Significance of measles, mumps and rubella:
(1) Measles is a leading cause of child mortality in developing countries.
(2) Epidemics of measles can occur in schools if students are unvaccinated.
(3) The risk of measles in a medical setting is 13 times that of the general population.
(4) 10-15% of young adults are susceptible to rubella.
(5) Rubella occurring in a susceptible woman who is pregnant can result in fetal malformations.
(6) Outbreaks of mumps have occurred in unvaccinated adolescents, college students and young adults.
In populations at high risk for exposure, two doses of vaccination are recommended. A single dose may not provide adequate immunity.
People who are not candidates for measles-mumps-rubella vaccine:
(1) in general anyone born during or before 1956 is considered immune, but a small percentage are still susceptible to measles and/or rubella.
(2) persons born after 1956 with either (a) physician documented infection, (b) evidence of immunity with IgG antibodies, (c) completion of an adequate course of vaccination
Immunization schedule in children:
(1) first dose from 12-18 months
(2) second dose may be given from 4-6 years of age, 11-12 years of age, or at any time provided within constraints
(3) constraints: both doses must be given after age 12 months, and second dose is given at least 1 month after first
Adult candidates for measles-mumps-rubella vaccine:
(1) two doses: persons at high exposure risk (a) if born after 1956, (b) if born before or during 1956 and shown to be seronegative
(1a) college students
(1b) adults working in health care facilities
(1c) international travelers
(2) one dose: (a) persons born after 1956 at low exposure risk or (b) if born before or during 1956 and either have no history of measles or no laboratory evidence of rubella immunity
Serologic testing:
(1) can be done if it is cost-effective and if all persons identified as non-immune will be immediately vaccinated
(2) during epidemics serologic testing is usually not performed since it may slow vaccination
Contraindications to vaccination:
(1) women should not be pregnant, and they should avoid becoming pregnant for 1 month after monovalent measles or mumps vaccines and for 3 months after rubella-containing vaccine
(2) measles vaccination is not recommended for HIV-infected persons who are severely immuncompromised
(3) hypersensitivity to vaccine components
