Measles, Mumps, and Rubella (MMR) Vaccine

The MMR vaccine contains live-attenuated measles and mumps viruses, prepared in chicken embryo cell cultures. It also contains live-attenuated rubella virus (rubella virus vaccine live), prepared in human diploid lung fibroblasts.

MMR vaccine and varicella vaccine are available as a combined vaccine (measles virus/mumps virus/rubella virus/varicella virus vaccine; MMRV vaccine).are available as a combined vaccine (measles virus/mumps virus/rubella virus/varicella virus vaccine; MMRV vaccine).

The MMR vaccine is a routine childhood vaccination (see CDC: Child and Adolescent Immunization Schedule by Age).

All adults who were born in 1957 or later should be given 1 dose of the vaccine unless they have one of the following (see CDC: Adult Immunization Schedule by Age):

• Documentation of vaccination with one or more doses of MMR

• Laboratory evidence that indicates immunity to the 3 diseases

• A contraindication to the vaccine

Diagnosis of disease by a physician without laboratory confirmation is not considered acceptable evidence of immunity for measles, mumps, or rubella.

A second dose of MMR vaccine (or, if they have not been vaccinated, 2 doses given ≥ 28 days apart) is recommended for adults who are likely to be exposed:

• Students in colleges or other post–high school educational institutions

• Health care workers born in 1957 or later with no evidence of immunity

• International travelers

• Patients with HIV infection, CD4 ≥ 15% and CD4 cell count ≥ 200/mcL for ≥ 6 months, and no evidence of immunity to measles, mumps, or rubella

People born before 1957 are generally considered immune. However, such people who work within health care facilities (whether or not they have patient care duties) should be considered for vaccination if they have no evidence of immunity. Two doses of MMR are given (one dose if only rubella coverage is needed).

If people aged ≥ 12 months were previously given ≤ 2 doses of mumps-containing vaccine and are identified by public health authorities to be at increased risk of mumps during a mumps outbreak, they should be given 1 dose of MMR vaccine.

Because rubella during pregnancy can have dire consequences for the fetus (eg, miscarriage, multiple birth defects), all women of childbearing age, regardless of birth year, should be screened for rubella immunity. If there is no evidence of immunity, women who are not pregnant should be vaccinated. Pregnant women who do not have evidence of immunity should be vaccinated when pregnancy is completed and before they are discharged from the health care facility.

People who were vaccinated with inactivated (killed) measles vaccine or measles vaccine of unknown type during 1963 to 1967 should be revaccinated with 2 doses of MMR vaccine.

People who were vaccinated before 1979 with killed mumps vaccine or mumps vaccine of unknown type and who are at high risk of mumps exposure should be offered revaccination with 2 doses of MMR vaccine.

Contraindications for the MMR vaccine include

• A severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component, including neomycin) after a previous dose or to a vaccine component, including neomycin

• Known severe primary or acquired immunodeficiency (eg, due to leukemia, lymphomas, solid tumors, tumors that affect bone marrow or the lymphatic system, AIDS, severe HIV infection, treatment with chemotherapy, or long-term use of immunosuppressants)

• Pregnancy (vaccination is postponed until pregnancy is completed)

• Family history of first-degree relatives (parents or siblings) with congenital hereditary immunodeficiency, unless the vaccine recipient is known to be immunocompetent

HIV infection is a contraindication only if immunocompromise is severe (CDC immunologic category 3 with CD4 < 15% or CD4 count < 200 cells/mcL); if immunocompromise is not severe, risks of wild measles outweigh risk of acquiring measles from the live vaccine.

Women who have been vaccinated should avoid becoming pregnant for ≥ 28 days afterward. The vaccine virus may be capable of infecting a fetus during early pregnancy. The vaccine does not cause congenital rubella syndrome, but risk of fetal damage is estimated at ≤ 3%.

Precautions with the MMR vaccine include

• Moderate or severe acute illness with or without fever (vaccination is postponed until illness resolves)

• Recent (within 11 months) treatment with blood products that contain antibody (specific interval depends on the product)

• History of thrombocytopenia or thrombocytopenic purpura

If a person is infected with Mycobacterium tuberculosis, MMR vaccine and possibly MMRV vaccine may temporarily suppress the response to tuberculin testing. Thus, if needed, this test can be done before or at the same time as vaccination. If people have already been vaccinated, testing should be postponed for 4 to 6 weeks after vaccination.

The MMR vaccine dose is 0.5 mL subcutaneous. The MMR vaccine is routinely given to children in 2 doses: one at age 12 to 15 months and one at age 4 to 6 years.

The MMR vaccine causes a mild or inapparent, noncommunicable infection. Symptoms include fever > 38° C, sometimes followed by a rash. Central nervous system reactions are very rare; the vaccine does not cause autism (see MMR vaccine and autism and Vaccine Safety).

Occasionally, the rubella component causes painful joint swelling in adults, usually in women.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): MMR ACIP Vaccine Recommendations (Measles, Mumps and Rubella)

2. Centers for Disease Control and Prevention (CDC): Measles Mumps, and Rubella (MMR) Vaccination: Information for Healthcare Providers

3. European Centre for Disease Prevention and Control (ECDC): Measles: Recommended vaccinations

4. European Centre for Disease Prevention and Control (ECDC): Mumps: Recommended vaccinations

5. European Centre for Disease Prevention and Control (ECDC): Rubella: Recommended vaccinations