non have evidence of measles immunity can receive an IGIM dose of 0.five mL/kg of body weight. Give 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 15 mL.

IG is non 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 forestall mumps or rubella infection later exposure and is not recommended for that purpose.

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

Unmarried antigen vaccine is no longer available in the U.S.; the student should go the combined MMR vaccine. If a college educatee or other person at increased take chances of exposure cannot produce written documentation of either immunization or disease, and titers are negative, they should receive ii doses of MMR.

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

No. Cocky-reported doses and history of vaccination provided past a parent or other caregiver are non considered to be valid. You should only take a written, dated tape as testify of vaccination.

Under 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 can be vaccinated without testing. Simply adults without testify of amnesty might exist considered for testing for measles-specific IgG antibiotic, merely testing is non needed prior to vaccination.

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

2 documented doses of MMR vaccine given on or subsequently the first birthday and separated past at least 28 days is considered proof of measles amnesty, according to ACIP. Documentation of appropriate vaccination supersedes the results of serologic testing for measles, mumps, rubella, and varicella.

A patient born in 1970 has a history of measles affliction and is also immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, just 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 amnesty. A positive serologic test for measles-specific IgG volition ostend 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 adult patients in our practice at high adventure for measles, including patients going back to college or preparing for international travel, who don't recall ever receiving MMR vaccine or having had measles illness. How should we manage these patients?

You take two options. You can exam for immunity or you lot can just give 2 doses of MMR at least 4 weeks apart. 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. If you or the patient opt for testing, and the tests indicate the patient is non immune to i or more of the vaccine components, give your patient 2 doses of MMR at to the lowest degree 4 weeks autonomously. If any exam results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination considering commercial tests may not exist sensitive enough to reliably detect vaccine-induced amnesty.

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

ACIP recommends 2 doses of MMR given at least 4 weeks apart for any developed born in 1957 or after who plans to travel internationally. There is no harm in giving MMR vaccine to a person who may already be allowed to one or more of the vaccine viruses.

A patient who was built-in before 1957 and is non a healthcare worker wants to become the MMR vaccine earlier 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, about every person acquired measles earlier adulthood. So, this patient tin be considered immune based on their nativity yr. However, MMR vaccine likewise may exist given to any person born earlier 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 take measles cases in our community. How can I best protect the immature children in my practise?

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

In certain circumstances, MMR is recommended for infants age six through 11 months. Give infants this historic period a dose of MMR before 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 country health department to find out if this is recommended in your state of affairs. Exercise not count any dose of MMR vaccine every bit office of the ii-dose serial if information technology is administered before a child'due south showtime birthday. Instead, repeat the dose when the kid is age 12 months.

In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum historic period (12 months, instead of 12 through fifteen months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until historic period 4 through vi years.

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

During a mumps outbreak should we offer a 3rd dose of MMR (MMR Two, Merck) to persons who have two prior documented doses of MMR?

In recent years, mumps outbreaks take occurred primarily in populations in institutional settings with close contact (such as residential colleges) or in shut-knit social groups. The current routine recommendation for two doses of MMR vaccine appears to be sufficient for mumps control in the general population, simply bereft for preventing mumps outbreaks in prolonged, close-contact settings, fifty-fifty where coverage with two doses of MMR vaccine is loftier.

In January 2018, the Advisory Committee on Immunization Practices (ACIP) published new guidance for MMR vaccination of persons at increased risk for acquiring mumps during an outbreak. Persons previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified by public health regime as beingness part of a group at increased risk for acquiring mumps because 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 about this recommendation is available at world wide web.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

In a measles outbreak, do children who accept not had MMR vaccine pose a threat to vaccinated people? It is my understanding that vaccinated people can still contract measles. Am I right?

You are correct that vaccinated people tin can still be infected with viruses or bacteria 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 (60% for flu in years with a good match of circulating and vaccine viruses, and lxx% for acellular pertussis vaccines in the three-v years later vaccination). More than data is available for each vaccine and disease at www.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines.

Administering Vaccines Back to elevation

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

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

We frequently demand to requite MMR vaccine to large adults. Is a 25-gauge needle with a length of five/eight" sufficient for a subcutaneous injection?

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

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

Aye, however, 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 xiii years and older, it may exist counted towards completion of the MMR and varicella vaccine series and does not need to be repeated.

Scheduling Vaccines Back to top

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

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

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

A dose of MMR vaccine administered upwardly to 4 days before the first birthday may be counted every bit valid. However, school entry requirements in some states may mandate administration on or after the start birthday. The four-day "grace period" should non be applied to the 28-24-hour interval minimum interval between two doses of a alive parenteral vaccine.

Tin MMR be given on the same day equally other alive virus vaccines?

Yes. However, if two parenteral or intranasal alive vaccines (MMR, varicella, LAIV and/or yellow fever) are not administered on the same 24-hour interval, they should be separated by an interval of at least 28 days.

If yous can give the second dose of MMR as early as 28 days afterwards the first dose, why practise nosotros routinely expect until kindergarten entry to give the second dose?

The second dose of MMR may be given as early equally 4 weeks after the first dose, and be counted as a valid dose if both doses were given afterwards the beginning birthday. The 2d dose is not a booster, merely rather information technology is intended to produce amnesty in the modest number of people who fail to respond to the beginning dose. The adventure of measles is higher in school-historic period children than those of preschool age, then it is important to receive the second dose by school entry. Information technology is also user-friendly to requite the second dose at this age, since the child will have an immunization visit for other schoolhouse entry vaccines.

What is the earliest age at which I tin can give MMR to an infant who will exist traveling internationally? Besides, which countries pose a loftier 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. Earlier their divergence from the U.s.a., children age 6 through 11 months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, heart- and low-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 copy of their immunization records with them every bit they travel. For boosted data on the worldwide measles situation, and on CDC's measles vaccination information for travelers, go to wwwnc.cdc.gov/travel.

If we requite a kid a dose of MMR vaccine at 6 months of age because they are in a community with cases of measles, when should we requite the next dose?

The next dose should be given at 12 months of historic period. The child volition also demand another dose at least 28 days later. For the child to be fully vaccinated, they need to have 2 doses of MMR vaccine given when the kid is 12 months of historic period and older. A dose given at less than 12 months of age does not count every bit office of the MMR vaccine two-dose series.

I have an 8-calendar month-quondam patient who is traveling internationally. The infant needs to exist protected from hepatitis A as well as 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 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age 6 through 11 months traveling outside the Us when protection confronting hepatitis A is recommended. MMR and hepatitis A vaccine may exist safely co-administered to children in this age group. Neither vaccine is counted as part of the child's routine vaccination series. For details of this recommendation, see the CDC ACIP recommendations for the prevention and control of hepatitis A at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page 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 world where there are measles cases?

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

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

No. A measles-containing vaccine administered more than 4 days before the first birthday should non be counted equally part of the series. MMR should be repeated when the child is historic period 12 through fifteen months (12 months if the child remains in an area where illness take a chance is high). The 2d dose should exist administered at least 28 days later the starting time dose.

Tin can I requite a tuberculin skin examination (TST) on the aforementioned day as a dose of MMR vaccine?

Yes. A TST can exist applied before or on the same day that MMR vaccine is given. Notwithstanding, if MMR vaccine is given on the previous day or earlier, the TST should exist 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 immune system.

An eighteen-yr-old college student 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 not adequate as proof of immunity. Adequate evidence of measles and mumps immunity includes a positive serologic test for antibody, birth before 1957, or written documentation of vaccination. For rubella, just serologic evidence or documented vaccination should be accepted as proof of immunity. Additionally, people born prior to 1957 may exist considered immune to rubella unless they are women who have the potential to become pregnant.

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

The Full general Best Practise Guidelines for Immunization (encounter world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html) makes the generic recommendation that alive parenterally or nasally administered vaccines not given on the same mean solar day should exist separated by at least 28 days. The CDC travel health website recommends that yellowish fever vaccine and other parenteral or nasal live vaccines should exist separated past at to the lowest degree 30 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 after 1957 take adequate presumptive evidence of amnesty to measles, mumps, and rubella, divers as documentation of two doses of measles and mumps vaccine and at least i dose of rubella vaccine, laboratory show 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 show of measles, mumps, and/or rubella immunity or laboratory confirmation of illness. During an outbreak of measles or mumps, healthcare facilities should recommend two doses of MMR separated by at least 4 weeks for unvaccinated healthcare personnel regardless of birth twelvemonth who lack laboratory evidence of measles or mumps amnesty or laboratory confirmation of affliction. During outbreaks of rubella, healthcare facilities should recommend i dose of MMR for unvaccinated personnel regardless of birth year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease.

Would yous consider healthcare personnel with two documented doses of MMR vaccine to be allowed fifty-fifty if their serology for 1 or more than of the antigens comes dorsum negative?

Yes. Healthcare personnel (HCP) with 2 documented doses of MMR vaccine are considered to be immune regardless of the results of a subsequent serologic test for measles, mumps, or rubella. Documented historic period-appropriate vaccination supersedes the results of subsequent serologic testing. In dissimilarity, HCP who do not take documentation of MMR vaccination and whose serologic examination is interpreted equally "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 information, come across 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 s/he infectious?

Approximately 5 to 15% of susceptible people who receive MMR vaccine volition develop a depression-grade fever and/or mild rash seven to 12 days subsequently vaccination. However, the person is not infectious, and no special precautions ( such as exclusion from work) need to be taken.

A 22-year-old female person is going to pharmacy school and the schoolhouse wants her to have a 2nd dose of MMR vaccine. She had the first dose equally a child and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles merely non immune to rubella. Can I give her a second dose of the MMR with her having measles after the outset dose?

Yes, as a healthcare professional, this person should get a second dose of MMR to ensure she is allowed to rubella. There is no harm in providing MMR to a person who is already immune to one or more of the components. If she adult measles only one day after getting her first MMR, she must have been exposed to the illness prior to vaccination.

Contraindications and Precautions Dorsum to top

What are the contraindications and precautions for MMR vaccine?

Contraindications:

• history of a severe (anaphylactic) reaction to any vaccine component (eastward.chiliad., neomycin) or following a previous dose of MMR • pregnancy • severe immunosuppression from either disease or therapy

Precautions:

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

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

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

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

We have a patient who has selective IgA deficiency. We besides take patients with selective IgM deficiency. Tin 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, just the vaccines are probable constructive.

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

There is no need to expect a specific interval before giving MMR. Injectable steroids are non considered immunosuppressive for the purpose of vaccination decisions, and so there is no concern about safety or efficacy of MMR.

Can I give 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 take a 40 lb six-year-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can nosotros requite the child MMR and varicella vaccine based on this methotrexate dosage?

Based on the weight and dosage provided (40 lbs and 15 mg/week), the child is currently receiving more than 0.four mg/kg/calendar week of methotrexate. This meets the Infectious Disease Lodge of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage tin can be reduced. The 2013 IDSA definition of depression-level immunosuppression for methotrexate is a dosage of less than 0.four mg/kg/week. For boosted details, see the 2013 IDSA Clinical Exercise Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/11/26/cid.cit684.full.pdf.

Is it true that egg allergy is not 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 astringent egg allergy. Neither the American Academy of Pediatrics nor ACIP consider egg allergy as a contraindication to MMR vaccine. ACIP recommends routine vaccination of egg-allergic children without the utilize 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 be transmitted via breast milk, the infection in the infant is asymptomatic.

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

Yes, but there should be sufficient fourth dimension betwixt the blood product and the MMR to reduce the chance of interference. The interval depends on the blood product received. See Table 3-five of ACIP's General Best Exercise Guidelines for Immunization for more than information, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Is information technology acceptable practice to administer MMR, Tdap, and influenza vaccines to a postpartum mom at the same time as administering RhoGam?

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

Delight describe the 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 current recommendations are every bit follows:

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

Administer the first dose at 12 through fifteen months and the 2nd dose to children age 4 through 6 years, or as early equally 28 days after the get-go dose.

Unless they have acceptable 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 2 appropriately spaced doses of MMR vaccine after constructive Fine art has been established. Established effective Art is defined equally receiving Fine art for at least half dozen months in combination with CD4 percentages of 15% or more for 6 months or longer for children historic period five years or younger. People older than 5 years should have CD4 percentages of 15% or more and a CD4 lymphocyte count of 200 or more than/mm3 for 6 months or longer. If laboratory results country just i blazon of parameter (percentages or counts) this is sufficient for vaccine decision-making.

Pregnancy and Postpartum Considerations Back to peak

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

Although the MMR vaccine package insert recommends a 3-month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for 4 weeks. For details on this issue, run into ACIP'south Control and Prevention of Rubella: Evaluation and Management of Suspected Outbreaks, Rubella in Meaning Women, and Surveillance for Congenital Rubella Syndrome.

How should teenage girls and women of kid-bearing age exist screened for pregnancy before MMR vaccination?

ACIP recommends that women of childbearing age be asked if they are currently significant or attempting to get pregnant. Vaccination should exist deferred for those who answer "yes." Those who answer "no" should exist brash to avoid pregnancy for 4 weeks following vaccination. Pregnancy testing is non necessary.

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

No specific action needs to be taken other than to reassure the adult female that no agin outcomes are expected as a issue of this vaccination. MMR vaccination during pregnancy is not a reason to terminate the pregnancy. Y'all should consult with others in your healthcare setting to place ways to foreclose such vaccination errors in the future. Detailed information about MMR vaccination in pregnancy is included in the nigh recent MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

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

Can we requite an MMR to a fifteen-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 non pose a risk to a pregnant household fellow member.

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

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

I have a female patient who has a not-allowed rubella titer two months after her second MMR vaccination. Should she be revaccinated? If so, should the titer once more be checked to determine seroconversion?

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

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

How soon later commitment can MMR be given to the mother?

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

Vaccine Safety Dorsum to top

Is there whatsoever evidence that MMR or thimerosal causes autism?

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

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

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

How probable 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 merely in people who were susceptible to rubella at the fourth dimension of vaccination. Joint symptoms are uncommon in children and in adult males. About 25% of non-allowed mail-pubertal women written report articulation pain afterwards receiving rubella vaccine, and about 10% to 30% study arthritis-like signs and symptoms.

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

Is there whatsoever impairment in giving an actress dose of MMR to a kid of age seven years whose tape is lost and the mother is non certain almost the final dose of MMR?

In general, although it is not platonic, receiving extra doses of vaccine poses no medical problem. However, receiving excessive doses of tetanus toxoid (due east.one thousand., DTaP, DT, Tdap, or Td) can increase the risk of a local adverse reaction. For details encounter the Actress Doses of Vaccine Antigens section of the ACIP General Best Practice Guidelines for Immunization at world wide web.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

Vaccination providers frequently come across people who do not take adequate documentation of vaccinations. Providers should only accept 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 accepted. An attempt to locate missing records should exist made whenever possible by contacting previous healthcare providers, reviewing country or local immunization information systems, and searching for a personally held record.

If records cannot exist located or will definitely not be bachelor anywhere because 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 culling to vaccination for certain antigens (e.thou., measles, rubella, hepatitis A, diphtheria, and tetanus).

Storage and Handling Back to top

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

The amount of fourth dimension in which a dose of vaccine must exist used afterward reconstitution varies past vaccine and is usually outlined somewhere in the vaccine's parcel insert. MMR must be used inside viii hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff teaching piece that outlines the time allowed between reconstitution and utilise, every bit stated in the package inserts for a number of vaccines. Handout can be found at the following link: www.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine exist stored?

MMR may be stored either in the refrigerator at ii°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 +v°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 similar this occur too oftentimes. If you doubtable that vaccine has been mishandled, you should store the vaccine equally recommended, then contact the manufacturer or state/local wellness department for guidance on its use. This is specially important for alive virus vaccines similar MMR and varicella.

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

Information technology is preferable to administer MMR immediately afterwards reconstitution. If reconstituted MMR is not used within 8 hours, it must be discarded. MMR should always exist 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?

Only the diluent supplied with the vaccine should be used to reconstitute any vaccine. Whatsoever vaccine reconstituted with the wrong diluent should be repeated.

Dorsum to top

summersantarld.blogspot.com

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

Share this post