measles, mumps & rubella combined vaccine (MMR)
Jump to navigation
Jump to search
Indications
- simultaneous immunization against measles, mumps & rubella
- all adults born in 1957 or later should receive one dose of MMR (measles, mumps, rubella) vaccine unless:
- proof of 1 dose of live vaccine on or after their 1st birthday
- documentation of physician-diagnosed measles
- laboratory evidence of immunity
- 2 doses of MMR vaccine for:
- HIV1-infected patients >= 1 year of age without severe immunosuppression
- 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]
Contraindications
- hypersensitivity to measles, mumps or rubella vaccine
- individuals with blood dyscrasias, leukemia, lymphoma, or other malignant neoplasm affecting the bone marrow or lymphatic systems
- anaphylactoid response to ingestion of eggs or to neomycin
- pregnancy (live virus vaccine)
- immunocompromised patients (except HIV patients)
- revaccination is safe
Caution:
- avoid pregnancy for 3 months afer vaccination (>=4 weeks)[15]
- postpone until after acute febrile illness
- postpone for 3 months in patients who have received blood products or immunoglobulin
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
- 2-4 weeks for MUMPS protection after vaccination
- duration of action is unknown, but may last 12-23 years
- elimination: liver
Adverse effects
- most common (1-10%)
- transient rash, tenderness, erythema & swelling, sore throat, allergic reactions, malaise
- 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]
- fever, febrile seizures
- thrombotic thrombocytopenic purpura[11]
- all serious adverse reactions must be reported to FDA
- no link with autism[4][11][12][13]
- MMR booster does not increase disease activity in patients with juvenile rheumatoid arthritis[9]
Drug interactions
- immunosuppressive agents decrease response to the vaccine
- immune globulins & blood products interefere with immune response to vaccine - give 6 weeks to 3 months after immune globulins
Test interactions
- temporary suppression of TB skin test reactivity with onset 3 days after vaccine administration
Mechanism of action
- stimulates immunity to measles, mumps & rubella
- 80% effective after 1st dose, 90% after 2nd dose
- live virus vaccine
More general terms
Additional terms
- 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)
References
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 871
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ 4.0 4.1 Journal Watch 22(24):185, 2002 Madsen KM el al, N Engl J Med 347:1477, 2002
- ↑ 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/15265850
- ↑ MUMPS Advisory #1, secretary of health
- ↑ 7.0 7.1 Ogbuanu IU et al Impact of a Third Dose of Measles-Mumps-Rubella Vaccine on a Mumps Outbreak Pediatrics. Nov 5, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23129075 <Internet> 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28877026 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1703309 - ↑ 8.0 8.1 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
- ↑ 9.0 9.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23780457 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1697965
- ↑ 10.0 10.1 Hambidge SJ et al Timely Versus Delayed Early Childhood Vaccination and Seizures. Pediatrics. May 19, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24843064 <Internet> http://pediatrics.aappublications.org/content/early/2014/05/14/peds.2013-3429.abstract
- ↑ 11.0 11.1 11.2 Maglione MA et al Safety of Vaccines Used for Routine Immunization of US Children: A Systematic Review. Pediatrics; published online July 1, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25086160 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25086161 <Internet> http://pediatrics.aappublications.org/content/early/2014/06/26/peds.2014-1494.full.pdf+html - ↑ 12.0 12.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25898051 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2275444
King BH Promising Forecast for Autism Spectrum Disorders. JAMA. 2015;313(15):1518-1519 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25898047 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2275426 - ↑ 13.0 13.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/30831577 https://annals.org/aim/article-abstract/2727208/further-evidence-mmr-vaccine-safety-scientific-communications-considerations - ↑ 14.0 14.1 14.2 Reuters Staff MMR Vaccine Linked With Less Severe COVID-19. Medscape - Nov 20, 2020. https://www.medscape.com/viewarticle/941391
- ↑ 15.0 15.1 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022