If you got the standard two doses of the measles, mumps, and rubella MMR vaccine after , you should be protected against the measles for life. Most people born before are thought to have been infected naturally with the virus through measles outbreaks. However there are some who are not immune.
People born before who have had the lab testing that shows they are not immune and may be at high risk should have one dose of the MMR vaccine and then a second dose 28 days later. You are at a high risk if you travel during an outbreak, are near travel hubs or destinations, or are a healthcare provider. You could be at risk if you only got one dose of the vaccine. That was also administered between and Audrey K. Chun, an associate professor in the department of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, said older adults are at a low risk for contracting measles.
Once a person has had the measles, they are immune for life. Its thse who received the vaccine between and are the exception, she noted. Chun said that people who are concerned about contracting measles should talk to their doctor. Your doctor can then decide if another vaccination is a good idea. In , a second measles dose was added to the national childhood immunisation schedule to increase the level of measles protection in the community.
People born between and are known to be at a greater risk of measles because they are less likely to have had a measles vaccine or they have had only one dose. Because there was less measles disease in the community due to the measles vaccine these people are also less likely to have immunity from natural infection than people born before If you're in this age group and not sure if you have had two measles doses you should check with your GP. If you have not had any measles vaccinations then you should have two doses given at least 4 weeks apart.
The AIR is a national register that can record vaccines given to people of all ages in Australia. This includes all vaccines funded under the National Immunisation Program, most school based vaccines provided under State and Territory vaccination programs and most privately funded vaccines including influenza and travel vaccines. Unfortunately, measles vaccines given prior to are less likely to be recorded on the AIR, and not all immunisation providers update the AIR.
You should check your vaccination records including those that might be with your parents. A personal history of measles and mumps is not acceptable as proof of immunity. Acceptable evidence of measles and mumps immunity includes a positive serologic test for antibody, birth before , or written documentation of vaccination.
For rubella, only serologic evidence or documented vaccination should be accepted as proof of immunity. Additionally, people born prior to may be considered immune to rubella unless they are women who have the potential to become pregnant.
When not given on the same day, is the interval between yellow fever and MMR vaccines 4 weeks 28 days or 30 days? I have seen the yellow fever and live virus vaccine recommendations published both ways. The CDC travel health website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated by at least 30 days if possible.
Either interval is acceptable. What is the recommendation for MMR vaccine for healthcare personnel? ACIP recommends that all HCP born during or after have adequate presumptive evidence of immunity to measles, mumps, and rubella, defined as documentation of two doses of measles and mumps vaccine and at least one dose of rubella vaccine, laboratory evidence of immunity, or laboratory confirmation of disease.
During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated by at least 4 weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory evidence of measles or mumps immunity or laboratory confirmation of disease.
During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of birth year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease. Would you consider healthcare personnel with 2 documented doses of MMR vaccine to be immune even if their serology for 1 or more of the antigens comes back negative?
Healthcare personnel HCP with 2 documented doses of MMR vaccine are considered to be immune regardless of the results of a subsequent serologic test for measles, mumps, or rubella. Documented age-appropriate vaccination supersedes the results of subsequent serologic testing.
In contrast, HCP who do not have documentation of MMR vaccination and whose serologic test is interpreted as "indeterminate" or "equivocal" should be considered not immune and should receive 2 doses of MMR vaccine minimum interval 28 days. ACIP does not recommend serologic testing after vaccination.
However, the person is not infectious, and no special precautions such as exclusion from work need to be taken. A year-old female is going to pharmacy school and the school wants her to have a second dose of MMR vaccine. She had the first dose as a child and developed measles within 24 hours of receiving the vaccine. Recent serologic testing showed she is immune to mumps and measles but not immune to rubella. Can I give her a second dose of the MMR with her having measles after the first dose?
Yes, as a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. There is no harm in providing MMR to a person who is already immune to one or more of the components. If she developed measles only one day after getting her first MMR, she must have been exposed to the disease prior to vaccination.
What are the contraindications and precautions for MMR vaccine? See www. We have many patients who are immunocompromised and cannot get the MMR vaccine. How should we advise our patients? People with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. To help prevent the spread of measles virus, make sure all your staff and patients who can be vaccinated are fully vaccinated according to the U.
Also, encourage patients to remind their family members and other close contacts to get vaccinated if they are not immune. If patients who cannot get MMR vaccine are exposed to measles, CDC has guidelines for immune globulin for post-exposure prophylaxis which can be found at www. We have a patient who has selective IgA deficiency. We also have patients with selective IgM deficiency.
Can MMR or varicella vaccine be administered to these patients? It is possible that the immune response may be weaker, but the vaccines are likely effective. I have a patient who is traveling internationally and needs MMR vaccine. He recently received an injectable steroid. How long should he wait before receiving MMR vaccine? There is no need to wait a specific interval before giving MMR. Injectable steroids are not considered immunosuppressive for the purpose of vaccination decisions, and so there is no concern about safety or efficacy of MMR.
Can I give MMR to a child whose sibling is receiving chemotherapy for leukemia? MMR and varicella vaccines should be given to the healthy household contacts of immunosuppressed children. We have a 40 lb six-year-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can we give the child MMR and varicella vaccine based on this methotrexate dosage?
Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced. The IDSA definition of low-level immunosuppression for methotrexate is a dosage of less than 0. Is it true that egg allergy is not considered a contraindication to MMR vaccine?
Several studies have documented the safety of measles and mumps vaccine which are grown in chick embryo tissue culture in children with severe egg allergy.
ACIP recommends routine vaccination of egg-allergic children without the use of special protocols or desensitization procedures. Can I give MMR to a breastfeeding mother or to a breastfed infant? Breastfeeding does not interfere with the response to MMR vaccine.
Vaccination of a woman who is breastfeeding poses no risk to the infant being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the infant is asymptomatic.
If a patient recently received a blood product, can he or she receive MMR vaccine? Yes, but there should be sufficient time between the blood product and the MMR to reduce the chance of interference. The interval depends on the blood product received. Is it acceptable practice to administer MMR, Tdap, and influenza vaccines to a postpartum mom at the same time as administering RhoGam?
Receipt of RhoGam is not a reason to delay vaccination. The current recommendations are as follows:. Administer 2 doses of MMR vaccine to all HIV-infected people age 12 months and older who do not have evidence of current severe immunosuppression or current evidence of measles, rubella, and mumps immunity.
If laboratory results state only one type of parameter percentage or counts this is sufficient for vaccine decision-making. Administer the first dose at 12 through 15 months and the second dose to children age 4 through 6 years, or as early as 28 days after the first dose. Unless they have acceptable current evidence of measles, mumps, and rubella immunity, people with perinatal HIV infection who were vaccinated prior to establishment of effective antiretroviral therapy ART should receive 2 appropriately spaced doses of MMR vaccine after effective ART has been established.
If laboratory results state only one type of parameter percentages or counts this is sufficient for vaccine decision-making. What is the recommended length of time a woman should wait after receiving rubella MMR vaccine before becoming pregnant?
How should teenage girls and women of child-bearing age be screened for pregnancy before MMR vaccination? ACIP recommends that women of childbearing age be asked if they are currently pregnant or attempting to become pregnant.
Vaccination should be deferred for those who answer "yes. Pregnancy testing is not necessary. If a pregnant woman inadvertently receives MMR vaccine, how should she be advised? No specific action needs to be taken other than to reassure the woman that no adverse outcomes are expected as a result of this vaccination.
MMR vaccination during pregnancy is not a reason to terminate the pregnancy. You should consult with others in your healthcare setting to identify ways to prevent such vaccination errors in the future. We require a pregnancy test for all our 7th graders before giving an MMR. Is this necessary? Can we give an MMR to a month-old whose mother is 2 months pregnant? Measles, mumps, and rubella vaccine viruses are not transmitted from the vaccinated person, so MMR vaccination of a household contact does not pose a risk to a pregnant household member.
If a woman's rubella test result shows she is "not immune" during a prenatal visit, but she has 2 documented doses of MMR vaccine, does she need a third dose of MMR vaccine postpartum? In , ACIP changed its recommendation for this situation see www.
It is recommended that women of childbearing age who have received 1 or 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should be administered 1 additional dose of MMR vaccine maximum of 3 doses and do not need to be retested for serologic evidence of rubella immunity. I have a female patient who has a non-immune rubella titer two months after her second MMR vaccination.
Should she be revaccinated? If so, should the titer again be checked to determine seroconversion? ACIP recommends that vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine maximum of three doses.
Repeat serologic testing for evidence of rubella immunity is not recommended. MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant.
Because of the theoretical risk to the fetus when the mother receives a live virus vaccine, women should be counseled to avoid becoming pregnant for 28 days after receipt of MMR vaccine.
How soon after delivery can MMR be given to the mother? MMR can be administered any time after delivery. The vaccine should be administered to a woman who is susceptible to either measles, mumps, or rubella before hospital discharge, even if she has received RhoGam during the hospital stay, leaves in less than 24 hours, or is breastfeeding. Is there any evidence that MMR or thimerosal causes autism?
This issue has been studied extensively, including a thorough review by the independent Institute of Medicine IOM. The IOM issued a report in that concluded there is no evidence supporting an association between MMR vaccine or thimerosal-containing vaccines and the development of autism. For more information on thimerosal and vaccines in general, visit www. A few parents are asking that their children receive separate components of the MMR vaccine because they fear MMR may be linked to autism.
What should I do? Only combined MMR is available. You should educate parents about the lack of association between MMR and autism. How likely is it for a person to develop arthritis from rubella vaccine? Arthralgia joint pain and transient arthritis joint redness or swelling following rubella vaccination occurs only in people who were susceptible to rubella at the time of vaccination. Joint symptoms are uncommon in children and in adult males. When joint symptoms occur, they generally begin 1 to 3 weeks after vaccination, usually are mild and not incapacitating, last about 2 days, and rarely recur.
Is there any harm in giving an extra dose of MMR to a child of age seven years whose record is lost and the mother is not sure about the last dose of MMR? In general, although it is not ideal, receiving extra doses of vaccine poses no medical problem.
However, receiving excessive doses of tetanus toxoid e. Vaccination providers frequently encounter people who do not have adequate documentation of vaccinations. Providers should only accept written, dated records as evidence of vaccination. With the exception of influenza vaccine and pneumococcal polysaccharide vaccine, self-reported doses of vaccine without written documentation should not be accepted. An attempt to locate missing records should be made whenever possible by contacting previous healthcare providers, reviewing state or local immunization information systems, and searching for a personally held record.
If records cannot be located or will definitely not be available anywhere because of the patient's circumstances, children without adequate documentation should be considered susceptible and should receive age-appropriate vaccination.
Serologic testing for immunity is an alternative to vaccination for certain antigens e. How long can reconstituted MMR vaccine be stored in a refrigerator before it must be discarded? The amount of time in which a dose of vaccine must be used after reconstitution varies by vaccine and is usually outlined somewhere in the vaccine's package insert. MMR must be used within 8 hours of reconstitution. MMRV must be used within 30 minutes; other vaccines must be used immediately. The Immunization Action Coalition has a staff education piece that outlines the time allowed between reconstitution and use, as stated in the package inserts for a number of vaccines.
Handout can be found at the following link: www. How should MMR vaccine be stored? The diluent should not be frozen and can be stored in the refrigerator or at room temperature. Here's everything you need to know about the measles vaccine.
When was the measles vaccine invented? How old do you have to be get the measles vaccine? Paper Boat Creative Getty Images.
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