Measles-Mumps-Rubella (MMR) Vaccination
All children should receive two doses of MMR vaccine: the first at 12-15 months of age and the second at 4-6 years of age, with a minimum 28-day interval between doses. 1
Routine Vaccination Schedule
Standard Two-Dose Series
- First dose: 12-15 months of age (may be given as early as 12 months in high-risk areas)
- Second dose: 4-6 years of age (before school entry)
- Minimum interval: 28 days between doses 2, 3
The second dose is not a booster but addresses primary vaccine failure, which occurs in approximately 5% of recipients after the first dose 2. After two doses, vaccine effectiveness reaches 96% for measles prevention 2.
High-Risk Areas
In counties with large inner-city populations, recent measles outbreaks among unvaccinated preschoolers, or >5 cases among preschoolers in each of the last 5 years, administer the first dose at 12 months rather than waiting until 15 months 2.
Special Populations
Adults born before 1957 are generally considered immune and do not require vaccination, though vaccination should be considered during outbreaks 4, 5.
Adults born in 1957 or later require documentation of:
- Two doses of MMR vaccine (minimum 28 days apart), OR
- Laboratory evidence of immunity, OR
- Laboratory confirmation of disease 4
High-risk adults requiring two doses include:
- Healthcare personnel
- Students in post-secondary educational institutions
- International travelers
- Military personnel 4, 5
Contraindications
Absolute contraindications include:
- Pregnancy (women should avoid pregnancy for 28 days after vaccination) 6
- Severe immunodeficiency (except HIV-infected persons without severe immunosuppression) 2
- History of anaphylactic reaction to vaccine components 1
HIV-infected persons aged ≥12 months without current severe immunosuppression should receive MMR vaccine at 12 months and 4-6 years 7. Those with perinatal HIV infection vaccinated before effective antiretroviral therapy should be revaccinated with two appropriately spaced doses once therapy is established 7.
Post-Exposure Prophylaxis
MMR Vaccine for Post-Exposure Prophylaxis
For immunocompetent persons ≥12 months exposed to measles, administer MMR vaccine within 72 hours of exposure 2, 1. This provides some protection and is preferable to immune globulin in most settings (schools, healthcare facilities, daycare) 2.
Vaccine effectiveness for post-exposure prophylaxis is 74% when given within 72 hours and 83.4% overall 8. However, MMR vaccine is contraindicated for post-exposure prophylaxis in immunocompromised persons and pregnant women 2.
For household contacts aged ≥6 months, vaccine within 72 hours is acceptable, but immune globulin is recommended if this window is missed 2.
Immune Globulin for Post-Exposure Prophylaxis
Immune globulin (IG) must be administered within 6 days of measles exposure to prevent or modify disease 2.
Dosing Recommendations
Standard intramuscular IG (IGIM):
- Immunocompetent persons: 0.25 mL/kg (maximum 15 mL) 2
- Immunocompromised persons: 0.5 mL/kg (maximum 15 mL) 2
- Infants <6 months: 0.5 mL/kg if injection volume is not a concern 9
Intravenous immune globulin (IGIV):
- 400 mg/kg as a single dose 9, 10
- Preferred when injection volume is a concern or for recipients ≥30 kg 9
- Recommended for severely immunocompromised persons and pregnant women without measles immunity 7, 10
IG Indications
IG is specifically indicated for susceptible household contacts at high risk:
- Infants ≤12 months (including those <6 months despite maternal antibodies if mother has measles) 2, 7
- Pregnant women 2
- Immunocompromised persons 2
Critical timing consideration: IG prophylaxis is NOT indicated for household contacts who received measles vaccine on or after their first birthday, unless immunocompromised 2.
Important Caveats for Post-Exposure Management
After IG administration, MMR vaccine must be delayed 5-6 months to avoid interference from passively acquired antibodies 2. The vaccine should then be given provided the person is ≥12 months and vaccine is not otherwise contraindicated.
IG does not prevent rubella or mumps and should not be used for post-exposure prophylaxis of these diseases 2. For rubella exposure in pregnancy, IG may modify symptoms but does not prevent infection or viremia, and infants with congenital rubella have been born to women who received IG after exposure 2.
Administration Details
- Dose: 0.5 mL subcutaneously or intramuscularly 2, 1
- Storage: 2-8°C; protect from light 2
- After reconstitution: Use immediately or store at 2-8°C protected from light for maximum 8 hours 1
MMR vaccine can be administered simultaneously with other vaccines at different anatomic sites without safety concerns or immune interference 2, 3.