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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 IM or 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
During clinical trials and postmarketing experience, cerebellitis, cerebellitis-like symptoms (including transient gait disturbance and transient ataxia), encephalitis, encephalopathy, meningitis, measles inclusion body encephalitis (MIBE), subacute sclerosing panencephalitis (SSPE), Guillain-Barre Syndrome (GBS), acute disseminated encephalomyelitis (ADEM), transverse myelitis, vasculitis (including Henoch-Schonlein purpura and Kawasaki syndrome), ataxia, polyneuritis, polyneuropathy, peripheral neuritis, ocular palsies, paresthesias, and syncope were reported.[30319] [67659]
Fever (2.7% to 66.8%) and febrile seizures (0.2%) have been reported during clinical trials. During postmarketing experience, afebrile seizures were also reported.[30319] [67659]
Measles/rubella-like rash was reported in 0.5% to 6.6% of patients in clinical trials. Measles/Measles-like rash (2.9% IM; 2.7% subcutaneous administration), Rubella/Rubella-like rash (2.7% IM; 2.7% subcutaneous administration), Varicella/Varicella-like rash (0.5% IM; 3.2% subcutaneous administration), and Mumps-like illness (0% IM; 0.3% subcutaneous administration) were reported during clinical trials. During clinical trials and postmarketing experience, anaphylactic shock, anaphylactoid reactions, angioedema, bronchospasm, Stevens-Johnson syndrome, acute hemorrhagic edema of infancy, erythema multiforme, encephalitis, urticaria, rash, measles-like rash, pruritus, and panniculitis were reported.[30319] [67659]
During clinical trials and postmarketing experience, thrombocytopenia, thrombocytopenic purpura, regional lymphadenopathy, and leukocytosis were reported. 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]
Anorexia or loss of appetite (21% to 45%) and parotid or salivary gland swelling (0.2%) have been reported in patients receiving MMR vaccine during clinical trials. During clinical trials and postmarketing experience, pancreatitis, diarrhea, vomiting, and nausea were reported.[30319] [67659]
Joint pain, including arthralgia and arthritis, were reported in 0.9% to 2% of patients receiving MMR vaccine during clinical trials. During clinical trials and postmarketing experience, myalgia was reported.[30319] [67659]
Irritability (63%) and drowsiness (27% to 45%) have been reported during clinical trials. Signs of meningeal irritation, including neck stiffness with or without photophobia or headache, were reported in 0.1% to 0.7% of patients receiving MMR vaccine during clinical trials. During clinical trials and postmarketing experience, meningitis, measles-like illness, mumps-like illness (including epididymitis, parotitis, and orchitis), atypical measles, fever, headache, dizziness, malaise, and irritability were reported.[30319] [67659]
Injection site reaction including pain (7% to 41%), redness (12% to 25%), swelling (1.9% to 11.3%), and erythema (10.4% to 16.2%) has been reported during measles; mumps; rubella virus (MMR) vaccine clinical trials. Erythema was reported more often in patients receiving subcutaneous MMR (16.2% overall; 13% mild; 3.2% moderate) compared to intramuscular administration (10.4% overall; 8.8% mild; 0.8% moderate; 0.8% missing data). Pain occurred in a similar incidence of patients receiving intramuscular MMR (7% overall; 5.1% mild; 1.9% moderate) and subcutaneous MMR (7.2% overall; 5.9% mild; 1.3% moderate). Swelling was reported more often in patients receiving subcutaneous MMR (5.3% overall; 2.9% mild; 1.1% moderate; 1.3% missing) compared to intramuscular administration (1.9% overall; 1.1% mild; 0.5% moderate, 0.3% missing).[30319] [67659]
During clinical trials and postmarketing experience, pneumonia, pneumonitis, sore throat or throat irritation, cough, rhinitis, nerve deafness, and otitis media were reported.[30319] [67659]
During clinical trials and postmarketing experience, retinitis, optic neuritis, papillitis, and conjunctivitis were reported.[30319] [67659]
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 an individual recently received an MMR vaccine. Approximately 5% of people experience a rash after the MMR vaccine; approximately 1% of syndromic panels report a positive measles result after MMR vaccination. Individuals 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]
The coadministration of certain medications may lead to harm and require avoidance or therapy modification; review all drug interactions prior to concomitant use of other medications.
This medication is contraindicated in patients with a history of hypersensitivity to it or any of its components. MMR II is contraindicated in individuals with a gelatin hypersensitivity; it contains hydrolyzed gelatin as a stabilizer.[30319] Use the Priorix vaccine with caution in individuals with a latex hypersensitivity; the tip caps of the prefilled syringes of diluent contain natural rubber latex.[67659] Measles virus; Mumps virus; Rubella virus vaccine is perseverative-free but contains trace neomycin and other components (e.g., gelatin, albumin). It is contraindicated in individuals with immediate-type hypersensitivity to these components. However, contact dermatitis is not a contraindication. Allergist consultation is advised if vaccination is essential in individuals with a history of anaphylactic reactions to neomycin. Most anaphylaxis cases after measles or mumps containing vaccines are due to components (e.g., gelatin, neomycin) other than egg protein.[30319][67659][72641] Despite measles and mumps vaccines being cultured in chick embryos, MMR can be safely administered to most egg-allergic patients without prior skin testing, as the risk of serious reactions is extremely low. Vaccination is appropriate unless there is a known life-threatening allergy to a specific vaccine component. Providers should review allergy history and be prepared to treat anaphylaxis.[72641]
Deferral of the MMR vaccine administration may be appropriate for a patient with a moderate or severe acute illness such as infection with or without fever. The Advisory Committee on Immunization Practices recommends that vaccinations be delayed during the course of a moderate or severe acute febrile illness and administered after the acute phase of illness has resolved. All vaccines can be administered to persons with minor illnesses such as diarrhea, mild upper-respiratory infection with or without low-grade fever, or other low-grade febrile illness. Vaccinate persons with moderate or severe febrile illness as soon as they have recovered from the acute phase of the illness.[65107]
Transient thrombocytopenia has been reported within 4 to 6 weeks after vaccination. Consider the potential risk and benefit of vaccination in individuals with thrombocytopenia or in those who experienced thrombocytopenia after vaccination with a previous dose of a measles, mumps, and rubella-containing vaccine.[30319] [67659]
Use caution when administering the measles, mumps, and rubella vaccine (MMR) to people with an individual or family history of febrile seizures. Pediatric patients with a history of febrile seizures or those with a family history of febrile seizures may be at a small increased risk of febrile seizure after MMR vaccination. Fever and associated febrile seizure are most common in the first 2 weeks after immunization with MMR vaccine.[30319] [67659]
Recommendations and precautions for individuals with immunosuppression are complex, but the measles, mumps, rubella (MMR) 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 individuals inadvertently vaccinated with measles-containing vaccine; additionally, disseminated mumps and rubella virus infection has occurred in immunosuppressed individuals 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, individuals 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 individuals 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 individuals with blood dyscrasias or any neoplastic disease that causes bone marrow suppression or affects the lymphatic system such as leukemia or lymphoma, including individuals currently receiving chemotherapy or radiation therapy.[30319] [43236] individuals 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 II) vaccine is contraindicated in individuals with an active febrile illness with fever greater than 101.3 degrees F (38.5 degrees C) or active untreated tuberculosis.[30319]
The measles, mumps, and rubella vaccine (MMR) is contraindicated during pregnancy due to the potential for serious maternal and fetal adverse outcomes associated with live virus exposure, as evidenced by data from wild-type infections. Wild-type measles infection during pregnancy has been linked to increased rates of spontaneous abortion, stillbirth, preterm delivery, and congenital defects. Wild-type mumps virus infection in the first trimester may raise the risk of spontaneous abortion; although the mumps vaccine can infect the placenta, it has not been shown to cause congenital malformations or fetal disease. Pregnant individuals infected with wild-type rubella virus face higher risks of miscarriage or stillbirth, and first-trimester infection can cause severe congenital defects leading to Congenital Rubella Syndrome (CRS), which includes eye abnormalities, congenital heart defects, hearing loss, microcephaly, and intellectual disabilities. One vaccine-associated CRS case has been reported postmarketing following inadvertent administration of a measles, mumps, and rubella (MMR)-containing vaccine at 5 weeks gestation. Postmarketing surveillance from 1978 to 2018 of 425 pregnancies with inadvertent MMR vaccination reported 16 major birth defects, 4 fetal deaths, and 50 miscarriages, but no CRS cases. A Vaccine in Pregnancy registry (1971 to 1989) monitoring 1,221 individuals inadvertently vaccinated with rubella virus vaccines around conception found no increase in fetal abnormalities or CRS. Vaccination during pregnancy is not recommended; if vaccination is necessary, it should be administered immediately postpartum.[30319] [65107] [67659]
Counsel people who may become pregnant about the reproductive risk associated with the measles, mumps, and rubella vaccine (MMR). This vaccine is contraindicated during pregnancy due to the potential for serious fetal adverse outcomes associated with live virus exposure, as evidenced by data from wild-type infections. Advise people who may become pregnant to use effective methods to prevent pregnancy for 1 month after vaccination.[30319] [65107] [67659]
The measles, mumps, and rubella vaccine (MMR) is considered compatible with breast-feeding. According to the Advisory Committee on Immunization Practices (ACIP), MMR may be used during lactation. This vaccine does not affect the safety of breast-feeding for the individual or the breast-fed child. The rubella vaccine virus may be excreted in human milk; however, the virus usually does not infect the child. If infection does occur, it is well tolerated because the virus is attenuated. The ability of either the measles or mumps virus vaccine to be secreted in human milk is unknown. In breast-feeding infants with serological evidence of rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of acquired rubella. There are no data to suggest that passive transfer of antibodies in human milk affects the efficacy of live-virus vaccines. Breast-fed children should be vaccinated according to the recommended schedule.[30319] [67659] [65107]
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: 09/05/2025, 11:24:49 AMThe 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 vaccine (MMR) is contraindicated during pregnancy due to the potential for serious maternal and fetal adverse outcomes associated with live virus exposure, as evidenced by data from wild-type infections. Wild-type measles infection during pregnancy has been linked to increased rates of spontaneous abortion, stillbirth, preterm delivery, and congenital defects. Wild-type mumps virus infection in the first trimester may raise the risk of spontaneous abortion; although the mumps vaccine can infect the placenta, it has not been shown to cause congenital malformations or fetal disease. Pregnant individuals infected with wild-type rubella virus face higher risks of miscarriage or stillbirth, and first-trimester infection can cause severe congenital defects leading to Congenital Rubella Syndrome (CRS), which includes eye abnormalities, congenital heart defects, hearing loss, microcephaly, and intellectual disabilities. One vaccine-associated CRS case has been reported postmarketing following inadvertent administration of a measles, mumps, and rubella (MMR)-containing vaccine at 5 weeks gestation. Postmarketing surveillance from 1978 to 2018 of 425 pregnancies with inadvertent MMR vaccination reported 16 major birth defects, 4 fetal deaths, and 50 miscarriages, but no CRS cases. A Vaccine in Pregnancy registry (1971 to 1989) monitoring 1,221 individuals inadvertently vaccinated with rubella virus vaccines around conception found no increase in fetal abnormalities or CRS. Vaccination during pregnancy is not recommended; if vaccination is necessary, it should be administered immediately postpartum.[30319] [65107] [67659]
The measles, mumps, and rubella vaccine (MMR) is considered compatible with breast-feeding. According to the Advisory Committee on Immunization Practices (ACIP), MMR may be used during lactation. This vaccine does not affect the safety of breast-feeding for the individual or the breast-fed child. The rubella vaccine virus may be excreted in human milk; however, the virus usually does not infect the child. If infection does occur, it is well tolerated because the virus is attenuated. The ability of either the measles or mumps virus vaccine to be secreted in human milk is unknown. In breast-feeding infants with serological evidence of rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of acquired rubella. There are no data to suggest that passive transfer of antibodies in human milk affects the efficacy of live-virus vaccines. Breast-fed children should be vaccinated according to the recommended schedule.[30319] [67659] [65107]
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