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

MMR Vaccine Schedule and Administration

Recommended Vaccination Schedule

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

First Dose Timing

• The minimum age for MMR vaccination is 12 months 1
• The routinely recommended age range is 12-15 months as part of standard childhood immunization 2, 1
• Children who miss the routine schedule can receive their first dose up to 12 years of age 1
• The slightly lower seroconversion rate at 12 months (93-96%) compared to 15 months (98%) has limited clinical significance because the second dose will capture most non-responders 2

Second Dose Timing

• The second dose is routinely recommended at 4-6 years of age (before school entry) 1, 3
• The minimum interval between first and second doses is 4 weeks 1, 4
• The second dose may be administered earlier than 4 years if needed, provided at least 4 weeks have elapsed since the first dose 1
• Children who miss the second dose by school entry should complete the schedule by age 11-12 years 1

Administration Guidelines

Route and Dosage

• MMR is administered subcutaneously as a 0.5 mL dose of reconstituted vaccine 4

Simultaneous Administration with Other Vaccines

• MMR may be administered simultaneously with other vaccines recommended for children at different anatomic sites 2, 4
• If not given simultaneously with other live vaccines, MMR should be administered at least 28 days before or after another live attenuated vaccine 2, 4
• MMR may be given at any time before or after an inactivated vaccine 2

MMRV Combination Vaccine Considerations

First Dose (Ages 12-47 Months)

For the first dose in children aged 12-47 months, separate MMR and varicella vaccines are recommended over MMRV due to increased febrile seizure risk. 1

• MMRV carries approximately one additional febrile seizure per 2,300-2,600 doses compared to separate vaccines in children aged 12-23 months 1
• Providers should discuss benefits and risks with parents/caregivers if considering MMRV 2, 1
• Unless parents express a preference for MMRV, CDC recommends separate MMR and varicella vaccines for the first dose 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 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 1

Contraindication for MMRV

• A personal or family history (sibling or parent) of seizures of any etiology is a precaution for MMRV vaccination 2, 1, 4
• Children with seizure history should receive separate MMR and varicella vaccines 2, 1

Special Circumstances

Infants and International Travel

• During measles outbreaks or international travel, infants aged 6-11 months should receive a single dose of MMR for protection 4
• This early dose does not count toward the routine two-dose schedule, and infants must be revaccinated at 12-15 months because maternal antibodies may interfere with seroconversion 4

Catch-Up Vaccination

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

High-Risk Populations Requiring Two Doses

• Students in postsecondary educational institutions, healthcare personnel born in 1957 or later, international travelers, and household contacts of immunocompromised persons should receive a complete 2-dose series with at least 4 weeks between doses 4

Contraindications and Precautions

Absolute Contraindications

• MMR should not be administered to severely immunocompromised children 1, 4
• Pregnant women should not receive MMR vaccine but can be vaccinated immediately postpartum if non-immune 4

Documentation

• Vaccination should be documented in the patient's permanent medical record 4
• Immunity can be verified through documentation of MMR vaccine receipt, laboratory evidence of immunity or disease, or birth before 1957 (except healthcare personnel should still be vaccinated regardless) 4

Vaccine Effectiveness

• Greater than 95% of susceptible persons develop antibody after a single dose of rubella vaccine 4
• Clinical efficacy studies show >90% protection against both clinical rubella and viremia for at least 15 years 4
• Vaccine-induced protection is considered long-term, probably lifelong 4
• The two-dose schedule ensures that primary vaccine failures (those who don't respond to the first dose) are captured with the second dose 2, 3