For more information on mumps outbreak control and post-exposure prophylaxis, healthcare providers should consult their health department and refer to the mumps chapter of the Manual for the Surveillance of Vaccine-Preventable Diseases. Some special considerations for rubella vaccination are described below. All women of childbearing age, especially those who grew up outside the United States in areas where routine rubella vaccination might not occur, should be vaccinated with one dose of MMR vaccine or have other acceptable presumptive evidence of rubella immunity.
Only a positive serologic test for rubella antibody or documentation of appropriate vaccination should be accepted as presumptive evidence of immunity for women who may become pregnant. Women known to be pregnant or attempting to become pregnant should not receive a live virus vaccine, including MMR vaccine. Although there is no evidence that rubella vaccine virus is harmful to the fetus during pregnancy, as a precaution, women should not get pregnant for 4 weeks 28 days after MMR vaccination.
Unlike with measles, MMR vaccine is not effective at helping protect people who have recently been infected with rubella post-exposure prophylaxis, or PEP.
For more information on rubella outbreak control and post-exposure prophylaxis, healthcare providers should consult their health department and refer to the rubella chapter of the Manual for the Surveillance of Vaccine-Preventable Diseases. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Vaccines and Preventable Diseases. Section Navigation. Facebook Twitter LinkedIn Syndicate.
Routine Measles, Mumps, and Rubella Vaccination. Minus Related Pages. Presumptive evidence of immunity can be established in any of the following ways: Written documentation of one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not considered high risk Written documentation of two doses of measles-containing vaccine for school-age children and adults at high risk, including students at post-high school secondary educational institutions, healthcare personnel, and international travelers Laboratory evidence of immunity Laboratory confirmation of disease Birth before see below for presumptive evidence of immunity criteria for health care personnel born before Top of Page.
Routine Vaccination Recommendations to Protect against Measles. Vaccination of Special Populations. Students at post-high school educational institutions. Adults who know they got the killed inactivated measles vaccine.
Groups at increased risk for measles because of a measles outbreak. Post-exposure prophylaxis. Groups at increased risk for mumps because of a mumps outbreak. Women of Childbearing Age. The current routine recommendation for 2 doses of MMR vaccine appears to be sufficient for mumps control in the general population, but insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 doses of MMR vaccine is high.
In a measles outbreak, do children who have not had MMR vaccine pose a threat to vaccinated people? It is my understanding that vaccinated people can still contract measles. Am I correct? You are correct that vaccinated people can still be infected with viruses or bacteria against which they are vaccinated. More information is available for each vaccine and disease at www. Should these doses be repeated? All live injected vaccines MMR, varicella, and yellow fever are recommended to be given subcutaneously.
However, intramuscular administration of any of these vaccines is not likely to decrease immunogenicity, and doses given IM do not need to be repeated.
We often need to give MMR vaccine to large adults. Can this be considered a valid dose? Although this is off-label use, CDC recommends that when a dose of MMRV is inadvertently given to a patient age 13 years and older, it may be counted towards completion of the MMR and varicella vaccine series and does not need to be repeated. How soon can we give the second dose of MMR vaccine to a child vaccinated at 12 months old? The minimum interval is 28 days for dose 2.
Does the 4-day "grace period" apply to the minimum age for administration of the first dose of MMR? What about the day minimum interval between doses of MMR? A dose of MMR vaccine administered up to 4 days before the first birthday may be counted as valid. However, school entry requirements in some states may mandate administration on or after the first birthday. The 4-day "grace period" should not be applied to the day minimum interval between two doses of a live parenteral vaccine.
Can MMR be given on the same day as other live virus vaccines? If you can give the second dose of MMR as early as 28 days after the first dose, why do we routinely wait until kindergarten entry to give the second dose? The second dose of MMR may be given as early as 4 weeks after the first dose, and be counted as a valid dose if both doses were given after the first birthday. The second dose is not a booster, but rather it is intended to produce immunity in the small number of people who fail to respond to the first dose.
The risk of measles is higher in school-age children than those of preschool age, so it is important to receive the second dose by school entry. It is also convenient to give the second dose at this age, since the child will have an immunization visit for other school entry vaccines. What is the earliest age at which I can give MMR to an infant who will be traveling internationally? Also, which countries pose a high risk to children for contracting measles?
ACIP recommends that children who travel or live abroad should be vaccinated at an earlier age than that recommended for children who reside in the United States. Before their departure from the United States, children age 6 through 11 months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, middle- and low-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to keep a copy of their immunization records with them as they travel.
For additional information on the worldwide measles situation, and on CDC's measles vaccination information for travelers, go to wwwnc. If we give a child a dose of MMR vaccine at 6 months of age because they are in a community with cases of measles, when should we give the next dose? The next dose should be given at 12 months of age. The child will also need another dose at least 28 days later. For the child to be fully vaccinated, they need to have 2 doses of MMR vaccine given when the child is 12 months of age and older.
A dose given at less than 12 months of age does not count as part of the MMR vaccine two-dose series. I have an 8-month-old patient who is traveling internationally. The infant needs to be protected from hepatitis A as well as measles, mumps, and rubella.
The family is leaving in 11 days. IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine.
For this reason, in February ACIP voted to recommend that hepatitis A vaccine should be administered to infants age 6 through 11 months traveling outside the United States when protection against hepatitis A is recommended. MMR and hepatitis A vaccine may be safely co-administered to children in this age group. Neither vaccine is counted as part of the child's routine vaccination series. Can I give the second dose of MMR earlier than age 4 through 6 years the kindergarten entry dose to young children traveling to areas of the world where there are measles cases?
The second dose of MMR can be given a minimum of 28 days after the first dose if necessary. If I give MMR to an infant traveler younger than age 1 year, will that dose be considered valid for the U.
A measles-containing vaccine administered more than 4 days before the first birthday should not be counted as part of the series. MMR should be repeated when the child is age 12 through 15 months 12 months if the child remains in an area where disease risk is high. The second dose should be administered at least 28 days after the first dose. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin test because of mild suppression of the immune system.
An year-old college student says he had both measles and mumps diseases as a preschooler, but never had MMR vaccine. Is rubella vaccine recommended in such a situation? This student should receive two doses of MMR, separated by at least 28 days. 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.
ITP usually gets better without treatment but, as with any rash, you should get advice from your GP as soon as possible. There's a small chance of having a seizure fit 6 to 11 days after the MMR vaccine. This can be caused by having a high temperature in response to the measles vaccine virus. It may sound alarming but having a seizure after the MMR vaccine is rare. They happen in about 1 in every 1, doses given. In fact, MMR-related seizures are less frequent than seizures that happen as a direct result of a measles infection.
It's rare for anyone to have a serious allergic reaction to a vaccine. The person who vaccinates you or your child will be trained to deal with allergic reactions and treat them immediately. With fast treatment, you or your child will make a good recovery. Let your doctor or nurse know if you or your child has had severe allergic reactions to:.
The MMR vaccine is safe for children and adults with a severe egg allergy. This is because the MMR vaccine is grown on chick cells, not the egg white or yolk. For more advice about what to expect after vaccinations and how to treat common side effects, read vaccination tips for parents. There's no evidence of any link between the MMR vaccine and autism. There are many studies that have investigated this. The main ingredient of the MMR vaccine is a small amount of weakened measles, mumps and rubella viruses.
MMRVaxPro contains porcine gelatine to ensure the vaccine remains safe and effective during storage. UK has more information about vaccines and porcine gelatine, including leaflets translated into Arabic, Bengali and Urdu. You can find a full list of ingredients in these patient information leaflets:.
Read more about why vaccinations are safe and important , including how they work and what they contain. Page last reviewed: 8 April Next review due: 8 April MMR measles, mumps and rubella vaccine. The MMR vaccine is a safe and effective combined vaccine. It protects against 3 serious illnesses: measles mumps rubella german measles These highly infectious conditions can easily spread between unvaccinated people.
Information: If you have any questions about vaccinations, you can: ask your GP surgery or other healthcare professionals for advice read more about why vaccination is safe and important.
Missed vaccines It's important to catch up on any missed vaccines. MMR at 1 year Newborn babies have antibodies passed on from their mother at birth.
MMR at 3 years and 4 months The 2nd dose is given at around 3 years and 4 months, before a child starts school. Babies over 6 months old are sometimes given the MMR vaccine earlier than usual if: they may have been exposed to the measles virus there is an outbreak of measles they are travelling abroad to a country where measles is common The 2 usual doses of MMR will still be needed when they're older to ensure full protection. As a precaution, the MMR vaccine is not recommended for pregnant women.
Non-urgent advice: Speak to your GP surgery if:. The benefits include: avoiding any delay between injections that could risk illness reducing discomfort for your child reducing the number of appointments needed Some private clinics in the UK offer single vaccines against measles, mumps and rubella, but these vaccines are unlicensed.
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