II. Precautions
- MMR Vaccination is safe, effective and prevents serious illness with potentially devestating consequences
- For every 1000 Measles cases, 50 will develop Pneumonia, 1 will develop Encephalitis and 2 will die
- Congenital Rubella (TORCH Virus) affected 20,000 U.S. newborns in 1964-5, prior to Rubella Vaccination
- Orchitis (with Infertility risk) occurs in up to 10% of males with Mumps
III. Indication
- Universally indicated for persons born after 1956
- Those born before 1957 in U.S. are presumed to have been exposed
-
Primary Series for all children
- Dose 1: Age 12-15 months old
- Dose 2: Age 4-6 years old
- Catch-up doses for anyone born after 1956
- At least one MMR dose
- Two MMR doses at least 4 weeks apart
- Unvaccinated children ages 12 months to 12 years
- College students
- Healthcare workers
- Travelers to high risk international areas
- Close contacts of Immunocompromised persons
- Impending travel to endemic region
- Infants 6-11 months: Administer one MMR dose
- Children >12 months and adults should have received 2 doses prior to travel
- Doses should be at least one month apart
- Adults with only one MMR Vaccine, should receive a second dose
- Outbreaks (esp Measles, Mumps in close quarters such as dormitories, barracks)
- Third dose is per public health department (but not in pregnancy, and not in Immunocompromised)
- Give a second dose, if never immunized (or unknown status), at 4 weeks after the first
- References
- (2014) Presc Lett 21(8): 44
- (2018) Presc Lett 25(3)
IV. Mechanism
V. Contraindications
- Absolute contraindications
- Anaphylactic reaction to neomycin (egg allergy is no longer a contraindication)
- Pregnancy
- Severe Immunodeficiency (e.g. AIDS with CD4 Count <200 cells/ul)
- Relative contraindications
- IG administration with within 3 months
- Thrombocytopenia
- ThrombocytopeniaPurpura
- Conditions not contraindicating Vaccination
- Tuberculosis or positive PPD
- Concurrent PPD testing
- Lactation
- Pregnancy in household contact or mother
- Household contact with Immunodeficiency (e.g. HIV)
- Non-anaphylactic reaction to egg or neomycin
VI. Dose
- Adult: 0.5 ml IM
-
Primary Series
- Dose 1: Age 12-15 months
- Dose 2: Age 4 to 6 years (administer by age 12)
- Alternate protocol
- Need a waiting period following Ig Administration
- See Red Book for wait period (3-11 months)
VII. Efficacy
- Protective after first dose in 93% of cases
- Protective after second dose in 97% of cases
VIII. Adverse Effects
-
Immune Thrombocytopenic Purpura (<1 case per 40,000)
- Occurs up to 6 weeks after MMR Vaccine
- Anaphylaxis (0.65 cases per 1 million Vaccinations)
- Mortality related to Vaccine (Vaccine-strain death)
- Since 1990, there have been a total of 397 MMR attributed deaths case reports
-
Encephalitis
- Occurs in 1 case per 3 million Vaccinations
- Contrast with 1 in 1000 with Measles
-
Aseptic Meningitis
- Onset 2-3 weeks after Vaccination
-
Febrile Seizures (uncommon)
- Occurs 7-10 days after first MMR dose
- Increased risk when first dose given after 12-15 months of age
-
Orchitis
- Occurs in 0.3 cases per 1 million MMR doses
-
Pneumonia
- Occurs in 2 cases per 1 million MMR doses
- Pruritic dermatitis
- Purpura may be present
-
Parotitis
- Rare complication 10-14 days after Vaccination
- References
IX. Drug Interactions
-
Varicella Vaccine or Yellow Fever Vaccine
- Do not give MMR within 30 days or these Vaccines
- MMR may be given with varicella or Yellow Fever
X. Precautions
- Avoid in pregnancy (FDA Category X)
XI. Safety
- Safe in HIV
- Safe for Egg-Allergic children (allergy unlikely)
- Allergic Reaction unlikely in 16 studies (n=1265)
- Skin Testing is not indicated
- Observe potentially allergic children for 90 minutes
- James (1995) N Engl J Med 332:1262-6 [PubMed]
- No association with Autism