Can I Get Measles Again if I Already Had It

Measles, Mumps, and Rubella

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

Affliction Issues

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

In 2019, a provisional total of 1,242 cases of measles from 31 states were reported to CDC. This was the largest number reported in a single year since 1992; 73% of cases were associated with outbreaks amidst unvaccinated people in New York. These outbreaks were independent and stopped earlier the cease of 2019. Between Jan i and Baronial 19, 2020, just 12 measles cases were reported by 7 jurisdictions. Limited travel as a event of the COVID-xix pandemic drastically reduced opportunities for travelers infected with measles to enter or travel inside the U.s.. CDC measles surveillance updates can exist found at www.cdc.gov/measles/cases-outbreaks.html.

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

Rubella was declared eliminated (the absenteeism of owned transmission for 12 months or more than) from the United states in 2004. Fewer than x cases (primarily import-related) have been reported annually in the United states since elimination was declared. Rubella incidence in the The states has decreased past more than 99% from the pre-vaccine era. A conditional total of iii cases of rubella, and no cases of built rubella syndrome, were reported in 2019.

How serious are measles, mumps, and rubella?

Measles tin pb 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, from 1987 to 2000, the nigh commonly reported complications associated with measles infection were pneumonia (half-dozen%), otitis media (7%), and diarrhea (8%). For every 1,000 reported measles cases in the United States, approximately one case of encephalitis and two to 3 deaths resulted. The hazard for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

Mumps most unremarkably causes fever and parotitis. Upwardly 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 balmy affliction with low-form fever, lymphadenopathy, and malaise. Up to l% of rubella virus infections are subclinical. Complications can include thrombocytopenic purpura and encephalitis. Rubella virus is teratogenic and infection in a significant woman, especially during the starting time trimester can effect in miscarriage, stillbirth, and nativity defects including cataracts, hearing loss, mental retardation, and congenital middle defects.

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

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

• a generalized rash lasting three or more days, and • a temperature of 101°F or higher (38.3°C or college), and • cough, coryza, and/or conjunctivitis.

Koplik spots, a rash present on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from i to ii days before the measles rash appears to 1 to two days after. They appear as punctate blue-white spots on the vivid red background of the buccal mucosa. Pictures of measles rash and Koplik spots can exist plant 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 take recently traveled abroad or who have had contact with international travelers.

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

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

Measles is highly contagious. A person with measles is infectious up to 4 days before through four days later 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 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 report suspected measles cases to their local health department and obtain specimens for measles testing, including serum sample for measles serologic testing and a throat swab (or nasopharyngeal swab) for viral confirmation.

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

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

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

For measles, there is an average of ten to 12 days from exposure to the appearance of the first symptom, which is usually fever. The measles rash doesn't ordinarily appear until approximately fourteen days after exposure (range: 7 to 21 days), and the rash typically begins two to 4 days later on the fever begins. The incubation flow of mumps averages xvi 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, as noted above, up to half of rubella virus infections cause no symptoms.

Vaccine Recommendations Back to top

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

The nigh recent comprehensive ACIP recommendations for the apply of MMR vaccine were published in 2013 and are bachelor at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at historic period 12 through 15 months, with a second dose at historic period 4 through 6 years. The second dose of MMR can be given as early on equally 4 weeks (28 days) after the beginning dose and exist counted as a valid dose if both doses were given after the child's offset altogether. 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 first dose.

Adults with no evidence of immunity (bear witness of immunity is defined as documented receipt of 1 dose [2 doses iv weeks apart if high risk] of alive measles virus-containing vaccine, laboratory evidence of amnesty or laboratory confirmation of illness, or birth before 1957) should get 1 dose of MMR vaccine unless the adult is in a loftier-take chances grouping. High-risk people demand 2 doses and include school-age children, healthcare personnel, international travelers, and students attending post-high schoolhouse educational institutions.

Live adulterate measles vaccine became available in the U.S. in 1963. An ineffective, inactivated measles vaccine was besides available in the U.Southward. in 1963–1967. Combined MMR vaccine (MMRII, Merck) was licensed in 1971. For people who previously received a dose of measles vaccine in 1963–1967 and are unsure which 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 risk-advisable with MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting tin can receive an additional dose of MMR vaccine even if they are considered completely vaccinated for their age or risk status.

What is considered acceptable bear witness of amnesty to measles?

Adequate presumptive evidence of amnesty confronting measles includes at least one of the following:

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

Although birth earlier 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 ii doses of MMR vaccine (minimum interval 28 days).

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

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

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

Cipher doses:

• adults born before 1957 except healthcare personnel* • adults born 1957 or after who are at low take chances (i.e., not an international traveler or healthcare worker, or person attending college or other mail-high school educational institution) and who have already received one or more documented doses of live measles vaccine • adults with laboratory bear witness of immunity or laboratory confirmation of measles

1 dose of MMR vaccine:

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

Ii doses of MMR vaccine:

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

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

* Healthcare personnel built-in before 1957 should be considered for MMR vaccination in the absenteeism of an outbreak, but 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, accept ii doses of MMR vaccine?

Although nascency before 1957 is considered acceptable prove of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born earlier 1957 who do non take laboratory evidence of measles immunity, laboratory confirmation of disease, or vaccination with 2 appropriately spaced doses of MMR vaccine.

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

Healthcare facilities should check with their state or local health department's immunization program for guidance. Access contact information here: world wide web.immunize.org/coordinators.

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

MMR can exist given to children as immature as half-dozen 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 historic period cannot be counted toward the 2-dose series for MMR.

How does being born before 1957 confer immunity to measles?

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

Why is a second dose of MMR necessary?

Approximately 7% of people do non develop measles immunity after the first dose of vaccine. This occurs for a variety of reasons. The second dose is to provide another chance to develop measles immunity for people who did not respond to the first dose. About 97% of people develop immunity to measles afterwards 2 doses of measles-containing vaccine.

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

There are two circumstances when a third dose of MMR is recommended. ACIP recommends that women of childbearing age who accept received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive ane boosted dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. MMR should not exist administered to a meaning woman.

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

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

MMR vaccine given within 72 hours of initial measles exposure can reduce the risk of getting sick or reduce the severity of symptoms. Some other selection for exposed, measles-susceptible individuals at high hazard of complications who cannot be vaccinated is to give immunoglobulin (IG) inside 6 days of exposure. Do not administer MMR vaccine and IG simultaneously, equally the IG invalidates the vaccine.

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

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

No. Adults with prove of amnesty do non demand whatsoever further vaccines. No "booster" doses of MMR vaccine are recommended for either adults or children. They are considered to have life-long immunity one time they have received the recommended number of MMR vaccine doses or have other evidence of immunity.

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

Both killed and live attenuated measles vaccines became bachelor in 1963. Alive adulterate vaccine was used more often than killed vaccine. The killed vaccine was plant to be not effective and people who received it should exist revaccinated with live vaccine. Without a written tape, it is not possible to know what type of vaccine an individual may have received. Then persons born during or afterwards 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles affliction 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 past at to the lowest degree 4 weeks.

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

Not necessarily. People who have documentation of receiving alive measles vaccine in the 1960s practise non demand to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least ane dose of live attenuated measles vaccine. This recommendation is intended to protect people who may accept received killed measles vaccine which was available in the Usa in 1963 through 1967 and was non constructive. People vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such equally people who piece of work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

I understand that ACIP changed its definition of show 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 illness equally evidence of immunity for measles, mumps, and rubella. ACIP removed md diagnosis of disease as evidence of immunity for measles and mumps. Medico diagnosis of disease had non 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 physician-diagnosed disease has become questionable. In add-on, documenting history from physician records is not a practical option for near 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 accept already been exposed to measles, mumps, or rubella?

Measles vaccine, given as MMR, may be constructive if given within the beginning iii days (72 hours) after exposure to measles. Allowed globulin may be effective for as long as half-dozen days afterward exposure. Postexposure prophylaxis with MMR vaccine does not preclude or modify the clinical severity of mumps or rubella. However, if the exposed person does not take prove of mumps or rubella immunity they should be vaccinated since not all exposures effect in infection.

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

In the 2013 revision of its MMR vaccine recommendations ACIP expanded the use of post-exposure IG prophylaxis for measles. Intramuscular IG (IGIM) should be administered to all infants younger than 12 months who take been exposed to measles. The dose of IGIM is 0.v mL/kg of body weight; the maximum dose is 15 mL. Alternatively, MMR vaccine can be given instead of IGIM to infants historic period six through xi months, if it can exist given within 72 hours of exposure.

Pregnant women without prove 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 prove of measles immunity or vaccination, who accept been exposed to measles should receive an IGIV dose of 400 mg/kg of torso weight.

For persons already receiving IGIV therapy, administration of at to the lowest degree 400 mg/kg torso weight within 3 weeks before measles exposure should be sufficient to preclude measles infection. For patients receiving subcutaneous allowed globulin (IGSC) therapy, administration of at least 200 mg/kg torso weight for two consecutive weeks before measles exposure should be sufficient.

Other people who do not accept prove of measles immunity can receive an IGIM dose of 0.five mL/kg of torso weight. Give priority to people who were exposed to measles in settings where they have intense, prolonged close contact (such every bit household, child care, classroom, etc.). The maximum dose of IGIM is xv mL.

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

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

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

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

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

No. Self-reported doses and history of vaccination provided by a parent or other caregiver are non considered to be valid. You should but have a written, dated record as show of vaccination.

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

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

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

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

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

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

We have adult patients in our do at high take a chance for measles, including patients going back to college or preparing for international travel, who don't call back always receiving MMR vaccine or having had measles illness. How should we manage these patients?

You have two options. You can test for immunity or yous can only give 2 doses of MMR at least 4 weeks autonomously. There is no impairment 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 non immune to 1 or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks autonomously. If whatsoever exam results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing afterwards vaccination because commercial tests may not be sensitive enough to reliably discover vaccine-induced immunity.

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

ACIP recommends 2 doses of MMR given at to the lowest degree 4 weeks autonomously for whatever adult 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 allowed to one or more of the vaccine viruses.

A patient who was built-in 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, information technology is not considered necessary, but he may be vaccinated. Before implementation of the national measles vaccination program in 1963, nigh every person caused measles before adulthood. So, this patient can exist considered immune based on their nascency twelvemonth. However, 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 built-in before 1957 for measles-specific antibody is not recommended by CDC.

We have measles cases in our community. How can I best protect the young children in my exercise?

First of all, make sure all your patients are fully vaccinated co-ordinate to the U.S. immunization schedule.

In certain circumstances, MMR is recommended for infants age 6 through 11 months. Requite infants this historic period a dose of MMR before international travel. In addition, consider measles vaccination for infants as young as historic period 6 months equally a control measure out during a U.S. measles outbreak. Consult your country health department to discover out if this is recommended in your state of affairs. Do not count whatsoever dose of MMR vaccine as part of the two-dose serial if it is administered before a kid's first birthday. Instead, repeat the dose when the child is age 12 months.

In the case of a local outbreak, y'all too 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 2d dose four weeks later (at the minimum interval) instead of waiting until historic period 4 through 6 years.

Finally, remember that infants too immature for routine vaccination and people with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage amidst those around them. Be sure to encourage all your patients and their family members to go vaccinated if they are not immune.

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

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

In Jan 2018, the Informational Committee on Immunization Practices (ACIP) published new guidance for MMR vaccination of persons at increased risk for acquiring mumps during an outbreak. Persons previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified past public health regime equally existence part of a group at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus�containing vaccine to better protection against mumps affliction and related complications. More than information nearly 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 understanding that vaccinated people can all the same contract measles. Am I correct?

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

Administering Vaccines Back to top

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

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

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

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

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

Yeah, even so, this effect is non addressed in the 2010 MMRV ACIP recommendations. Although this is off-characterization apply, CDC recommends that when a dose of MMRV is inadvertently given to a patient age 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 Dorsum to top

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

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 old and the 2d dose at age 4–6 years old. The minimum interval is 28 days for dose 2. If you lot accept an outbreak in your community or a child is traveling internationally, so consider using the minimum interval instead of waiting until age 4–6 years onetime for dose 2.

Does the 4-day "grace menstruum" apply to the minimum age for administration of the commencement dose of MMR? What most the 28-day minimum interval between doses of MMR?

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

Tin MMR be given on the aforementioned 24-hour interval as other alive virus vaccines?

Yes. However, if ii parenteral or intranasal alive vaccines (MMR, varicella, LAIV and/or yellowish fever) are non administered on the aforementioned day, they should be separated by an interval of at to the lowest degree 28 days.

If you can requite the second dose of MMR as early as 28 days later the beginning dose, why practice we routinely expect until kindergarten entry to give the second dose?

The second dose of MMR may be given every bit early as 4 weeks after the first dose, and be counted every bit a valid dose if both doses were given later the first altogether. The second dose is not a booster, just rather it is intended to produce immunity in the modest number of people who fail to respond to the first dose. The risk of measles is higher in school-age children than those of preschool historic period, then information technology is important to receive the second dose past school entry. It is also convenient to requite the 2nd dose at this historic period, since the kid will accept an immunization visit for other school entry vaccines.

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

ACIP recommends that children who travel or live abroad should be vaccinated at an earlier age than that recommended for children who reside in the U.s.a.. Earlier their departure from the United States, children age 6 through xi months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, eye- and low-income countries. Consequently, CDC encourages all international travelers to be upwardly to date on their immunizations regardless of their travel destination and to continue a copy of their immunization records with them as they travel. For additional information on the worldwide measles situation, and on CDC's measles vaccination data for travelers, go to wwwnc.cdc.gov/travel.

If we requite a child a dose of MMR vaccine at 6 months of historic period considering they are in a community with cases of measles, when should nosotros requite the side by side dose?

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

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

No. IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in Feb 2022 ACIP voted to recommend that hepatitis A vaccine should exist administered to infants age 6 through eleven months traveling exterior the Usa 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 equally part of the child's routine vaccination series. For details of this recommendation, see the CDC ACIP recommendations for the prevention and control of hepatitis A at www.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, folio 18.

Can I give the second dose of MMR earlier than historic period 4 through half dozen years (the kindergarten entry dose) to young children traveling to areas of the world where there are measles cases?

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

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

No. A measles-containing vaccine administered more than four days before the first birthday should not be counted as part of the series. MMR should be repeated when the child is age 12 through 15 months (12 months if the child remains in an surface area where disease run a risk is loftier). The 2nd dose should be administered at to the lowest degree 28 days after the first dose.

Can I give a tuberculin pare test (TST) on the aforementioned day as a dose of MMR vaccine?

Aye. A TST tin be applied before or on the aforementioned day that MMR vaccine is given. However, if MMR vaccine is given on the previous day or earlier, the TST should exist delayed for at least 28 days. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin test because of balmy suppression of the immune system.

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

This educatee should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is not acceptable as proof of immunity. Adequate evidence of measles and mumps immunity includes a positive serologic test for antibody, nativity before 1957, or written documentation of vaccination. For rubella, only serologic show or documented vaccination should be accustomed 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 significant.

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

The Full general All-time 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 not given on the same day should be separated by at least 28 days. The CDC travel health website recommends that xanthous fever vaccine and other parenteral or nasal alive vaccines should be separated past at least xxx days if possible. Either interval is acceptable.

For Healthcare Personnel Dorsum to top

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, divers equally documentation of two doses of measles and mumps vaccine and at least 1 dose of rubella vaccine, laboratory evidence of immunity, or laboratory confirmation of illness. 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 2 doses of MMR separated by at least four weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory evidence of measles or mumps amnesty or laboratory confirmation of disease. During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of nativity year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease.

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

Yeah. Healthcare personnel (HCP) with 2 documented doses of MMR vaccine are considered to be immune regardless of the results of a subsequent serologic exam 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 as "indeterminate" or "equivocal" should be considered non immune and should receive 2 doses of MMR vaccine (minimum interval 28 days). ACIP does not recommend serologic testing after vaccination. For more data, see ACIP'due south recommendations on the apply of MMR vaccine at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 22.

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

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

A 22-year-one-time female is going to pharmacy school and the schoolhouse wants her to have a 2nd dose of MMR vaccine. She had the offset dose as a kid and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles but not immune to rubella. Can I give her a second dose of the MMR with her having measles afterward the first dose?

Yeah, as a healthcare professional, this person should get a 2d dose of MMR to ensure she is immune to rubella. At that place is no harm in providing MMR to a person who is already immune to one or more of the components. If she developed measles only ane day after getting her first MMR, she must have been exposed to the illness prior to vaccination.

Contraindications and Precautions Dorsum to top

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

• receipt of an antibiotic-containing blood product in the previous 3–11 months, depending on the type of blood product received. See www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html, Table 3-5 for more data on this event • moderate or severe acute illness with or without fever • history of thrombocytopenia or thrombocytopenic purpura • Important details about the contraindications and precautions for MMR vaccine are in the current MMR ACIP argument, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

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

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

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

There is no known risk associated with MMR or varicella vaccination in someone with selective IgA or IgM deficiency. It is possible that the immune response may exist weaker, just the vaccines are likely effective.

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

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

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

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

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

Based on the weight and dosage provided (forty lbs and 15 mg/week), the child is currently receiving more 0.four mg/kg/calendar week of methotrexate. This meets the Infectious Affliction Society of America (IDSA) definition of loftier-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage tin can be reduced. The 2013 IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0.four mg/kg/week. For additional details, come across the 2013 IDSA Clinical Practise 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 safety of measles and mumps vaccine (which are grown in chick embryo tissue civilisation) in children with severe egg allergy. Neither the American Academy of Pediatrics nor ACIP consider egg allergy every bit a contraindication to MMR vaccine. ACIP recommends routine vaccination of egg-allergic children without the utilise 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 gamble to the infant being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the infant is asymptomatic.

If a patient recently received a blood product, 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 blood product received. Come across Tabular array three-5 of ACIP's General Best Practice Guidelines for Immunization for more than data, available at world wide web.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

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

Aye. Receipt of RhoGam is non a reason to delay vaccination. For more than information see the ACIP General Best Practice Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Please describe the current ACIP recommendations for the employ 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 ii doses of MMR vaccine to all HIV-infected people age 12 months and older who do non have testify of electric current severe immunosuppression or current bear witness of measles, rubella, and mumps immunity. To be regarded as non having evidence of current severe immunosuppression, a child historic period 5 years or younger must accept CD4 percentages of fifteen% or more for 6 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 one type of parameter (percent or counts) this is sufficient for vaccine decision-making.

Administrate the first dose at 12 through 15 months and the second dose to children age 4 through half-dozen years, or as 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 (ART) should receive 2 accordingly spaced doses of MMR vaccine after effective Art has been established. Established effective ART is divers equally receiving Art for at least half-dozen months in combination with CD4 percentages of 15% or more than for vi months or longer for children age 5 years or younger. People older than five years should accept CD4 percentages of 15% or more than and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results country 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 wait after receiving rubella (MMR) vaccine before becoming pregnant?

Although the MMR vaccine package insert recommends a 3-calendar month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for iv weeks. For details on this outcome, 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 changeable age be screened for pregnancy before MMR vaccination?

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

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

No specific action needs to be taken other than to reassure the woman that no adverse outcomes are expected as a result of this vaccination. MMR vaccination during pregnancy is not a reason to finish the pregnancy. Yous should consult with others in your healthcare setting to identify ways to forestall such vaccination errors in the time to come. Detailed information well-nigh MMR vaccination in pregnancy is included in the most recent MMR ACIP statement, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

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

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

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

If a woman's rubella exam upshot shows she is "non immune" during a prenatal visit, but she has 2 documented doses of MMR vaccine, does she demand a third dose of MMR vaccine postpartum?

In 2013, ACIP changed its recommendation for this 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 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered one additional dose of MMR vaccine (maximum of iii doses) and do not need to be retested for serologic evidence of rubella immunity. MMR should not be administered to a meaning adult female.

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

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

MMR vaccines should not be administered to women known to exist pregnant or attempting to become significant. Because of the theoretical adventure 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 can MMR be given to the mother?

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

Vaccine Safe Back to pinnacle

Is there any evidence that MMR or thimerosal causes autism?

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

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

Merck no longer produces single antigen measles, mumps, and/or rubella vaccines for the U.S. market. Merely combined MMR is available. Y'all should brainwash parents about the lack of association between MMR and autism.

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

Arthralgia (articulation 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-immune mail service-pubertal women report joint pain afterwards receiving rubella vaccine, and about 10% to 30% report arthritis-like signs and symptoms.

When joint symptoms occur, they generally begin one to 3 weeks later on vaccination, unremarkably are mild and not incapacitating, terminal about 2 days, and rarely recur.

Is there any harm in giving an extra dose of MMR to a child of age vii years whose record is lost and the mother is not sure virtually the last dose of MMR?

In general, although information technology is not ideal, receiving extra doses of vaccine poses no medical problem. However, receiving excessive doses of tetanus toxoid (eastward.g., DTaP, DT, Tdap, or Td) tin can increase the adventure of a local adverse reaction. For details see the Actress Doses of Vaccine Antigens section of the ACIP General Best Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

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

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

Storage and Handling Back to superlative

How long can reconstituted MMR vaccine be stored in a fridge earlier it must be discarded?

The corporeality of fourth dimension in which a dose of vaccine must be used after reconstitution varies past vaccine and is unremarkably outlined somewhere in the vaccine'due south parcel insert. MMR must be used inside 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used immediately. The Immunization Activity Coalition has a staff pedagogy piece that outlines the time immune between reconstitution and utilize, as stated in the package inserts for a number of vaccines. Handout tin can be found at the post-obit 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 exist stored in the refrigerator or at room temperature.

If the MMR is combined with varicella vaccine as MMRV (ProQuad, Merck), information technology must be stored in the freezer at -fifty°C to -15°C (-58°F to +5°F).

A box of MMR vaccine (non reconstituted) was left at room temperature overnight. Can I employ information technology?

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

One time MMR vaccine has been reconstituted with diluent, how before long must it exist used?

It is preferable to administer MMR immediately after reconstitution. If reconstituted MMR is not used within viii hours, information technology must be discarded. MMR should always exist refrigerated and should never be left at room temperature.

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

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

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