The measles Measles Measles is a highly contagious viral infection that is most common among children. It is characterized by fever, cough, coryza, conjunctivitis, an enanthem (Koplik spots) on the oral mucosa... read more , mumps Mumps Mumps is an acute, contagious, systemic viral disease, usually causing painful enlargement of the salivary glands, most commonly the parotids. Complications may include orchitis, meningoencephalitis... read more , and rubella Rubella ( See also Congenital Rubella.) Rubella is a contagious viral infection that may cause adenopathy, rash, and sometimes constitutional symptoms, which are usually mild and brief. Infection during... read more (MMR) vaccine effectively protects against all 3 infections. People who are given the MMR vaccine according to the US vaccination schedule are considered protected for life.
For more information, see MMR Advisory Committee on Immunization Practices Vaccine Recommendations (Measles, Mumps and Rubella) and Centers for Disease Control and Prevention (CDC): Measles Mumps, and Rubella (MMR) Vaccination. A summary of changes to the 2022 adult immunization schedule is available here.
(See also Overview of Immunization Overview of Immunization Immunity can be achieved Actively by using antigens (eg, vaccines, toxoids) Passively by using antibodies (eg, immune globulins, antitoxins) A toxoid is a bacterial toxin that has been modified... read more .)
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, prepared in human diploid lung fibroblasts.
MMR vaccine and varicella vaccine Varicella Vaccine Varicella vaccination provides effective protection against varicella (chickenpox). It is not known how long protection against varicella lasts. But, live-virus vaccines, like the varicella... read more are available as a combined vaccine (MMRV vaccine).
Indications for MMR Vaccine
The MMR vaccine is a routine childhood vaccination ( see Table: Recommended Immunization Schedule for Ages 0–6 Years Recommended Immunization Schedule for Ages 0–6 Years ).
All adults who were born in 1957 or later should be given 1 dose of the vaccine unless they have one of the following:
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
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
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 of MMR Vaccine
Contraindications for the MMR vaccine include
A severe allergic reaction (eg, anaphylaxis Anaphylaxis Anaphylaxis is an acute, potentially life-threatening, IgE-mediated allergic reaction that occurs in previously sensitized people when they are reexposed to the sensitizing antigen. Symptoms... read more ) after a previous dose or to a vaccine component, including neomycin
Known severe primary or acquired immunodeficiency (eg, due to leukemia, lymphomas, solid tumors, tumors that affect bone marrow or the lymphatic system, AIDS, severe HIV infection, treatment with chemotherapy, or long-term use of immunosuppressants)
Pregnancy (vaccination is postponed until pregnancy is completed)
Family history of first-degree relatives (parents or siblings) with congenital hereditary immunodeficiency, unless the vaccine recipient is known to be immunocompetent
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 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
The MMR vaccine causes a mild or inapparent, noncommunicable infection. Symptoms include fever > 38° C, sometimes followed by a rash. Central nervous system reactions are very rare; the vaccine does not cause autism Autism Spectrum Disorders Autism spectrum disorders are neurodevelopmental disorders characterized by impaired social interaction and communication, repetitive and stereotyped patterns of behavior, and uneven intellectual... read more (see MMR vaccine and autism Measles-mumps-rubella (MMR) vaccine Despite the rigorous vaccine safety systems in place in the US, some parents remain concerned about the safety of the use and schedule of vaccines in children. These concerns have led some parents... read more and Vaccine Safety Vaccine Safety Immunity can be achieved Actively by using antigens (eg, vaccines, toxoids) Passively by using antibodies (eg, immune globulins, antitoxins) A toxoid is a bacterial toxin that has been modified... read more ).
Occasionally, the rubella component causes painful joint swelling in adults, usually in women.
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Advisory Committee on Immunization Practices (ACIP): MMR ACIP Vaccine Recommendations (Measles, Mumps and Rubella)
Centers for Disease Control and Prevention (CDC): Measles Mumps, and Rubella (MMR) Vaccination: Information for Healthcare Providers
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