A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia

Measles, Mumps, Rubella (MMR)

Pathophysiology

  • Measles: Virus
    Respiratory transmission
    Incubation 10-12 days
  • Mumps: Virus
    Respiratory transmission
    Incubation 14-18 days
  • Rubella: Virus
    Respiratory transmission
    Incubation 12-23 days

Vaccine Description

Live attenuated vaccine

Dose & Route

0.5 mL reconstituted vaccine given Subcut

Dose Recommended  Age

Dose 1………12 – 15 months                                  (see minimum intervals below)
Dose 2………4 – 6 years                                          (see minimum intervals below)

Minimum Intervals

Dose 1  – MUST be at least 12 months of age

Dose 2* – At least 28 days after dose #1; usually given at 4-6 years of age.

*Children who have received 2 doses of MMR with dose #1 no earlier than the 1st birthday and dose #2 at least 4 weeks after dose #1 do not need an additional dose for school entry.

Special Situations

International travel – infants age 6-11 months: 1 dose before departure; revaccinate with 2 doses at 12-15 months (12 months for children in high- risk areas) and dose 2 as early as 4 weeks later.

Unvaccinated children age 12 months and older: 2-dose series at least 4 weeks apart before departure.

Combination Vaccine Administration

  • *See information on MMRV / Febrile Seizures
  • ProQuad® (MMRV) may be used to simultaneously administer MMR and varicella vaccine to children ages 12 mos. through 12 yrs. when both vaccines are indicated.
  • Spacing and timing of MMRV from individual component vaccines (MMR and varicella):
    • At least 1 month between a dose of a measles-containing vaccine and a dose of MMRV
    • At least 3 months between a dose of varicella vaccine and a dose of MMRV.
    • However, if varicella vaccine and MMRV are inadvertently given at least 28 days apart, the doses may be counted as valid.

Contraindications

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component.
  • Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy or patients with HIV infection who are severely immunocompromised).
  • Pregnancy

Precautions

  • Moderate or severe acute illness with or without fever.
  • Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product).
  • Refer to Tables 4 & 5 on page 67 & 68 as this varies depending on the blood product.
  • History of thrombocytopenia or thrombocytopenic purpura.
  • Need for tuberculin skin testing.

Special Considerations & Instructions

  • Vaccine should be stored in the refrigerator.
  • Diluent may be stored at room temperature.
  • For corticosteroid recipients: administration of MMR should be avoided for at least 1 month after cessation of high dose therapy (see Contraindications).
  • Pregnancy should be avoided for 1 month following MMR vaccine.
  • If PPD is needed and not given the same day as MMR, PPD testing should be delayed 4-6 weeks after MMR vaccination.
  • Vaccine must be used within 8 hours of reconstitution, kept refrigerated, and protected from exposure to light.
  • Mumps protection in a non-outbreak setting.
    • One dose of mumps-containing vaccine for pre-school children and non-high risk adults.
    • 2 doses of mumps-containing vaccine for children in grades K-12 (school requirement) and adults at high risk
      • Persons working in health care facilities.
      • International travelers.
      • Students attending post-high school educational institutions.
    • Birth prior to 1957.
    • Laboratory evidence of immunity.
    • Documentation of provider- diagnosed disease is not considered acceptable evidence of immunity for measles, mumps, or rubella.
  • Mumps protection in an outbreak setting (depending on the epidemiology of the outbreak).
    • Second dose of vaccine should be considered for adults.
    • Two doses of vaccine for children ages 1-4 years of age if affected by the outbreak.
      • 1st dose should be administered at 12 months of age.
      • 2nd dose should be given 28 or more days after the 1st dose.
    • At this time, children K-12 must be immunized with 2 doses of a measles- containing vaccine, 2 mumps, and 1 rubella, or provide laboratory evidence of immunity to measles, mumps, and rubella. This also applies to University System of Georgia students born in 1957 or later.

* PRIORIX and M-M-R II are fully interchangeable. ACIP General Best Practices states a preference that doses of vaccine in a series come from the same manufacturer; however, vaccination should not be deferred when the manufacturer of the previously administered vaccine is unknown or when the vaccine from the same manufacturer is unavailable. Studies have shown that PRIORIX is safe and immunogenic when administered as a second dose after M-M-R II. Measles, Mumps, Rubella Vaccine (PRIORIX): Recommendations of the Advisory Committee on Immunization Practices — United States, 2022 | MMWR (cdc.gov)

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