These adults include. People 6 months of age and older who will be traveling internationally should be protected against measles.
Before any international travel—. Healthcare personnel should have documented presumptive evidence of immunity , according to the recommendations of the Advisory Committee on Immunization Practices pdf icon [48 pages]. Healthcare personnel without evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days. Women of childbearing age should check with their doctor to make sure they are vaccinated before they get pregnant.
Women of childbearing age who are not pregnant and do not have presumptive evidence of immunity should get at least one dose of MMR vaccine. It is safe for breastfeeding women to receive MMR vaccination. Breastfeeding does not interfere with the response to MMR vaccine, and the baby will not be affected by the vaccine through breast milk. During a mumps outbreak, public health authorities might recommend an additional dose of MMR vaccine for people who belong to groups at increased risk for getting mumps.
These groups are usually those who are likely to have close contact, such as sharing sport equipment or drinks, kissing, or living in close quarters, with a person who has mumps. Your local public health authorities or institution will communicate to the groups at increased risk that they should receive this dose.
If you already have two doses of MMR, it is not necessary to seek out vaccination unless you are part of this group. Top of Page. Learn who should not get MMRV vaccine , which protects against measles, mumps, rubella, and varicella chickenpox. If you do not have presumptive evidence of immunity against measles, mumps, and rubella, talk with your doctor about getting vaccinated.
If you do not have written documentation of MMR vaccine, you should get vaccinated. The MMR vaccine is safe, and there is no harm in getting another dose if you may already be immune to measles, mumps, or rubella. If you received a measles vaccine in the s, you may not need to be revaccinated.
People who have documentation of receiving LIVE measles vaccine in the s do not need to be revaccinated. People who were vaccinated prior to 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 those who may have received killed measles vaccine, which was available in and was not effective.
During a mumps outbreak public health authorities might recommend an additional dose of MMR vaccine for people who belong to groups at increased risk for getting mumps, regardless if they meet the criteria listed above.
Before vaccines were available, nearly everyone was infected with measles, mumps, and rubella viruses during childhood. The majority of people born before are likely to have been infected naturally and therefore are presumed to be protected against measles, mumps, and rubella. Healthcare personnel born before without laboratory evidence of immunity or disease should consider getting two doses of MMR vaccine.
MMR vaccine is very effective at protecting people against measles, mumps, and rubella, and preventing the complications caused by these diseases. People who receive MMR vaccination according to the U. While MMR provides effective protection against mumps for most people, immunity against mumps may decrease over time and some people may no longer be protected against mumps later in life. An additional dose may be needed if you are at risk because of a mumps outbreak.
MMR is an attenuated weakened live virus vaccine. This means that after injection, the viruses cause a harmless infection in the vaccinated person with very few, if any, symptoms before they are eliminated from the body. Some people who get two doses of MMR vaccine may still get measles, mumps, or rubella if they are exposed to the viruses that cause these diseases.
However, disease symptoms are generally milder in vaccinated people. MMRV vaccine protects against four diseases: measles, mumps, rubella, and varicella chickenpox. This vaccine is only licensed for use in children 12 months through 12 years of age. CDC recommends that children get one dose of MMRV vaccine at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose of MMRV vaccine earlier than 4 through 6 years. You can choose to pay for vaccines that you are not eligible to receive for free.
After a single dose of MMR vaccine, 90—95 out of people will be protected from measles, 69—81 protected from mumps and 90—97 from rubella. The MMR vaccine is given as an intramuscular injection injected into a muscle in your thigh or upper arm. It is given as 2 doses, usually at 12 months and 15 months of age. Like all medicines, vaccines can cause side effects, although not everyone gets them. Most side effects are mild and short lived.
The chance of a severe reaction from MMR is very small, but the risks from not being vaccinated are very serious. Because the MMR vaccine combines 3 separate vaccines measles, mumps, rubella in 1 injection, each vaccine can cause reactions at different times after the injection. Vaccines do not cause autism. The confusion came about because in a British doctor thought there was a link between the MMR vaccine and autism.
It has since been found that the doctor had changed the patient data and the laboratory reports were incorrect. There are now many well-conducted studies that have addressed this issue, and some studies have more than one million children in them.
These studies strongly show no evidence of any connection between autism and the MMR vaccine, even among at-risk individuals. The MMR vaccine is very safe. Read more:. This section will be of most interest to clinicians eg, nurses, doctors, pharmacists and specialists.
Looking for Where to get medical help A health professional or service Patient portals Newsletters View all. Measles : The infection can be serious, with 1 in 10 needing to go to hospital. Complications include diarrhoea which can lead to dehydration , ear infections which can cause hearing loss , pneumonia which is the most common cause of death and encephalitis brain inflammation , which can cause brain damage.
Read more about measles. Mumps : The symptoms of mumps are usually mild, such as swollen salivary glands at the side of your face , headache and fever, but it can cause serious complications such as deafness, swollen testicles or ovaries, and meningitis. Read more about mumps. Rubella also called German measles : This is usually a mild infection that gets better within about 7—10 days, but it becomes a serious concern if a pregnant woman catches the infection during the first 20 weeks of pregnancy.
This is because the rubella virus can affect the development of the baby and cause severe health problems such as eye problems, deafness, heart abnormalities and brain damage. Read more about rubella. Should older children who have missed one or both doses of the MMR vaccine still have the vaccine? Children who have had measles : These children still need to receive the MMR vaccine.
Two doses of MMR vaccine are recommended to protect the child from mumps and rubella. About a 6—10 days after the MMR injection, some children get a very mild form of measles.
This includes a rash, high temperature, loss of appetite and a general feeling of being unwell for about 2 or 3 days. Around 1—4 weeks after having the MMR injection, 1 in 50 children develop a mild form of mumps. This includes swelling of the glands in the cheek, neck or under the jaw. It lasts for a day or two. Around 12—14 days after the injection, the rubella vaccine may cause a brief rash and possibility a slightly raised temperature.
On rare occasions, a rash may also occur up to 6 weeks later. Rarely, at around 1—3 weeks, some adults experience painful, stiff or swollen joints, which can last for around 3 days. Side effects What should I do? Mild rash May be from the measles or rubella part of the vaccine. Multiple myeloma is a hematologic cancer and is considered immunosuppressive so MMR vaccine is contraindicated in this person.
We have adult patients in our practice at high risk for measles, including patients going back to college or preparing for international travel, who don't remember ever receiving MMR vaccine or having had measles disease.
How should we manage these patients? You have two options. You can test for immunity or you can just give 2 doses of MMR at least 4 weeks apart. There is no harm in giving MMR vaccine to a person who may already be immune to one or more of the vaccine viruses. If you or the patient opt for testing, and the tests indicate the patient is not immune to one or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks apart.
If any test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination because commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity.
I have a year-old patient who is traveling to Haiti for a mission trip. She doesn't recall ever getting an MMR booster she didn't go to college and never worked in health care. She was rubella immune when pregnant 20 years ago. Her measles titer is negative. Would you recommend an MMR booster? ACIP recommends 2 doses of MMR given at least 4 weeks apart for any adult born in or later who plans to travel internationally. A patient who was born before and is not a healthcare worker wants to get the MMR vaccine before international travel.
Does he need a dose of MMR? No, it is not considered necessary, but he may be vaccinated. Before implementation of the national measles vaccination program in , virtually every person acquired measles before adulthood.
So, this patient can be considered immune based on their birth year. However, MMR vaccine also may be given to any person born before who does not have a contraindication to MMR vaccination. Routine testing of patients born before 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 practice? First of all, make sure all your patients are fully vaccinated according to the U. In certain circumstances, MMR is recommended for infants age 6 through 11 months.
Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants as young as age 6 months as a control measure during a U.
Consult your state health department to find out if this is recommended in your situation. Do not count any dose of MMR vaccine as part of the 2-dose series if it is administered before a child's first birthday. Instead, repeat the dose when the child is age 12 months. In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum 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 6 years.
Finally, remember that infants too young for routine vaccination and people with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those around them.
Be sure to encourage all your patients and their family members to get vaccinated if they are not immune. In recent 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 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 2 doses of MMR vaccine is high.
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 still contract measles. Am I correct? You are correct that vaccinated people can still be infected with viruses or bacteria against which they are vaccinated. More information is available for each vaccine and disease at www. Should these doses be repeated?
All live injected vaccines MMR, varicella, and yellow fever are recommended to be given subcutaneously. However, intramuscular administration of any of these vaccines is not likely to decrease immunogenicity, and doses given IM do not need to be repeated. We often need to give MMR vaccine to large adults. Can this be considered a valid dose? Although this is off-label use, 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 need to be repeated.
How soon can we give the second dose of MMR vaccine to a child vaccinated at 12 months old? The minimum interval is 28 days for dose 2. Does the 4-day "grace period" apply to the minimum age for administration of the first dose of MMR?
What about the day minimum interval between doses of MMR? A dose of MMR vaccine administered up to 4 days before the first birthday may be counted as valid. However, school entry requirements in some states may mandate administration on or after the first birthday. The 4-day "grace period" should not be applied to the day minimum interval between two doses of a live parenteral vaccine. Can MMR be given on the same day as other live virus vaccines?
If you can give the second dose of MMR as early as 28 days after the first dose, why do we routinely wait until kindergarten entry to give the second dose? The second dose of MMR may be given as early as 4 weeks after the first dose, and be counted as a valid dose if both doses were given after the first birthday.
The second dose is not a booster, but rather it is intended to produce immunity in the small 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 age, so it is important to receive the second dose by school entry. It is also convenient to give the second 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 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 United States.
Before their departure from the United States, children age 6 through 11 months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, middle- and low-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to keep a copy of their immunization records with them as they travel.
For additional information on the worldwide measles situation, and on CDC's measles vaccination information for travelers, go to wwwnc. If we give a child a dose of MMR vaccine at 6 months of age 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 age. The child will also need another dose at least 28 days later.
For the child to be fully vaccinated, they need to have 2 doses of MMR vaccine given when the child is 12 months of age and older. A dose given at less than 12 months of age does not count as part of the MMR vaccine two-dose series. I have an 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.
IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in February ACIP voted to recommend that hepatitis A vaccine should be administered to infants age 6 through 11 months traveling outside the United States when protection against hepatitis A is recommended.
MMR and hepatitis A vaccine may be safely co-administered to children in this age group. Neither vaccine is counted as part of the child's routine vaccination series. Can I give the second dose of MMR earlier than age 4 through 6 years the kindergarten entry dose to young children traveling to areas of the world where there are measles cases?
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 1 year, will that dose be considered valid for the U. A measles-containing vaccine administered more than 4 days before the first birthday should not be counted as part of the series. MMR should be repeated when the child is age 12 through 15 months 12 months if the child remains in an area where disease risk is high.
The second dose should be administered at least 28 days after the first dose. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin test because of mild suppression of the immune system.
An year-old college student says he had both measles and mumps diseases as a preschooler, but never had MMR vaccine. Is rubella vaccine recommended in such a situation?
This student should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is not acceptable as proof of immunity. Acceptable evidence of measles and mumps immunity includes a positive serologic test for antibody, birth before , or written documentation of vaccination.
For rubella, only serologic evidence or documented vaccination should be accepted as proof of immunity. Additionally, people born prior to may be considered immune to rubella unless they are women who have the potential to become pregnant. When not given on the same day, is the interval between yellow fever and MMR vaccines 4 weeks 28 days or 30 days? I have seen the yellow fever and live virus vaccine recommendations published both ways. The CDC travel health website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated by at least 30 days if possible.
Either interval is acceptable. What is the recommendation for MMR vaccine for healthcare personnel? ACIP recommends that all HCP born during or after have adequate presumptive evidence of immunity to measles, mumps, and rubella, defined as documentation of two doses of measles and mumps vaccine and at least one dose of rubella vaccine, laboratory evidence of immunity, or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated by at least 4 weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory evidence of measles or mumps immunity or laboratory confirmation of disease.
During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of birth year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease. Would you consider healthcare personnel with 2 documented doses of MMR vaccine to be immune even if their serology for 1 or more of the antigens comes back negative? Healthcare personnel HCP with 2 documented doses of MMR vaccine are considered to be immune regardless of the results of a subsequent serologic test for measles, mumps, or rubella.
Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who do not have documentation of MMR vaccination and whose serologic test is interpreted as "indeterminate" or "equivocal" should be considered not immune and should receive 2 doses of MMR vaccine minimum interval 28 days. ACIP does not recommend serologic testing after vaccination. However, the person is not infectious, and no special precautions such as exclusion from work need to be taken.
A year-old female is going to pharmacy school and the school wants her to have 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 immune to rubella. Can I give her a second dose of the MMR with her having measles after the first dose? Yes, as a healthcare professional, 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 one or more of the components. If she developed measles only one day after getting her first MMR, she must have been exposed to the disease prior to vaccination. What are the contraindications and precautions for MMR vaccine? See www. We 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 high MMR vaccination coverage among those around them.
To help prevent the spread of measles virus, make sure all your staff and patients who can be vaccinated are fully vaccinated according to the U. Also, encourage patients to remind their family members and other close contacts to get vaccinated if they are not immune. If patients who cannot get MMR vaccine are exposed to measles, CDC has guidelines for immune globulin for post-exposure prophylaxis which can be found at www.
We have a patient who has selective IgA deficiency. We also have patients with selective IgM deficiency. Can MMR or varicella vaccine be administered to these patients? It is possible that the immune response may be weaker, but the vaccines are likely effective. I have a patient who is traveling internationally and needs MMR vaccine. He recently received an injectable steroid.
How long should he wait 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. Can I give MMR to a child whose sibling is receiving chemotherapy for leukemia?
MMR and varicella vaccines should be given to the healthy household contacts of immunosuppressed children. We have a 40 lb six-year-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can we give the child MMR and varicella vaccine based on this methotrexate dosage? Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced.
The IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0. 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 culture in children with severe egg allergy.
ACIP recommends routine vaccination of egg-allergic children without the use of special protocols or desensitization procedures. Can I give MMR to a breastfeeding mother or to a breastfed infant? Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no risk to the infant being breastfed.
Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the infant is asymptomatic. If a patient recently received a blood product, can he or she receive MMR vaccine? Yes, 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. Is it acceptable practice to administer MMR, Tdap, and influenza vaccines to a postpartum mom at the same time as administering RhoGam?
Receipt of RhoGam is not a reason to delay vaccination. The current recommendations are as follows:. Administer 2 doses of MMR vaccine to all HIV-infected people age 12 months and older who do not have evidence of current severe immunosuppression or current evidence of measles, rubella, and mumps immunity. If laboratory results state only one type of parameter percentage or counts this is sufficient for vaccine decision-making.
Administer the first dose at 12 through 15 months and the second dose to children age 4 through 6 years, or as early as 28 days after the first 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.
If laboratory results state only one type of parameter percentages or counts this is sufficient for vaccine decision-making. What is the recommended length of time a woman should wait after receiving rubella MMR vaccine before becoming pregnant? 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 pregnant or attempting to become pregnant.
Vaccination should be deferred for those who answer "yes. Pregnancy testing is not necessary. If a pregnant woman inadvertently receives MMR vaccine, how should she be advised?
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