If You Have Had Measles Can You Get It Again

Measles, Mumps, and Rubella

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

Disease Issues

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

In 2019, a provisional total of one,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 among unvaccinated people in New York. These outbreaks were contained and stopped earlier the stop of 2019. Between January 1 and Baronial 19, 2020, just 12 measles cases were reported by 7 jurisdictions. Limited travel as a result of the COVID-19 pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the United States. CDC measles surveillance updates tin can be establish at www.cdc.gov/measles/cases-outbreaks.html.

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

Rubella was declared 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) have been reported annually in the United States since elimination was declared. Rubella incidence in the Us has decreased by more 99% from the pre-vaccine era. A provisional total of three cases of rubella, and no cases of congenital rubella syndrome, were reported in 2019.

How serious are measles, mumps, and rubella?

Measles tin can lead to serious complications and death, even with modern medical care. The 1989–1991 measles outbreak in the U.S. resulted in more than 55,000 cases and more than 100 deaths. In the United states of america, from 1987 to 2000, the most ordinarily reported complications associated with measles infection were pneumonia (vi%), otitis media (7%), and diarrhea (8%). For every i,000 reported measles cases in the United States, approximately ane case of encephalitis and two to three deaths resulted. The take chances for decease from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

Mumps most normally causes fever and parotitis. Upwardly to 25% of persons with mumps have few or no symptoms. Complications of mumps include orchitis (inflammation of the testicle) and oophoritis (inflammation of the ovary). Other complications of mumps include pancreatitis, deafness, aseptic meningitis, and encephalitis. Mumps affliction is typically milder, with fewer complications, in fully vaccinated case patients.

Rubella is generally a mild disease with low-grade fever, lymphadenopathy, and angst. Upwardly to 50% of rubella virus infections are subclinical. Complications can include thrombocytopenic purpura and encephalitis. Rubella virus is teratogenic and infection in a pregnant woman, specially during the first trimester can event 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 illness and the clinically compatible symptoms of cough, coryza (runny olfactory organ), and/or conjunctivitis (red, watery eyes). The affliction begins with a prodrome of fever and malaise before rash onset. A clinical case of measles is defined equally an illness characterized by

• a generalized rash lasting 3 or more days, and • a temperature of 101°F or higher (38.three°C or higher), 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 ii days earlier the measles rash appears to 1 to ii days afterwards. They appear as punctate blueish-white spots on the bright red 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 specially aware of the possibility of measles in people with fever and rash who have recently traveled away or who accept had contact with international travelers.

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

What should our clinic practice if we doubtable a patient has measles?

Measles is highly contagious. A person with measles is infectious up to 4 days before through 4 days after the twenty-four hour period 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 single-patient airborne infection isolation room. Providers should immediately isolate and written report suspected measles cases to their local wellness 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.S.; healthcare providers should written report all cases of suspected measles to public health authorities immediately to help reduce the number of secondary cases. Do not wait for the results of laboratory testing to study clinically-suspected measles to the local health section.

More information on measles affliction, diagnostic testing, and infection command can be found at www.cdc.gov/measles/hcp/alphabetize.html.

How long does it take to show signs of measles, mumps, and rubella after beingness exposed?

For measles, in that location is an average of x to 12 days from exposure to the appearance of the first symptom, which is usually fever. The measles rash doesn't usually announced until approximately 14 days afterwards exposure (range: vii to 21 days), and the rash typically begins 2 to 4 days subsequently the fever begins. The incubation period of mumps averages 16 to 18 days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation catamenia of rubella is 14 days (range: 12 to 23 days). However, as noted above, up to half of rubella virus infections cause no symptoms.

Vaccine Recommendations Back to top

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

The most contempo comprehensive ACIP recommendations for the use of MMR vaccine were published in 2013 and are bachelor 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 6 years. The second dose of MMR can be given every bit early equally 4 weeks (28 days) later the beginning dose and be counted as a valid dose if both doses were given after the child's start birthday. The second dose is not a booster, but rather is intended to produce immunity in the small number of people who fail to reply to the get-go dose.

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

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

What is considered acceptable evidence of immunity to measles?

Adequate presumptive testify of amnesty against measles includes at least 1 of the post-obit:

• written documentation of acceptable vaccination: • laboratory testify of amnesty • laboratory confirmation of measles (verbal history of measles does not count) • birth earlier 1957

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

During an outbreak of measles, healthcare facilities should recommend 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 2 doses of MMR vaccine recommended to prevent measles?

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

Zero doses:

• adults born earlier 1957 except healthcare personnel* • adults born 1957 or later who are at depression risk (i.e., not an international traveler or healthcare worker, or person attending college or other post-high school educational institution) and who accept already received i 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 born 1957 or later who are at low risk (i.e., non an international traveler, healthcare worker, or person attending higher or other mail service-loftier schoolhouse educational establishment) and have no documented vaccination with live measles vaccine and no laboratory bear witness of amnesty or prior measles infection

Ii doses of MMR vaccine:

� high-risk adults without whatsoever prior documented live measles vaccination and no laboratory testify of amnesty or prior measles infection, including:

Persons who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine it was, or are sure it was inactivated measles vaccine, should be revaccinated with either one (if depression-risk) or two (if high-chance) doses of MMR vaccine.

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

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

Although nativity earlier 1957 is considered acceptable evidence of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) built-in before 1957 who exercise not have laboratory evidence of measles immunity, laboratory confirmation of illness, or vaccination with two accordingly spaced doses of MMR vaccine.

All the same, during a local outbreak of measles, all healthcare personnel, including those born earlier 1957, are recommended to take two doses of MMR vaccine at the appropriate interval if they lack laboratory evidence of measles.

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

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

MMR can be given to children as young as vi months of historic period who are at high risk of exposure such as during international travel or a community outbreak. Withal, doses given BEFORE 12 months of age cannot exist counted toward the 2-dose serial for MMR.

How does existence born earlier 1957 confer immunity to measles?

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

Why is a second dose of MMR necessary?

Approximately seven% of people do not develop measles immunity after the offset dose of vaccine. This occurs for a diverseness of reasons. The 2d dose is to provide another take a chance to develop measles amnesty for people who did non respond to the get-go dose. Well-nigh 97% of people develop immunity to measles subsequently 2 doses of measles-containing vaccine.

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

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

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

When is it appropriate to employ MMR vaccine for measles mail-exposure prophylaxis?

MMR vaccine given inside 72 hours of initial measles exposure can reduce the risk of getting sick or reduce the severity of symptoms. Another choice for exposed, measles-susceptible individuals at high risk of complications who cannot exist vaccinated is to requite immunoglobulin (IG) within six days of exposure. Do non administrate MMR vaccine and IG simultaneously, equally the IG invalidates the vaccine.

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

Exercise any adults need "booster" doses of MMR vaccine to prevent measles?

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

Many people who were young children in the 1960s do not have records indicating what type of measles vaccine they received in the mid-1960s. What measles vaccine was nearly frequently given in that time period? That guidance would help 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 than often than killed vaccine. The killed vaccine was plant to exist non effective and people who received it should be revaccinated with live vaccine. Without a written record, it is non possible to know what type of vaccine an individual may have received. So persons born during or afterward 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 to the lowest degree i dose of MMR. Some people at increased take chances of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least iv weeks.

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

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

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

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

Is in that location 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 be effective if given within the first 3 days (72 hours) later on exposure to measles. Immune globulin may be effective for every bit long every bit 6 days later exposure. Postexposure prophylaxis with MMR vaccine does not forbid or alter the clinical severity of mumps or rubella. Still, if the exposed person does non accept evidence of mumps or rubella immunity they should be vaccinated since not all exposures result in infection.

What are the current ACIP recommendations for apply of allowed 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 be administered to all infants younger than 12 months who have been exposed to measles. The dose of IGIM is 0.v mL/kg of trunk weight; the maximum dose is 15 mL. Alternatively, MMR vaccine tin be given instead of IGIM to infants age 6 through 11 months, if information technology tin can be given within 72 hours of exposure.

Pregnant women without show of measles immunity who are exposed to measles should receive an intravenous IG (IGIV) dose of 400 mg/kg of trunk weight. Severely immunocompromised people, irrespective of testify of measles immunity or vaccination, who have been exposed to measles should receive an IGIV dose of 400 mg/kg of torso weight.

For persons already receiving IGIV therapy, assistants of at to the lowest degree 400 mg/kg body weight inside 3 weeks before measles exposure should be sufficient to prevent measles infection. For patients receiving subcutaneous immune globulin (IGSC) therapy, administration of at least 200 mg/kg body weight for ii consecutive weeks before measles exposure should exist sufficient.

Other people who exercise non have evidence of measles amnesty can receive an IGIM dose of 0.v mL/kg of body weight. Give priority to people who were exposed to measles in settings where they have intense, prolonged close contact (such as household, kid care, classroom, etc.). The maximum dose of IGIM is 15 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 command measles outbreaks.

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

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

Unmarried antigen vaccine is no longer bachelor in the U.S.; the student should get the combined MMR vaccine. If a college student 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 two doses of MMR.

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

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

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

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

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

Two documented doses of MMR vaccine given on or after the first altogether 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 likewise immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, only is concerned about the measles exposure adventure. Should the patient receive the MMR vaccine?

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

We take developed patients in our exercise at loftier risk for measles, including patients going back to college or preparing for international travel, who don't remember ever receiving MMR vaccine or having had measles disease. How should nosotros manage these patients?

Yous accept ii options. You tin can test for amnesty or you can but give ii doses of MMR at to the lowest degree four weeks apart. There is no harm in giving MMR vaccine to a person who may already be immune to one or more of the vaccine viruses. If you or the patient opt for testing, and the tests indicate the patient is not immune to one or more than of the vaccine components, give your patient 2 doses of MMR at least iv weeks autonomously. If whatsoever examination results are indeterminate or equivocal, consider your patient nonimmune. ACIP does non recommend serologic testing after vaccination because commercial tests may non exist sensitive enough to reliably detect vaccine-induced immunity.

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

ACIP recommends two doses of MMR given at least four weeks apart for any developed built-in in 1957 or later on who plans to travel internationally. There is no damage 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 earlier 1957 and is not 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, only he may be vaccinated. Before implementation of the national measles vaccination program in 1963, well-nigh every person acquired measles before adulthood. And then, this patient can be considered immune based on their nascence twelvemonth. Still, MMR vaccine also may be given to any person built-in 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 past CDC.

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

First of all, make 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 half dozen through 11 months. Give infants this age a dose of MMR earlier international travel. In addition, consider measles vaccination for infants as young as historic period 6 months as a control mensurate during a U.South. measles outbreak. Consult your state health department to observe out if this is recommended in your situation. Do not count any dose of MMR vaccine as part of the 2-dose series 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 also might consider vaccinating children age 12 months and older at the minimum historic period (12 months, instead of 12 through xv months) and giving the second dose four weeks later (at the minimum interval) instead of waiting until age 4 through half dozen years.

Finally, call up that infants likewise immature for routine vaccination and people with medical weather that contraindicate measles immunization depend on high MMR vaccination coverage among those effectually them. Exist sure to encourage all your patients and their family unit members to get vaccinated if they are not immune.

During a mumps outbreak should we offer a 3rd dose of MMR (MMR 2, 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 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, merely insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 doses of MMR vaccine is high.

In January 2018, the Advisory Committee on Immunization Practices (ACIP) published new guidance for MMR vaccination of persons at increased take chances for acquiring mumps during an outbreak. Persons previously vaccinated with two doses of a mumps virus�containing vaccine who are identified by public health authorities 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 better protection against mumps disease and related complications. More information nigh this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

In a measles outbreak, do children who have non had MMR vaccine pose a threat to vaccinated people? Information technology is my agreement that vaccinated people tin still contract measles. Am I right?

You are correct that vaccinated people tin even so be infected with viruses or bacteria against which they are vaccinated. No vaccine is 100% effective. Vaccine effectiveness varies from greater than 95% (for diseases such every bit measles, rubella, and hepatitis B) to much lower (60% for flu in years with a good match of circulating and vaccine viruses, and 70% for acellular pertussis vaccines in the 3-5 years after vaccination). More information is available for each vaccine and illness at world wide web.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines.

Administering Vaccines Back to superlative

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

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

We oftentimes demand to requite MMR vaccine to big adults. Is a 25-gauge needle with a length of 5/8" sufficient for a subcutaneous injection?

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

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

Yes, however, this effect is non 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 historic period 13 years and older, it may be counted towards completion of the MMR and varicella vaccine series and does not need to exist repeated.

Scheduling Vaccines Back to top

How soon tin can nosotros 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 ii doses of MMR vaccine with the first dose at historic period 12–fifteen months quondam and the second dose at historic period 4–6 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, then consider using the minimum interval instead of waiting until age 4–6 years old for dose two.

Does the 4-day "grace period" utilize to the minimum age for assistants of the first dose of MMR? What most the 28-twenty-four hour period minimum interval betwixt doses of MMR?

A dose of MMR vaccine administered upwards to 4 days earlier the first birthday may be counted as valid. Notwithstanding, schoolhouse entry requirements in some states may mandate administration on or after the first birthday. The 4-twenty-four hour period "grace menses" should non be applied to the 28-twenty-four hour period minimum interval between 2 doses of a live parenteral vaccine.

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

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

If y'all can give the 2nd dose of MMR as early as 28 days after the first dose, why practise nosotros routinely look until kindergarten entry to give the second dose?

The 2nd dose of MMR may exist given as early as 4 weeks after the commencement dose, and be counted as a valid dose if both doses were given after the offset birthday. The second dose is non a booster, but rather it is intended to produce amnesty in the small number of people who neglect to respond to the kickoff dose. The risk of measles is higher in school-age children than those of preschool historic period, and so it is important to receive the 2nd dose by school entry. It is likewise convenient to give the 2nd dose at this age, since the child will have an immunization visit for other school entry vaccines.

What is the earliest age at which I can give MMR to an babe who will be traveling internationally? Besides, which countries pose a loftier run a 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 age 6 through 11 months should receive 1 dose of MMR. The gamble for measles exposure can be loftier in high-, centre- and depression-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to keep a copy of their immunization records with them as they travel. For boosted information on the worldwide measles state of affairs, and on CDC's measles vaccination information for travelers, go to wwwnc.cdc.gov/travel.

If we give a child a dose of MMR vaccine at six months of age considering they are in a community with cases of measles, when should we give the next dose?

The next dose should be given at 12 months of age. The child will also need another dose at least 28 days later. For the child to be fully vaccinated, they need to have two doses of MMR vaccine given when the kid is 12 months of age and older. A dose given at less than 12 months of age does not count as function of the MMR vaccine two-dose serial.

I take an 8-calendar month-old patient who is traveling internationally. The infant needs to be protected from hepatitis A likewise as measles, mumps, and rubella. The family is leaving in 11 days. Can 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 Feb 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age half-dozen through 11 months traveling outside the United states of america when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this age group. Neither vaccine is counted as office of the child's routine vaccination serial. For details of this recommendation, see the CDC ACIP recommendations for the prevention and command of hepatitis A at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, folio eighteen.

Tin I give the second dose of MMR earlier than age 4 through vi years (the kindergarten entry dose) to young children traveling to areas of the earth where there are measles cases?

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

If I give MMR to an infant traveler younger than historic period 1 year, will that dose be considered valid for the U.S. immunization schedule?

No. A measles-containing vaccine administered more than iv days before the kickoff birthday should non be counted as part of the series. MMR should be repeated when the child is age 12 through xv months (12 months if the child remains in an area where disease adventure is loftier). The second dose should be administered at least 28 days after the first dose.

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

Yes. A TST can be applied before or on the same day that MMR vaccine is given. However, if MMR vaccine is given on the previous mean solar 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 examination considering of mild suppression of the immune organisation.

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

This student should receive 2 doses of MMR, separated by at least 28 days. A personal history of measles and mumps is not acceptable as proof of immunity. Acceptable show of measles and mumps immunity includes a positive serologic test for antibiotic, birth before 1957, or written documentation of vaccination. For rubella, but serologic prove or documented vaccination should be accepted as proof of immunity. Additionally, people built-in prior to 1957 may be considered immune to rubella unless they are women who have the potential to go meaning.

When not given on the same 24-hour interval, is the interval between yellow fever and MMR vaccines 4 weeks (28 days) or 30 days? I have seen the yellow fever and live virus vaccine recommendations published both ways.

The General Best Practise Guidelines for Immunization (see www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html) makes the generic recommendation that alive parenterally or nasally administered vaccines not given on the same day should be separated by at to the lowest degree 28 days. The CDC travel wellness website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated past at to the lowest degree 30 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 afterwards 1957 have adequate presumptive evidence of immunity to measles, mumps, and rubella, defined equally documentation of 2 doses of measles and mumps vaccine and at least 1 dose of rubella vaccine, laboratory prove of immunity, or laboratory confirmation of disease. Further, ACIP recommends that healthcare facilities should consider vaccination of all unvaccinated healthcare personnel who were born before 1957 and who lack laboratory evidence of measles, mumps, and/or rubella amnesty or laboratory confirmation of illness. During an outbreak of measles or mumps, healthcare facilities should recommend ii doses of MMR separated by at least 4 weeks for unvaccinated healthcare personnel regardless of nativity year who lack laboratory evidence of measles or mumps immunity or laboratory confirmation of illness. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of nascence year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease.

Would you consider healthcare personnel with ii documented doses of MMR vaccine to be immune even if their serology for 1 or more of the antigens comes back 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 contrast, HCP who practice not have documentation of MMR vaccination and whose serologic test is interpreted every bit "indeterminate" or "equivocal" should be considered non allowed and should receive 2 doses of MMR vaccine (minimum interval 28 days). ACIP does not recommend serologic testing after vaccination. For more than information, meet ACIP'southward 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 will develop a depression-class fever and/or mild rash 7 to 12 days later vaccination. Nevertheless, the person is not infectious, and no special precautions ( such equally exclusion from work) need to be taken.

A 22-year-one-time female is going to chemist's shop schoolhouse and the school wants her to have a second dose of MMR vaccine. She had the first dose every bit a child and developed measles within 24 hours of receiving the vaccine. Contempo serologic testing showed she is immune to mumps and measles only not immune to rubella. Can I give her a 2nd dose of the MMR with her having measles after the get-go dose?

Aye, as a healthcare professional, this person should get a 2nd dose of MMR to ensure she is immune to rubella. There is no harm in providing MMR to a person who is already allowed to one or more of the components. If she developed measles only one day afterwards getting her first MMR, she must accept been exposed to the disease prior to vaccination.

Contraindications and Precautions Back to top

What are the contraindications and precautions for MMR vaccine?

Contraindications:

• history of a severe (anaphylactic) reaction to any vaccine component (e.g., 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–eleven months, depending on the type of claret product received. See world wide web.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html, Tabular array 3-5 for more than information on this effect • moderate or astringent acute illness with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Important details about the contraindications and precautions for MMR vaccine are in the current MMR ACIP statement, available at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Nosotros 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 amidst those around them. To help foreclose the spread of measles virus, brand certain all your staff and patients who can be vaccinated are fully vaccinated according to the U.Due south. 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 mail service-exposure prophylaxis which tin be establish at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

We have a patient who has selective IgA deficiency. We too accept 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 immune response may be weaker, but the vaccines are likely effective.

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

At that place is no need to wait a specific interval before giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, so in that location is no business near safe or efficacy of MMR.

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

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

We have a forty lb half dozen-twelvemonth-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Tin we requite the kid 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 0.4 mg/kg/calendar week of methotrexate. This meets the Communicable diseases Society of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such fourth dimension as the methotrexate dosage can be reduced. The 2013 IDSA definition of depression-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/week. For additional details, see the 2013 IDSA Clinical Practice 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 have documented the safe of measles and mumps vaccine (which are grown in chick embryo tissue civilisation) in children with severe egg allergy. Neither the American University of Pediatrics nor ACIP consider egg allergy as a contraindication to MMR vaccine. ACIP recommends routine vaccination of egg-allergic children without the use of special protocols or desensitization procedures.

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

Yeah. Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no risk to the babe existence breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via chest milk, the infection in the babe is asymptomatic.

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

Aye, but there should be sufficient time between the blood product and the MMR to reduce the chance of interference. The interval depends on the claret product received. Come across Table 3-5 of ACIP's Full general All-time Practice Guidelines for Immunization for more information, bachelor at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

Is it acceptable practise to administer MMR, Tdap, and flu vaccines to a postpartum mom at the same time equally administering RhoGam?

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

Delight depict the 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 current recommendations are as follows:

Administer 2 doses of MMR vaccine to all HIV-infected people historic period 12 months and older who do not have evidence of electric current astringent immunosuppression or current evidence of measles, rubella, and mumps amnesty. To be regarded every bit not having prove of electric current severe immunosuppression, a kid historic period v years or younger must have CD4 percentages of 15% or more for vi months or longer; a person older than 5 years must take CD4 percentages of 15% or more and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results state only ane blazon of parameter (percentage or counts) this is sufficient for vaccine decision-making.

Administer the showtime dose at 12 through 15 months and the second dose to children age four through 6 years, or equally early as 28 days after the first 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 effective antiretroviral therapy (Fine art) should receive 2 appropriately spaced doses of MMR vaccine after effective ART has been established. Established constructive ART is defined equally receiving ART for at least 6 months in combination with CD4 percentages of 15% or more for 6 months or longer for children age v years or younger. People older than 5 years should accept CD4 percentages of 15% or more and a CD4 lymphocyte count of 200 or more/mm3 for vi months or longer. If laboratory results state just i type of parameter (percentages or counts) this is sufficient for vaccine decision-making.

Pregnancy and Postpartum Considerations Back to top

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

Although the MMR vaccine package insert recommends a iii-month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for 4 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 historic period be screened for pregnancy before MMR vaccination?

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

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

No specific activity needs to exist taken other than to reassure the adult female that no adverse outcomes are expected every bit a result of this vaccination. MMR vaccination during pregnancy is not a reason to cease the pregnancy. Y'all should consult with others in your healthcare setting to identify ways to prevent such vaccination errors in the future. Detailed information about MMR vaccination in pregnancy is included in the most contempo MMR ACIP argument, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Nosotros require a pregnancy test for all our 7th 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 meaning. Vaccination should be deferred for those who answer "yes." Those who answer "no" should be advised to avoid pregnancy for one calendar month post-obit vaccination.

Tin nosotros give an MMR to a fifteen-month-sometime whose mother is 2 months pregnant?

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

If a woman's rubella test issue shows she is "not immune" during a prenatal visit, but she has two documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum?

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

I have a female patient who has a non-immune rubella titer 2 months later her second MMR vaccination. Should she be revaccinated? If so, should the titer again exist 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 one additional dose of MMR vaccine (maximum of three doses). Repeat serologic testing for testify 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 exist administered to women known to exist significant or attempting to go significant. Considering of the theoretical risk to the fetus when the female parent receives a live virus vaccine, women should be counseled to avoid becoming pregnant for 28 days after receipt of MMR vaccine.

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

MMR tin be administered whatsoever 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 infirmary stay, leaves in less than 24 hours, or is breastfeeding.

Vaccine Condom Back to top

Is there any 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 in that location is no evidence supporting an association betwixt MMR vaccine or thimerosal-containing vaccines and the development of autism. For more than information on thimerosal and vaccines in general, visit world wide web.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

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

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

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

Arthralgia (joint pain) and transient arthritis (joint redness or swelling) following rubella vaccination occurs only in people who were susceptible to rubella at the time of vaccination. Joint symptoms are uncommon in children and in adult males. About 25% of not-allowed post-pubertal women report joint hurting after receiving rubella vaccine, and about ten% to 30% report arthritis-similar signs and symptoms.

When joint symptoms occur, they generally brainstorm i to 3 weeks after vaccination, commonly are mild and not incapacitating, last about 2 days, and rarely recur.

Is in that location whatever harm in giving an extra dose of MMR to a kid of age vii years whose record is lost and the female parent is non sure nigh the last dose of MMR?

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

Vaccination providers frequently encounter people who do non take acceptable documentation of vaccinations. Providers should but accept written, dated records as prove of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, cocky-reported doses of vaccine without written documentation should not be accepted. An endeavour to locate missing records should be made whenever possible by contacting previous healthcare providers, reviewing state or local immunization information systems, and searching for a personally held record.

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

Storage and Handling Back to elevation

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

The amount of time in which a dose of vaccine must be used afterwards reconstitution varies by vaccine and is commonly outlined somewhere in the vaccine's package insert. MMR must be used inside 8 hours of reconstitution. MMRV must be used within thirty minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff teaching piece that outlines the fourth dimension allowed between reconstitution and use, equally stated in the bundle inserts for a number of vaccines. Handout can be institute at the following link: world wide web.immunize.org/catg.d/p3040.pdf.

How should MMR vaccine be stored?

MMR may be stored either in the refrigerator at 2°C to 8°C (36°F to 46°F) or in the freezer at -50°C to -15°C (-58°F to +5°F). The diluent should not be frozen and tin be stored in the fridge 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 (non reconstituted) was left at room temperature overnight. Can I utilize it?

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

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

It is preferable to administrate MMR immediately afterward reconstitution. If reconstituted MMR is not used within 8 hours, information technology 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 any problem with doing this?

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

Dorsum to meridian

roundscoon1999.blogspot.com

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

Share this post