What is the recommended schedule for the Measles, Mumps, and Rubella (MMR) vaccine?

MMR Vaccine Schedule

The first dose of MMR vaccine should be administered at 12-15 months of age, with the second dose routinely given at 4-6 years of age (before school entry). 1

Standard Two-Dose Schedule

First Dose (12-15 Months)

• The minimum age for MMR vaccination is 12 months. 1
• The CDC and AAP recommend routine administration between 12-15 months of age as part of the standard childhood immunization schedule. 1
• For children who missed the routine schedule, the first dose can still be administered up to 12 years of age. 1

Second Dose (4-6 Years)

• The second dose is routinely recommended at 4-6 years of age, typically before kindergarten entry. 1
• This second dose may be administered earlier than 4 years of age, provided at least 4 weeks have elapsed since the first dose. 1
• The minimum interval between first and second doses is 4 weeks. 1
• Children who have not received the second dose by school entry should complete the schedule by age 11-12 years. 2

MMRV Combination Vaccine Considerations

First Dose (12-47 Months)

• For children aged 12-47 months, either separate MMR plus varicella vaccines OR the combination MMRV vaccine may be used. 2, 1
• Unless parents express a preference for MMRV, the CDC recommends using separate MMR and varicella vaccines for the first dose in this age group due to increased febrile seizure risk. 2
• MMRV carries approximately one additional febrile seizure per 2,300-2,600 doses compared to separate vaccines in children aged 12-23 months. 2

Second Dose and First Dose ≥48 Months

• For the second dose at any age (15 months-12 years) or first dose at ≥48 months, MMRV vaccine is generally preferred over separate injections. 2, 1
• The 47-month cutoff was selected because approximately 97% of febrile seizures occur in children ≤47 months of age. 2

Special Circumstances and Precautions

Seizure History

• A personal or family history (sibling or parent) of seizures of any etiology is a precaution for MMRV vaccination. 1
• Children with such history should receive separate MMR and varicella vaccines instead of MMRV. 2, 1

Catch-Up Vaccination

• Older children and adolescents who have not been vaccinated should receive 2 doses at least 4 weeks apart. 1
• Adults born in 1957 or later should receive at least one dose unless they have documentation of vaccination or laboratory evidence of immunity. 3

High-Risk Situations

• During measles outbreaks or international travel, infants aged 6-11 months should receive a single dose of MMR for protection. 3
• This early dose does not count toward the routine two-dose schedule; these children must be revaccinated at 12-15 months and again at 4-6 years. 3

Administration Guidelines

• MMR can be administered simultaneously with other vaccines at different anatomic sites. 1, 3
• If not given simultaneously with other live vaccines, MMR should be administered at least 28 days before or after another live vaccine. 1, 3
• The vaccine is given subcutaneously as a 0.5 mL dose. 3

Contraindications

• MMR should not be administered to severely immunocompromised children. 1, 3
• Pregnant women should not receive MMR vaccine but can be vaccinated immediately postpartum if non-immune. 3