Dosing and uses of Measles mumps and rubella vaccine, live (M-M-R-II)
Adult dosage forms and strengths
measles virus/mumps virus/rubella virus
injection
- ≥1000 TCID50/≥20000 TCID50/≥1000 TCID50
Immunization Against Measles, Mumps & Rubella
Adults born before 1957 are considered immune to measles and mumps; all adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless contraindicated, or laboratory evidence of immunity to each of the 3 diseases
19-49 years old: 0.5 mL SC; second dose may be administered 28 days apart
>50 years old: 0.5 mL SC; administer 1 dose only
2nd dose recommendations
- Student in postsecondary eduction
- Recent exposure
- Occupational risk
- Previously vaccinated with killed measles vaccine
- Vaccinated with unknown type of measles vaccine during 1963-67
- International travelers
- Healthcare personnel should consider receiving 2 doses of MMR vaccine at the appropriate interval for measles and mumps or 1 dose of MMR vaccine for rubella
Immunization in Pregnancy
Pregnant women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the health-care facility
Pregnancy should be avoided for 28 days following vaccine administration
Vaccination Schedules
Up-to-date vaccination schedules available at www.cdc.gov/nip/publications
Pediatric dosage forms and strengths
Immunization Against Measles, Mumps & Rubella
Routine vaccination: First dose of 0.5 mL SC between age 12-15 months; administer second dose between 4-6 yr
Minimum age for 1st dose is 12 months
International traveL
- 6-12 months: Administer 1 dose of MMR before departure from the United States for international travel; revaccinate with 2 doses of MMR, the first at age 12-15 months (12 months if the child remains in an area where disease risk is high), and the second dose at least 4 weeks later
- >12 months: Administer 2 doses of MMR before departure from the United States for international travel; the first dose should be administered on or after age 12 months and the second dose at least 4 weeks later
Catch-up vaccination
- Ensure all school-aged children and adolescents received 2 doses (0.5 mL SC each)
- Minimum time between 1st and 2nd dose is 4 wk
Perinatal HIV infection
- Revaccinate persons who were vaccinated before establishment of effective antiretroviral therapy with 2 appropriately spaced doses of MMR vaccine once effective ART has been established
12 months or older with HIV infection
- Vaccinate all persons with HIV infection who do not have evidence of current severe immunosuppression
Administration
Inject SC into outer aspect of upper arm
Measles mumps and rubella vaccine, live (M-M-R-II) adverse (side) effects
Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967
Frequency not defined
Fever
Syncope
Ataxia
Pain at site
Headache
Rash
Lymphadenopathy
Myalgia
Stevens-Johnson syndrome
Thrombocytopenia
Optic neuritis
Encephalitis
Malaise
Irritability
Guillain-Barre synd
Subacute sclerosing panencephalitis (rare)
Seizures
Parotitis
Bronchospasm
Leukocytosis
Conjunctivitis
Otitis media
Nerve deafness
Warnings
Contraindications
Allergy to neomycin or gelatin
Pregnancy
HIV: CD4+ count <200 cells/mcL
Severely immunocompromised patients
Receiving imunosuppressive therapy other than corticosteroids or replacement therapy
Current febrile respiratory illness or febrile infection
Patients diagnosed with blood dyscrasias, leukemia, lymphomas or other malignant neoplasms
Cautions
Syncope accompanied by by transient visual disturbances reported with vaccines
Pospone vaccination on patients with moderate to severe acute illness (with or without fever); may consider on patients with mild illness
Use caution in patients with history of cerebral injuries, seizures, or conditioins where stress to fever should be avoided
Measles vaccine may provide some protection if administered within 72 hr of exposure
Rubella and mumps vaccine does not alter course of the disease following postexposure to either virus
Postpone vaccination in patients with active untreated tuberculosis
Immune globulins may interfere with immune response if administered recently or concurrently
Pregnancy and lactation
Pregnancy category: C
Lactation: Uot known if measles and mumps excreted in breast milk; rubella is excreted in milk; use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Measles mumps and rubella vaccine, live (M-M-R-II)
Mechanism of action
Live, attenuated viruses stimulate active immunity to disease caused by measles, rubella, and mumps viruses
Pharmacokinetics
Duration: >15 years after 2 doses
Onset: Active immunity detected after 1 dose
Pharmacogenomics
HLA-B7, HLA-B51, HLA-DRB1*13, and HLADQA1*01 is associated with a measles vaccine response
Homozygosity at HLA-B, HLA-DR, and HLA-DQA1 has been associated with a measles vaccine nonresponse
