Can You Gt Measles Again if You Ahd Them as Kid

Measles, Mumps, and Rubella

Illness Issues Contraindications and Precautions Vaccine Recommendations Pregnancy and Postpartum Considerations Administering Vaccines Vaccine Prophylactic Scheduling Vaccines Storage and Treatment 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 1,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a unmarried yr since 1992; 73% of cases were associated with outbreaks among unvaccinated people in New York. These outbreaks were contained and stopped before the end of 2019. Betwixt January 1 and August 19, 2020, just 12 measles cases were reported by 7 jurisdictions. Limited travel equally 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 can be found at world wide web.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, there has been a more than than 99% subtract in mumps cases in the United States. All the same, outbreaks nonetheless occasionally occur. In 2006, there was an outbreak affecting more than 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 than 3,000 cases. Since 2015, numerous outbreaks have been reported beyond the United states, in higher campuses, prisons, and close-knit communities, including a large outbreak in northwest Arkansas where nearly 3,000 cases were reported in 2016. These outbreaks have shown that when people with mumps have close contact with a lot of other people (such as amidst residential college students and families in shut-knit communities) mumps can spread even among vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A conditional total of iii,484 cases of mumps were reported to CDC in 2019.

Rubella was declared eliminated (the absenteeism of endemic transmission for 12 months or more) from the Usa 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 The states has decreased by more than 99% from the pre-vaccine era. A provisional total of 3 cases of rubella, and no cases of congenital rubella syndrome, were reported in 2019.

How serious are measles, mumps, and rubella?

Measles can lead to serious complications and death, fifty-fifty 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 commonly reported complications associated with measles infection were pneumonia (6%), otitis media (7%), and diarrhea (8%). For every one,000 reported measles cases in the United States, approximately one case of encephalitis and two to three deaths resulted. The hazard for death from measles or its complications is greater for infants, immature children, and adults than for older children and adolescents.

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

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

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

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

• a generalized rash lasting three or more 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 1 to 2 days before the measles rash appears to 1 to two days afterward. They appear equally punctate bluish-white spots on the brilliant cerise 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 aware of the possibility of measles in people with fever and rash who have recently traveled abroad or who have 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 also collect blood for serologic testing during the first clinical run into with a person who has suspected or likely measles.

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

Measles is highly contagious. A person with measles is infectious upwardly to 4 days earlier through four days later on the day of rash onset. Patients with suspected measles should be isolated for 4 days after they develop a rash. Airborne precautions should be followed in healthcare settings past 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 report suspected measles cases to their local wellness department and obtain specimens for measles testing, including serum sample for measles serologic testing and a pharynx swab (or nasopharyngeal swab) for viral confirmation.

Measles is a nationally notifiable illness in the U.S.; healthcare providers should report all cases of suspected measles to public health authorities immediately to aid reduce the number of secondary cases. Do not wait for the results of laboratory testing to report clinically-suspected measles to the local health department.

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

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

For measles, there is an average of 10 to 12 days from exposure to the appearance of the showtime symptom, which is usually fever. The measles rash doesn't commonly appear until approximately 14 days after exposure (range: vii to 21 days), and the rash typically begins 2 to 4 days later on the fever begins. The incubation catamenia of mumps averages sixteen to 18 days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation period of rubella is 14 days (range: 12 to 23 days). However, equally 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 available at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a 2nd dose at age 4 through 6 years. The second dose of MMR can exist given as early as 4 weeks (28 days) after the starting time dose and be counted as a valid dose if both doses were given after the child'southward get-go altogether. The 2d dose is not a booster, merely rather is intended to produce immunity in the minor number of people who fail to reply to the get-go dose.

Adults with no bear witness of immunity (evidence of immunity is defined as documented receipt of 1 dose [ii doses four weeks apart if high chance] of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or nascence before 1957) should get 1 dose of MMR vaccine unless the adult is in a loftier-adventure group. High-risk people need ii doses and include schoolhouse-historic period children, healthcare personnel, international travelers, and students attention postal service-loftier schoolhouse educational institutions.

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

What is considered acceptable bear witness of amnesty to measles?

Acceptable presumptive prove of immunity against measles includes at least i of the following:

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

Although nascency before 1957 is considered acceptable evidence of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel built-in before 1957 who do not have other evidence of amnesty with 2 doses of MMR vaccine (minimum interval 28 days).

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

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

Zero, ane, or two doses of MMR vaccine are needed for the adults described beneath.

Zero doses:

• adults built-in earlier 1957 except healthcare personnel* • adults born 1957 or afterward who are at depression run a risk (i.e., not an international traveler or healthcare worker, or person attention college or other mail-loftier schoolhouse educational establishment) and who accept already received one or more than documented doses of alive measles vaccine • adults with laboratory prove of immunity or laboratory confirmation of measles

One dose of MMR vaccine:

• adults born 1957 or subsequently who are at depression risk (i.e., not an international traveler, healthcare worker, or person attending higher or other postal service-high school educational institution) and have no documented vaccination with live measles vaccine and no laboratory evidence of immunity or prior measles infection

Two doses of MMR vaccine:

� high-hazard adults without any prior documented live measles vaccination and no laboratory evidence of immunity or prior measles infection, including:

Persons who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine information technology was, or are sure it was inactivated measles vaccine, should be revaccinated with either i (if low-risk) or ii (if loftier-chance) doses of MMR vaccine.

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

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

Although birth before 1957 is considered acceptable evidence of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born before 1957 who exercise not have laboratory evidence of measles amnesty, laboratory confirmation of disease, or vaccination with two accordingly spaced doses of MMR vaccine.

However, during a local outbreak of measles, all healthcare personnel, including those built-in earlier 1957, are recommended to take 2 doses of MMR vaccine at the advisable interval if they lack laboratory evidence of measles.

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

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

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

How does existence born before 1957 confer immunity to measles?

People born earlier 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a issue, these people are very probable to have had measles affliction. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons born earlier 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered.

Why is a 2d dose of MMR necessary?

Approximately seven% of people do not develop measles immunity after the first dose of vaccine. This occurs for a variety of reasons. The 2nd dose is to provide some other take a chance to develop measles immunity for people who did not reply to the beginning dose. Nearly 97% of people develop immunity to measles after 2 doses of measles-containing vaccine.

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

At that place are 2 circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing historic period who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not conspicuously positive should receive 1 additional dose of MMR vaccine (maximum of three doses). Farther testing for serologic bear witness of rubella immunity is non recommended. MMR should not be administered to a pregnant woman.

In 2018, ACIP published guidance for MMR vaccination of people at increased risk for acquiring mumps during an outbreak. People previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified by public health regime as being part of a group or population at increased risk for acquiring mumps considering of an outbreak should receive a 3rd dose of a mumps virus�containing vaccine (MMR or MMRV) to better protection against mumps disease and related complications. More data about this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

When is it appropriate to use MMR vaccine for measles postal service-exposure prophylaxis?

MMR vaccine given inside 72 hours of initial measles exposure can reduce the risk of getting ill or reduce the severity of symptoms. Another option for exposed, measles-susceptible individuals at high run a risk of complications who cannot exist vaccinated is to give immunoglobulin (IG) within six days of exposure. Do non administer MMR vaccine and IG simultaneously, as the IG invalidates the vaccine.

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

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

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

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

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

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

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

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

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

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

Measles vaccine, given equally MMR, may exist effective if given within the first iii days (72 hours) after exposure to measles. Immune globulin may be effective for as long as vi days later exposure. Postexposure prophylaxis with MMR vaccine does not forbid or alter the clinical severity of mumps or rubella. However, if the exposed person does not have evidence of mumps or rubella amnesty they should exist vaccinated since non all exposures result in infection.

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

In the 2013 revision of its MMR vaccine recommendations ACIP expanded the use of mail-exposure IG prophylaxis for measles. Intramuscular IG (IGIM) should be administered to all infants younger than 12 months who accept been exposed to measles. The dose of IGIM is 0.5 mL/kg of body weight; the maximum dose is 15 mL. Alternatively, MMR vaccine can exist given instead of IGIM to infants age half-dozen through 11 months, if it can be given within 72 hours of exposure.

Pregnant women without evidence of measles immunity who are exposed to measles should receive an intravenous IG (IGIV) dose of 400 mg/kg of body weight. Severely immunocompromised people, irrespective of show 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, administration of at least 400 mg/kg body weight inside 3 weeks earlier 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 two sequent weeks before measles exposure should exist sufficient.

Other people who do non have testify of measles immunity can receive an IGIM dose of 0.5 mL/kg of body weight. Give priority to people who were exposed to measles in settings where they have intense, prolonged close contact (such equally household, child care, 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 non exist used to control measles outbreaks.

IG has non been shown to forestall mumps or rubella infection subsequently exposure and is non recommended for that purpose.

We frequently come across college students who lack vaccination records, only whose titer results show they are not immune to some combination of measles, rubella, and/or mumps. What blazon of vaccine should these students receive?

Single antigen vaccine is no longer available in the U.S.; the educatee should go the combined MMR vaccine. If a higher educatee or other person at increased risk of exposure cannot produce written documentation of either immunization or affliction, and titers are negative, they should receive two doses of MMR.

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

No. Self-reported doses and history of vaccination provided by a parent or other caregiver are not considered to be valid. You should only accept a written, dated tape every bit evidence of vaccination.

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

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

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

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

A patient born in 1970 has a history of measles illness and is also immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, but is concerned about the measles exposure hazard. Should the patient receive the MMR vaccine?

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

We have developed patients in our practice at high chance for measles, including patients going back to college or preparing for international travel, who don't call back ever receiving MMR vaccine or having had measles disease. How should we manage these patients?

You have 2 options. You can test for immunity or you tin can just requite 2 doses of MMR at least four 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 signal the patient is non immune to ane or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks apart. If whatever test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination considering commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity.

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

ACIP recommends ii doses of MMR given at least iv weeks apart for any developed born in 1957 or later who plans to travel internationally. There is no harm in giving MMR vaccine to a person who may already be immune to 1 or more than of the vaccine viruses.

A patient who was born before 1957 and is not a healthcare worker wants to get the MMR vaccine earlier international travel. Does he need a dose of MMR?

No, it is non considered necessary, but he may exist vaccinated. Earlier implementation of the national measles vaccination program in 1963, nearly every person acquired measles before machismo. And so, this patient can be considered immune based on their nascency year. Notwithstanding, MMR vaccine also may be given to any person born before 1957 who does non take 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 exercise?

First 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 historic period 6 through 11 months. Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants every bit immature as age six months as a control measure during a U.S. measles outbreak. Consult your country wellness department to detect out if this is recommended in your situation. Do not count any dose of MMR vaccine as part of the 2-dose series if it is administered before a child'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 historic period 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through vi years.

Finally, remember that infants too young for routine vaccination and people with medical weather condition that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. Be sure to encourage all your patients and their family members to go vaccinated if they are non allowed.

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

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

In January 2018, the Advisory Committee on Immunization Practices (ACIP) published new guidance for MMR vaccination of persons at increased risk for acquiring mumps during an outbreak. Persons previously vaccinated with two doses of a mumps virus�containing vaccine who are identified by public wellness authorities as being role of a group at increased run a risk for acquiring mumps because of an outbreak should receive a 3rd dose of a mumps virus�containing vaccine to improve protection confronting mumps illness and related complications. More than information most this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

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

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

Administering Vaccines Back to top

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

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

We often need to requite MMR vaccine to large adults. Is a 25-guess needle with a length of 5/8" sufficient for a subcutaneous injection?

Yes. A 5/8" needle is recommended for subcutaneous injections for people of all sizes.

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

Yes, however, this event 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 historic period 13 years and older, it may be counted towards completion of the MMR and varicella vaccine series and does not demand to be repeated.

Scheduling Vaccines Back to top

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

For routine vaccination, children without contraindications to MMR vaccine should receive 2 doses of MMR vaccine with the first dose at age 12–15 months onetime and the 2nd dose at age 4–half dozen years onetime. The minimum interval is 28 days for dose 2. If you have an outbreak in your customs or a kid is traveling internationally, then consider using the minimum interval instead of waiting until historic period 4–vi years one-time for dose ii.

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

A dose of MMR vaccine administered up to 4 days before the kickoff birthday may exist counted as valid. Withal, schoolhouse entry requirements in some states may mandate assistants on or after the first birthday. The 4-day "grace period" should not exist applied to the 28-day minimum interval betwixt two doses of a live parenteral vaccine.

Can MMR exist given on the same 24-hour interval equally other live virus vaccines?

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

If yous tin give the 2d dose of MMR every bit early as 28 days later the first dose, why practice nosotros routinely wait until kindergarten entry to give the second dose?

The second dose of MMR may be given as early every bit four weeks afterwards the commencement dose, and exist counted equally a valid dose if both doses were given after the start birthday. The second dose is not a booster, only rather information technology is intended to produce immunity in the small number of people who fail to respond to the commencement dose. The gamble of measles is higher in school-age children than those of preschool historic period, and so it is important to receive the 2d 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 infant who volition be traveling internationally? Also, which countries pose a high risk to children for contracting measles?

ACIP recommends that children who travel or live away should be vaccinated at an before historic period than that recommended for children who reside in the United States. Before their departure from the United States, children historic period 6 through 11 months should receive i dose of MMR. The run a risk for measles exposure can be high in high-, eye- and depression-income countries. Consequently, CDC encourages all international travelers to be up to appointment on their immunizations regardless of their travel destination and to continue a copy of their immunization records with them equally they travel. For additional information on the worldwide measles situation, and on CDC's measles vaccination data for travelers, get to wwwnc.cdc.gov/travel.

If nosotros give a kid a dose of MMR vaccine at 6 months of historic period because 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 historic period. The kid volition also need another dose at least 28 days later on. For the kid to be fully vaccinated, they need to accept 2 doses of MMR vaccine given when the child is 12 months of historic period and older. A dose given at less than 12 months of age does non count as part of the MMR vaccine 2-dose serial.

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

No. IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in Feb 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age half-dozen through 11 months traveling exterior the U.s. when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this historic period group. Neither vaccine is counted as part of the child's routine vaccination series. For details of this recommendation, see the CDC ACIP recommendations for the prevention and command of hepatitis A at world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page 18.

Tin can I give the 2nd dose of MMR earlier than age 4 through 6 years (the kindergarten entry dose) to young children traveling to areas of the earth where at that place are measles cases?

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

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

No. A measles-containing vaccine administered more than four days before the first altogether should non be counted as part of the serial. MMR should be repeated when the child is age 12 through 15 months (12 months if the kid remains in an area where illness risk is high). The second dose should exist administered at least 28 days after the kickoff dose.

Can I give a tuberculin skin test (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 day or earlier, the TST should be delayed for at to the lowest degree 28 days. Live measles vaccine given prior to the awarding of a TST can reduce the reactivity of the pare examination because of balmy suppression of the immune system.

An eighteen-year-one-time higher educatee 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 ii doses of MMR, separated past at to the lowest degree 28 days. A personal history of measles and mumps is not acceptable as proof of immunity. Acceptable testify of measles and mumps amnesty includes a positive serologic exam for antibody, birth before 1957, or written documentation of vaccination. For rubella, simply serologic evidence or documented vaccination should be accepted as proof of immunity. Additionally, people born prior to 1957 may be considered immune to rubella unless they are women who have the potential to become meaning.

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

The General Best Exercise Guidelines for Immunization (see world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html) makes the generic recommendation that live parenterally or nasally administered vaccines non given on the same day should be separated past at least 28 days. The CDC travel health website recommends that xanthous fever vaccine and other parenteral or nasal live vaccines should exist separated by at least 30 days if possible. Either interval is acceptable.

For Healthcare Personnel Back to tiptop

What is the recommendation for MMR vaccine for healthcare personnel?

ACIP recommends that all HCP built-in during or after 1957 have adequate presumptive prove of amnesty to measles, mumps, and rubella, defined as documentation of ii doses of measles and mumps vaccine and at to the lowest degree ane dose of rubella vaccine, laboratory testify of immunity, or laboratory confirmation of affliction. 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 disease. During an outbreak of measles or mumps, healthcare facilities should recommend two doses of MMR separated past at least 4 weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory prove of measles or mumps immunity or laboratory confirmation of disease. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of birth yr who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease.

Would yous consider healthcare personnel with 2 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 two documented doses of MMR vaccine are considered to exist allowed regardless of the results of a subsequent serologic examination for measles, mumps, or rubella. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. In dissimilarity, HCP who do not have documentation of MMR vaccination and whose serologic test is interpreted every bit "indeterminate" or "equivocal" should be considered not immune and should receive two doses of MMR vaccine (minimum interval 28 days). ACIP does not recommend serologic testing after vaccination. For more information, run into ACIP's recommendations on the employ of MMR vaccine at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, folio 22.

If a healthcare worker develops a rash and depression-course fever afterward MMR vaccine, is s/he infectious?

Approximately 5 to xv% of susceptible people who receive MMR vaccine volition develop a low-grade fever and/or mild rash 7 to 12 days after vaccination. All the same, the person is non infectious, and no special precautions ( such as exclusion from work) need to be taken.

A 22-year-quondam female is going to chemist's shop school and the schoolhouse wants her to take a second dose of MMR vaccine. She had the first dose as a child and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles but not allowed to rubella. Tin can I give her a second dose of the MMR with her having measles after the starting time dose?

Yes, as a healthcare professional person, this person should get a second dose of MMR to ensure she is immune to rubella. There is no harm in providing MMR to a person who is already immune to i or more than of the components. If she developed measles only ane mean solar day after getting her first MMR, she must accept been exposed to the affliction prior to vaccination.

Contraindications and Precautions Back to height

What are the contraindications and precautions for MMR vaccine?

Contraindications:

• history of a severe (anaphylactic) reaction to whatever 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 blood product in the previous three–11 months, depending on the type of blood product received. Come across world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html, Table 3-5 for more information on this event • moderate or severe acute illness with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Important details nearly the contraindications and precautions for MMR vaccine are in the current MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

People with medical weather condition that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. To help forbid the spread of measles virus, make sure all your staff and patients who tin can exist vaccinated are fully vaccinated according to the U.S. immunization schedule. Also, encourage patients to remind their family members and other close contacts to go vaccinated if they are non allowed.

If patients who cannot go MMR vaccine are exposed to measles, CDC has guidelines for immune globulin for post-exposure prophylaxis which tin can be establish at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Nosotros have a patient who has selective IgA deficiency. We besides have 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. Information technology is possible that the immune response may be weaker, but the vaccines are probable effective.

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

There is no need to wait a specific interval before giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, and so there is no concern about safety or efficacy of MMR.

Tin can I give MMR to a child whose sibling is receiving chemotherapy for leukemia?

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

We take a forty lb half dozen-year-former patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Tin nosotros give the child MMR and varicella vaccine based on this methotrexate dosage?

Based on the weight and dosage provided (twoscore lbs and 15 mg/week), the kid is currently receiving more 0.iv mg/kg/week of methotrexate. This meets the Infectious disease Society of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can exist reduced. The 2013 IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/week. For boosted details, run into 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 information technology true that egg allergy is not considered a contraindication to MMR vaccine?

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

Can I give MMR to a breastfeeding female parent or to a breastfed infant?

Yes. Breastfeeding does non interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no risk to the babe being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the baby is asymptomatic.

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

Yes, but there should be sufficient time between the claret production and the MMR to reduce the chance of interference. The interval depends on the blood product received. Run across Table iii-5 of ACIP's General Best Practise Guidelines for Immunization for more data, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

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

Yeah. Receipt of RhoGam is not a reason to filibuster vaccination. For more information run into the ACIP General Best Practice Guidelines for Immunization, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

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

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

Administer 2 doses of MMR vaccine to all HIV-infected people age 12 months and older who do not have evidence of electric current severe immunosuppression or current evidence of measles, rubella, and mumps immunity. To exist regarded as not having evidence of electric current astringent immunosuppression, a child historic period 5 years or younger must accept CD4 percentages of 15% or more for 6 months or longer; a person older than 5 years must have 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 type of parameter (per centum or counts) this is sufficient for vaccine controlling.

Administrate the first dose at 12 through xv months and the second dose to children historic period 4 through 6 years, or as early as 28 days subsequently the offset 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 effective antiretroviral therapy (ART) should receive 2 appropriately spaced doses of MMR vaccine after effective Art has been established. Established effective Fine art is defined as receiving Fine art for at least 6 months in combination with CD4 percentages of xv% or more for 6 months or longer for children age 5 years or younger. People older than v years should have CD4 percentages of 15% or more than and a CD4 lymphocyte count of 200 or more/mm3 for half-dozen months or longer. If laboratory results state only one type of parameter (percentages or counts) this is sufficient for vaccine decision-making.

Pregnancy and Postpartum Considerations Back to top

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

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

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

ACIP recommends that women of childbearing age be asked if they are currently meaning or attempting to go pregnant. Vaccination should be deferred for those who answer "yep." Those who answer "no" should be advised to avoid pregnancy for 4 weeks post-obit vaccination. Pregnancy testing is not necessary.

If a pregnant adult female inadvertently receives MMR vaccine, how should she be brash?

No specific activeness needs to exist taken other than to reassure the woman that no adverse outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy is not a reason to terminate the pregnancy. You 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 almost contempo MMR ACIP statement, bachelor at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

No. ACIP recommends that women of childbearing age be asked if they are currently meaning or attempting to become pregnant. Vaccination should be deferred for those who answer "yes." Those who reply "no" should be brash to avert pregnancy for 1 month following vaccination.

Can we give an MMR to a fifteen-month-old whose mother is ii months meaning?

Yes. Measles, mumps, and rubella vaccine viruses are non transmitted from the vaccinated person, and so MMR vaccination of a household contact does non pose a risk to a meaning household member.

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

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

I have a female person patient who has a non-immune rubella titer two months later on her 2d MMR vaccination. Should she be revaccinated? If so, should the titer once again be checked to determine seroconversion?

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

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

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

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

Vaccine Safety Dorsum to superlative

Is there any evidence that MMR or thimerosal causes autism?

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

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

Merck no longer produces single antigen measles, mumps, and/or rubella vaccines for the U.S. market place. Only combined MMR is available. You should brainwash parents about the lack of clan between MMR and autism.

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

Arthralgia (joint pain) and transient arthritis (joint redness or swelling) following rubella vaccination occurs merely in people who were susceptible to rubella at the time of vaccination. Articulation symptoms are uncommon in children and in adult males. About 25% of non-immune mail service-pubertal women report joint hurting after receiving rubella vaccine, and about 10% to 30% study arthritis-similar signs and symptoms.

When joint symptoms occur, they by and large brainstorm 1 to three weeks afterwards vaccination, commonly are balmy and not incapacitating, terminal about 2 days, and rarely recur.

Is there any harm in giving an extra dose of MMR to a kid of age seven years whose record is lost and the mother is not certain well-nigh the concluding dose of MMR?

In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem. Withal, receiving excessive doses of tetanus toxoid (e.g., DTaP, DT, Tdap, or Td) can increase the risk of a local agin reaction. For details meet the Extra Doses of Vaccine Antigens department of the ACIP General Best Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Vaccination providers frequently run across people who do non have adequate documentation of vaccinations. Providers should only take written, dated records equally prove of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should non be accepted. An attempt to locate missing records should be made whenever possible past contacting previous healthcare providers, reviewing state or local immunization data systems, and searching for a personally held tape.

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

Storage and Treatment Dorsum to top

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

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

How should MMR vaccine be stored?

MMR may exist stored either in the refrigerator at 2°C to 8°C (36°F to 46°F) or in the freezer at -l°C to -fifteen°C (-58°F to +five°F). The diluent should not exist frozen and tin be stored in the refrigerator or at room temperature.

If the MMR is combined with varicella vaccine equally MMRV (ProQuad, Merck), it must be stored in the freezer at -fifty°C to -fifteen°C (-58°F to +v°F).

A box of MMR vaccine (non reconstituted) was left at room temperature overnight. Tin can I use it?

Unfortunately, serious errors in vaccine storage and handling like this occur as well often. If you suspect that vaccine has been mishandled, yous should shop the vaccine as recommended, and so contact the manufacturer or state/local health section for guidance on its apply. This is particularly important for live virus vaccines like MMR and varicella.

Once MMR vaccine has been reconstituted with diluent, how presently must it exist used?

It is preferable to administer MMR immediately after reconstitution. If reconstituted MMR is not used within 8 hours, it must exist discarded. MMR should ever 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 any problem with doing this?

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

Dorsum to top

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

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