No. ACIP recommends that anyone capable of bearing children be asked if they are currently pregnant or attempting to become pregnant. Vaccination should be deferred for those who answer “yes.” Those who answer “no” should be advised to avoid pregnancy for one month following vaccination.
Yes. Measles, mumps, and rubella vaccine viruses are not transmitted from the vaccinated person, so MMR vaccination of a household contact does not pose a risk to a pregnant household member.
In 2013, ACIP updated its recommendation for this situation (see www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, pages 18–20). It is recommended that people capable of bearing children 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 1 additional dose of MMR vaccine (maximum of 3 doses) and do not need to be retested for serologic evidence of rubella immunity. MMR should not be administered to a pregnant person but should be given after delivery if indicated.
ACIP recommends that vaccinated people of childbearing age who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should 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 18–20, for more information on this issue.
MMR vaccines should not be administered to people 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, people capable of bearing children should be counseled to avoid becoming pregnant for 28 days after receipt of MMR vaccine.
MMR can be administered any time after delivery. The vaccine should be administered to a post-partum mother who is susceptible to either measles, mumps, or rubella before hospital discharge, even if the mother has received RhoGam during the hospital stay, leaves in less than 24 hours, or is breastfeeding.
No. This issue has been studied extensively, including a thorough review by the independent Institute of Medicine (IOM). The IOM issued a report in 2004 that concluded there is no evidence supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. Additional evidence documenting that MMR or thimerosal do not cause autism, see Immunize.org’s patient resources at: www.immunize.org/clinical/vaccine-confidence/topic/autism/.
Merck does not manufacture single 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. You may provide parents with Immunize.org’s parent handout (developed in collaboration with the Autism Science Foundation): “Evidence Shows Vaccines Unrelated to Autism,” found at www.immunize.org/wp-content/uploads/catg.d/p4028.pdf. Immunize.org also has a parent handout specifically for concerns related to MMR and autism, “MMR Does Not Cause Autism: Examine the Evidence,” found at www.immunize.org/wp-content/uploads/catg.d/p4026.pdf.
Arthralgia (joint pain) and transient arthritis (joint redness or swelling) following rubella vaccination occurs only in people who were susceptible to rubella at the time of vaccination. Joint symptoms are uncommon in children and in adult biological males. About 25% of non-immune post-pubertal biological females report joint pain after receiving rubella vaccine, and about 10% to 30% report arthritis-like signs and symptoms.
When joint symptoms occur, they generally begin 1 to 3 weeks after vaccination, usually are mild, last a few days, and rarely recur.
The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is usually outlined in the vaccine’s package insert. MMR must be used within 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used “immediately,” which is not a clearly defined term but may be considered to be within 30 minutes. Immunize.org has a staff education piece that outlines the time allowed between reconstitution and use, as stated in the package inserts for a number of vaccines. This handout can be found at the following link: www.immunize.org/wp-content/uploads/catg.d/p3040.pdf.
MMRII (Merck) brand of MMR vaccine 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). Prescribing information for the Priorix (GSK) brand of MMR vaccine states that it should be stored refrigerated (at 2°C to 8°C), but not in the freezer. For both brands, the diluent should not be 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).
Unfortunately, serious errors in vaccine storage and handling like this occur too often. If you suspect that vaccine has been mishandled, you should take the following steps: label the affected vaccine package clearly so it will not be used before knowing whether it is still usable, return the vaccine to recommended storage conditions, and then contact the manufacturer or state/local health department for guidance on whether it is still usable or should be wasted. This is particularly important for live virus vaccines like MMR and varicella.
The guidance for handling after reconstitution is the same for both brands of MMR vaccine (MMRII and Priorix). It is preferable to administer MMR immediately after reconstitution. If not used immediately, the reconstituted vaccine should be store refrigerated (2°C to 8°C [36°F to 46°F]) until use. If reconstituted MMR is not used within 8 hours, it must be discarded.
Only the diluent supplied with the MMR vaccine should be used to reconstitute any vaccine. A vaccine reconstituted with the incorrect diluent should not be used. If administered, the dose should be repeated.
