Can the Measles, Mumps, and Rubella (MMR) vaccine be given together with other vaccines in a healthy pediatric or adult patient?

MMR Vaccine Can Be Given Together with Other Vaccines

Yes, MMR vaccine can and should be administered simultaneously with other vaccines at separate anatomic sites, and this approach is strongly recommended by the CDC and ACIP. 1

Core Principle for Simultaneous Administration

Simultaneous administration of MMR with other routine vaccines does not impair antibody responses or increase adverse reaction rates. 2 The key evidence supporting this practice includes:

• All inactivated vaccines can be given together with MMR at any time without concern for interference, including DTaP/DTP, hepatitis A, hepatitis B, Hib, IPV, and pneumococcal vaccines 1
• Equivalent antibody responses and no clinically important increases in adverse events occur when DTP, Hib, OPV (or IPV), hepatitis B, and varicella vaccines are administered with MMR either simultaneously at different sites or at separate times 2
• Routine simultaneous administration of MMR, DTP, HbCV, and OPV (or IPV) to all children ≥15 months who are eligible is recommended 2

Live Vaccine Considerations

There is one critical timing rule for live vaccines:

• Live parenteral vaccines (like MMR and varicella) may be administered simultaneously on the same day at different sites, OR must be separated by at least 4 weeks if not given together 1
• Administering two live parenteral vaccines within 28 days of each other (rather than simultaneously) may result in impaired immune response 1

This means if you give MMR today, you can either give varicella vaccine today at a different site, or you must wait 4 weeks. The 1-27 day window should be avoided.

Specific Vaccine Combinations Proven Safe with MMR

Pediatric Vaccines

• DTaP, Hib, hepatitis B, IPV, varicella, and pneumococcal conjugate vaccines can all be administered simultaneously with MMR 2, 1
• Clinical trials demonstrated that concomitant administration of MMR with varicella and hepatitis vaccines showed seroconversion rates >93-100% for all antigens with no significant safety concerns 1
• A study of 1,915 children showed that MMRV (combined MMR-varicella) given with Hib/HepB and DTaP concomitantly was well-tolerated with appropriate immune responses 3
• MMR administered with the fourth dose of pneumococcal conjugate vaccine (PCV7) showed noninferior immune responses in 694 children aged 12-15 months 4

Adult Vaccines

• Simultaneous administration of hepatitis A, varicella, and MMR vaccines in adults produces comparable immune responses and safety profiles to sequential administration 1

Administration Technique

Critical technical points:

• Vaccines must be given at separate anatomic sites when administered simultaneously 1
• Individual vaccines should never be mixed in the same syringe unless specifically FDA-licensed for mixing 1
• Ensure full recommended doses are administered (do not use reduced volumes) 5

Clinical Decision-Making Algorithm

Simultaneous administration is particularly important when: 1

1. There is imminent exposure to several infectious diseases
2. The patient is preparing for foreign travel
3. There is uncertainty the patient will return for future doses - this is the most common real-world scenario
4. The child might not be brought back for future immunizations

In these situations, administer all vaccines (including DTP, OPV/IPV, MMR, HbCV, hepatitis B, and varicella) appropriate to the age and previous vaccination status simultaneously. 2

Common Pitfalls to Avoid

• Do not unnecessarily delay vaccines by spacing them out when simultaneous administration is safe - approximately one-third of missed vaccination opportunities occur when vaccines are not given together during the same visit 1
• Do not give two live parenteral vaccines 1-27 days apart - this is the only problematic window; either give them same day or wait ≥28 days 1
• Do not assume that more vaccines given together means more adverse events - the safety profiles are comparable whether vaccines are given together or separately 2, 3

Safety Profile

Serious outcomes after MMR are rare in both children and adults: 6

• Incidence of serious outcomes (anaphylaxis, encephalitis, Guillain-Barré syndrome, immune thrombocytopenia, meningitis, seizure) ≤6 per 100,000 doses 6
• Common non-serious outcomes include injection site reactions (157 per 100,000), arthropathy (263 per 100,000), and rash (113 per 100,000) 6
• When MMR is given with other vaccines simultaneously, the safety profile remains comparable to when vaccines are given separately 3, 4, 7