Children vaccinated before age 12 months should be revaccinated with 2 doses of appropriately spaced MMR or MMRV vaccine, the first dose administered when the child is age 12 through 15 months 12 months if the child remains in an area where disease risk is high and the second dose at least 4 weeks later. Persons who experienced perinatal HIV-infection who may have received MMR vaccine prior to the establishment of effective combined antiretroviral therapy cART , should be revaccinated with 2 appropriately spaced doses of MMR i.
MMR series should be administered once effective cART has been established for at least 6 months and there is no evidence of severe immunosuppression. Generally, persons can be considered immune to rubella if they were born before , have serologic evidence of rubella immunity equivocal test results should be considered negative , or laboratory confirmation of disease, or have documentation of adequate vaccination for rubella. Birth before provides only presumptive evidence of rubella immunity; it does not guarantee that a person is immune to rubella.
Birth before is not acceptable evidence of rubella immunity for women who could become pregnant. Clinical diagnosis of rubella is unreliable and should not be considered in assessing immune status. Because many rash illnesses may mimic rubella infection and many rubella infections are unrecognized, the only reliable evidence of previous rubella infection is the presence of serum rubella IgG antibody.
Laboratories that regularly perform antibody testing are generally the most reliable. Follow-up studies indicate that 1 dose of vaccine confers long-term, probably lifelong, protection. Although titers to rubella wane in the years after vaccination, there is no evidence that this leads to significant susceptibility to clinical rubella or CRS.
Clinical rubella and CRS-affected pregnancies are extremely rare in vaccinated persons the United States. As with other vaccines, a history of a severe allergic reaction anaphylaxis to a vaccine component or following a prior dose is a contraindication to further doses.
Moderate or severe acute illness with or without fever in a patient is considered a precaution to vaccination, although persons with minor illness may be vaccinated. Persons with alpha-gal allergy may wish to consult their physician before receiving a vaccine that contains gelatin. Severe immunocompromise e. Patients who have not received chemotherapy for at least 3 months, whose disease remains in remission, and who have restored immunocompetence, may receive MMR or MMRV vaccine.
Healthy, susceptible close contacts of severely immunocompromised persons should be vaccinated. Persons receiving systemic high-dose corticosteroid therapy 2 milligrams per kilogram of body weight or more per day or 20 milligrams or more per day of prednisone for 14 days or more should not receive MMR or MMRV vaccine because of concern about vaccine safety.
MMR or MMRV should not be administered for at least 1 month after cessation of systemic high-dose corticosteroid therapy. Although persons receiving high doses of systemic corticosteroids daily or on alternate days for less than 14 days generally can receive MMR or MMRV immediately after cessation of treatment, some experts prefer waiting until 2 weeks after completion of therapy. Available data indicate that vaccination with MMR has not been associated with severe or unusual adverse reactions in HIV-infected persons who are not severely immunosuppressed, although antibody responses have been variable.
A family history of congenital or hereditary immunodeficiency in first-degree relatives e. Receipt of specific antiviral drugs e.
These drugs should be avoided for 14 days after vaccination. Simultaneous use of aspirin or aspirin-containing products is a precaution for MMRV vaccine due to the varicella component.
The manufacturer recommends that vaccine recipients avoid the use of salicylates for 6 weeks after receiving MMRV vaccine because of the association between aspirin use and Reye syndrome following chickenpox. A personal or family i. Children with a personal or family history of seizures of any etiology should ideally be vaccinated with separate MMR and VAR vaccines because the risks for using MMRV vaccine in this group of children generally outweigh the benefits.
MMR vaccine may be administered to egg-allergic persons without prior routine skin testing or the use of special protocols. The effect of the administration of antibody-containing blood products e. Because of the potential inhibition of the response to vaccination by passively transferred antibodies, neither MMR vaccine nor MMRV vaccine nor VAR vaccine should be administered for 3 to 11 months after receipt of antibody-containing blood products.
The interval between the antibody-containing blood product and receipt of MMR or MMRV vaccine is determined by the type of product administered. Antibody-containing products should not be given for 2 weeks following vaccination unless the benefits exceed those of the vaccine. In such cases, vaccine recipients should either be revaccinated later at the appropriate intervals ranging 3 to 11 months or tested for immunity and revaccinated if seronegative.
Measles vaccine and possibly mumps, rubella, and varicella vaccines may transiently suppress the response to tuberculin skin test TST in a person infected with Mycobacterium tuberculosis.
TST and measles-containing vaccine may be administered at the same visit if necessary. Simultaneously administering TST and measles-containing vaccine does not interfere with reading the TST result at 48 to 72 hours and ensures that the person has received measles vaccine.
If the measles-containing vaccine has been administered recently, TST screening should be delayed for at least 4 weeks after vaccination. If a pregnant woman inadvertently receives MMR or MMRV vaccine, termination of pregnancy is not recommended because the risk to the fetus appears to be extremely low. Instead, individual counseling for these women is recommended. Data from susceptible women who received rubella vaccine showed no evidence of CRS in offspring.
Studies conducted in six Latin American countries showed a negligible or absent risk for CRS after administration of rubella vaccine shortly before or during pregnancy.
Of the 1, susceptible pregnant women followed, 70 3. The experts determined that evidence supports a causal relation between MMR vaccination and anaphylaxis, febrile seizures, thrombocytopenic purpura, transient arthralgia, and measles inclusion body encephalitis in persons with demonstrated immunodeficiencies. Most adverse events reported following MMR vaccination such as fever and rash are attributable to the measles component.
Most persons with fever do not have other symptoms. MMR vaccine is associated with a very small risk of febrile seizures; approximately one case for every 3, to 4, doses of MMR vaccine administered.
The febrile seizures typically occur 6 to 14 days after vaccination and do not appear to be associated with any long-term sequelae. Children with a personal or family history of febrile seizures or family history of epilepsy might be at increased risk for febrile seizures after MMR vaccination.
Allergic reactions following the administration of MMR vaccine are rare. Most of these are minor and consist of a wheal and flare or urticaria at the injection site. Immediate, anaphylactic reactions to MMR vaccine occur in 1. Rarely, MMR vaccine may cause thrombocytopenia within two months after vaccination. The clinical course of these cases is usually transient and benign, although hemorrhage occurs rarely.
Based on case reports, the risk for MMR vaccine-associated thrombocytopenia may be higher for persons who have previously had immune thrombocytopenic purpura, particularly for those who had thrombocytopenic purpura after an earlier dose of MMR vaccine. Measles inclusion body encephalitis has been documented after measles vaccination in persons with immune deficiencies.
The illness is also known to occur within 1 year after initial infection with wild-type measles virus and has a high death rate. In the cases after MMR vaccination, the time from vaccination to development of measles inclusion body encephalitis was 4—9 months, consistent with development of measles inclusion body encephalitis after infection with wild-type measles virus. Two postlicensure studies indicated that one additional febrile seizure per 2, to 2, children age 12 through 23 months occurred 5 to 12 days after the first dose of MMRV vaccine, compared with children who had received the first dose of MMR vaccine and VAR vaccine administered as separate injections at the same visit.
Data from postlicensure studies do not suggest that this increased risk exists for children age 4 to 6 years receiving the second dose of MMRV vaccine. For information on guidance for state and local health department staff who are involved in surveillance activities for vaccine-preventable diseases, please consult the Manual for the Surveillance of Vaccine-Preventable Diseases.
The editors would like to acknowledge Zaney Leroy, Ginger Redmon, and Greg Wallace for their contributions to this chapter. American Academy of Pediatrics. Control and prevention of rubella: evaluation and management of suspected outbreaks, rubella in pregnant women, and surveillance for congenital rubella syndrome. MMWR ;50 No.
RR :1— Immunization of health-care personnel. Notice to readers. Revised ACIP recommendations for avoiding pregnancy after receiving rubella-containing vaccine. Supplement sponsorship. Potential conflicts of interest. He is an employee of Sanofi Pasteur and consultant to Merck, both producers of the vaccine. Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. Plotkin Stanley A. Reprints or correspondence: Dr. Plotkin, Sanofi Pasteur, Wismer Rd. Plotkin Sanofipasteur. Oxford Academic. Cite Cite Stanley A. Select Format Select format. Permissions Icon Permissions.
Abstract Congenital rubella syndrome CRS was discovered in the s, rubella virus was isolated in the early s, and rubella vaccines became available by the end of the same decade.
Frequency of defects in infants whose mothers had rubella during pregnancy. Google Scholar Crossref. Search ADS. Rubella during pregnancy: a follow-up study of children born after an epidemic of rubella in Sweden, , with additional investigations on proplylaxis and treatment of maternal rubella. Google Scholar PubMed.
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