| Measles, Mumps, and Rubella |
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| Disease Issues |
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| What is the
current situation with measles, mumps, and
rubella in the United States? |
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| 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 among unvaccinated people in New
York. These outbreaks were contained and
stopped before the end of 2019. Between
January 1 and August 19, 2020, just 12 measles
cases were reported by 7 jurisdictions.
Limited travel as a result of the COVID-19
pandemic drastically reduced opportunities for
travelers infected with measles to enter or
travel within the United States. CDC measles
surveillance updates can be found at
www.cdc.gov/measles/cases-outbreaks.html. |
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| Since the
pre-vaccine era, there has been a more than
99% decrease in mumps cases in the United
States. However, outbreaks still occasionally
occur.
In 2006, there was an outbreak affecting more
than 6,584 people in the United States, with
many cases occurring on college campuses. In
2009, an
outbreak started in close-knit religious communities and schools in the Northeast,
resulting in more than 3,000 cases. Since
2015, numerous outbreaks
have been reported across the US, in college
campuses, prisons, and close-knit communities,
including a large outbreak in northwest
Arkansas where
almost 3,000 cases were reported in 2016.
These outbreaks have shown that when people
with mumps have close contact with a lot of
other people (such
as among residential college students and families in close-knit communities) mumps can
spread even among vaccinated people. However,
outbreaks are
much larger in areas where vaccine coverage
rates are lower. A provisional total of 3,484
cases of mumps were reported to CDC in 2019. |
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| 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
elimination was declared. Rubella incidence in
the United States has
decreased by more than 99% from the pre-vaccine era. A provisional total of 3
cases of rubella, and no cases of congenital
rubella syndrome, were
reported in 2019. |
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| How serious
are measles, mumps, and rubella? |
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| 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 100 deaths. In the
United States, from 1987 to 2000, the most
commonly reported complications associated
with measles
infection were pneumonia (6%), 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 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. |
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| Mumps most
commonly causes fever and parotitis. Up to 25%
of persons with mumps have 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. |
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| Rubella is
generally a mild illness 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 woman, especially
during the first
trimester can result in miscarriage, stillbirth, and birth defects including
cataracts, hearing loss, mental retardation,
and congenital heart defects. |
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What are the signs and symptoms healthcare
providers should look for in diagnosing
measles? |
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| Healthcare
providers should suspect measles in patients
with a febrile rash illness and the clinically
compatible symptoms of cough, coryza (runny
nose),
and/or conjunctivitis (red, watery eyes). The
illness begins with a prodrome of fever and
malaise before rash onset. A clinical case of
measles is defined
as an illness characterized by |
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a generalized rash lasting 3 or more
days, and |
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a temperature of 101°F or higher (38.3°C
or higher), and |
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cough, coryza, and/or conjunctivitis. |
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| Koplik spots, a
rash present on mucous membranes, are
considered pathognomonic for measles. Koplik
spots occur from 1 to 2 days before the
measles
rash appears to 1 to 2 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 be found at
www.cdc.gov/measles/about/photos.html. |
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| Providers should
be especially aware of the possibility of
measles in people with fever and rash who have
recently traveled abroad or who have had
contact with international travelers. |
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| Providers should
immediately isolate and report suspected
measles cases to their local health department
and obtain specimens for measles testing,
including viral specimens for confirmation and
genotyping. Providers should also collect
blood for serologic testing during the first
clinical encounter with a
person who has suspected or probable measles. |
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| What should
our clinic do if we suspect a patient has
measles? |
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| Measles is highly
contagious. A person with measles is
infectious up to 4 days before through 4 days
after 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. |
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| Measles is a
nationally notifiable disease in the U.S.;
healthcare providers should report all cases
of suspected measles to public health
authorities
immediately to help reduce the number of
secondary cases. Do not wait for the results
of laboratory testing to report
clinically-suspected measles to the
local health department. |
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| More information
on measles disease, diagnostic testing, and
infection control can be found at
www.cdc.gov/measles/hcp/index.html. |
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| How long does
it take to show signs of measles, mumps, and
rubella after being exposed? |
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| For measles,
there is an average of 10 to 12 days from
exposure to the appearance of the first
symptom, which is usually fever. The measles
rash doesn't
usually appear until approximately 14 days
after exposure (range: 7 to 21 days), and the
rash typically begins 2 to 4 days after 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). However, as noted
above, up to half of rubella virus infections
cause no symptoms. |
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| What are the
current recommendations for the use of MMR
vaccine? |
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| The most recent
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 second dose of MMR can be
given as early 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 first birthday.
The second dose is not a booster, but rather
is intended to produce immunity in the small
number of people who
fail to respond to the first dose. |
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| Adults with no
evidence of immunity (evidence of immunity is
defined as documented receipt of 1 dose [2
doses 4 weeks apart if high risk] of live
measles
virus-containing vaccine, laboratory evidence
of immunity or laboratory confirmation of
disease, or birth before 1957) should get 1
dose of MMR vaccine
unless the adult is in a high-risk group.
High-risk people need 2 doses and include
school-age children, healthcare personnel,
international travelers, and
students attending post-high school
educational institutions. |
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| Live attenuated
measles vaccine became available in the U.S.
in 1963. An ineffective, inactivated measles
vaccine was also available in the U.S. 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-appropriate with
MMR vaccine. At the discretion of the state
public health department, anyone exposed to
measles in an
outbreak setting can receive an additional
dose of MMR vaccine even if they are
considered completely vaccinated for their age
or risk status. |
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What is considered acceptable evidence of
immunity to measles? |
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| Acceptable
presumptive evidence of immunity against
measles includes at least one of the
following: |
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written documentation of adequate
vaccination: |
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one or more doses of a
measles-containing vaccine administered
on or after the first birthday for
preschool-age children and adults not at
high
risk |
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two doses of measles-containing vaccine
for school-age children, adolescents,
and adults at high risk, including
college students, healthcare
personnel, and international travelers |
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laboratory evidence of immunity |
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laboratory confirmation of measles
(verbal history of measles does not
count) |
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birth before 1957 |
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| Although birth
before 1957 is considered acceptable evidence
of measles immunity, healthcare facilities
should consider vaccinating unvaccinated
personnel born before 1957 who do not have
other evidence of immunity with 2 doses of MMR
vaccine (minimum interval 28 days). |
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| During an
outbreak of measles, healthcare facilities
should recommend 2 doses of MMR vaccine at the
appropriate interval for unvaccinated
healthcare
personnel regardless of birth year if they
lack laboratory evidence of measles immunity. |
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For which adults are 0, 1, or 2 doses of MMR
vaccine recommended to prevent measles? |
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| Zero, one, or two
doses of MMR vaccine are needed for the adults
described below. |
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| Zero doses: |
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adults born before 1957 except
healthcare personnel* |
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adults born 1957 or later who are at low
risk (i.e., not an international
traveler or healthcare worker, or person attending college or other post-high school educational institution) and
who have already received one or more documented doses of live measles vaccine |
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adults with laboratory evidence of
immunity or laboratory confirmation of
measles |
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| One dose of MMR
vaccine: |
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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-high
school educational institution) and have
no documented vaccination with live measles vaccine and no laboratory
evidence of immunity or prior measles
infection |
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| Two doses of MMR
vaccine: |
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high-risk adults without any prior
documented live measles vaccination and
no laboratory evidence of immunity or
prior measles infection,
including: |
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healthcare personnel* |
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international travelers born in 1957 or
later |
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persons attending colleges and other
post-high school educational
institutions |
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| Persons 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, should be revaccinated with
either one (if low-risk) or two (if high-risk)
doses of MMR vaccine. |
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| * Healthcare
personnel born before 1957 should be
considered for MMR vaccination in the absence
of an outbreak, but are recommended for MMR
vaccination during outbreaks. |
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Given the risk of outbreaks of measles in the
U.S., should all healthcare personnel,
including those born before 1957, have 2 doses
of MMR vaccine? |
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| Although birth
before 1957 is considered acceptable evidence
of measles immunity for routine vaccination, healthcare facilities should consider
vaccinating unvaccinated healthcare personnel
(HCP) born before 1957 who do not have
laboratory evidence of measles immunity,
laboratory
confirmation of disease, or vaccination with 2 appropriately spaced doses of MMR vaccine. |
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| 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 appropriate interval if they
lack laboratory evidence of measles. |
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| Healthcare
facilities should check with their state or
local health department's immunization program
for guidance. Access contact information here:
www.immunize.org/coordinators. |
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| If there is an
outbreak in my area, can we vaccinate children
younger than 12 months? |
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| MMR can be given
to children as young as 6 months of age who
are at high risk of exposure such as during international travel or a community outbreak.
However, doses given BEFORE 12 months of age
cannot be counted toward the 2-dose series for
MMR. |
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| How does being
born before 1957 confer immunity to measles? |
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| 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 have had measles disease.
Surveys suggest that 95% to 98% of those born
before 1957 are immune to measles. Persons
born before
1957 can be presumed to be immune. However, if
serologic testing indicates that the person is
not immune, at least 1 dose of MMR should be
administered. |
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| Why is a
second dose of MMR necessary? |
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| Approximately 7%
of people do not 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
after two doses of measles-containing vaccine. |
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| Are there any
situations where more than 2 doses of MMR are
recommended? |
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| There are two
circumstances when a third 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 clearly positive
should receive 1 additional dose of MMR
vaccine (maximum of
3 doses). Further testing for serologic
evidence of rubella immunity is not
recommended. MMR should not be administered to
a pregnant woman. |
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| In 2018, ACIP
published guidance for MMR vaccination of
people at increased risk for acquiring mumps
during an outbreak. People previously
vaccinated
with 2 doses of a mumps virus–containing
vaccine who are identified by public health
authorities as 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
against mumps disease and related
complications. More information about this
recommendation is available at
www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf. |
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| When is it
appropriate to use MMR vaccine for measles
post-exposure prophylaxis? |
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| 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 six days of exposure. Do not administer
MMR vaccine and IG simultaneously, as the IG
invalidates the vaccine. |
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| 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. |
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Do any adults need "booster" doses of MMR
vaccine to prevent measles? |
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| No. Adults with
evidence of immunity do not need any further
vaccines. No "booster" doses of MMR vaccine
are recommended for either adults or
children. They are considered to have
life-long immunity once they have received the
recommended number of MMR vaccine doses or
have other
evidence of immunity. |
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Many people who were young children in the
1960s do not have 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 not to be revaccinated. |
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| Both killed and
live attenuated measles vaccines became
available in 1963. Live attenuated vaccine was
used more often than killed vaccine. The
killed vaccine was found to be not 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. So persons born during or after 1957
who received killed measles vaccine or measles
vaccine of unknown type, or who cannot
document having been vaccinated or having
laboratory-confirmed measles disease should
receive at least 1 dose of MMR. Some people at
increased risk of exposure to measles (such as
healthcare professionals and international
travelers) should receive 2 doses of MMR
separated by at least 4 weeks. |
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Do people who received MMR in the 1960s
need to have their dose repeated? |
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| Not necessarily.
People who have documentation of receiving
live measles vaccine in the 1960s do not need
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 one dose
of live attenuated measles vaccine. This recommendation is intended to protect people
who may have received killed measles vaccine
which was available
in the United States in 1963 through 1967 and
was not effective. People vaccinated before
1979 with either killed mumps vaccine or mumps
vaccine of
unknown type who are at high risk for mumps
infection (such as people who work in a
healthcare facility) should be considered for
revaccination with 2
doses of MMR vaccine. |
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| I understand
that ACIP changed its definition of evidence
of immunity to measles, rubella, and mumps in 2013. Please explain. |
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| In the 2013
revision of its MMR vaccine recommendations
ACIP includes laboratory confirmation of
disease as evidence of immunity 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 evidence of
immunity for rubella. With the decrease in
measles and mumps cases over the last 30
years, the validity of
physician-diagnosed disease 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. |
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| Is there
anything that can be done for unvaccinated
people who have already been exposed to
measles, mumps, or rubella? |
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| Measles vaccine,
given as MMR, may be effective if given within
the first 3 days (72 hours) after exposure to measles. Immune globulin may be effective
for as 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 not have
evidence of mumps or rubella immunity they
should be vaccinated since not all exposures
result in infection. |
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| What are the
current ACIP recommendations for use of immune
globulin (IG) for measles, mumps, and rubella
post-exposure prophylaxis? |
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| 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 have been exposed to
measles. The dose of IGIM is 0.5 mL/kg of body
weight; the
maximum dose is 15 mL. Alternatively, MMR vaccine can be given instead of IGIM to
infants age 6 through 11 months, if it can be
given within 72 hours of
exposure. |
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| Pregnant women
without evidence of measles immunity who are
exposed to measles should receive an
intravenous IG (IGIV) dose of 400 mg/kg of
body
weight. Severely immunocompromised people,
irrespective of evidence of measles immunity
or vaccination, who have been exposed to
measles should
receive an IGIV dose of 400 mg/kg of body
weight. |
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| For persons
already receiving IGIV therapy, administration
of at least 400 mg/kg body weight within 3
weeks before measles exposure should be
sufficient
to prevent measles infection. For patients
receiving subcutaneous immune globulin (IGSC)
therapy, administration of at least 200 mg/kg
body weight for 2
consecutive weeks before measles exposure
should be sufficient. |
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| 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. |
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| 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. |
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| IG has not been
shown to prevent mumps or rubella infection
after exposure and is not recommended for that purpose. |
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| 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? |
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| Single 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 risk of exposure cannot produce
written documentation of either immunization
or disease, and titers are negative, they
should receive two doses
of MMR. |
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| I have
patients who claim to remember receiving MMR
vaccine but have no written record, or whose parents report the patient has been
vaccinated.
Should I accept this as evidence of
vaccination? |
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| No. Self-reported
doses and history of vaccination provided by a
parent or other caregiver are not considered
to be valid. You should only accept a
written, dated record as evidence of
vaccination. |
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| Under what
circumstances should adults be considered for
testing for measles-specific antibody prior to getting vaccinated? |
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| 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. |
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| CDC does not
recommend measles antibody testing after MMR
vaccination to verify the patient's immune
response to vaccination. |
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| Two documented
doses of MMR vaccine given on or after the
first birthday and separated by at least 28
days is considered proof of measles immunity,
according to ACIP. Documentation of
appropriate vaccination supersedes the results
of serologic testing for measles, mumps,
rubella, and varicella. |
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| A patient born
in 1970 has a history of measles disease and
is also immunosuppressed due to multiple myeloma. The patient wants to travel to
Africa, but
is concerned about the measles exposure risk.
Should the patient receive the MMR vaccine? |
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| A
history of having had measles is not
sufficient evidence of measles immunity. 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. |
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| 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? |
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| 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. |
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| I have a
45-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? |
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| ACIP recommends 2
doses of MMR given at least 4 weeks apart for
any 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 immune to one or more of the vaccine
viruses. |
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| A patient who
was born before 1957 and is not a healthcare
worker wants to get the MMR vaccine before international travel. Does he need a dose of
MMR? |
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| No, it
is not considered necessary, but he may be
vaccinated. Before implementation of the
national measles vaccination program in 1963,
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 1957 who does
not have a contraindication to MMR
vaccination. |
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| Routine testing
of patients born before 1957 for
measles-specific antibody is not recommended
by CDC. |
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| We have
measles cases in our community. How can I best
protect the young children in my practice? |
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| First of all,
make sure all your patients are fully
vaccinated according to the U.S. immunization
schedule. |
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| 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.S. measles outbreak.
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. |
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| 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. |
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| 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. |
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| During a mumps
outbreak should we offer a third dose of MMR
(MMR II, Merck) to persons who have two prior
documented doses of MMR? |
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| 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 January 2018,
the Advisory Committee on Immunization
Practices (ACIP) published new guidance for
MMR vaccination of persons at increased risk
for
acquiring mumps during an outbreak. Persons
previously vaccinated with 2 doses of a mumps
virus–containing vaccine who are identified by
public health
authorities as being 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 improve protection
against mumps disease and related
complications. More information about 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
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. 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 after vaccination).
More information is
available for each vaccine and disease at
www.cdc.gov/vaccines/vpd-vac/default.htm and
www.immunize.org/vaccines. |
|
|
|
|
|
| Our clinic has
been giving MMR by the wrong route (IM rather
than SC) for years. Should these doses be repeated? |
|
| All live injected
vaccines (MMR, varicella, and yellow fever)
are recommended to 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. Is a
25-gauge needle with a length of 5/8"
sufficient for a subcutaneous injection? |
|
| Yes. A 5/8"
needle is recommended for subcutaneous
injections for people of all sizes. |
|
| MMRV was
mistakenly given to a 31-year-old instead of
MMR. Can this be considered a valid dose? |
|
| Yes, however,
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 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? |
|
| 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 second dose at age 4–6
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 4–6 years old 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 28-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" also may be applied to the 28-day minimum interval between two doses of MMR. However, this "grace period"
does not apply to the strict 28-day minimum interval between two different live vaccines (e.g., MMR and varicella vaccines, if not administered at the same visit). |
|
| Can MMR be
given on the same day as other live virus
vaccines? |
|
| Yes. However, if
two parenteral or intranasal live vaccines
(MMR, varicella, LAIV and/or yellow fever) are
not administered on the same day, they should
be
separated by an interval of at least 28 days. |
|
| 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.cdc.gov/travel. |
|
| 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. Can I give
hepatitis A IG and MMR vaccine simultaneously? |
|
| No. IG may
contain antibodies to measles, mumps, and
rubella that could reduce the effectiveness of
MMR vaccine. For this reason, in February 2018
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. 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,
page 18. |
|
| 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? |
|
| Yes. The second
dose of MMR can be given a minimum of 28 days
after the first dose if necessary. |
|
| If I give MMR
to an infant traveler younger than age 1 year,
will that dose be considered valid for the
U.S. immunization schedule? |
|
| No. 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. |
|
| Can I give a
tuberculin skin test (TST) on the same day as
a dose of MMR vaccine? |
|
| Yes. A TST can be
applied before or on the same day that MMR
vaccine is given. However, if MMR vaccine is
given on the previous day or earlier, the TST
should be delayed for at least 28 days. 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 18-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 1957, 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
1957 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 General Best
Practice Guidelines for Immunization (see
www.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 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 1957 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. 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
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? |
|
| 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 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. For more information, see ACIP's
recommendations on the use of MMR vaccine at
www.cdc.gov/mmwr/pdf/rr/rr6204.pdf, page 22. |
|
| If a
healthcare worker develops a rash and
low-grade fever after MMR vaccine, is s/he
infectious? |
|
| Approximately 5
to 15% of susceptible people who receive MMR
vaccine will develop a low-grade fever and/or mild rash 7 to 12 days after vaccination.
However, the person is not infectious, and no
special precautions ( such as exclusion from
work) need to be taken. |
|
| A 22-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? |
|
|
Contraindications: |
|
| • |
|
history of a severe (anaphylactic)
reaction to any vaccine component (e.g.,
neomycin) or following a previous dose
of MMR |
|
|
|
| • |
|
pregnancy |
|
|
|
| • |
|
severe immunosuppression from either
disease or therapy |
|
|
| Precautions: |
|
| • |
|
receipt of an antibody-containing blood
product in the previous 3–11 months,
depending on the type of blood product
received. See
www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html,
Table 3-5 for more information on this
issue |
|
|
|
| • |
|
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, available at
www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. |
|
|
| We have many
patients who are immunocompromised and cannot
get the MMR vaccine. How should 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.S. immunization
schedule. 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.cdc.gov/mmwr/pdf/rr/rr6204.pdf. |
|
| 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? |
|
| 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 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? |
|
| Yes. 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? |
|
| Based on the
weight and dosage provided (40 lbs and 15
mg/week), the child is currently receiving
more than 0.4 mg/kg/week of methotrexate. This
meets the Infectious Disease Society of
America (IDSA) definition of high-level
immunosuppression. Administration of both
varicella and MMR vaccines are contraindicated
until such time as the methotrexate dosage can
be reduced. The 2013 IDSA definition of
low-level immunosuppression for methotrexate
is a dosage of less than 0.4 mg/kg/week. For
additional details, see the 2013 IDSA Clinical
Practice Guideline for Vaccination of the
Immunocompromised Host:
cid.oxfordjournals.org/content/early/2013/11/26/cid.cit684.full.pdf. |
|
| Is 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. Neither the American Academy of
Pediatrics nor ACIP consider egg allergy as a
contraindication to MMR vaccine. ACIP
recommends routine
vaccination of egg-allergic children without
the use of special protocols or
desensitization procedures. |
|
| Can 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 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. See Table 3-5 of ACIP's
General Best Practice Guidelines for
Immunization for more information, available
at
www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html. |
|
| Is it
acceptable practice to administer MMR, Tdap,
and influenza vaccines to a postpartum mom at
the same time as administering RhoGam? |
|
| Yes. Receipt of
RhoGam is not a reason to delay vaccination.
For more 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 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: |
|
| 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. To be regarded as not having
evidence of current severe immunosuppression,
a child age 5
years or younger must have CD4 percentages of
15% or more for 6 months or longer; a person
older than 5 years must have CD4 percentages
of 15% or
more and a CD4 lymphocyte count of 200 or
more/mm3 for 6 months or longer. If laboratory
results state only 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. Established effective ART is defined as receiving ART for at least 6 months
in combination with CD4 percentages of 15% or
more for 6
months or longer for children age 5 years or
younger. People older than 5 years should have
CD4 percentages of 15% or more and a CD4
lymphocyte
count of 200 or more/mm3 for 6 months or
longer. If laboratory results state only 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? |
|
| Although the MMR
vaccine package insert recommends a 3-month
deferral of pregnancy after MMR vaccination, ACIP recommends deferral of pregnancy
for 4 weeks. For details on this issue, 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
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." Those who
answer "no" should be advised to avoid
pregnancy for 4 weeks following vaccination.
Pregnancy testing
is not necessary. |
|
| If a
pregnant 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 terminate the pregnancy. You should consult
with others in your healthcare setting to
identify ways to
prevent such vaccination errors in the future. Detailed information about MMR vaccination in
pregnancy is included in the most recent MMR
ACIP
statement, available at
www.cdc.gov/mmwr/pdf/rr/rr6204.pdf. |
|
| We require a
pregnancy test for all our 7th graders before
giving an MMR. Is this necessary? |
|
| No. ACIP
recommends that women of childbearing age be
asked if they are currently 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. |
|
| Can we give an
MMR to a 15-month-old whose mother is 2 months
pregnant? |
|
| 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. |
|
| If a woman's
rubella test result shows she is "not immune"
during a prenatal visit, but 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 18–20). 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 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
woman. |
|
| I have a
female patient who has a non-immune rubella
titer two months after her second MMR
vaccination. Should she be revaccinated? If
so, should the
titer again be checked to determine
seroconversion? |
|
| ACIP recommends
that vaccinated women of childbearing age who
have received one or two doses of
rubella-containing vaccine and have a rubella
serum IgG levels that is not clearly positive
should 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 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
pregnant for 28 days after receipt of MMR
vaccine. |
|
| How soon after
delivery can MMR be given to the mother? |
|
| MMR can be
administered any time after 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. |
|
|
|
|
|
| Is there any
evidence that MMR or thimerosal causes autism? |
|
| 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.
For more information on thimerosal and
vaccines in general, visit
www.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html. |
|
| A few parents
are asking that their children receive
separate components of the MMR vaccine because
they fear MMR may be linked to autism. What
should I do? |
|
| Merck no longer
produces single antigen measles, mumps, and/or
rubella vaccines for the U.S. market. 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 (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 males. About
25% of non-immune post-pubertal women 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 and
not incapacitating, last about 2 days, and
rarely
recur. |
|
| Is there any
harm in giving an extra dose of MMR to a child
of age seven years whose record is lost and
the mother is not sure about the last dose of
MMR? |
|
| In general,
although it is not ideal, receiving extra
doses of vaccine poses no medical problem.
However, receiving excessive doses of tetanus
toxoid (e.g.,
DTaP, DT, Tdap, or Td) can increase the risk
of a local adverse reaction. For details see
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
not have adequate documentation of
vaccinations. Providers should only accept
written, dated
records as evidence of vaccination. With the
exception of influenza vaccine and
pneumococcal polysaccharide vaccine,
self-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 state or local
immunization information systems, and
searching for a personally held record. |
|
| If records cannot
be located or will definitely not be available
anywhere because of the patient's
circumstances, children without adequate
documentation
should be considered susceptible and should
receive age-appropriate vaccination. Serologic
testing for immunity is an alternative to
vaccination for certain
antigens (e.g., measles, rubella, hepatitis A,
diphtheria, and tetanus). |
|
|
|
|
|
| How long can
reconstituted MMR vaccine be stored in a
refrigerator before it must be discarded? |
|
|
The amount of time in
which a dose of vaccine must be used after
reconstitution varies by vaccine and is
usually outlined somewhere 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. The
Immunization Action Coalition 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. Handout can be found at
the following 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 -15°C
(-58°F to +5°F). 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). |
|
| A box of MMR
vaccine (not reconstituted) was left at room
temperature overnight. Can I use it? |
|
| Unfortunately,
serious errors in vaccine storage and handling
like this occur too often. If you suspect that
vaccine has been mishandled, you should store
the vaccine as recommended, 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. |
|
| 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 8 hours, it must be discarded. MMR
should
always be 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 be
repeated. |
|
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ACIP Recommendations
Vaccine Information Statements 
