Measles Mumps Rubella Vaccine

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Contents 1 Indications 2 Contraindications 3 Dosage 4 Pharmacokinetics 5 Adverse-effects 6 Drug-interactions 7 Test-interactions 8 Mechanism-of-action 9 More General Terms 10 Additional Terms 11 References

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:

• children

• 1st dose at 15 months
• 2nd dose prior to school entry

• college students, military recruits & hospital workers born after 1957
• travelers to endemic areas born after 1957

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:

• females should avoid pregnancy for 3 months afer vaccination
• postpone until after acute febrile illness
• 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
• 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]

• all serious adverse reactions must be reported to FDA
• no link with autism [4]

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

• live virus vaccine

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

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: [1]
6. MUMPS Advisory #1, secretary of health

measles, mumps & rubella combined vaccine (MMR)