MMR Vaccine

1. Mechanism
   1. Live vaccine
2. Indication
   1. Universally indicated for persons born after 1957
3. Contraindications
   1. Absolute contraindications
      1. Anaphylactic reaction to neomycin (egg allergy is no longer a contraindication)
      2. Pregnancy
      3. Immunodeficiency
   2. Relative contraindications
      1. IG administration with within 3 months
      2. Thrombocytopenia
      3. ThrombocytopeniaPurpura
   3. Conditions not contraindicating vaccination
      1. Tuberculosis or positive PPD
      2. Concurrent PPD testing
      3. Lactation
      4. Pregnancy in household contact or mother
      5. Household contact with Immunodeficiency (e.g. HIV)
      6. Non-anaphylactic reaction to egg or neomycin
4. Dose
   1. Adult: 0.5 ml IM
5. Schedule
   1. Standard
      1. Dose 1: Age 12-15 months
      2. Dose 2: Age 4 to 6 months (administer by age 12)
   2. Altered
      1. Need a waiting period following Ig Administration
      2. See Red Book for wait period (3-11 months)
6. Adverse Effects
   1. Thrombocytopenia (<1 case per 30,000)
   2. Anaphylaxis (only 33 reports in >70 million doses)
   3. Vaccine-strain death (<5 reports in 200 million doses)
   4. References
      1. (1996) MMWR Morb Mortal Wkly Rep 45(No. RR-12):1-35
7. Drug Interactions
   1. Varicella Vaccine or Yellow Fever Vaccine
      1. Do not give MMR within 30 days or these vaccines
      2. MMR may be given with varicella or Yellow Fever
8. Precautions
   1. Avoid in pregnancy (FDA Category X)
      1. See Immunization in Pregnancy
9. Safety data
   1. Safe in HIV
   2. Safe for Egg-Allergic children (allergy unlikely)
      1. Allergic Reaction unlikely in 16 studies (n=1265)
      2. Skin Testing is not indicated
      3. Observe potentially allergic children for 90 minutes
      4. James (1995) N Engl J Med 332:1262-6
   3. No association with Autism
      1. DeStefano (2001) Pediatr Infect Dis 20:887-8
      2. Madsen (2002) N Engl J Med 347:1477-82
      3. Patja (2000) Pediatr Infect Dis 19:1127-34
      4. Smeeth (2004) Lancet 364:963-9