MUMPS, MEASLES, RUBELLA (MMR)
KEY POINTS
1. Worldwide; 875,000 deaths/yr.
2. MMR diseases are common in many countries, including Western Europe.
3. Persons born before 1957 in the U.S. are considered immune (except for healthcare workers and child-bearing age women).
4. Targets,
a. Born ≥ 1957 in U.S. (≥ 1970 in Canada) without history of MMR disease or a vaccine primary series history,
i. Previous vaccination with killed vaccine
ii. Previous vaccination with an unknown measles vaccine between 1963-67
b. Anyone 18yrs or older and anyone born after 1956, unless they have had all 3 diseases or can show they have been vaccinated.
Diseases:
1. Mumps – Contagious viral illness of the salivary glands (parotids), and occasionally the
testes and brain (meningitis)
a. Signs/Symptoms
i. Fever
ii. Rash
iii. Swollen parotid (cheek/jaw) glands
b. Complications: Sexual sterility
2. Measles (rubeola) – An highly contagious viral illness of the respiratory tract and skin, and
occasionally the GI tract, lungs, and/or brain
a. Signs/Symptoms
i. Fever
ii. Cough (dry)
iii. Conjunctivitis
iv. Runny nose
v. Red rash
b. Complications:
i. Pneumonia
ii. Diarrhea
iii. Encephalitis
iv. Death
3. Rubella (German measles) – Usually a mild, contagious viral illness
a. Signs/Symptoms
i. Fever
ii. Rash (generalized, blotchy)
iii. Conjunctivitis
iv. Joint aches (arthritis in women)
v. Generalized gland enlargement (lymph nodes)
Prevalence:
Worldwide: 875,000 deaths/yr.
MMR diseases are common in many countries, including Western Europe.
Transmission:
Respiratory droplets and direct nasal secretion contact.
Persons born before 1957 in the U.S. are considered immune (except for healthcare workers and child-bearing age women).
MMR given within 72 Hrs of measles exposure may give some measles protection, but not for mumps or rubella.
Treatment: Immunoglobulin
Prevention:
1. Vaccine (live/MMR)
a. 0.5cc subcutaneously
b. Primary Series:
i. Pediatric: 1st dose at 12-15 months-old, then at 4-6yrs-old
ii. Adults: 2 doses, at least 28 days apart
c. Born ≥ 1957, non-immune,
i. 2 doses, 28 days apart
ii. Booster: 1 dose, with travel
d. Side-Effects
i . Fever or generalized rash in about 5-15% of vaccines, within 7-12 days of vaccination, lasting 1 -2 days
ii. Seizures with fever – no longterm consequences
iii. Injection site pain, swelling, rash, or itching
iv. Swollen lymph nodes and parotid glands
v. Transient low platelet count within 2 months
e. Precautions/Contraindications
i. Postpone vaccination if moderately ill.
ii. Neomycin or gelatin systemic allergy
iii. Pregnancy
iv. Severe immune suppression
v. If have recently received high doses of immune globulins within 3-6 months (depending on the globulin), delay MMR.
vi. If received plasma/blood products, delay MMR 3-7 months.
vii. Active, untreated tuberculosis
viii. Start TB treatment prior
ix. Low platelet counts – must evaluate risk/benefit of MMR.
x. Severely immune-compromised, especially post-solid organ transplant or on chronic immunosuppressants.
xi. Wait at least 1mo. post high-dose steroid discontinuation before taking MMR.
xii. Be off chemotherapy at least 3 months
xiii. Can use in leukemia, in remission.
xiv. Pregnancy
xv. Avoid pregnancy for at least 1mo. post MMR.
xvi. If pregnancy occurs within 1mo. of MMR, medical consultation needed on risks to fetus.
f. Vaccine Targets
i. Born ≥ 1957 in U.S. (≥ 1970 in Canada) without history of MMR disease or a vaccine primary series history
ii. Previous vaccination with killed vaccine
iii. Previous vaccination with an unknown measles vaccine between 1963-67
iv. Children 6-11 months traveling to high-risk area should receive MMR x 1, then the routinely timed series later.
v. Children 12 months – 4yrs who already had 1 dose and who are traveling to high-risk areas should receive their 2nd dose (accelerated from the usual 4-6 yrs-old timing), at least 4 wks from the 1st dose (no further need after that).
vi. Anyone who has not had MMR disease(s) or a primary series, or who received killed or unknown vaccine (probably only need 1 dose of current vaccine)
vii. Anyone 18yrs or older and anyone born after 1956, unless they have had all 3 diseases or can show they have been vaccinated
How do I schedule an appointment?
Online: Schedule an Appointment.
Call Us: (713) 550-2000 A customer service representative will help you choose an appointment time, and can forward any documents you will need to complete.