What is the recommended schedule and administration for the Rubella (German measles) vaccine?

Rubella Vaccine Schedule and Administration

The rubella vaccine is recommended for all children with a first dose at 12-15 months of age and a second dose at 4-6 years of age, administered subcutaneously as 0.5 mL of reconstituted vaccine, preferably as part of the MMR (measles, mumps, rubella) combination vaccine. 1

Standard Schedule for Children

• First dose: Administered at 12-15 months of age as part of routine childhood immunization 1, 2
• Second dose: Administered at 4-6 years of age (before school entry) 1, 2
• The minimum interval between doses is 4 weeks, though the recommended schedule spaces them further apart 2, 3
• The vaccine is administered subcutaneously as a 0.5 mL dose 1
• Preferably given as MMR combination vaccine rather than monovalent rubella vaccine 1

Special Circumstances

• For children in high-risk areas for measles transmission, initial MMR vaccination may be given at 12 months of age 1
• Infants vaccinated with MMR before their first birthday should be revaccinated, as maternal antibodies may interfere with seroconversion 1
• During international travel, infants aged 6-11 months should receive a single dose of MMR, but this does not count toward the routine two-dose schedule 1
• During measles outbreaks, infants aged 6-11 months should receive a single dose of MMR for protection 1

Administration Considerations

• MMR can be administered simultaneously with other vaccines at different anatomic sites 1, 3
• If not administered simultaneously with other live vaccines, MMR should be given at least 28 days before or after another live vaccine 2, 3
• Two MMR vaccines are currently available in the US (M-M-R II and PRIORIX) and are considered fully interchangeable 1
• Documentation of vaccination should be maintained in the patient's permanent medical record 1

Catch-up Vaccination

• Older children who have not received rubella vaccine should be vaccinated promptly 1
• For catch-up vaccination of previously unvaccinated children and adolescents, 2 doses are recommended at least 4 weeks apart 1, 2
• Adults born in 1957 or later should receive at least one dose of MMR vaccine unless they have documentation of vaccination or laboratory evidence of immunity 1

Effectiveness and Immunity

• Greater than 95% of susceptible persons who receive a single dose of rubella vaccine develop antibody 1
• Clinical efficacy studies show that >90% of vaccinees have protection against both clinical rubella and viremia for at least 15 years 1
• Vaccine-induced protection is considered long-term, probably lifelong 1
• Persons can be considered immune to rubella if they have documentation of laboratory evidence of immunity or adequate immunization with at least one dose of rubella vaccine on or after the first birthday 1

Women of Childbearing Age

• All women of childbearing age should be considered susceptible to rubella unless they have received at least one dose of MMR or have serologic evidence of immunity 1
• MMR vaccine should be offered to all women of childbearing age who do not have acceptable evidence of rubella immunity 1
• Vaccination of susceptible postpubertal females confers individual protection against rubella-induced fetal injury 1

Contraindications and Precautions

• MMR should not be administered to severely immunocompromised children 2
• For persons with HIV infection, MMR is recommended for all persons aged ≥12 months who do not have evidence of current severe immunosuppression 4
• A personal or family history of seizures is a precaution for MMRV vaccination; in these cases, separate MMR and varicella vaccines are recommended 2

The two-dose schedule of MMR vaccine provides optimal protection against rubella, measles, and mumps while reducing the risk of outbreaks in school settings and communities 1, 4. Following this recommended schedule is critical for maintaining rubella elimination in the United States and preventing congenital rubella syndrome 4.