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Measles/Mumps/Rubella Vaccines, MMR
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General Dosing Information
0.5 mL subcutaneously once. Consider a second dose at least 28 days after initial dose in people considered previously unvaccinated due to previous vaccination with inactivated or unknown type of measles vaccine or who have been vaccinated with killed or unknown type of mumps vaccine before 1979.[53026] [55005]
0.5 mL subcutaneously for 2 doses. Administer the first dose at age 12 to 15 months and the second dose at age 4 to 6 years. It may be administered as the second dose in patients who received a first dose of another MMR vaccine.[53026] [55005] [67659] For catch-up immunization, administer the 2 doses at least 28 days apart.[53026] [55005]
0.5 mL IM or subcutaneously once. Consider a second dose at least 28 days after initial dose in people considered previously unvaccinated due to previous vaccination with inactivated or unknown type of measles vaccine or who have been vaccinated with killed or unknown type of mumps vaccine before 1979.[53026] [55005]
0.5 mL IM or subcutaneously for 2 doses. Administer the first dose at age 12 to 15 months and the second dose at age 4 to 6 years. It may be administered as the second dose in patients who received a first dose of another MMR vaccine.[53026] [55005] [67659] For catch-up immunization, administer the 2 doses at least 28 days apart.[53026] [55005]
0.5 mL subcutaneously for 2 doses. Administer the second dose at least 28 days after initial dose. Administer prior to departure.[70447]
0.5 mL subcutaneously for 2 doses. Administer the second dose at least 28 days after initial dose. Administer prior to departure.[70447]
0.5 mL subcutaneously once prior to departure. Routine prophylaxis should be administered starting at age 12 to 15 months.[70447]
0.5 mL IM or subcutaneously for 2 doses. Administer the second dose at least 28 days after initial dose. Administer prior to departure.[70447]
0.5 mL IM or subcutaneously for 2 doses. Administer the second dose at least 28 days after initial dose. Administer prior to departure.[70447]
0.5 mL IM or subcutaneously once prior to departure. Routine prophylaxis should be administered starting at age 12 to 15 moths.[70447]
0.5 mL subcutaneously once; consider 2 doses separated by at least 28 days for measles and mumps or at least 1 dose for rubella.[53026] [55005]
0.5 mL IM or subcutaneously once; consider 2 doses separated by at least 28 days for measles and mumps or at least 1 dose for rubella.[53026] [55005]
0.5 mL subcutaneously for 2 doses. Administer the second dose at least 28 days after initial dose. Do not administer if CD4 count is less than 200 cells/m3 or CD4 percentage is less than 15%.[53026]
0.5 mL subcutaneously for 2 doses. Administer the second dose at least 28 days after initial dose. Children and adolescents who received the MMR vaccine prior to beginning effective antiretroviral therapy (ART) without evidence of immunity should be vaccinated with 2 appropriately spaced doses once effective ART is established.[55005] Do not administer if CD4 count is less than 200 cells/m3 or CD4 percentage is less than 15%.[53026]
0.5 mL IM or subcutaneously for 2 doses. Administer the second dose at least 28 days after initial dose. Do not administer if CD4 count is less than 200 cells/m3 or CD4 percentage is less than 15%.[53026]
0.5 mL IM or subcutaneously for 2 doses. Administer the second dose at least 28 days after initial dose. Children and Adolescents who received the MMR vaccine prior to beginning effective antiretroviral therapy (ART) without evidence of immunity should be vaccinated with 2 appropriately spaced doses once effective ART is established.[55005] Do not administer if CD4 count is less than 200 cells/m3 or CD4 percentage is less than 15%.[53026]
0.5 mL subcutaneously once. Complete 2-dose series at least 28 days apart if previously did not receive any doses of MMR or 1 dose if previously received 1 dose MMR.[53026] [55005]
0.5 mL subcutaneously once. Complete 2-dose series at least 28 days apart if previously did not receive any doses of MMR or 1 dose if previously received 1 dose MMR.[53026] [55005]
0.5 mL IM or subcutaneously once. Complete 2-dose series at least 28 days apart if previously did not receive any doses of MMR or 1 dose if previously received 1 dose MMR.[53026] [55005]
0.5 mL IM or subcutaneously once. Complete 2-dose series at least 28 days apart if previously did not receive any doses of MMR or 1 dose if previously received 1 dose MMR.[53026] [55005]
0.5 mL subcutaneously once in those who have only received one previous dose prior to the outbreak and live in a community experiencing a measles outbreak.[55005]
0.5 mL subcutaneously once in those who have only received one previous dose prior to the outbreak and live in a community experiencing a measles outbreak.[55005]
0.5 mL subcutaneously once in those with ongoing risk of exposure.[55005]
0.5 mL IM or subcutaneously once in those who have only received one previous dose prior to the outbreak and live in a community experiencing a measles outbreak.[55005]
0.5 mL IM or subcutaneously once in those who have only received one previous dose prior to the outbreak and live in a community experiencing a measles outbreak.[55005]
0.5 mL subcutaneously once in those with ongoing risk of exposure.[55005]
0.5 mL subcutaneously once within 72 hours of measles exposure. In people who have received only 1 dose of vaccine prior to measles exposure, revaccination within 72 hours of exposure may prevent disease.[55005]
0.5 mL subcutaneously once within 72 hours of measles exposure. In people who have received only 1 dose of vaccine prior to measles exposure, revaccination within 72 hours of exposure may prevent disease.[55005]
0.5 mL subcutaneously within 72 hours of measles exposure. Infants who receive the vaccination prior to 12 months of age may not achieve immunity to all 3 diseases; therefore, revaccination with 2 MMR doses (first dose at 12 to 15 months, second dose at least 28 days later) is recommended.[53026] [55005]
0.5 mL IM or subcutaneously once within 72 hours of measles exposure. In people who have received only 1 dose of vaccine prior to measles exposure, revaccination within 72 hours of exposure may prevent disease.[55005]
0.5 mL IM or subcutaneously once within 72 hours of measles exposure. In people who have received only 1 dose of vaccine prior to measles exposure, revaccination within 72 hours of exposure may prevent disease.[55005]
0.5 mL IM or subcutaneously within 72 hours of measles exposure. Infants who receive the vaccination prior to 12 months of age may not achieve immunity to all 3 diseases; therefore, revaccination with 2 MMR doses (first dose at 12 to 15 months, second dose at least 28 days later) is recommended.[53026] [55005]
0.5 mL subcutaneously once in people who were previously vaccinated with 2 doses of a mumps virus-containing vaccine and are identified by public health authorities as being at increased risk for acquiring mumps because of an outbreak.[62828]
0.5 mL subcutaneously once in people who were previously vaccinated with 2 doses of a mumps virus-containing vaccine and are identified by public health authorities as being at increased risk for acquiring mumps because of an outbreak.[62828]
0.5 mL IM or subcutaneously once in people who were previously vaccinated with 2 doses of a mumps virus-containing vaccine and are identified by public health authorities as being at increased risk for acquiring mumps because of an outbreak.[62828]
0.5 mL IM or subcutaneously once in people who were previously vaccinated with 2 doses of a mumps virus-containing vaccine and are identified by public health authorities as being at increased risk for acquiring mumps because of an outbreak.[62828]
0.5 mL subcutaneously once upon completion of pregnancy and before discharge from the health-care facility.[55005] [62828]
0.5 mL subcutaneously once upon completion of pregnancy and before discharge from the health-care facility.[55005] [62828]
0.5 mL/dose IM (MMR II) or subcutaneously (MMR II, Priorix).
0.5 mL/dose IM (MMR II) or subcutaneously (MMR II, Priorix).
0.5 mL/dose IM (MMR II) or subcutaneously (MMR II, Priorix).
0.5 mL/dose IM (MMR II) or subcutaneously (MMR II, Priorix).
6 to 11 months: Safety and efficacy have not been established; however, 0.5 mL/dose IM (MMR II) or subcutaneously (MMR II, Priorix) is recommended in certain situations.
1 to 5 months: Safety and efficacy have not been established.
Safety and efficacy have not been established
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
† Off-label indication
The measles, mumps, and rubella (MMR) vaccine is a combination injection consisting of 3 live virus vaccinations intended to confer immunity against measles, mumps, and rubella. The MMR vaccine is approved in patients 12 months of age or older. In addition to children, adolescents and adults should also be up to date on their MMR vaccine. Unvaccinated women of childbearing age without evidence of immunity, who are not pregnant, should receive at least 1 dose of the MMR vaccine; pregnancy should be avoided for 1 month after vaccination. The MMR vaccine is effective at protecting patients against measles, mumps, and rubella, and preventing the complications caused by these diseases. One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella. Two doses of MMR vaccine are 97% effective against measles and 88% effective against rubella. About 3 out of 100 patients who get 2 doses of MMR vaccine will get measles if exposed to the virus, however, they are more likely to have a milder illness and are less likely to spread the disease to other people. Although 2 doses of MMR vaccine are 88% effective at preventing mumps, outbreaks can still occur in highly vaccinated U.S. communities, particularly in settings where people have close, prolonged contact, such as universities and close-knit communities. During an outbreak, an additional MMR dose may help improve protection against mumps disease and related complications. The Centers for Disease Control and Prevention (CDC) has issued a Health Alert Network (HAN) Health Advisory to increase awareness of an increase in measles cases globally and in the United States. From January 1 to March 14, 2024, the CDC has been notified of 58 confirmed cases in the United States. Fifty-four (93%) of cases were linked to international travel. Most cases have been among children aged 12 months and older who had not received the measles-mumps-rubella (MMR) vaccine. Patients traveling internationally should be current on their measles vaccination. Parents traveling internationally with children should consult with their child's healthcare provider at least 4 weeks before travel.[30319][67659][67660][70447]
For storage information, see the specific product information within the How Supplied section.
Reconstitution (MMR II)
Intramuscular Injection (MMR II)
Reconstitution (MMR II)
Reconstitution (Priorix)
Subcutaneous Injection
Events reported after administration of measles/mumps/rubella vaccines, MMR or its component vaccines without regard to causality include retinitis, papillitis, retrobulbar neuritis, polyneuritis, polyneuropathy, syncope, and paresthesias. Although cases of Guillain-Barre syndrome (GBS) have been reported after administration of MMR vaccination, a causal relationship has not been established. Recent mass vaccination campaigns that involved approximately 8 million doses of measles-rubella vaccine in the UK and > 70 million doses of measles vaccine in Latin America demonstrated no increased incidence of GBS over baseline rates. Expert committees at the Institute of Medicine (IOM) have reviewed available evidence concerning the causal relationship between MMR vaccination and various adverse events. Although vasculitis, otitis media, conjunctivitis, optic neuritis, ocular palsies, Guillain-Barre syndrome, and ataxia have been reported after administration of MMR or its component vaccines and are listed in the manufacturer's package insert, the IOM has determined that no causal relationship has been established between these events and MMR vaccination.[23937] In addition, evidence does not support a causal association of measles-containing vaccine with risk for Crohn's disease or other inflammatory bowel disease. Cases of aseptic meningitis have been reported to VAERS after measles, mumps, and rubella vaccination. Although a causal relationship between the Urabe strain of mumps vaccine and aseptic meningitis has been shown, there is no evidence to link Jeryl Lynn mumps vaccine to aseptic meningitis.
Approximately 5% of children develop a fever of >= 103 degrees F after measles/mumps/rubella vaccine, MMR. Febrile reactions usually occur 7—12 days after vaccination and generally last 1—2 days. Most persons with fever are otherwise asymptomatic; however, febrile seizures have been reported occasionally. The risk of seizure attributable to the measles component of MMR is approximately 1 in 3,000 doses and usually occurs 6—11 days after vaccination. A higher incidence of seizures has been reported in patients 15—35 days after administration of MMR containing the Urabe mumps strain (1 in 2600 Urabe doses).[24166] Data from a population-based cohort study of 537,171 children of whom 82% received MMR vaccination at 15—17 months of age suggest that prematurity, male gender, low birth weight, or a family history of febrile seizures do not significantly affect the likelihood of febrile seizures after MMR vaccination. Children with febrile seizures after MMR vaccinations did not have an increased rate of epilepsy development as compared with children who were unvaccinated at the time of their first febrile seizure. Due to the limited number of children with a sibling with epilepsy, more data are needed to determine if these children are more likely to have a febrile seizure after MMR vaccination as compared with nonvaccinated children.[29582] The Advisory Committee on Immunization Practices recommends vaccination of children with a personal or family history of convulsions, as the benefits substantially outweigh the risks.[23937]
Anaphylactic shock, anaphylactoid reactions, angioneurotic edema (angioedema), bronchospasm, facial edema, pruritus, rash (unspecified), measles-like rash, urticaria, panniculitis, Stevens-Johnson syndrome, Henoch-Schonlein purpura, acute hemorrhagic edema of infancy, and erythema multiforme have been reported without regard to causality during clinical trials with measles/mumps/rubella vaccine, MMR or with monovalent or bivalent vaccine containing measles, mumps, or rubella. Measles- and rubella-containing vaccines (including MMR) can cause transient rashes (e.g., maculopapular rash). The rash usually appears 7 to 10 days after vaccination and occurs in roughly 5% of vaccinated persons. Have immediate availability of adequate treatment provisions including epinephrine injection 1 mg/mL in the event of an anaphylactic or anaphylactoid reaction.[30319]
Purpura and thrombocytopenia have been reported during clinical trials without regard to causality with use of the measles/mumps/rubella vaccine, MMR or with use of monovalent or bivalent vaccine containing measles, mumps, or rubella. Surveillance of adverse reactions in the U.S. and other countries indicates that MMR vaccine can, in rare instances, cause clinically important thrombocytopenia within 2 months of vaccination. In prospective studies, the reported frequency of clinically apparent thrombocytopenia after MMR vaccination was 1 case per 30,000 to 40,000 vaccinated, with a temporal clustering of cases occurring 2 to 3 weeks after vaccination. Based on passive surveillance, the reported frequency of thrombocytopenia is roughly 1 case per 100,000 doses in Canada and France, and 1 case per 1 million doses in the U.S.. The clinical course of these cases was usually transient and benign, although hemorrhage occurred rarely. In children, a causal association of MMR vaccine and immune thrombocytopenic purpura (ITP) has been demonstrated. The absolute risk of ITP in children aged 12 to 23 months within 6 weeks of immunization was 1 in 22,300 doses (two of every three cases of ITP were vaccine-attributed). The MMR-related cases tended to be milder and of shorter-duration than non-vaccine associated cases. Children with ITP before MMR vaccine had no vaccine-associated recurrences of purpura; the authors concluded that a history of previous ITP did not contraindicate the administration of the vaccine.[26721]
Encephalitis, acute disseminated encephalomyelitis (ADEM), encephalopathy, and measles inclusion body encephalitis have been reported without regard to causality during clinical trials of the measles/mumps/rubella vaccine, MMR or with use of monovalent or bivalent vaccine containing measles, mumps, or rubella. There have been reports of subacute sclerosing panencephalitis (SSPE) in children who did not have a history of infection with wild-type measles but did receive the measles vaccine. The association of SSPE cases to measles vaccination is about 1 case per million vaccine doses distributed, which is much less than the association with wild-type measles infection (6 to 22 cases of SSPE per million cases of measles).[30319] Encephalitis and encephalopathy have been reported approximately once for every 3 million doses of MMR vaccine administered since licensure of these vaccines. Roughly 1 in 1,000 persons infected with measles virus develops encephalitis with resultant permanent central nervous system impairment. Thus, encephalopathy occurs much less frequently after administration of measles vaccine than after measles infection.[23937] [30319] Measles inclusion body encephalitis, pneumonitis, and death as a direct consequence of disseminated measles vaccine virus infection have been reported in immunocompromised patients inadvertently vaccinated with measles-containing vaccine.[30319]
Joint symptoms such as arthralgia, arthritis, and myalgia or musculoskeletal pain are associated with the rubella component of the measles/mumps/rubella vaccine, MMR. Joint symptoms are usually transient; only rarely have vaccine recipients developed chronic joint symptoms. Among susceptible persons, arthralgia and transient arthritis occur more frequently among adults than among children and more frequently among postpubertal females than among males. In women, incidence rates for arthritis and arthralgia are generally higher (12—26%) than those seen in children (0—3%), and the reactions tend to be more marked and of longer duration. Symptoms may persist for a matter of months or on rare occasions for years. In adolescent girls, the reactions appear to be intermediate in incidence between those seen in children and in adult women. Even in women older than 35 years, these reactions are generally well tolerated and rarely interfere with normal activities. When acute joint symptoms do occur, they generally begin 1—3 weeks after vaccination, persist for 1 day to 3 weeks, and rarely recur. Tell postpubertal females about the frequent occurrence of generally self-limited arthralgia and/or arthritis beginning 2 to 4 weeks after vaccination.
Adverse events reported without regard to causality during clinical trials or postmarketing with measles/mumps/rubella vaccines, MMR or with use of monovalent or bivalent vaccine containing measles, mumps, or rubella include headache, malaise, irritability, diarrhea, vomiting, and nausea.
An injection site reaction usually consisting of burning or stinging may occur after administration of measles/mumps/rubella vaccines, MMR. Wheal and flare, erythema, swelling, induration, tenderness, and vesiculation at the injection site may also be noted.
Excretion of small amounts of the live attenuated rubella virus from the nose or throat has occurred in most susceptible patients 7 to 28 days after vaccination. No documented confirmed cases of transmitted rubella vaccine virus have been reported.[67659]
Do not give the measles, mumps, and rubella (MMR) vaccine via intravenous administration. The vaccine is for subcutaneous (MMR II, Priorix) or intramuscular (MMR II) administration only.[30319] [67659]
The measles, mumps, and rubella (MMR) vaccine is contraindicated in patients with hypersensitivity to any vaccine component.[30319] [67659] MMR II is contraindicated in patients with a gelatin hypersensitivity; it contains hydrolyzed gelatin as a stabilizer.[30319] Use the Priorix vaccine with caution in patients with a latex hypersensitivity; the tip caps of the prefilled syringes of diluent contain natural rubber latex.[67659] Because measles and mumps viruses are cultured from chick embryos, and each vaccine dose contains 25 mcg or less of neomycin, it is generally regarded that patients with a history of egg hypersensitivity or neomycin hypersensitivity are more likely to develop an allergic reaction if given the MMR vaccine. The MMR vaccine is contraindicated in persons who have experienced an anaphylactic reaction to topically or systemically administered neomycin.[23937] [30319] However, a history of contact dermatitis to neomycin is not a contraindication to receiving MMR vaccination; in these patients, the adverse reaction to neomycin in the vaccine is usually an erythematous, pruritic nodule or papule appearing 48 to 96 hours after vaccination. In persons allergic to eggs, the risk for serious allergic reactions after administration of measles- or mumps-containing vaccines is extremely low, but patients with a history of anaphylactic, anaphylactoid, or other immediate reactions after egg ingestion may be at an enhanced risk of an immediate-type hypersensitivity reaction. In a study of 54 children with documented egg allergy, a single 0.5 mL subcutaneous dose of the MMR vaccine was administered safely, despite the confirmation of egg allergy with a food challenge.[24433] [30319] Thus, according to the CDC, skin testing is not required before administering MMR to persons allergic to eggs.[23937] As with any biologic product, the prescriber or healthcare professional should have procedures in place to manage allergic reactions. If an anaphylactic or other clinically significant hypersensitivity reaction occurs, institute appropriate therapy.[67659]
Patients with thrombocytopenia may develop more severe thrombocytopenia after vaccination. In addition, patients who experience thrombocytopenia with the first dose of the MMR vaccine or any vaccine component may develop thrombocytopenia with repeat doses. Consider the potential risks and benefits of further vaccine receipt; evaluation of serologic status may help determine the need for additional doses. In children, a causal association of MMR vaccine and immune thrombocytopenic purpura (ITP) has been demonstrated. In one study, the absolute risk of ITP in children aged 12 to 23 months within 6 weeks of immunization was 1 in 22,300 doses (two of every three cases of ITP were vaccine-attributed). The MMR-related cases tended to be milder and of shorter-duration than non-vaccine associated cases. Children with ITP before MMR vaccine had no vaccine-associated recurrences of purpura; the authors concluded that a history of previous ITP did not contraindicate the administration of the vaccine.[26721] The decision to vaccinate children with MMR should depend on the benefits of immunity to measles, mumps, and rubella and the risks for recurrence or exacerbation of thrombocytopenia after vaccination or during natural infection with measles or rubella. According to the CDC, the benefits of primary immunization are usually greater than the potential risks, especially when the incidence of thrombocytopenia after measles or rubella disease is considered.[23937]
Children with a personal or family history of a seizure disorder may be at an increased risk of developing febrile seizures after MMR vaccination. The risk of this complication, however, appears to be low. In addition, febrile seizures occur commonly among children in whom measles disease develops. Therefore, according to the CDC, the benefits of administering MMR vaccine to children with a history of convulsions substantially outweighs the risks.[23937]
Safety and effectiveness of measles vaccine in neonates and infants below the age of 6 months have not been established, and the safety and effectiveness of mumps and rubella vaccine in patients less than 12 months of age have not been established. The MMR vaccine is only indicated in patients at least 12 months of age, but receipt in infants may be acceptable in certain conditions (see Dosage). The vaccine may not be as immunogenic in infants. If vaccination first occurred before the age of 12 months, revaccinate between 12 and 15 months of age and again before elementary school entry.
Recommendations and precautions for patients with immunosuppression are complex, but the measles virus; mumps virus; rubella virus (MMR) live vaccine is contraindicated in any person with a primary immunodeficiency state (e.g., severe combined immunodeficiency (SCID), IgA deficiency, hypogammaglobulinemia, agammaglobulinemia, or dysgammaglobulinemia) or an acquired immunodeficiency state.[30319] [43236] Measles inclusion body encephalitis, pneumonitis, and death as a direct consequence of disseminated measles vaccine virus infection have been reported in immunocompromised patients inadvertently vaccinated with measles-containing vaccine; additionally, disseminated mumps and rubella virus infection has occurred in immunosuppressed patients who were inadvertently given the MMR vaccine.[30319] A family history of congenital or hereditary immunodeficiency is also a contraindication for MMR vaccine unless the immune competence of the potential vaccine recipient is demonstrated.[30319] The MMR vaccine may be administered to persons with human immunodeficiency virus (HIV) infection if the CD4 count is 200 cells/mm3 or higher; however, patients with a CD4 count less than 200 cell/mm3 or who meet the diagnostic criteria of acquired immunodeficiency syndrome (AIDS) should not receive the vaccine.[34362] [43236] The MMR vaccine should also not be administered to those with cellular immune deficiency or those patients on immunosuppressive therapy such as high-dose corticosteroid therapy.[30319] However, corticosteroid therapy is usually not a contraindication to administering live-virus vaccines when administration is short-term (less than 2 weeks); a low-to-moderate dose (less than 2 mg/kg of body weight or 20 mg/day of prednisone or equivalent for persons who weigh more than 10 kg when administered for less than 2 weeks); long-term, alternate-day treatment with short-acting preparations; maintenance physiologic doses (replacement therapy); or when administered topically (skin, eyes), inhaled, or by local injection. Health care providers should wait at least 1 month after discontinuation of high-dose corticosteroid therapy given for more than 2 weeks before administering MMR vaccine.[43236] The vaccine is also contraindicated in patients with blood dyscrasias or any neoplastic disease that causes bone marrow suppression or affects the lymphatic system such as leukemia or lymphoma, including patients currently receiving chemotherapy or radiation therapy.[30319] [43236] Patients with leukemia, lymphoma, or other malignancies whose disease is in remission and whose chemotherapy or radiation therapy has been terminated for at least 3 months can receive live-virus vaccines.[43236]
The measles, mumps, and rubella (MMR) vaccine is contraindicated in pregnancy or people who may become pregnant within the next month. Educate individuals of reproductive capacity on the importance of prevention of pregnancy for 4 weeks after vaccination. Acquisition of wild-type measles during pregnancy has reportedly led to increased rates of spontaneous abortion, stillbirth, congenital defects, and prematurity. Wild-type mumps virus infection during the first trimester of pregnancy may increase the rate of spontaneous abortion. The mumps vaccine virus has been shown to infect the placenta, but there is no evidence that it causes congenital malformation or disease in the fetus or infant. Pregnant individuals infected with wild-type rubella virus are at increased risk of miscarriage or stillbirth, and their neonates are at risk for Congenital Rubella Syndrome (CRS). CRS in the infant can lead to eye problems (cataracts, glaucoma, retinitis), congenital heart defects, hearing loss, microcephaly, and intellectual disabilities. Between 1971 and 1989, a Vaccine in Pregnancy registry tracked 1,221 individuals who inadvertently received rubella virus vaccines within 3 months before or after conception. No increase in fetal abnormalities or cases of CRS was observed. From 1978 to 2018, postmarketing data followed 425 individual pregnancies prospectively who received measles, mumps, and rubella vaccine inadvertently. Among these, there were 16 cases of major birth defects, 4 cases of fetal death, 50 miscarriages, but no abnormalities or cases of CRS were reported. However, one case of CRS has been reported during postmarketing experience. A pregnant individual was inadvertently administered a measles, mumps, rubella virus containing vaccine from an unknown manufacturer at 5 weeks gestation. If vaccination is needed, vaccinate individuals immediately after delivery.[30319] [65107] [67659]
According to the CDC, live-virus vaccines administered to a lactating woman do not affect the safety of breast-feeding for women or their infants. Although live viruses in vaccines can replicate in vaccine recipients (i.e., the mother), the majority of live viruses in vaccines have been demonstrated not to be excreted in human milk. The rubella vaccine virus may be excreted in human milk; however, the virus usually does not infect the infant. If infection does occur, it is well tolerated because the virus is attenuated. There are no data to suggest that passive transfer of antibodies in human milk can affect the efficacy of live-virus vaccines. Breastfed infants should be vaccinated according to the recommended schedule.[43236] The manufacturer of the measles/mumps/rubella (MMR) vaccine states that caution should be used when the vaccine is administered to a breast-feeding woman; lactating women immunized with live attenuated rubella vaccine may secrete the virus in breast milk and transmit it to breast-feeding infants. In the infants with serological evidence of rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of acquired rubella. The ability of either the measles or mumps vaccine virus to be secreted in human milk is unknown.[30319] Consider the benefits of breast-feeding, the risk of infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, health care providers are encouraged to report the adverse effect to the FDA.
Patients with active, untreated tuberculosis should not be vaccinated with MMR. The MMR vaccine is contraindicated in patients with a febrile respiratory illness such as a respiratory infection or other active infection associated with a fever. The ACIP, however, recommends that all vaccines can be given to patients with minor illnesses such as diarrhea, mild upper respiratory infection, or other low-grade febrile illnesses.
The measles, mumps, and rubella (MMR) vaccine may result in temporary suppression of tuberculin reactivity causing a laboratory test interference with a tuberculin skin test. Therefore, administer a tuberculin skin test either before, simultaneously with, or at least 4 to 6 weeks after MMR vaccination to avoid false-negative results.[30319] [67659] Additionally, syndromic polymerase chain reaction (PCR) panels may incorrectly identify a measles infection if a patient recently received an MMR vaccine. Approximately 5% of patients experience a rash after the MMR vaccine; approximately 1% of syndromic panels report a positive measles result after MMR vaccination. Patients identified with a positive result were pediatric patients without known measles risk who, in most cases, received the vaccine less than 3 weeks beforehand. Inclusion of measles virus in syndromic PCR panels can result in incidental detection of measles vaccines. Health care providers should assess clinical features and vaccine history after a positive test.[70504]
Many epidemiological studies suggest that most people who develop disease-specific antibodies to the measles, mumps, and rubella viruses (MMR) after immunization develop long-term immunity. Active immunization with the MMR vaccine stimulates the immune system to produce disease-specific antibodies by inducing a subclinical and noncommunicable infection with attenuated virus particles. Clinical studies indicate that MMR is highly immunogenic, with 1 injection stimulating measles antibodies (hemagglutination inhibition) in 95% of recipients; mumps-neutralizing antibodies in 96% of recipients; and rubella antibodies (hemagglutination inhibition) in 99% of recipients. A small percentage (1% to 5%) of individuals fail to seroconvert after the primary dose; therefore, 2 doses are necessary. These vaccine-induced antibodies are capable of virus neutralization by opsonization, complement activation, and induction of cell-mediated immunity.[23937][30319]
Revision Date: 03/04/2025, 01:24:00 PMThe measles, mumps, and rubella vaccine (MMR) is administered intramuscularly (MMR II) or subcutaneously (MMR II, Priorix).[30319][67659]
Infants and Children 11 months to 7 years
Among 284 triple seronegative infants and children aged 11 months to 7 years who received MMR vaccination, measles antibodies were detected in 95%, mumps antibodies in 96%, and rubella antibodies in 99% of susceptible persons.[30319]
Long-term immunity
After subcutaneous administration of MMR vaccine, antibodies to measles, mumps, and rubella viruses are still detectable in most individuals 11 to 13 years after primary vaccination. Further data indicate greater than 99% of people receiving 2 doses of measles vaccine (with the first dose administered no earlier than the first birthday) develop serologic evidence of measles immunity. Although vaccination produces lower antibody concentration than natural disease, serologic and epidemiologic evidence indicate vaccination produces long-term, probably life-long immunity in most people. More than 97% of patients develop measurable antibodies after mumps vaccination. Similar to measles, mumps vaccination produces lower antibody concentrations than natural disease, but serologic and epidemiologic data indicate long-term immunity. After vaccination with rubella vaccine, 95% or more of children 12 months or older develop serologic evidence of immunity. Clinical efficacy and challenge studies indicate greater than 90% of people have protection against rubella for at least 15 years.[30319][55005]
The measles, mumps, and rubella (MMR) vaccine is contraindicated in pregnancy or people who may become pregnant within the next month. Educate individuals of reproductive capacity on the importance of prevention of pregnancy for 4 weeks after vaccination. Acquisition of wild-type measles during pregnancy has reportedly led to increased rates of spontaneous abortion, stillbirth, congenital defects, and prematurity. Wild-type mumps virus infection during the first trimester of pregnancy may increase the rate of spontaneous abortion. The mumps vaccine virus has been shown to infect the placenta, but there is no evidence that it causes congenital malformation or disease in the fetus or infant. Pregnant individuals infected with wild-type rubella virus are at increased risk of miscarriage or stillbirth, and their neonates are at risk for Congenital Rubella Syndrome (CRS). CRS in the infant can lead to eye problems (cataracts, glaucoma, retinitis), congenital heart defects, hearing loss, microcephaly, and intellectual disabilities. Between 1971 and 1989, a Vaccine in Pregnancy registry tracked 1,221 individuals who inadvertently received rubella virus vaccines within 3 months before or after conception. No increase in fetal abnormalities or cases of CRS was observed. From 1978 to 2018, postmarketing data followed 425 individual pregnancies prospectively who received measles, mumps, and rubella vaccine inadvertently. Among these, there were 16 cases of major birth defects, 4 cases of fetal death, 50 miscarriages, but no abnormalities or cases of CRS were reported. However, one case of CRS has been reported during postmarketing experience. A pregnant individual was inadvertently administered a measles, mumps, rubella virus containing vaccine from an unknown manufacturer at 5 weeks gestation. If vaccination is needed, vaccinate individuals immediately after delivery.[30319] [65107] [67659]
According to the CDC, live-virus vaccines administered to a lactating woman do not affect the safety of breast-feeding for women or their infants. Although live viruses in vaccines can replicate in vaccine recipients (i.e., the mother), the majority of live viruses in vaccines have been demonstrated not to be excreted in human milk. The rubella vaccine virus may be excreted in human milk; however, the virus usually does not infect the infant. If infection does occur, it is well tolerated because the virus is attenuated. There are no data to suggest that passive transfer of antibodies in human milk can affect the efficacy of live-virus vaccines. Breastfed infants should be vaccinated according to the recommended schedule.[43236] The manufacturer of the measles/mumps/rubella (MMR) vaccine states that caution should be used when the vaccine is administered to a breast-feeding woman; lactating women immunized with live attenuated rubella vaccine may secrete the virus in breast milk and transmit it to breast-feeding infants. In the infants with serological evidence of rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of acquired rubella. The ability of either the measles or mumps vaccine virus to be secreted in human milk is unknown.[30319] Consider the benefits of breast-feeding, the risk of infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, health care providers are encouraged to report the adverse effect to the FDA.
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