Routine Measles, Mumps, and Rubella Vaccination

The Advisory Committee on Immunization Practices (ACIP) recommends that healthy people who do not have evidence of immunity to measles, mumps, and rubella should get vaccinated against these diseases.

Children

ACIP and CDC recommend two doses of MMR vaccine routinely for children, starting with the first dose at age 12 through 15 months and the second dose at age 4 through 6 years before school entry. Children can receive the second dose earlier as long as it is at least 28 days after the first dose.

Teens and adults should also be up to date on MMR vaccinations. MMR vaccination is especially important for—

• Students at post-high school educational institutions
• International travelers
• Healthcare professionals
• Women of childbearing age who are not pregnant
• People who care for or are around immunocompromised people
• People living with HIV without evidence of severe immunosupression

After vaccination, it is not necessary to test patients for antibodies to confirm immunity.

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MMR Vaccination Recommendations for Specific Groups

Healthcare professionals should consider vaccinating people in the following groups who do not have evidence of immunity against measles, mumps, and rubella —

Students at post-high school educational institutions

Students at post-high school educational institutions who do not have evidence of immunity need two doses of MMR vaccine, separated by at least 28 days.

Adults

Adults who do not have evidence of immunity should get at least one dose of MMR vaccine.

International travelers

People 6 months of age and older who will be traveling internationally should be protected against measles. Before any international travel—

• Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose separated by at least 28 days).
• Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days.
• Teenagers and adults who do not have evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days.

Healthcare professionals

Healthcare professionals should have documented evidence of immunity, according to the recommendations of the Advisory Committee on Immunization Practices [48 pages]. Healthcare professionals without evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days.

Healthcare professionals who receive MMR vaccine may continue to work. There are no reports of recently vaccinated people transmitting live attenuated measles, mumps, or rubella viruses to susceptible contacts.

Women of Childbearing Age

All women of childbearing age (including adolescent girls and premenopausal adult women), especially those who grew up outside the United States in areas where routine rubella vaccination might not occur, should be vaccinated with 1 dose of MMR vaccine or have other acceptable evidence of rubella immunity. Only a positive serologic test for rubella antibody or documentation of appropriate vaccination should be accepted for women who may become pregnant.

Women known to be pregnant or attempting to become pregnant should not receive rubella vaccine. Although there is no evidence that rubella vaccine virus causes fetal damage, women should not get pregnant for 4 weeks (28 days) after rubella or MMR vaccination.

Household and Close Contacts of Immunocompromised Persons

People with compromised immune systems are at high risk for severe complications if infected with measles. All family and other close contacts of people with compromised immune systems 12 months of age or older should receive 2 doses of MMR vaccine unless they have other evidence of measles immunity.

People with Human Immunodeficiency Virus (HIV) Infection

People 12 months of age or older with HIV infection who do not have evidence of measles, rubella, and mumps immunity or evidence of severe immunosuppression should receive 2 doses of MMR vaccine.

People with perinatal HIV infection who were vaccinated with measles-, rubella-, or mumps-containing vaccine before establishment of effective antiretroviral therapy (ART) should receive 2 appropriately spaced doses of MMR vaccine (1 dose now and another dose at least 28 days later) once effective ART has been established unless they have other acceptable current evidence of measles, rubella, and mumps immunity.

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Contraindications and Precautions for MMR Vaccination

Contraindications and precautions to vaccination generally dictate circumstances when vaccines will not be given. Most contraindications and precautions are temporary, and the vaccine can be given at a later time.

Contraindications

A contraindication is a condition in a recipient that greatly increases the chance of a serious adverse reaction.

People with a contraindication for MMR vaccine should not receive MMR vaccine, including anyone who—

• Had a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Has a known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised)
• Is pregnant
• Has a history of anaphylactic reactions to neomycin

Precautions

A precaution is similar to a contraindication. A precaution is a condition in a recipient that might increase the chance or severity of a serious adverse reaction, or that might compromise the ability of the vaccine to produce immunity (such as administering measles vaccine to a person with passive immunity to measles from a blood transfusion).

Precautions for MMR vaccine include—

• Moderate or severe acute illness with or without fever
• Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product)⁷
• History of thrombocytopenia or thrombocytopenic purpura
• Need for tuberculin skin testing
• Personal or family history of seizures

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Post-exposure MMR Vaccination

Measles

People exposed to measles who cannot readily show that they have evidence of immunity against measles should be offered post-exposure prophylaxis (PEP) unless contraindicated or risk outweighs the benefit due to precautions, or be excluded from the setting (school, hospital, childcare). MMR vaccine, if administered within 72 hours of initial measles exposure, may provide some protection or modify the clinical course of disease. Immunoglobulin (IG), if administered within six days of exposure, may also provide some protection or modify the clinical course of disease.

MMR vaccine and IG as post-exposure prophylaxis (PEP)

If MMR vaccine is not administered within 72 hours of exposure as post-exposure prophylaxis (PEP), MMR vaccine should still be offered at any interval following exposure to the disease in order to offer protection from future exposures. People who receive MMR vaccine or immunoglobulin (IG) as PEP should be monitored for signs and symptoms consistent with measles for at least one incubation period.

Except in healthcare settings, unvaccinated people who receive their first dose of MMR vaccine within 72 hours after exposure may return to childcare, school, or work.

If many measles cases are occurring among infants younger than 12 months of age, measles vaccination of infants as young as 6 months of age may be used as an outbreak control measure. Note that children vaccinated before their first birthday should be revaccinated when they are 12 through 15 months old and again when they are 4 through 6 years of age.

Post-exposure prophylaxis for healthcare professionals

If a healthcare professional without evidence of immunity is exposed to measles, MMR vaccine should be given within 72 hours, or IG should be given within 6 days when available. Exclude healthcare professionals without evidence of immunity from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine. [1]

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Footnote

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Mumps

People exposed to mumps who cannot readily show that they have evidence of immunity against mumps should be excluded from the setting (school, hospital, childcare).

To assist with control of mumps outbreaks, mumps-containing vaccine should be administered to persons without evidence of immunity, and everyone should be brought up to date with age-appropriate vaccination (one or two doses) unless contraindicated or risk outweighs the benefit due to precautions. Although mumps-containing vaccination has not been shown to be effective in preventing mumps in people already infected, it will prevent infection in those people who are not yet exposed or infected.

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Rubella

People exposed to rubella who cannot readily show that they have evidence of immunity against rubella should be excluded from the setting (school, hospital, childcare). In settings where pregnant women may be exposed, control measures should begin as soon as rubella is suspected and should not be postponed until laboratory confirmation of the infection.

Rubella vaccine is not effective for post-exposure prophylaxis of rubella. However, vaccination after exposure is not harmful and may possibly prevent later disease. Rubella vaccine should be given to people without evidence of immunity, and everyone should be brought up to date with age-appropriate vaccination (one or two doses) unless contraindicated or risk outweighs the benefit due to precautions.

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