MMR Vaccine

MMR Vaccination is safe, effective and prevents serious illness with potentially devestating consequences
1. For every 1000 Measles cases, 50 will develop Pneumonia, 1 will develop Encephalitis and 2 will die
2. Congenital Rubella (TORCH Virus) affected 20,000 U.S. newborns in 1964-5, prior to Rubella Vaccination
3. Orchitis (with Infertility risk) occurs in up to 10% of males with Mumps

Universally indicated for persons born after 1956
1. Those born before 1957 in U.S. are presumed to have been exposed
Primary Series for all children
1. Dose 1: Age 12-15 months old
2. Dose 2: Age 4-6 years old
Catch-up doses for anyone born after 1956
1. At least one MMR dose
2. Two MMR doses at least 4 weeks apart
  1. Unvaccinated children ages 12 months to 12 years
  2. College students
  3. Healthcare workers
  4. Travelers to high risk international areas
  5. Close contacts of Immunocompromised persons
Impending travel to endemic region
1. Infants 6-11 months: Administer one MMR dose
2. Children >12 months and adults should have received 2 doses prior to travel
  1. Doses should be at least one month apart
  2. Adults with only one MMR Vaccine, should receive a second dose
Outbreaks (esp Measles, Mumps in close quarters such as dormitories, barracks)
1. Third dose is per public health department (but not in pregnancy, and not in Immunocompromised)
2. Give a second dose, if never immunized (or unknown status), at 4 weeks after the first
References
1. (2014) Presc Lett 21(8): 44
2. (2018) Presc Lett 25(3)

Absolute contraindications
1. Anaphylactic reaction to neomycin (egg allergy is no longer a contraindication)
2. Pregnancy
3. Severe Immunodeficiency (e.g. AIDS with CD4 Count <200 cells/ul)
Relative contraindications
1. IG administration with within 3 months
2. Thrombocytopenia
3. Thrombocytopenia Purpura
Conditions not contraindicating Vaccination
1. Tuberculosis or positive PPD
2. Concurrent PPD testing
3. Lactation
4. Pregnancy in household contact or mother
5. Household contact with Immunodeficiency (e.g. HIV)
6. Non-anaphylactic reaction to egg or neomycin

Adult: 0.5 ml IM
Primary Series
1. Dose 1: Age 12-15 months
2. Dose 2: Age 4 to 6 years (administer by age 12)
Alternate protocol
1. Need a waiting period following Ig Administration
2. See Red Book for wait period (3-11 months)

Immune Thrombocytopenic Purpura (<1 case per 40,000)
1. Occurs up to 6 weeks after MMR Vaccine
Anaphylaxis (0.65 cases per 1 million Vaccinations)
Mortality related to Vaccine (Vaccine-strain death)
1. Since 1990, there have been a total of 397 MMR attributed deaths case reports
Encephalitis
1. Occurs in 1 case per 3 million Vaccinations
2. Contrast with 1 in 1000 with Measles
Aseptic Meningitis
1. Onset 2-3 weeks after Vaccination
Febrile Seizures (uncommon)
1. Occurs 7-10 days after first MMR dose
2. Increased risk when first dose given after 12-15 months of age
Orchitis
1. Occurs in 0.3 cases per 1 million MMR doses
Pneumonia
1. Occurs in 2 cases per 1 million MMR doses
Pruritic dermatitis
1. Purpura may be present
Parotitis
1. Rare complication 10-14 days after Vaccination
References
1. (1996) MMWR Morb Mortal Wkly Rep 45(No. RR-12):1-35 [PubMed]

Varicella Vaccine or Yellow Fever Vaccine
1. Do not give MMR within 30 days or these Vaccines
2. MMR may be given with varicella or Yellow Fever