II. Precautions

  1. MMR Vaccination is safe, effective and prevents serious illness with potentially devestating consequences
    1. For every 1000 Measles cases, 50 will develop Pneumonia, 1 will develop Encephalitis and 2 will die
    2. Congenital Rubella (TORCH Virus) affected 20,000 U.S. newborns in 1964-5, prior to Rubella Vaccination
    3. Orchitis (with Infertility risk) occurs in up to 10% of males with Mumps

III. Indication

  1. Universally indicated for persons born after 1956
    1. Those born before 1957 in U.S. are presumed to have been exposed
  2. Primary Series for all children
    1. Dose 1: Age 12-15 months old
    2. Dose 2: Age 4-6 years old
  3. Catch-up doses for anyone born after 1956
    1. At least one MMR dose
    2. Two MMR doses at least 4 weeks apart
      1. Unvaccinated children ages 12 months to 12 years
      2. College students
      3. Healthcare workers
      4. Travelers to high risk international areas
      5. Close contacts of Immunocompromised persons
  4. Impending travel to endemic region
    1. Infants 6-11 months: Administer one MMR dose
    2. Children >12 months and adults should have received 2 doses prior to travel
      1. Doses should be at least one month apart
      2. Adults with only one MMR Vaccine, should receive a second dose
  5. Outbreaks (esp Measles, Mumps in close quarters such as dormitories, barracks)
    1. Third dose is per public health department (but not in pregnancy, and not in Immunocompromised)
    2. Give a second dose, if never immunized (or unknown status), at 4 weeks after the first
  6. References
    1. (2014) Presc Lett 21(8): 44
    2. (2018) Presc Lett 25(3)

IV. Mechanism

V. Contraindications

  1. Absolute contraindications
    1. Anaphylactic reaction to neomycin (egg allergy is no longer a contraindication)
    2. Pregnancy
    3. Severe Immunodeficiency (e.g. AIDS with CD4 Count <200 cells/ul)
  2. Relative contraindications
    1. IG administration with within 3 months
    2. Thrombocytopenia
    3. ThrombocytopeniaPurpura
  3. Conditions not contraindicating Vaccination
    1. Tuberculosis or positive PPD
    2. Concurrent PPD testing
    3. Lactation
    4. Pregnancy in household contact or mother
    5. Household contact with Immunodeficiency (e.g. HIV)
    6. Non-anaphylactic reaction to egg or neomycin

VI. Dose

  1. Adult: 0.5 ml IM
  2. Primary Series
    1. Dose 1: Age 12-15 months
    2. Dose 2: Age 4 to 6 years (administer by age 12)
  3. Alternate protocol
    1. Need a waiting period following Ig Administration
    2. See Red Book for wait period (3-11 months)

VII. Efficacy

  1. Protective after first dose in 93% of cases
  2. Protective after second dose in 97% of cases

VIII. Adverse Effects

  1. Immune Thrombocytopenic Purpura (<1 case per 40,000)
    1. Occurs up to 6 weeks after MMR Vaccine
  2. Anaphylaxis (0.65 cases per 1 million Vaccinations)
  3. Mortality related to Vaccine (Vaccine-strain death)
    1. Since 1990, there have been a total of 397 MMR attributed deaths case reports
  4. Encephalitis
    1. Occurs in 1 case per 3 million Vaccinations
    2. Contrast with 1 in 1000 with Measles
  5. Aseptic Meningitis
    1. Onset 2-3 weeks after Vaccination
  6. Febrile Seizures (uncommon)
    1. Occurs 7-10 days after first MMR dose
    2. Increased risk when first dose given after 12-15 months of age
  7. Orchitis
    1. Occurs in 0.3 cases per 1 million MMR doses
  8. Pneumonia
    1. Occurs in 2 cases per 1 million MMR doses
  9. Pruritic dermatitis
    1. Purpura may be present
  10. Parotitis
    1. Rare complication 10-14 days after Vaccination
  11. References
    1. (1996) MMWR Morb Mortal Wkly Rep 45(No. RR-12):1-35 [PubMed]

IX. Drug Interactions

  1. Varicella Vaccine or Yellow Fever Vaccine
    1. Do not give MMR within 30 days or these Vaccines
    2. MMR may be given with varicella or Yellow Fever

X. Precautions

  1. Avoid in pregnancy (FDA Category X)
    1. See Immunization in Pregnancy

XI. Safety

  1. Safe in HIV
  2. Safe for Egg-Allergic children (allergy unlikely)
    1. Allergic Reaction unlikely in 16 studies (n=1265)
    2. Skin Testing is not indicated
    3. Observe potentially allergic children for 90 minutes
    4. James (1995) N Engl J Med 332:1262-6 [PubMed]
  3. No association with Autism
    1. DeStefano (2001) Pediatr Infect Dis 20:887-8 [PubMed]
    2. Madsen (2002) N Engl J Med 347:1477-82 [PubMed]
    3. Patja (2000) Pediatr Infect Dis 19:1127-34 [PubMed]
    4. Smeeth (2004) Lancet 364:963-9 [PubMed]

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Ontology: Measles-Mumps-Rubella Vaccine (C0065828)

Definition (HL7V3.0) <p>measles, mumps and rubella virus vaccine</p>
Definition (NCI) A trivalent vaccine containing live attenuated viruses that can cause measles, mumps and rubella. It is an injection administered subcutaneously in two separate doses.
Definition (MSH) A combined vaccine used to prevent MEASLES; MUMPS; and RUBELLA.
Concepts Pharmacologic Substance (T121) , Immunologic Factor (T129)
MSH D022542
SnomedCT 61153008, 396429000
CPT 90707
HL7 03, 3
Swedish Vaccin mot mässling, påssjuka, röda hund
Czech MMR vakcína, spalničky-příušnice-zarděnky - vakcína
English Measles + Mumps + Rubella vaccine, measles/mumps/rubella virus vaccine, Measles-Mumps-Rubella Vaccine [Chemical/Ingredient], M-M-R Vaccine, mmr vaccine, measles mumps rubella vaccine, mmr vaccines, mmr, measles mumps rubella (MMR) vaccine, vaccine mmr, MMR Vaccine, Measles, Mumps, Rubella Vaccine, Mumps Measles Rubella Vaccine, Mumps-Measles-Rubella Vaccine, Vaccine, MMR, Vaccine, Measles-Mumps-Rubella, Vaccine, Mumps-Measles-Rubella, M-M-R II, Measles/Mumps/Rubella Vaccine, Measles, Mumps, and Rubella Vaccine, Measles Mumps Rubella Vaccine, Measles, Mumps and Rubella Virus Vaccine, Live, Live measles, mumps and rubella virus vaccine, measles, mumps and rubella virus vaccine, measles,mumps&rubella vac live, MMR, MMR vaccine, Measles, mumps and rubella vaccine, Measles/mumps/rubella vaccine, Measles, mumps and rubella vaccine (product), Measles, mumps and rubella vaccine (substance), Measles-Mumps-Rubella Vaccine, MEASLES/MUMPS/RUBELLA VIRUS VACCINE,LIVE, Measles, Mumps, and Rubella Virus Vaccine Live
Finnish MPR-rokote
Italian Vaccino MMR, Vaccino contro il morbillo, gli orecchioni, la rosolia, Vaccino morbilloso, parotitico e rubeolico
Japanese 麻疹・流行性耳下腺炎・風疹ウイルスワクチン, 麻疹・流行性耳下腺炎・風疹ウイルス生ワクチン, 麻疹・流行性耳下腺炎・風疹ワクチン, ワクチン-麻疹・流行性耳下腺炎・風疹, 生ワクチン-麻疹・流行性耳下腺炎・風疹ウイルス, ワクチン-麻疹・流行性耳下腺炎・風疹ウイルス, 麻疹-流行性耳下腺炎-風疹ワクチン, MMRワクチン, ワクチン-MMR, ワクチン-麻疹-流行性耳下腺炎-風疹, ワクチン-麻疹-流行性耳下腺炎-風疹ウイルス, 生ワクチン-麻疹-流行性耳下腺炎-風疹ウイルス, 麻疹-流行性耳下腺炎-風疹ウイルスワクチン, 麻疹-流行性耳下腺炎-風疹ウイルス生ワクチン
Spanish Vacuna contra el Sarampión-Parotiditis-Rubéola, vacuna antisarampionosa, antiparotidítica y antirrubeólica (producto), vacuna antisarampionosa, antiparotiditis urliana y antirrubeólica (producto), vacuna antisarampionosa, antiparotídea y antirrubeólica, vacuna antisarampionosa, antiparotidítica y antirrubeólica (sustancia), vacuna antisarampionosa, antiparotidítica y antirrubeólica, vacuna triple viral (sustancia), vacuna MMR, vacuna triple viral, vacuna antisarampionosa, antiparotiditis urliana y antirrubeólica (sustancia), vacuna antisarampionosa, antiparotiditis urliana y antirrubeólica, vacuna contra el sarampión, la parotiditis urliana y la rubéola, Vacuna SPR
Polish Szczepionka przeciw odrze śwince różyczce, Szczepionka MMR
French Vaccin ROR, Vaccin anti-rougeole-oreillons-rubéole, Vaccin contre la rougeole, les oreillons et la rubéole, Vaccin rougeole-oreillons-rubéole
German Impfstoff, MMR-, MMR-Impfstoff, MMR-Vakzine, Impfstoff, Masern-Mumps-Röteln-, Masern-Mumps-Röteln-Impfstoff, Masern-Mumps-Röteln-Vakzine
Portuguese Vacina MMR, Vacina contra Sarampo-Caxumba-Rubéola