Is Someone Had Measles Does That Mean They Wont Get It Again

Measles, Mumps, and Rubella

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

Disease Issues

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

In 2019, a provisional full 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 among unvaccinated people in New York. These outbreaks were contained and stopped before the end of 2019. Between January 1 and August nineteen, 2020, simply 12 measles cases were reported by seven jurisdictions. Limited travel as a outcome of the COVID-nineteen pandemic drastically reduced opportunities for travelers infected with measles to enter or travel within the Us. CDC measles surveillance updates tin be establish at www.cdc.gov/measles/cases-outbreaks.html.

Since the pre-vaccine era, at that place has been a more than than 99% decrease in mumps cases in the United States. However, outbreaks notwithstanding occasionally occur. In 2006, there was an outbreak affecting more than 6,584 people in the The states, with many cases occurring on higher campuses. In 2009, an outbreak started in close-knit religious communities and schools in the Northeast, resulting in more than iii,000 cases. Since 2015, numerous outbreaks have been reported across the Usa, in college campuses, prisons, and close-knit communities, including a large outbreak in northwest Arkansas where most 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 every bit among residential college students and families in close-knit communities) mumps can spread fifty-fifty amongst vaccinated people. However, outbreaks are much larger in areas where vaccine coverage rates are lower. A provisional total of three,484 cases of mumps were reported to CDC in 2019.

Rubella was declared eliminated (the absence of endemic transmission for 12 months or more) from the United States in 2004. Fewer than 10 cases (primarily import-related) have been reported annually in the United States since emptying was declared. Rubella incidence in the The states has decreased past more than 99% from the pre-vaccine era. A conditional 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, even with modern medical care. The 1989–1991 measles outbreak in the U.S. resulted in more than 55,000 cases and more than than 100 deaths. In the Usa, from 1987 to 2000, the about commonly reported complications associated with measles infection were pneumonia (6%), otitis media (7%), and diarrhea (8%). For every i,000 reported measles cases in the United States, approximately ane case of encephalitis and 2 to three deaths resulted. The risk for death from measles or its complications is greater for infants, young children, and adults than for older children and adolescents.

Mumps nigh commonly 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 disease is typically milder, with fewer complications, in fully vaccinated instance patients.

Rubella is mostly a balmy affliction with low-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 pregnant adult female, peculiarly during the starting time trimester tin can result in miscarriage, stillbirth, and nascency defects including cataracts, hearing loss, mental retardation, and congenital center defects.

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

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

• a generalized rash lasting 3 or more days, and • a temperature of 101°F or higher (38.iii°C or higher), and • cough, coryza, and/or conjunctivitis.

Koplik spots, a rash present on mucous membranes, are considered pathognomonic for measles. Koplik spots occur from ane to 2 days earlier the measles rash appears to 1 to ii days afterward. They appear as punctate blue-white spots on the bright red background of the buccal mucosa. Pictures of measles rash and Koplik spots can exist constitute at world wide web.cdc.gov/measles/virtually/photos.html.

Providers should be peculiarly aware of the possibility of measles in people with fever and rash who have recently traveled away 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 start clinical encounter with a person who has suspected or probable measles.

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

Measles is highly contagious. A person with measles is infectious up to four days before through 4 days after the day of rash onset. Patients with suspected measles should be isolated for iv 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 unmarried-patient airborne infection isolation room. Providers should immediately isolate and report suspected measles cases to their local wellness section 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 assist reduce the number of secondary cases. Do non wait for the results of laboratory testing to written report clinically-suspected measles to the local health department.

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

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

For measles, there is an average of 10 to 12 days from exposure to the appearance of the outset symptom, which is usually fever. The measles rash doesn't usually appear until approximately fourteen days later on exposure (range: seven to 21 days), and the rash typically begins 2 to 4 days subsequently the fever begins. The incubation period of mumps averages 16 to 18 days (range: 12 to 25 days) from exposure to onset of parotitis. The incubation period of rubella is 14 days (range: 12 to 23 days). Yet, as noted to a higher place, upwards 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 www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. MMR vaccine is recommended routinely for all children at age 12 through 15 months, with a second dose at age 4 through 6 years. The 2nd dose of MMR can be given as early on as 4 weeks (28 days) after the first dose and be counted as a valid dose if both doses were given after the child's beginning birthday. The 2d dose is not a booster, but rather is intended to produce amnesty in the small number of people who fail to reply to the first dose.

Adults with no bear witness of immunity (show of amnesty is defined equally documented receipt of 1 dose [2 doses 4 weeks apart if loftier take chances] of live measles virus-containing vaccine, laboratory evidence of amnesty or laboratory confirmation of disease, or nascence before 1957) should get ane dose of MMR vaccine unless the developed is in a high-chance group. High-risk people demand 2 doses and include school-historic period children, healthcare personnel, international travelers, and students attending post-high school educational institutions.

Alive adulterate measles vaccine became available in the U.S. in 1963. An ineffective, inactivated measles vaccine was also available in the U.Due 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 information technology was, or are certain information technology was inactivated measles vaccine, that dose should be considered invalid and the patient revaccinated as age- and adventure-appropriate with MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an boosted dose of MMR vaccine fifty-fifty if they are considered completely vaccinated for their age or risk status.

What is considered adequate evidence of amnesty to measles?

Acceptable presumptive testify of immunity against measles includes at least one of the following:

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

Although birth before 1957 is considered acceptable evidence of measles immunity, healthcare facilities should consider vaccinating unvaccinated personnel born before 1957 who practise not have other evidence of immunity with 2 doses of MMR vaccine (minimum interval 28 days).

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

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

Zippo, one, or ii doses of MMR vaccine are needed for the adults described below.

Cypher doses:

• adults built-in earlier 1957 except healthcare personnel* • adults born 1957 or later on who are at low risk (i.due east., not an international traveler or healthcare worker, or person attending college or other post-high school educational establishment) and who have already received i or more than documented doses of live measles vaccine • adults with laboratory evidence of immunity or laboratory confirmation of measles

One dose of MMR vaccine:

• adults born 1957 or later who are at low risk (i.e., not an international traveler, healthcare worker, or person attending college or other post-loftier school educational institution) and have no documented vaccination with live measles vaccine and no laboratory evidence of immunity or prior measles infection

Two doses of MMR vaccine:

� high-run a risk adults without whatever prior documented live measles vaccination and no laboratory evidence of amnesty or prior measles infection, including:

Persons who previously received a dose of measles vaccine in 1963–1967 and are unsure which type of vaccine it was, or are certain it was inactivated measles vaccine, should be revaccinated with either ane (if low-risk) or 2 (if high-risk) doses of MMR vaccine.

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

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

Although nascence earlier 1957 is considered adequate bear witness of measles immunity for routine vaccination, healthcare facilities should consider vaccinating unvaccinated healthcare personnel (HCP) born before 1957 who exercise not accept laboratory testify of measles immunity, laboratory confirmation of illness, or vaccination with 2 appropriately spaced doses of MMR vaccine.

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

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

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

MMR can exist given to children as young equally half-dozen months of age who are at high risk of exposure such as during international travel or a customs outbreak. However, doses given Earlier 12 months of age cannot be counted toward the two-dose series for MMR.

How does being born before 1957 confer amnesty to measles?

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

Why is a second dose of MMR necessary?

Approximately 7% of people do not develop measles immunity afterwards the showtime 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 later on ii doses of measles-containing vaccine.

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

At that place are ii circumstances when a 3rd dose of MMR is recommended. ACIP recommends that women of childbearing age who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not conspicuously positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic show of rubella immunity is not recommended. MMR should not exist administered to a significant woman.

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

When is it appropriate to apply MMR vaccine for measles post-exposure prophylaxis?

MMR vaccine given within 72 hours of initial measles exposure can reduce the risk of getting sick or reduce the severity of symptoms. Another option for exposed, measles-susceptible individuals at high risk of complications who cannot be vaccinated is to give immunoglobulin (IG) within half dozen days of exposure. Do not administer MMR vaccine and IG simultaneously, as the IG invalidates the vaccine.

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

Practise any adults demand "booster" doses of MMR vaccine to forbid measles?

No. Adults with testify 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 one time they accept received the recommended number of MMR vaccine doses or have other testify of immunity.

Many people who were young children in the 1960s do not take records indicating what blazon of measles vaccine they received in the mid-1960s. What measles vaccine was near often given in that fourth dimension menstruum? 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. Alive adulterate vaccine was used more than oft than killed vaccine. The killed vaccine was found to be non effective and people who received it should be revaccinated with live vaccine. Without a written record, it is not possible to know what type of vaccine an individual may have received. Then persons born during or later on 1957 who received killed measles vaccine or measles vaccine of unknown blazon, or who cannot certificate having been vaccinated or having laboratory-confirmed measles illness should receive at least 1 dose of MMR. Some people at increased gamble of exposure to measles (such as healthcare professionals and international travelers) should receive ii doses of MMR separated by at to the lowest degree 4 weeks.

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

Non necessarily. People who have documentation of receiving live measles vaccine in the 1960s do not 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 to the lowest degree one dose of live adulterate measles vaccine. This recommendation is intended to protect people who may have received killed measles vaccine which was bachelor in the The states in 1963 through 1967 and was non effective. People vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such as people who work in a healthcare facility) should exist considered for revaccination with 2 doses of MMR vaccine.

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

In the 2013 revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of disease as evidence of amnesty for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Physician diagnosis of disease had not previously been accepted as prove 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 physician records is not a practical option for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

Is at that place anything that tin can be washed for unvaccinated people who have already been exposed to measles, mumps, or rubella?

Measles vaccine, given as MMR, may be effective if given inside the kickoff 3 days (72 hours) after exposure to measles. Allowed globulin may be effective for equally long as 6 days after exposure. Postexposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella. However, if the exposed person does non have evidence of mumps or rubella immunity they should be vaccinated since not all exposures effect in infection.

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

In the 2013 revision of its MMR vaccine recommendations ACIP expanded the use of mail service-exposure IG prophylaxis for measles. Intramuscular IG (IGIM) should exist administered to all infants younger than 12 months who have been exposed to measles. The dose of IGIM is 0.5 mL/kg of trunk weight; the maximum dose is 15 mL. Alternatively, MMR vaccine tin be given instead of IGIM to infants historic period 6 through eleven months, if it can be given within 72 hours of exposure.

Pregnant women without show of measles amnesty who are exposed to measles should receive an intravenous IG (IGIV) dose of 400 mg/kg of body weight. Severely immunocompromised people, irrespective of evidence of measles immunity or vaccination, who have 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 trunk weight within 3 weeks earlier measles exposure should be sufficient to foreclose measles infection. For patients receiving subcutaneous immune globulin (IGSC) therapy, administration of at to the lowest degree 200 mg/kg torso weight for 2 consecutive weeks earlier measles exposure should be sufficient.

Other people who do not have evidence 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 as household, child care, classroom, etc.). The maximum dose of IGIM is 15 mL.

IG is not indicated for persons who accept 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 ofttimes come across 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 blazon of vaccine should these students receive?

Single antigen vaccine is no longer available in the U.South.; 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 accept patients who claim to retrieve receiving MMR vaccine only accept no written tape, or whose parents study the patient has been vaccinated. Should I accept this equally evidence of vaccination?

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

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

Adults without evidence of immunity and no contraindications to MMR vaccine tin exist vaccinated without testing. Just adults without evidence of amnesty 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 afterwards MMR vaccination to verify the patient's immune response to vaccination.

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

A patient born in 1970 has a history of measles disease and is as well immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, but is concerned virtually the measles exposure risk. Should the patient receive the MMR vaccine?

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

Nosotros accept adult patients in our practise at high risk for measles, including patients going back to college or preparing for international travel, who don't think e'er receiving MMR vaccine or having had measles disease. How should nosotros manage these patients?

You accept two options. You tin can test for amnesty or you lot 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 non allowed to one or more of the vaccine components, give your patient 2 doses of MMR at to the lowest degree 4 weeks apart. If any exam results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination considering commercial tests may non exist sensitive enough to reliably detect 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 immune when pregnant 20 years agone. Her measles titer is negative. Would yous recommend an MMR booster?

ACIP recommends 2 doses of MMR given at least 4 weeks autonomously for whatsoever adult born in 1957 or after who plans to travel internationally. There is no harm in giving MMR vaccine to a person who may already be immune to ane or more of the vaccine viruses.

A patient who was built-in before 1957 and is non a healthcare worker wants to get the MMR vaccine before international travel. Does he demand a dose of MMR?

No, it is non considered necessary, but he may be vaccinated. Before implementation of the national measles vaccination program in 1963, virtually every person caused measles before adulthood. So, this patient can be considered immune based on their birth year. However, MMR vaccine also may exist given to whatever person built-in earlier 1957 who does not take a contraindication to MMR vaccination.

Routine testing of patients born earlier 1957 for measles-specific antibody is not recommended by CDC.

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

Get-go of all, make certain all your patients are fully vaccinated according to the U.S. immunization schedule.

In sure circumstances, MMR is recommended for infants age 6 through 11 months. Requite infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants every bit young as age 6 months as a control measure during a U.Southward. measles outbreak. Consult your country health section to notice out if this is recommended in your situation. Do not count whatsoever dose of MMR vaccine as function of the 2-dose series if information technology is administered before a child's start birthday. Instead, repeat the dose when the child is age 12 months.

In the instance of a local outbreak, y'all also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through xv months) and giving the 2nd dose four weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.

Finally, recollect 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 get vaccinated if they are not immune.

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

In contempo years, mumps outbreaks accept occurred primarily in populations in institutional settings with close contact (such every bit residential colleges) or in close-knit social groups. The current routine recommendation for ii 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 two 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 run a risk for acquiring mumps during an outbreak. Persons previously vaccinated with 2 doses of a mumps virus�containing vaccine who are identified by public wellness authorities equally existence part of a group at increased hazard for acquiring mumps considering of an outbreak should receive a 3rd dose of a mumps virus�containing vaccine to improve protection confronting mumps disease and related complications. More than information virtually this recommendation is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf.

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

You are correct that vaccinated people can notwithstanding 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 (lx% for influenza in years with a skilful match of circulating and vaccine viruses, and seventy% for acellular pertussis vaccines in the 3-5 years afterward vaccination). More information is available for each vaccine and disease at www.cdc.gov/vaccines/vpd-vac/default.htm and www.immunize.org/vaccines.

Administering Vaccines Back to top

Our clinic has been giving MMR past the incorrect road (IM rather than SC) for years. Should these doses be repeated?

All live injected vaccines (MMR, varicella, and xanthous fever) are recommended to be given subcutaneously. However, intramuscular administration of any of these vaccines is not likely to subtract immunogenicity, and doses given IM practice not need to be repeated.

We oftentimes demand to give MMR vaccine to large adults. Is a 25-gauge needle with a length of v/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?

Yes, notwithstanding, this issue is not addressed in the 2010 MMRV ACIP recommendations. Although this is off-label use, CDC recommends that when a dose of MMRV is inadvertently given to a patient historic period thirteen years and older, it may exist counted towards completion of the MMR and varicella vaccine series and does not need to be repeated.

Scheduling Vaccines Dorsum to acme

How before long can we give the second dose of MMR vaccine to a child vaccinated at 12 months sometime?

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

Does the 4-day "grace period" apply to the minimum age for administration of the get-go dose of MMR? What about the 28-day minimum interval between doses of MMR?

A dose of MMR vaccine administered up to 4 days earlier the first birthday may exist counted every bit valid. Yet, school entry requirements in some states may mandate administration on or later on the first birthday. The 4-mean solar day "grace menstruum" should not exist practical to the 28-day minimum interval between two doses of a alive parenteral vaccine.

Can MMR be given on the same day as other live virus vaccines?

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

If you lot can give the second dose of MMR as early as 28 days afterward the beginning dose, why practise we routinely wait until kindergarten entry to give the second dose?

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

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

ACIP recommends that children who travel or alive away should be vaccinated at an before age than that recommended for children who reside in the United States. Before their departure from the Usa, children age 6 through 11 months should receive one 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 keep a copy of their immunization records with them as they travel. For additional information on the worldwide measles state of affairs, and on CDC'due south measles vaccination data for travelers, go to wwwnc.cdc.gov/travel.

If we give a child a dose of MMR vaccine at half dozen months of historic period because they are in a community with cases of measles, when should we give the next dose?

The adjacent dose should be given at 12 months of age. The child volition likewise demand some other dose at least 28 days later. For the child to exist fully vaccinated, they need to take 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 historic period does not count every bit office 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 every bit well equally measles, mumps, and rubella. The family is leaving in xi days. Can I requite hepatitis A IG and MMR vaccine simultaneously?

No. IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in Feb 2018 ACIP voted to recommend that hepatitis A vaccine should be administered to infants age half dozen through 11 months traveling outside the The states when protection confronting 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 role of the child's routine vaccination serial. For details of this recommendation, encounter the CDC ACIP recommendations for the prevention and control of hepatitis A at world wide web.cdc.gov/mmwr/volumes/69/rr/pdfs/rr6905a1-H.pdf, page 18.

Can I requite 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?

Yep. The second dose of MMR can exist given a minimum of 28 days later on the first dose if necessary.

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

No. A measles-containing vaccine administered more than iv days earlier the starting time birthday should not exist counted as part of the series. MMR should be repeated when the child is historic period 12 through fifteen months (12 months if the child remains in an expanse where affliction take chances is high). The 2d dose should be administered at least 28 days after the offset dose.

Tin can I requite a tuberculin pare test (TST) on the same twenty-four hour period equally a dose of MMR vaccine?

Aye. A TST can be applied before or on the same twenty-four hours 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 skin test because of mild suppression of the immune system.

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

This student should receive ii doses of MMR, separated by at to the lowest degree 28 days. A personal history of measles and mumps is not acceptable equally proof of amnesty. Acceptable prove of measles and mumps amnesty includes a positive serologic examination for antibody, birth before 1957, or written documentation of vaccination. For rubella, only serologic prove or documented vaccination should be accustomed every bit proof of immunity. Additionally, people born prior to 1957 may exist considered immune to rubella unless they are women who accept the potential to go meaning.

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

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

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

Yes. Healthcare personnel (HCP) with 2 documented doses of MMR vaccine are considered to be immune regardless of the results of a subsequent serologic test for measles, mumps, or rubella. Documented historic period-advisable vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who practice not have documentation of MMR vaccination and whose serologic test is interpreted as "indeterminate" or "equivocal" should be considered non allowed and should receive 2 doses of MMR vaccine (minimum interval 28 days). ACIP does non recommend serologic testing after vaccination. For more than information, come across ACIP's recommendations on the use of MMR vaccine at world wide web.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 22.

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

Approximately five to 15% 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 not infectious, and no special precautions ( such as exclusion from piece of work) need to exist taken.

A 22-yr-quondam female is going to pharmacy school and the schoolhouse wants her to accept 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 requite her a second dose of the MMR with her having measles later the first dose?

Yep, as a healthcare professional, this person should go a second dose of MMR to ensure she is allowed to rubella. There is no harm in providing MMR to a person who is already immune to one or more of the components. If she developed measles just one day after getting her outset MMR, she must have been exposed to the disease prior to vaccination.

Contraindications and Precautions Dorsum to superlative

What are the contraindications and precautions for MMR vaccine?

Contraindications:

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

Precautions:

• receipt of an antibody-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/general-recs/timing.html, Table iii-v for more than information 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 statement, bachelor at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

People with medical weather that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. To help prevent the spread of measles virus, make certain all your staff and patients who can exist vaccinated are fully vaccinated co-ordinate to the U.S. immunization schedule. Besides, encourage patients to remind their family members and other close contacts to get vaccinated if they are not immune.

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

We have a patient who has selective IgA deficiency. Nosotros also have patients with selective IgM deficiency. Can MMR or varicella vaccine be administered to these patients?

At that place is no known risk associated with MMR or varicella vaccination in someone with selective IgA or IgM deficiency. It is possible that the immune response may be weaker, simply the vaccines are likely constructive.

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 then there is no concern about condom or efficacy of MMR.

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

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

Nosotros have a 40 lb six-twelvemonth-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Tin we 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 child is currently receiving more than than 0.4 mg/kg/week of methotrexate. This meets the Infectious Disease Club of America (IDSA) definition of high-level immunosuppression. Assistants of both varicella and MMR vaccines are contraindicated until such time every bit the methotrexate dosage can be reduced. The 2013 IDSA definition of depression-level immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/week. For additional details, see the 2013 IDSA Clinical Exercise Guideline for Vaccination of the Immunocompromised Host: cid.oxfordjournals.org/content/early/2013/eleven/26/cid.cit684.full.pdf.

Is it truthful that egg allergy is non considered a contraindication to MMR vaccine?

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

Tin I give MMR to a breastfeeding mother or to a breastfed infant?

Yes. Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding poses no risk to the infant existence 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 claret product, tin can he or she receive MMR vaccine?

Yes, simply there should be sufficient fourth dimension between the claret product and the MMR to reduce the risk of interference. The interval depends on the blood production received. Come across Table 3-5 of ACIP'southward General Best Practice Guidelines for Immunization for more than information, available at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

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

Yeah. Receipt of RhoGam is non a reason to delay vaccination. For more than information encounter the ACIP Full general All-time Practise Guidelines for Immunization, available at www.cdc.gov/vaccines/hcp/acip-recs/full general-recs/timing.html.

Please depict the current ACIP recommendations for the use of MMR vaccine in people who are infected with HIV.

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

Administrate 2 doses of MMR vaccine to all HIV-infected people historic period 12 months and older who do not have evidence of current astringent immunosuppression or electric current bear witness of measles, rubella, and mumps immunity. To exist regarded as not having evidence of current severe immunosuppression, a child age 5 years or younger must have CD4 percentages of xv% or more for 6 months or longer; a person older than v years must take CD4 percentages of fifteen% or more and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results land only one blazon of parameter (percentage or counts) this is sufficient for vaccine decision-making.

Administrate the commencement dose at 12 through 15 months and the 2nd dose to children age 4 through 6 years, or as early on every bit 28 days later 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 appropriately spaced doses of MMR vaccine afterwards effective Art has been established. Established effective ART is divers as receiving Art for at least 6 months in combination with CD4 percentages of 15% or more for 6 months or longer for children historic period 5 years or younger. People older than 5 years should have CD4 percentages of fifteen% or more and a CD4 lymphocyte count of 200 or more/mm3 for 6 months or longer. If laboratory results state only i blazon of parameter (percentages or counts) this is sufficient for vaccine decision-making.

Pregnancy and Postpartum Considerations Back to top

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

Although the MMR vaccine package insert recommends a 3-month deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy for iv weeks. For details on this outcome, encounter ACIP'due south 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 pregnant or attempting to go pregnant. Vaccination should be deferred for those who respond "yes." Those who answer "no" should be advised to avoid pregnancy for iv weeks following vaccination. Pregnancy testing is non necessary.

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

No specific action needs to be taken other than to reassure the woman that no agin outcomes are expected as a event of this vaccination. MMR vaccination during pregnancy is non a reason to terminate the pregnancy. Y'all should consult with others in your healthcare setting to identify ways to foreclose such vaccination errors in the future. Detailed information almost MMR vaccination in pregnancy is included in the most recent MMR ACIP argument, available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf.

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

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

Can we give an MMR to a 15-month-old whose mother is 2 months meaning?

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 run a risk to a pregnant household member.

If a woman'due south rubella test result shows she is "non immune" during a prenatal visit, simply she has 2 documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum?

In 2013, ACIP changed its recommendation for this situation (see www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–twenty). Information technology is recommended that women of childbearing historic period who have received 1 or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should exist administered i boosted dose of MMR vaccine (maximum of three doses) and practise not need to be retested for serologic evidence of rubella immunity. MMR should non be administered to a pregnant woman.

I have a female patient who has a non-immune rubella titer ii months later on her second 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 take received 1 or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should be administered i boosted dose of MMR vaccine (maximum of iii doses). Repeat serologic testing for evidence of rubella amnesty is not recommended. Run into www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20, for more information on this issue.

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

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

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

Vaccine Safety Back to height

Is in that location any prove that MMR or thimerosal causes autism?

No. This event has been studied extensively, including a thorough review by the independent Plant of Medicine (IOM). The IOM issued a study in 2004 that concluded at that place is no testify 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 world wide web.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html.

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

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

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

Arthralgia (articulation hurting) 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 non-immune post-pubertal women written report joint pain after receiving rubella vaccine, and most ten% to xxx% report arthritis-like signs and symptoms.

When joint symptoms occur, they generally brainstorm ane to 3 weeks subsequently vaccination, unremarkably are mild and not incapacitating, last almost 2 days, and rarely recur.

Is in that location any impairment in giving an actress dose of MMR to a child of age 7 years whose record is lost and the mother is not sure about the final dose of MMR?

In general, although it is non ideal, receiving actress doses of vaccine poses no medical problem. Still, receiving excessive doses of tetanus toxoid (e.yard., DTaP, DT, Tdap, or Td) can increase the take a chance of a local adverse reaction. For details run across the Extra Doses of Vaccine Antigens section of the ACIP General Best Practice Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.

Vaccination providers frequently encounter people who do non have adequate documentation of vaccinations. Providers should only have written, dated records every bit show 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 information systems, and searching for a personally held record.

If records cannot exist located or volition definitely not be available anywhere because of the patient'due 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.yard., measles, rubella, hepatitis A, diphtheria, and tetanus).

Storage and Handling Back to acme

How long can reconstituted MMR vaccine be stored in a refrigerator before information technology must be discarded?

The amount of time in which a dose of vaccine must be used later on reconstitution varies by vaccine and is usually outlined somewhere in the vaccine's packet insert. MMR must be used within eight hours of reconstitution. MMRV must exist used within 30 minutes; other vaccines must be used immediately. The Immunization Activity Coalition has a staff pedagogy piece that outlines the time allowed between reconstitution and use, as stated in the package inserts for a number of vaccines. Handout tin can be found at the post-obit link: www.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 -xv°C (-58°F to +five°F). The diluent should not exist frozen and can be stored in the refrigerator or at room temperature.

If the MMR is combined with varicella vaccine as MMRV (ProQuad, Merck), it must be stored in the freezer at -50°C to -15°C (-58°F to +5°F).

A box of MMR vaccine (not reconstituted) was left at room temperature overnight. Tin can I utilize information technology?

Unfortunately, serious errors in vaccine storage and handling like this occur too often. If yous doubtable that vaccine has been mishandled, you should shop the vaccine as recommended, and so contact the manufacturer or state/local health department 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 soon must it be used?

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

I misplaced the diluent for the MMR dose and then I used normal saline instead. Is in that location 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 be repeated.

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

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