Note: The minimum interval between two doses of MMR vaccine is 28 days (CDC/ACIP [McLean 2013]). Refer to Additional Information for a description of acceptable evidence of immunity. Consult CDC/ACIP annual immunization schedules for additional information including specific detailed recommendations for catch-up scenarios and/or care of patients with high-risk conditions. According to ACIP, doses administered ≤4 days before minimum interval or age are considered valid; however, local or state mandates may supersede this timeframe (ACIP [Kroger 2021]).
Primary immunization: Children ≥12 months: SubQ: 0.5 mL per dose for a total of 2 doses given as follows: 12 to 15 months of age and the second dose at 4 to 6 years of age; the second dose is recommended prior to entering kindergarten or first grade. The second dose may be administered at any time provided at least 28 days have elapsed since the first dose (CDC/ACIP [McLean 2013]).
Catch-up immunization (CDC/ACIP [McLean 2013]): School-aged Children and Adolescents: Ensure that 2 doses have been given at least 28 days apart
Measles outbreak without acceptable evidence of immunity and at risk for exposure: Note: Should be administered within 72 hours postexposure.
Infants 6 to 11 months: SubQ: 0.5 mL per dose as a single dose (CDC/ACIP [McLean 2013]). Children should be vaccinated at ≥12 months with standard 2-dose series
Children 1 to 4 years: Children who received 1 dose (0.5 mL SubQ) of MMR should be considered for a second dose if the outbreak involves preschool-aged children (CDC/ACIP [McLean 2013]).
Mumps outbreak (eg, community):
Children 1 to 4 years (without acceptable evidence of immunity and at risk for exposure): Children who received 1 dose of MMR should be considered for a second dose (0.5 mL SubQ) if the outbreak involves preschool-aged children (CDC/ACIP [McLean 2013])
Children and Adolescents (fully immunized [2 previous MMR doses]); community outbreak: A third dose of MMR vaccine may be considered; appropriate patients should be guided by public health officials (ACIP/CDC [Marin 2018]); in a large, cohort trial (total: n=20,496; treatment cohort: n=4,783; age range: 18 to 24 years), subjects who received a third dose of MMR vaccine had significantly decreased incidence of mumps compared to those students who had only received 2 doses (Cardemil 2017); consult local public health authorities.
Household/close contacts of immunocompromised persons without acceptable evidence of immunity: Children ≥12 months and Adolescents: SubQ: 0.5 mL per dose for a total of 2 doses administered at least 28 days apart unless they have acceptable evidence of immunity (CDC/ACIP [McLean 2013])
HIV infection without evidence of MMR immunity: Children ≥12 months and Adolescents: SubQ: 0.5 mL per dose. Children and adolescents with HIV infection and without evidence of severe immunosuppression should have 2 additional doses of MMR; those with perinatal HIV infection who were vaccinated prior to effective ART should have 2 additional doses of MMR once ART is established (CDC/ACIP [McLean 2013]).
International travel, without evidence of immunity (CDC/ACIP [McLean 2013]):
Infants 6 to 11 months: SubQ: 0.5 mL per dose. Administer 1 dose of MMR before departure from the United States; these infants should be revaccinated with 2 doses of MMR with the first dose between 12 to 15 months of age (and at least 28 days after the previous dose; target 12 months of age if child remains in area where disease risk if high) and the second dose at least 28 days later.
Children ≥12 months and Adolescents: SubQ: 0.5 mL per dose. Administer 2 doses of MMR before departure from the United States with the second dose at least 28 days later.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Measles, mumps, and rubella vaccines (MMR) (combined): Drug information")
Note: The minimum interval between 2 doses of MMR vaccine is 28 days (CDC/ACIP [McLean 2013]).
Immunization: SubQ: 0.5 mL per dose; 1 or 2 doses administered at least 28 days apart based upon the following criteria (CDC/ACIP [McLean 2013]):
Adults born in or after 1957 should be vaccinated with ≥1 dose unless they have acceptable evidence of immunity.
Adults born prior to 1957 are considered immune to measles, mumps, and rubella but may be vaccinated with 1 or 2 doses if they do not have contraindications to the vaccine. Pregnant adults born prior to 1957 are not considered immune to rubella.
Adults who received inactivated or unknown type of measles vaccine during 1963 to 1967: One or two doses of MMR.
Adults who received inactivated or unknown type of mumps vaccine before 1979 and who are at high risk: Two doses of MMR.
Health care personnel: Persons born in or after 1957 should have 2 doses of vaccine unless they have acceptable evidence of immunity. Unvaccinated persons born prior to 1957 should also consider vaccination with 2 doses of MMR for measles and mumps or 1 dose of MMR for rubella unless they have laboratory evidence or laboratory confirmation of disease (CDC/ACIP [McLean 2013]).
HIV infection (without severe immunosuppression): Two doses of MMR unless there is acceptable evidence of immunity.
Household/close contacts of immunocompromised persons: Two doses of MMR unless there is acceptable evidence of immunity.
International travelers: Two doses of MMR prior to travel unless there is acceptable evidence of immunity.
Measles, mumps, or rubella outbreak (community): Adults who received 1 dose of MMR should be considered for a second dose if the outbreak involves measles or mumps in adults. Vaccination should also be considered for persons born prior to 1957 without evidence of immunity who may be exposed to mumps. A single dose of a rubella-containing vaccine is considered adequate vaccination during a rubella outbreak. During a mumps outbreak, a third dose of MMR vaccine is recommended for at-risk persons who have been previously vaccinated with 2 doses (CDC/ACIP [Marin 2018]; Cardemil 2017); consult local public health authorities.
Measles, mumps, or rubella outbreak (healthcare facility): Unvaccinated health care personnel without evidence of immunity regardless of birth year should receive 2 doses during a measles or mumps outbreak and one dose during a rubella outbreak.
Students: Persons entering post high school educational facilities should receive 2 doses of MMR unless they have acceptable evidence of immunity prior to enrollment.
Women of childbearing potential: One dose of MMR unless they have acceptable evidence of immunity. Vaccination should not be given during pregnancy and pregnancy should be avoided for 28 days after vaccine administration.
There are no dosage adjustments provided in manufacturer's labeling.
There are no dosage adjustments provided in manufacturer's labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, powder for reconstitution [preservative free]:
M-M-R II: Measles virus ≥1000 TCID50, mumps virus ≥12,500 TCID50, and rubella virus ≥1000 TCID50 [contains albumin (human), bovine serum, chicken egg protein, gelatin, neomycin, sorbitol, and sucrose 1.9 mg/vial; supplied with diluent]
No
In the United States, the appropriate CDC-approved Vaccine Information Statement (VIS) must be provided to the patient/caregiver before administering each dose of this vaccine; the VIS edition date and date it was provided to the patient/caregiver should be recorded as required by US law; VIS is available at http://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html.
SubQ: Administer as soon as possible following reconstitution; administer subcutaneously into the anterolateral aspect of the thigh or arm; not for IV administration. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection (ACIP [Kroger 2021]). To prevent syncope related injuries, adolescents should be vaccinated while seated or lying down (ACIP [Kroger 2021]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.
SubQ: Administer SubQ in outer aspect of the upper arm or into the higher outer aspect of the thigh. Not for IV administration. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope related injuries, patients should be vaccinated while seated or lying down (ACIP [Kroger 2021]). US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, Vaccine Information Statement (VIS) edition date and date it was provided, and the administering person's name, title, and address be recorded.
Priorix (Canadian product): SubQ administration preferred; may also be given by IM injection in the anterolateral aspect of the thigh or the deltoid muscle; do not administer intravascularly. Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, patients should be vaccinated while seated or lying down (NACI 2019).
Prior to reconstitution, store the powder at 2°C to 8°C (36°F to 46°F). Protect from light. Diluent may be stored in refrigerator or at room temperature (20°C to 25°C [68°F to 77°F]). Do not freeze diluent. Use as soon as possible following reconstitution; may be stored under refrigeration and protected from light for up to 8 hours.
Provide active immunity to measles, mumps, and rubella viruses (FDA approved in ages ≥12 months and adults)
The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination for the following (CDC/ACIP [McLean 2013]):
• All children (first dose given at 12 to 15 months of age)
• Adults born 1957 or later (without evidence of immunity or documentation of vaccination). Vaccine may be given to adults born prior to 1957 if they do not have contraindications to the MMR vaccine.
• Adults at higher risk for exposure to and transmission of measles, mumps, and rubella should receive special consideration for vaccination, unless an acceptable evidence of immunity exists. This includes international travelers, persons attending colleges and other post high school education, and persons working in healthcare facilities.
MMR (measles, mumps and rubella virus vaccine) may be confused with MMRV (measles, mumps, rubella, and varicella) vaccine
MMR (measles, mumps and rubella virus vaccine) may be confused with MCV (meningococcal conjugate vaccine; MCV4 is the correct abbreviation)
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs that have a heightened risk of causing significant patient harm when used in error.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined:
Cardiovascular: Syncope, vasculitis
Central nervous system: Acute disseminated encephalomyelitis, ataxia, dizziness, Guillain-Barré syndrome, headache, irritability, malaise, paresthesia, polyneuropathy, retrobulbar neuritis, seizure, sensorineural hearing loss, subacute sclerosing panencephalitis, transverse myelitis
Dermatologic: Erythema multiforme, IgA vasculitis (Henoch-Schnolein purpura/acute hemorrhagic edema of infancy), morbilliform rash, pruritus, rash, Stevens-Johnson syndrome, urticaria
Endocrine & metabolic: Diabetes mellitus
Gastrointestinal: Diarrhea, nausea, pancreatitis, parotitis, sore throat, vomiting
Genitourinary: Epididymitis, orchitis
Hematologic & oncologic: Leukocytosis, lymphadenopathy (regional), purpura, thrombocytopenia
Hypersensitivity: Anaphylactoid reaction, anaphylaxis, angioedema
Infection: Atypical measles
Local: Injection site reaction (including burning, induration, redness, stinging, swelling, tenderness, vesiculation, wheal and flare)
Neuromuscular & skeletal: Arthropathy (arthralgia/arthritis: Women 12% to 26%; children ≤3%), myalgia, panniculitis
Ophthalmic: Conjunctivitis, oculomotor nerve paralysis, optic neuritis, optic papillitis, retinitis
Otic: Otitis media
Respiratory: Bronchospasm, cough, pneumonia, rhinitis
Miscellaneous: Febrile seizures, fever
<1%, postmarketing, and/or case reports: Aseptic meningitis (associated with Urabe strain of mumps vaccine), brain disease, encephalitis
Hypersensitivity to measles, mumps, and/or rubella vaccine or any component of the formulation (including gelatin and neomycin); active febrile illness (fever >38.5°C [>101.3°F]); active untreated tuberculosis; immunosuppressed or immunodeficient individuals due to disease or medical therapy; pregnancy.
Concerns related to adverse effects:
• Anaphylactoid/hypersensitivity reactions: Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (ACIP [Kroger 2021]).
• Febrile seizures: Febrile seizures have been reported within 2 weeks following immunization with MMR vaccine; risk is increased in those who experienced previous febrile seizure from any cause and those with family history of febrile seizures.
• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis, tendinopathy) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescents and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2021]).
Disease-related concerns:
• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Defer administration in patients with moderate or severe acute illness (with or without fever). Although fever is a contraindication per the manufacturer, current guidelines allow for administration to patients with mild acute illness (without fever) (ACIP [Kroger 2021]; CDC/ACIP [McLean 2013]).
• CNS disorders: Use with caution in patients with history of cerebral injury, seizures, or other conditions where stress due to fever should be avoided.
• Measles exposure: Exposure to measles is not a contraindication to vaccine; use within 72 hours of exposure may provide some protection.
• Mumps exposure: Postexposure vaccination has not been shown to prevent or alter disease following mumps exposure (CDC/ACIP [McLean 2013]).
• Rubella exposure: Postexposure vaccination has not been shown to prevent or alter disease following rubella exposure (CDC/ACIP [McLean 2013]).
• Thrombocytopenia: Thrombocytopenia (transient) has been reported 4 to 6 weeks after vaccination; use with caution in patients with thrombocytopenia and those who developed thrombocytopenia after a previous dose.
• Tuberculosis: Defer vaccination in patients with active untreated tuberculosis.
Concurrent drug therapy issues:
• Immune globulins: Recent administration of immune globulins may interfere with immune response. Guidelines with suggested administration intervals are available (ACIP [Kroger 2021]).
• Vaccines: In order to maximize vaccination rates, the ACIP recommends simultaneous administration (ie, >1 vaccine on the same day at different anatomic sites) of all age-appropriate vaccines (live or inactivated) for which a person is eligible at a single clinic visit, unless contraindications exist. The use of combination vaccines is generally preferred over separate injections, taking into consideration provider assessment, patient preference, and potential adverse events. When using combination vaccines, the minimum age for administration is the oldest minimum age for any individual component; the minimum interval between dosing is the greatest minimum interval between any individual components. The ACIP prefers each dose of a specific vaccine in a series come from the same manufacturer when possible (ACIP [Kroger 2021]).
Special populations:
• Altered immunocompetence: Use is contraindicated in severely immunocompromised patients. The ACIP does not recommend vaccination for persons with primary or acquired immunodeficiency (including immunosuppression associated with cellular immunodeficiency, hypogammaglobulinemia, dysgammaglobulinemia and AIDs, or severe immunosuppression associated with HIV); persons with blood dyscrasia, leukemia, lymphoma, or other malignant neoplasms which affect the bone marrow or lymphatic system; persons with a family history of congenital or hereditary immunodeficiency in first degree relatives (unless immunocompetence can be established); persons taking systemic corticosteroid therapy for ≥2 weeks in doses of corticosteroids ≥2 mg/kg of body weight or prednisone (or equivalent) ≥20 mg/day for persons who weigh >10 kg. Patients with HIV infection, who are asymptomatic and not severely immunosuppressed may be vaccinated (severe immunosuppression is defined as CD4+ T-lymphocyte <15% at any age or CD4 count <200 lymphocytes/mm3 for persons >5 years) (CDC/ACIP [McLean 2013]). Patients with leukemia who are in remission and who have not received chemotherapy for at least 3 months may be vaccinated. In general, household and close contacts of persons with altered immunocompetence may receive all age appropriate vaccines (ACIP [Kroger 2021]).
• Pediatric: Safety and efficacy of measles vaccine has not been established in children <6 months of age and safety and efficacy of mumps and rubella vaccines have not been established in <12 months of age. Local health departments may recommend vaccine to children 6 to 12 months of age in outbreak situations, but this would not count towards their immunization series.
Dosage form specific issues:
• Albumin: Some dosage forms may contain human albumin.
• Egg allergy: Vaccine may contain trace amounts of chick embryo antigen. Use caution in patients with history of immediate hypersensitivity/anaphylactic reactions following egg ingestion. Generally, the MMR vaccine can be safely administered to persons with an egg allergy (ACIP [Kroger 2021]).
• Gelatin: Products may contain gelatin. Use is contraindicated in patients with a history of anaphylactic/anaphylactoid reaction to gelatin
• Neomycin sensitivity: Manufactured with neomycin. Use is contraindicated in patients with history of anaphylactic/anaphylactoid reactions to neomycin. Contact dermatitis due to neomycin is not a contraindication to the vaccine.
Other warnings/precautions:
• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2021]). One study reported that routine prophylactic administration of acetaminophen prior to vaccination to prevent fever decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).
• Appropriate use: Use of this vaccine for specific medical and/or other indications (eg, immunocompromising conditions, hepatic or kidney disease, diabetes) is also addressed in the annual ACIP Recommended Immunization Schedules (refer to CDC schedule for detailed information). Specific recommendations for vaccination in immunocompromised patients with asplenia, cancer, HIV infection, cerebrospinal fluid leaks, cochlear implants, hematopoietic stem cell transplant (prior to or after), sickle cell disease, solid organ transplant (prior to or after), or those receiving immunosuppressive therapy for chronic conditions as well as contacts of immunocompromised patients are available from the IDSA (Rubin 2014).
• Blood products: Recent administration of blood or blood products may interfere with immune response. Guidelines with suggested administration intervals are available (ACIP [Kroger 2021]).
• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and may be improved by administering the vaccine at the recommended dose, route, and interval. Vaccines may not be effective if administered during periods of altered immune competence (ACIP [Kroger 2021]).
None known.
Acetaminophen: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Corticosteroids (Systemic): May enhance the adverse/toxic effect of Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Corticosteroids (Systemic) may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Dimethyl Fumarate: May enhance the adverse/toxic effect of Vaccines (Live). Specifically, Dimethyl Fumarate may increase the risk of vaccinal infection. Dimethyl Fumarate may diminish the therapeutic effect of Vaccines (Live). Management: Non-US labeling for dimethyl fumarate states that live attenuated vaccine administration is not recommended during treatment. US labeling states that safety and effectiveness of live vaccines administered with dimethyl fumarate has not been assessed. Risk C: Monitor therapy
Dupilumab: May enhance the adverse/toxic effect of Vaccines (Live). Risk X: Avoid combination
Immune Globulins: May diminish the therapeutic effect of Vaccines (Live). Management: Live organism vaccination should be withheld for as long as 6 to 11 months following immune globulin administration. Recommendations vary by product and immune globulin dose, see full monograph for details. Risk D: Consider therapy modification
Immunosuppressants (Cytotoxic Chemotherapy): May enhance the adverse/toxic effect of Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Immunosuppressants (Miscellaneous Oncologic Agents): Rubella- or Varicella-Containing Live Vaccines may enhance the adverse/toxic effect of Immunosuppressants (Miscellaneous Oncologic Agents). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Miscellaneous Oncologic Agents) may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Immunosuppressants (Therapeutic Immunosuppressant Agents): May enhance the adverse/toxic effect of Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Therapeutic Immunosuppressant Agents) may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Methotrexate: May enhance the adverse/toxic effect of Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Methotrexate may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Propacetamol: May diminish the therapeutic effect of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider therapy modification
Rabies Immune Globulin (Human): May diminish the therapeutic effect of Vaccines (Live). Management: Avoid administering the measles vaccine within 4 months after administration of rabies immune globulin. Avoid administering other live vaccines within 3 months after administration of rabies immune globulin. Risk D: Consider therapy modification
Rho(D) Immune Globulin: May diminish the therapeutic effect of Measles, Mumps, and Rubella Virus Vaccine. Management: Do not delay administration of the measles, mumps, and rubella virus vaccine in women who have recently received Rho (D) immune globulin. If possible, women should be tested 3 or more months after vaccine administration to ensure immunity. Risk D: Consider therapy modification
RiTUXimab: May enhance the adverse/toxic effect of Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. RiTUXimab may diminish the therapeutic effect of Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Tezepelumab: May enhance the adverse/toxic effect of Vaccines (Live). Risk X: Avoid combination
Tildrakizumab: May enhance the adverse/toxic effect of Vaccines (Live). The risk for contracting an infection from the vaccine may be increased. Tildrakizumab may diminish the therapeutic effect of Vaccines (Live). Risk X: Avoid combination
Tralokinumab: May enhance the adverse/toxic effect of Vaccines (Live). Risk X: Avoid combination
Tuberculin Tests: Vaccines (Live) may diminish the diagnostic effect of Tuberculin Tests. Management: It is preferable to administer live vaccines simultaneously with tuberculin tests. If a live vaccine has been recently administered, the tuberculin skin test should be administered 4 to 6 weeks following the administration of the vaccine. Risk D: Consider therapy modification
Vaccines (Live): May diminish the therapeutic effect of other Vaccines (Live). Management: Two or more injectable or nasally administered live vaccines not administered on the same day should be separated by at least 28 days (ie, 4 weeks). If not, the vaccine administered second should be repeated at least 4 week later. Risk C: Monitor therapy
This vaccine should not be administered to women who plan to become pregnant within 1 month of immunization.
Prenatal screening is recommended for all pregnant women who lack evidence of rubella immunity. Women of childbearing age without documentation of rubella vaccination or serologic evidence of immunity should be vaccinated (for women of childbearing potential, birth prior to 1957 is not acceptable evidence of immunity to rubella).
Sterility in males and infertility in prepubescent females may occur with natural mumps infection (CDC/ACIP [McLean 2013]).
Based on information collected following inadvertent administration during pregnancy, adverse events have not been observed following use of rubella vaccine. However, theoretical risks cannot be ruled out; use of this vaccine is contraindicated in pregnant females. The risk of congenital rubella syndrome following vaccination is significantly less than the risk associated following infection; therefore, inadvertent administration of MMR during pregnancy is not considered an indication to terminate pregnancy.
Adverse consequences of natural infection in unvaccinated pregnant women have been reported. Measles infection during pregnancy may increase the risk of premature labor, preterm delivery, spontaneous abortion and low birth weights. Rubella infection during the first trimester may lead to miscarriages, stillbirths, and congenital rubella syndrome (includes auditory, ophthalmic, cardiac and neurologic defects; intrauterine and postnatal growth retardation); fetal rubella infection can occur during any trimester of pregnancy. Maternal mumps infection during the first trimester may increase the risk of spontaneous abortion or intrauterine fetal death.
Prenatal screening is recommended for all pregnant women who lack evidence of rubella immunity. Women of childbearing age without documentation of rubella vaccination or serologic evidence of immunity should be vaccinated (for women of childbearing potential, birth prior to 1957 is not acceptable evidence of immunity to rubella). Women who are pregnant should be vaccinated upon completion or termination of pregnancy, prior to discharge. Household contacts of pregnant women may be vaccinated (CDC/ACIP [McLean 2013]).
Observe for syncope for 15 minutes following administration (ACIP [Kroger 2021]). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.
As a live, attenuated vaccine, MMR vaccine offers active immunity to disease caused by the measles, mumps, and rubella viruses.
Onset of action: The median seroconversion after 1 vaccine dose is 96% (measles), 99% (rubella), mumps (94%) (CDC/ACIP [McLean 2013]).
Duration: The median duration of immunity after 2 doses is ≥15 years for all components of the vaccine (CDC/ACIP [McLean 2013]).
Using separate sites and syringes, MMR may be administered concurrently with DTaP or Haemophilus b conjugate vaccine (PedvaxHIB®). Varicella vaccine may be administered with MMR using separate sites and syringes; however, if not administered simultaneously, doses should be separated by at least 30 days. Unless otherwise specified, MMR should be given 1 month before or 1 month after live viral vaccines.
Acceptable presumptive evidence of immunity includes one of the following (CDC/ACIP [McLean 2013]):
1. Documentation of adequate vaccination (for measles, mumps, and rubella). Adequate vaccination for mumps and measles is defined as 1 dose of a live virus vaccine for preschool children and adults not at high risk and 2 doses of a live virus vaccine for school-aged children and high-risk adults. Healthcare personnel (paid and unpaid workers with potential exposure), international travelers, and students in institutions of post high school education are considered high-risk adults.
2. Laboratory evidence of immunity or laboratory confirmation of disease (for measles, mumps, and rubella)
3. Birth prior to 1957 (measles, mumps, and rubella); for women of childbearing potential, birth prior to 1957 is not acceptable evidence of immunity to rubella.
4. Documentation of physician-diagnosed disease (for measles, mumps, or rubella) is not acceptable evidence of immunity.
Previous vaccination:
Measles: Persons who received a measles vaccine of unknown type, an inactivated measles vaccine, or further attenuated measles vaccine accompanied by immune globulin or high-titer immune globulin should be considered unvaccinated (CDC/ACIP [McLean 2013]).
Mumps: Persons vaccinated prior to 1979 with either killed mumps vaccine or a mumps vaccine of unknown type and who are at high risk for infection should be considered for revaccination with 2 doses of MMR vaccine (CDC/ACIP [McLean 2013]).
