MEASLES MUMPS AND RUBELLA (MMR) VACCINE


As of 2005 available in combination with Varicella under the brand name "Proquad"

I. Revaccination

  1. The recommendation for a second MMR came around 1991, so many won't have gotten 2nd at 11-12y, so check, esp. young people!
  2. For re-vaccination, give MMR, NOT MONOVALENT MEASLES vaccine, because protection against rubella is also necessary

II. Adverse effects

  1. 5-15% get fever > 103F; us. starts 5-12d after vaccination and lasts several days
  2. Febrile sz may occur from the fever; may be more common in kids with h/o sz but no proven increase in risk of eventual sz disorder or other neurological prob. in these kids and ACIP reccs giving them MMR (MMWR 45:11, 1996), but make sure parents of these kids treat ANY fever occurring after the vaccination with antipyretics
  3. Also can get transient rashes
  4. Rarely, thrombocytopenia in 2mos after immunization (1:30,000-40,000); usually transient and benign
  5. For second shot, giving it at age 4-5 may result in lower incidence of side effects than at age 10-12 (rash, seizures, arthralgias, RR 0.56; Peds. 100:767, 1997--AFP)

II. Contraindications to MMR

  1. Immunosuppression (leukemia, lymphoma, generalized malignancy, immunosuppressive Rx (inhaled steroids don't count), HIV-see "Vaccination issues in AIDS"); some cases of death from measles vaccine-strain viral infection in immunocompromised persons
  2. Pregnancy (or poss. of getting preg. <3mo post-immuniz.), though no evidence for teratogenicity
  3. URI and/or mild fever is not a contraind.
  4. Mod-severe febrile illnesses: waiting "Avoids superimposing adverse effects of vaccination on underlying illness or mistakenly attributing a manifestation of the underlying illness og the vaccine." (MMWR 45:11, 1996)
  5. Egg allergy-not a contraindication even though some egg albumin in the vaccine (ibid)
  6. Recent vaccination with immune globlulins may reduce effectiveness
  7. MMR containing the RA 27/3 Rubella strain ass'd with risk of acute arthritis and poss. chronic arthritis; unclear to me if that's still used