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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,
    1. Born ≥ 1957 in U.S. (≥ 1970 in Canada) without history of MMR disease or a vaccine primary series history,
      1. Previous vaccination with killed vaccine
      2. Previous vaccination with an unknown measles vaccine between 1963-67
    2. 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)

Signs/Symptoms

  1. Fever
  2. Rash
  3. Swollen parotid (cheek/jaw) glands

Complications: Sterility

2. Measles (rubeola) – An highly contagious viral illness of the respiratory tract and skin, and
occasionally the GI tract, lungs, and/or brain

Signs/Symptoms,

  1. Fever
  2. Cough (dry)
  3. Conjunctivitis
  4. Runny nose
  5. Red rash

Complications: Pneumonia, diarrhea, encephalitis, death

 

3. Rubella (German measles) – Usually a mild, contagious viral illness

Signs/Symptoms

  1. Fever
  2. Rash (generalized, blotchy)
  3. Conjunctivitis
  4. Joint aches (arthritis in women)
  5. Generalized gland enlargement (lymph nodes)

 

Prevalence:

  • Worldwide; 875,000 deaths/yr.
  • MMR diseases are common in many countries, including Western Europe.

 

Transmission:

  1. Respiratory droplets and direct nasal secretion contact.
  2. Persons born before 1957 in the U.S. are considered immune (except for healthcare workers and child-bearing age women).
  3. 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)
    1. 0.5cc subcutaneously
    2. Primary Series:
      1. Pediatric: 1st dose at 12-15 month’s-old, then at 4-6yrs-old
      2. Adults: 2 doses, at least 28 days apart
    3. Born ≥ 1957, nonimmune,
      1. 2 doses, 28 days apart
      2. Booster: 1 dose, with travel
    4. Side-Effects
      1. Fever or generalized rash in about 5-15% of vaccinees, within 7-12 days of vaccination, lasting 1 -2 days
      2. Seizures with fever – no longterm consequences
      3. Injection site pain, swelling, rash, or itching
      4. Swollen lymph nodes and parotid glands
      5. Transient low platelet count within 2 months
    5. Precautions/Contraindications
      1. Postpone vaccination if moderately ill
      2. Neomycin or gelatin systemic allergy
      3. Pregnancy
      4. Severe immune suppression
      5. If received high doses of immune globulins within 3-6 months (depending on the globulin), delay MMR.
      6. Plasma/blood products, delay MMR 3-7 months.
      7. Active, untreated tuberculosis
      8. Start TB treatment prior
      9. Low platelet counts – to evaluate risk/benefit of MMR.
      10. Severely immune compromised, especially post-solid organ transplant or on chronic immunosuppressants.
      11. Wait at least 1mo. post high-dose steroid discontinuation before taking MMR.
      12. Be off chemotherapy at least 3morsquo;s
      13. Can use in leukemia, in remission.
      14. Pregnancy
      15. Avoid pregnancy for at least 1mo. post MMR.
      16. If pregnancy occurs within 1mo. of MMR, counsel on risks to fetus.
    6. Vaccine Targets
      1. Born ≥ 1957 in U.S. (≥ 1970 in Canada) without history of MMR disease or a vaccine primary series history,
      2. Previous vaccination with killed vaccine
      3. Previous vaccination with an unknown measles vaccine between 1963-67
      4. Children 6-11morsquo;s traveling to high-risk area should receive MMR x 1, then the routinely timed series later
      5. Children 12 morsquo;s – 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)
      6. Anyone who has not had MMR disease(s) or a primary series, or who receive killed or unknown vaccine (probably only need 1 dose of current vaccine)
      7. Anyone 18yrs or older and anyone born after 1956, unless they have had all 3 diseases or can show they have been vaccinated

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