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Measles, Mumps, and Rubella (MMR) Vaccine


Margot L. Savoy

, MD, MPH, Lewis Katz School of Medicine at Temple University

Reviewed/Revised Jul 2023

Preparations of MMR Vaccine

The MMR vaccine contains live-attenuated measles and mumps viruses, prepared in chicken embryo cell cultures. It also contains live-attenuated rubella virus (rubella virus vaccine live), prepared in human diploid lung fibroblasts.

Indications for MMR Vaccine

The MMR vaccine is a routine childhood vaccination (see CDC: Child and Adolescent Immunization Schedule by Age).

All adults who were born in 1957 or later should be given 1 dose of the vaccine unless they have one of the following (see CDC: Adult Immunization Schedule by Age):

  • Documentation of vaccination with one or more doses of MMR

  • Laboratory evidence that indicates immunity to the 3 diseases

  • A contraindication to the vaccine

Documented diagnosis of disease by a physician is not considered acceptable evidence of immunity for measles, mumps, or rubella.

Pearls & Pitfalls

  • Documented diagnosis of disease is not considered acceptable evidence of immunity for measles, mumps, or rubella.

A second dose of MMR vaccine (or, if they have not been vaccinated, 2 doses given ≥ 28 days apart) is recommended for adults who are likely to be exposed:

  • Students in colleges or other post–high school educational institutions

  • Health care workers born in 1957 or later with no evidence of immunity

  • International travelers

  • Patients with HIV infection, CD4 ≥ 15% and CD4 cell count ≥ 200/mcL for ≥ 6 months, and no evidence of immunity to measles, mumps, or rubella

People born before 1957 are generally considered immune. However, such people who work within health care facilities (whether or not they have patient care duties) should be considered for vaccination if they have no evidence of immunity. Two doses of MMR are given (one dose if only rubella coverage is needed).

If people aged ≥ 12 months were previously given ≤ 2 doses of mumps-containing vaccine and are identified by public health authorities to be at increased risk of mumps during a mumps outbreak, they should be given 1 dose of MMR vaccine.

Because rubella during pregnancy can have dire consequences for the fetus (eg, miscarriage, multiple birth defects), all women of childbearing age, regardless of birth year, should be screened for rubella immunity. If there is no evidence of immunity, women who are not pregnant should be vaccinated. Pregnant women who do not have evidence of immunity should be vaccinated when pregnancy is completed and before they are discharged from the health care facility.

People who were vaccinated with inactivated (killed) measles vaccine or measles vaccine of unknown type during 1963 to 1967 should be revaccinated with 2 doses of MMR vaccine.

People who were vaccinated before 1979 with killed mumps vaccine or mumps vaccine of unknown type and who are at high risk of mumps exposure should be offered revaccination with 2 doses of MMR vaccine.

Contraindications and Precautions for MMR Vaccine

Contraindications for the MMR vaccine include

HIV infection is a contraindication only if immunocompromise is severe (CDC immunologic category Immunologic Categories (HIV Infection Stages) for Children < 13 Years With HIV Infection Based on Age-Specific CD4+ T-Cell Count or Percentage Immunologic Categories (HIV Infection Stages) for Children < 13 Years With HIV Infection Based on Age-Specific CD4+ T-Cell Count or Percentage 3 with CD4 < 15% or CD4 count < 200 cells/mcL); if immunocompromise is not severe, risks of wild measles outweigh risk of acquiring measles from the live vaccine.

Women who have been vaccinated should avoid becoming pregnant for ≥ 28 days afterward. The vaccine virus may be capable of infecting a fetus during early pregnancy. The vaccine does not cause congenital rubella syndrome Symptoms and Signs Congenital rubella is a viral infection acquired from the mother during pregnancy. Signs are multiple congenital anomalies that can result in fetal death. Diagnosis is by serology and viral... read more , but risk of fetal damage is estimated at ≤ 3%.

Precautions with the MMR vaccine include

  • Moderate or severe acute illness with or without fever (vaccination is postponed until illness resolves)

  • Recent (within 11 months) treatment with blood products that contain antibody (specific interval depends on the product)

  • History of thrombocytopenia or thrombocytopenic purpura

If a person is infected with Mycobacterium tuberculosis, MMR vaccine and possibly MMRV vaccine may temporarily suppress the response to tuberculin testing. Thus, if needed, this test can be done before or at the same time as vaccination. If people have already been vaccinated, testing should be postponed for 4 to 6 weeks after vaccination.

Dose and Administration of MMR Vaccine

The MMR vaccine dose is 0.5 mL subcutaneous. The MMR vaccine is routinely given to children in 2 doses: one at age 12 to 15 months and one at age 4 to 6 years.

Adverse Effects of MMR Vaccine

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

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