MMR Vaccine Recommendations | Mumps - CDC
Introduction
Mumps vaccine is included in these combination vaccines:
- Measles, mumps, and rubella (MMR) vaccine
- Measles, mumps, rubella, and varicella (MMRV) vaccine
This page summarizes CDC's current MMR and MMRV vaccine recommendations by age and risk. Access the official, full text below:
ACIP Recommendations on MMR vaccine and other MMWR articles. Advisory Committee on Immunization Prac...
ACIP Recommendations on MMRV vaccine and other MMWR articles. Advisory Committee on Immunization Pra...
MMR effectiveness against mumps
Two doses of mumps vaccine are 88% (range 32% to 95%) effective at preventing mumps.
One dose is 78% (range 49% to 91%) effective at preventing mumps.
Presumptive evidence of immunity
ACIP recommends that people who don't have presumptive evidence of immunity to measles, mumps, and rubella should get vaccinated against these diseases.
Presumptive evidence of immunity can be established in any of the following ways:
- Written documentation of adequate vaccines for measles, mumps, and rubella
- One or more doses of a MMR vaccine administered on or after the first birthday
- Two doses of MMR vaccine for school-age children and adults at high risk, including college students, healthcare personnel, and international travelers
- Laboratory evidence of immunity
- Laboratory confirmation of disease
- Birth before 1957
Healthcare providers should not accept verbal reports of vaccination without written documentation as presumptive evidence of immunity.
Routine MMR recommendations
Children
CDC recommends children should routinely get 2 doses of MMR vaccine:
- First dose at age 12 through 15 months
- Second dose at age 4 through 6 years (before school entry)
This can be administered as MMR or MMRV vaccine. Children can receive the second dose of MMR vaccine earlier than 4 through 6 years (as long as it is at least 28 days after the first dose). A second dose of MMRV vaccine can be given 3 months after the first dose up to 12 years of age.
CDC recommends that separate MMR and varicella vaccines be given for the first dose in children aged 12–47 months; however, MMRV may be used if parents or caregivers express a preference.
Adults
Adults and teens should also be up to date on MMR vaccinations with either 1 or 2 doses (depending on risk factors); unless they have other presumptive evidence of immunity to measles, mumps, and rubella. MMR vaccination is especially important for healthcare professionals, international travelers, and other specific groups.
One dose of MMR vaccine, or other presumptive evidence of immunity, is sufficient for most adults. Providers generally do not need to actively screen adult patients for measles immunity in non-outbreak areas in the United States. After vaccination, it is also not necessary to test patients for antibodies to confirm immunity. There is no recommendation for a catch-up program among adults for a second dose of MMR (e.g., people born before 1989 or otherwise).
Special considerations for mumps vaccine
After the U.S. mumps vaccination program started in 1967, there has been a more than 99% decrease in mumps cases in the United States. However, mumps outbreaks still occur, particularly in settings where people have close, prolonged contact, such as universities, schools, and correctional facilities.
In outbreaks of highly vaccinated communities, the proportion of cases that occur among vaccinated people may be high. This does not mean that the vaccine is ineffective. The effectiveness of the vaccine is assessed by comparing the attack rate in vaccinated people with the attack rate in unvaccinated people. During outbreaks, unvaccinated people usually have a much greater mumps attack rate than fully vaccinated people.
For groups at increased risk during mumps outbreak
In October 2017, ACIP recommended that people identified by public health authorities as being part of a group at increased risk for acquiring mumps in an outbreak should receive a third dose of MMR vaccine. This recommendation aims to improve protection of people in outbreak settings against mumps disease and mumps-related complications.
Vaccination during outbreaks
- Children 12 months of age to 4 years of age who are unvaccinated should receive 1 dose of MMR or MMRV.
- People 4 years of age or older who are unvaccinated or have received only 1 dose of MMR or MMRV should receive MMR.
- 2 doses for unvaccinated
- 1 dose for people who previously received the first dose (administered 28 days apart)
- You should not give a third dose unless your patient is part of a group at increased risk, determined by your local public health authorities. If you suspect an outbreak or are unsure if your patient belongs to a group at increased risk, contact your local health department for more information.
Mumps in vaccinated people
During these outbreaks, people who previously had 1 or 2 doses of MMR vaccine can still get mumps and transmit the disease. Disease symptoms are generally milder, and complications are less frequent in vaccinated people.
Experts aren't sure why vaccinated people still get mumps, but some evidence suggests that:
- Some people's immune systems may not respond as well as they should to the vaccine.
- The mumps vaccine may produce antibodies (proteins created by the body's immune system to help fight infections) that are not as effective against wild-type virus strains.
- In some people, antibodies from mumps vaccination may decrease overtime, until they no longer protect the person from mumps.
- As most people are not routinely exposed to mumps, there is less immunologic boosting (where people are exposed to mumps which boosts their immunity, but they do not get sick).
Post-exposure prophylaxis for mumps
Unlike with measles, MMR vaccine is not effective at helping protect people who have recently been infected with mumps (post-exposure prophylaxis, or PEP). MMR vaccine should not be used as post-exposure prophylaxis in immediate close contacts.
However, vaccination after exposure is not harmful and may possibly prevent later disease if re-exposed. Close contacts should still be offered a 1 dose to help protect them against future exposures; in the event that their prior exposures did not result in infection.
For more information on mumps outbreak control and post-exposure prophylaxis, healthcare providers should:
- Consult their health department.
- Refer to the mumps chapter of the Surveillance of Vaccine-Preventable Diseases Manual.
MMR & MMRV contraindications and precautions
Contraindications and precautions to vaccination generally dictate circumstances when vaccines will not be given. Most contraindications and precautions are temporary, and the vaccine can be given at a later time.
Contraindications
A contraindication is a condition in a recipient that greatly increases the chance of a serious adverse reaction; or due to the theoretical risk in the case of pregnant patient.
People with a contraindication for MMR or MMRV vaccine should not receive the vaccine, including anyone who—
- Had a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
- Has a known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, congenital immunodeficiency, or long-term immunosuppressive therapy or patients with human immunodeficiency virus [HIV] infection who are severely immunocompromised)
- Is pregnant
Precautions
A precaution is a condition in a recipient that might increase the chance or severity of a serious adverse reaction; or that might compromise the ability of the vaccine to produce immunity. This includes administering MMR or MMRV vaccine to a person with passive immunity to measles from a blood transfusion.
Precautions for MMR or MMRV vaccine include—
- Moderate or severe acute illness with or without fever
- Recent (within 11 months) receipt of antibody-containing blood product (specific interval depends on product)
- History of thrombocytopenia or thrombocytopenic purpura
- Need for tuberculin skin testing or interferon gamma release assay (IGRA) testing
- Personal or family history of seizures
Resources
Manuals & chapters
Comments
Post a Comment