Contents

Search

measles, mumps & rubella combined vaccine (MMR)

Indications: 1) simultaneous immunization against measles, mumps & rubella 2) all adults born in 1957 or later should receive one dose of MMR (measles, mumps, rubella) vaccine unless: a) proof of 1 dose of live vaccine on or after their 1st birthday b) documentation of physician-diagnosed measles c) laboratory evidence of immunity 3) 2 doses of MMR vaccine for: a) children 1] 1st dose at 15 months 2] 2nd dose prior to school entry b) college students, military recruits & hospital workers born after 1957 c) travelers to endemic areas born after 1957 d) a 3rd dose may help prevent mumps outbreak [7] 4) HIV1-infected patients >= 1 year of age without severe immunosuppression 5) patients with perinatal HIV who received MMR vaccination prior to antiretroviral therapy should be revaccinated with two doses of MMR [8] * MMR vaccine associated with less severe COVID-19 [14] - persons with highest mumps IgG titers had asymptomatic COVID-19 [14] Contraindications: 1) hypersensitivity to measles, mumps or rubella vaccine 2) individuals with blood dyscrasias, leukemia, lymphoma, or other malignant neoplasm affecting the bone marrow or lymphatic systems 3) anaphylactoid response to ingestion of eggs or to neomycin 4) pregnancy (live virus vaccine) 5) immunocompromised patients (except HIV patients) 6) revaccination is safe Caution: 1) avoid pregnancy for 3 months afer vaccination (>=4 weeks) [15] 2) postpone until after acute febrile illness 3) postpone for 3 months in patients who have received blood products or immunoglobulin pregnancy-category - safety in lactation ? Dosage: Children > 15 months & adults: 0.5 mL SC - CDC recommends all children get two doses of MMR starting with 1st dose at 12-15 months of age, the 2nd dose at 4-6 years of age Injection: 1000 TCID50 of measles & rubella vaccine 5000 TCID of mumps vaccine Pharmacokinetics: 1) 2-4 weeks for MUMPS protection after vaccination 2) duration of action is unknown, but may last 12-23 years 3) elimination: liver Adverse effects: 1) most common (1-10%) - transient rash, tenderness, erythema & swelling, sore throat, allergic reactions, malaise 2) uncommmon (< 1%) - fever, febrile seizures - especially within 1st 2 weeks - relative risk may be as high as 10% [5] - administration of MMR vaccine later than the recommended age of 12-15 months increases seizure risk (RR=2.5) [10] 3) thrombotic thrombocytopenic purpura [11] 4) all serious adverse reactions must be reported to FDA 5) no link with autism [4,11,12,13] 6) MMR booster does not increase disease activity in patients with juvenile rheumatoid arthritis [9] Test interactions: - temporary suppression of TB skin test reactivity with onset 3 days after vaccine administration Drug interactions: 1) immunosuppressive agents decrease response to the vaccine 2) immune globulins & blood products interefere with immune response to vaccine - give 6 weeks to 3 months after immune globulins Mechanism of action: 1) stimulates immunity to measles, mumps & rubella 2) 80% effective after 1st dose, 90% after 2nd dose 3) live virus vaccine

Related

measles & rubella combined vaccine (M-R-VAX II) measles virus vaccine, live, attenuated (Attenuvax) Proquad (measles, mumps, rubella [MMR] plus varicella viruses live, MMRV) rubella & mumps combined vaccine (Biavax II) rubella virus vaccine, live (Meruvax II)

General

live virus vaccine vaccine combination

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 871
  3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. Journal Watch 22(24):185, 2002 Madsen KM el al, N Engl J Med 347:1477, 2002
  5. Journal Watch 24(16):127-128, 2004 Vestergaard M, Hviid A, Madsen KM, Wohlfahrt J, Thorsen P, Schendel D, Melbye M, Olsen J. MMR vaccination and febrile seizures: evaluation of susceptible subgroups and long-term prognosis. JAMA. 2004 Jul 21;292(3):351-7. PMID: 15265850
  6. MUMPS Advisory #1, secretary of health
  7. Ogbuanu IU et al Impact of a Third Dose of Measles-Mumps-Rubella Vaccine on a Mumps Outbreak Pediatrics. Nov 5, 2012 PMID: 23129075 http://pediatrics.aappublications.org/content/early/2012/10/30/peds.2012-0177.abstract - Cardemil CV, Dahl RM, James L et al Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control. N Engl J Med 2017; 377:947-956. September 7, 2017. PMID: 28877026 http://www.nejm.org/doi/full/10.1056/NEJMoa1703309
  8. McLean HQ et al Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. June 14, 2013 / 62(RR04);1-34 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
  9. Heijstek MW et al Effects of the Live Attenuated Measles-Mumps-Rubella Booster Vaccination on Disease Activity in Patients With Juvenile Idiopathic Arthritis. A Randomized Trial. JAMA. 2013;309(23):2449-2456 PMID: 23780457 http://jama.jamanetwork.com/article.aspx?articleid=1697965
  10. Hambidge SJ et al Timely Versus Delayed Early Childhood Vaccination and Seizures. Pediatrics. May 19, 2014 PMID: 24843064 http://pediatrics.aappublications.org/content/early/2014/05/14/peds.2013-3429.abstract
  11. Maglione MA et al Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review. Pediatrics; published online July 1, 2014 PMID: 25086160 http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1079.full.pdf+html - Byington CL Vaccines: Can Transparency Increase Confidence and Reduce Hesitancy? Pediatrics; published online July 1, 2014 PMID: 25086161 http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1494.full.pdf+html
  12. Jain A, MarshallJ, Buikema A et al Autism Occurrence by MMR Vaccine Status Among US Children With Older Siblings With and Without Autism. JAMA. 2015;313(15):1534-1540 PMID: 25898051 http://jama.jamanetwork.com/article.aspx?articleid=2275444 - King BH Promising Forecast for Autism Spectrum Disorders. JAMA. 2015;313(15):1518-1519 PMID: 25898047 http://jama.jamanetwork.com/article.aspx?articleid=2275426
  13. Hviid A, Hansen JV, Frisch M, Melbye M. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Ann Intern Med. 2019. Mar 5. PMID: 30831578 https://annals.org/aim/article-abstract/2727726/measles-mumps-rubella-vaccination-autism-nationwide-cohort-study - Omer SB, Yildirim I. Further Evidence of MMR Vaccine Safety: Scientific and Communications Considerations. Ann Intern Med. 2019. Mar 5. PMID: 30831577 https://annals.org/aim/article-abstract/2727208/further-evidence-mmr-vaccine-safety-scientific-communications-considerations
  14. Reuters Staff MMR Vaccine Linked With Less Severe COVID-19. Medscape - Nov 20, 2020. https://www.medscape.com/viewarticle/941391
  15. Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022