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Methods: Consecutive children aged yr, attending the immunization clinic of a tertiary care hospital in Delhi for routine DT vaccination, were enrolled. Results: The pre-vaccination percentage seropositivity observed in the children recruited, was Keywords: Measles, MMR vaccine, mumps, rubella, seroconversion, seroprotection. Results Eighty four children of the recruited were followed up between wk. Open in a separate window. Discussion The percentage seroprotection for measles was around 21 per cent at yr which was very low in comparison with all the previous studies in which children had received only one dose of measles antigen containing vaccine i.
References 1. The elimination of indigenous measles, mumps and rubella from Finland by a year, two dose vaccination program. N Engl J Med. Mason WH. Nelson textbook of pediatrics. Philadelphia Pa: Saunders Elsevier; Antibody response to measles immunization in India. Bull World Health Organ. Mumps virus vaccines. Wkly Epidemiol Rec. Individual vaccines; pp. American Academy of Pediatrics. Committee on Infectious Diseases.
Age for routine administration of the second dose of measles-mumps-rubella vaccine. Essential paediatrics. Persistence of measles antibody after revaccination. Adults without evidence of immunity and no contraindications to MMR vaccine can be vaccinated without testing. Only adults without evidence of immunity might be considered for testing for measles-specific IgG antibody, but testing is not needed prior to vaccination. CDC does not recommend measles antibody testing after MMR vaccination to verify the patient's immune response to vaccination.
Two documented doses of MMR vaccine given on or after the first birthday and separated by at least 28 days is considered proof of measles immunity, according to ACIP. Documentation of appropriate vaccination supersedes the results of serologic testing for measles, mumps, rubella, and varicella.
A patient born in has a history of measles disease and is also immunosuppressed due to multiple myeloma. The patient wants to travel to Africa, but is concerned about the measles exposure risk. Should the patient receive the MMR vaccine? A history of having had measles is not sufficient evidence of measles immunity. A positive serologic test for measles-specific IgG will confirm that the person is immune and is not at risk of infection regardless of the multiple myeloma.
Multiple myeloma is a hematologic cancer and is considered immunosuppressive so MMR vaccine is contraindicated in this person. We have adult patients in our practice at high risk for measles, including patients going back to college or preparing for international travel, who don't remember ever receiving MMR vaccine or having had measles disease.
How should we manage these patients? You have two options. You can test for immunity or you can just give 2 doses of MMR at least 4 weeks apart. There is no harm in giving MMR vaccine to a person who may already be immune to one or more of the vaccine viruses.
If you or the patient opt for testing, and the tests indicate the patient is not immune to one or more of the vaccine components, give your patient 2 doses of MMR at least 4 weeks apart.
If any test results are indeterminate or equivocal, consider your patient nonimmune. ACIP does not recommend serologic testing after vaccination because commercial tests may not be sensitive enough to reliably detect vaccine-induced immunity. I have a year-old patient who is traveling to Haiti for a mission trip. She doesn't recall ever getting an MMR booster she didn't go to college and never worked in health care. She was rubella immune when pregnant 20 years ago. Her measles titer is negative.
Would you recommend an MMR booster? ACIP recommends 2 doses of MMR given at least 4 weeks apart for any adult born in or later who plans to travel internationally. A patient who was born before and is not a healthcare worker wants to get the MMR vaccine before international travel. Does he need a dose of MMR?
No, it is not considered necessary, but he may be vaccinated. Before implementation of the national measles vaccination program in , virtually every person acquired measles before adulthood.
So, this patient can be considered immune based on their birth year. However, MMR vaccine also may be given to any person born before who does not have a contraindication to MMR vaccination. Routine testing of patients born before for measles-specific antibody is not recommended by CDC. We have measles cases in our community. How can I best protect the young children in my practice? First of all, make sure all your patients are fully vaccinated according to the U.
In certain circumstances, MMR is recommended for infants age 6 through 11 months. Give infants this age a dose of MMR before international travel. In addition, consider measles vaccination for infants as young as age 6 months as a control measure during a U. Consult your state health department to find out if this is recommended in your situation.
Do not count any dose of MMR vaccine as part of the 2-dose series if it is administered before a child's first birthday. Instead, repeat the dose when the child is age 12 months. In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age 12 months, instead of 12 through 15 months and giving the second dose 4 weeks later at the minimum interval instead of waiting until age 4 through 6 years.
Finally, remember that infants too young for routine vaccination and people with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. Be sure to encourage all your patients and their family members to get vaccinated if they are not immune.
In recent years, mumps outbreaks have occurred primarily in populations in institutional settings with close contact such as residential colleges or in close-knit social groups. The current routine recommendation for 2 doses of MMR vaccine appears to be sufficient for mumps control in the general population, but insufficient for preventing mumps outbreaks in prolonged, close-contact settings, even where coverage with 2 doses of MMR vaccine is high.
In a measles outbreak, do children who have not had MMR vaccine pose a threat to vaccinated people? It is my understanding that vaccinated people can still contract measles. Am I correct? You are correct that vaccinated people can still be infected with viruses or bacteria against which they are vaccinated. More information is available for each vaccine and disease at www.
Should these doses be repeated? All live injected vaccines MMR, varicella, and yellow fever are recommended to be given subcutaneously.
However, intramuscular administration of any of these vaccines is not likely to decrease immunogenicity, and doses given IM do not need to be repeated. We often need to give MMR vaccine to large adults.
Can this be considered a valid dose? Although this is off-label use, CDC recommends that when a dose of MMRV is inadvertently given to a patient age 13 years and older, it may be counted towards completion of the MMR and varicella vaccine series and does not need to be repeated. How soon can we give the second dose of MMR vaccine to a child vaccinated at 12 months old?
The minimum interval is 28 days for dose 2. Does the 4-day "grace period" apply to the minimum age for administration of the first dose of MMR? What about the day minimum interval between doses of MMR? A dose of MMR vaccine administered up to 4 days before the first birthday may be counted as valid. However, school entry requirements in some states may mandate administration on or after the first birthday. The 4-day "grace period" should not be applied to the day minimum interval between two doses of a live parenteral vaccine.
Can MMR be given on the same day as other live virus vaccines? If you can give the second dose of MMR as early as 28 days after the first dose, why do we routinely wait until kindergarten entry to give the second dose?
The second dose of MMR may be given as early as 4 weeks after the first dose, and be counted as a valid dose if both doses were given after the first birthday. The second dose is not a booster, but rather it is intended to produce immunity in the small number of people who fail to respond to the first dose.
The risk of measles is higher in school-age children than those of preschool age, so it is important to receive the second dose by school entry. It is also convenient to give the second dose at this age, since the child will have an immunization visit for other school entry vaccines. What is the earliest age at which I can give MMR to an infant who will be traveling internationally? Also, which countries pose a high risk to children for contracting measles? ACIP recommends that children who travel or live abroad should be vaccinated at an earlier age than that recommended for children who reside in the United States.
Before their departure from the United States, children age 6 through 11 months should receive 1 dose of MMR. The risk for measles exposure can be high in high-, middle- and low-income countries. Consequently, CDC encourages all international travelers to be up to date on their immunizations regardless of their travel destination and to keep a copy of their immunization records with them as they travel.
For additional information on the worldwide measles situation, and on CDC's measles vaccination information for travelers, go to wwwnc. If we give a child a dose of MMR vaccine at 6 months of age because they are in a community with cases of measles, when should we give the next dose? The next dose should be given at 12 months of age. The child will also need another dose at least 28 days later. For the child to be fully vaccinated, they need to have 2 doses of MMR vaccine given when the child is 12 months of age and older.
A dose given at less than 12 months of age does not count as part of the MMR vaccine two-dose series. I have an 8-month-old patient who is traveling internationally. The infant needs to be protected from hepatitis A as well as measles, mumps, and rubella. The family is leaving in 11 days. IG may contain antibodies to measles, mumps, and rubella that could reduce the effectiveness of MMR vaccine. For this reason, in February ACIP voted to recommend that hepatitis A vaccine should be administered to infants age 6 through 11 months traveling outside the United States when protection against hepatitis A is recommended.
MMR and hepatitis A vaccine may be safely co-administered to children in this age group. Neither vaccine is counted as part of the child's routine vaccination series. Can I give the second dose of MMR earlier than age 4 through 6 years the kindergarten entry dose to young children traveling to areas of the world where there are measles cases?
The second dose of MMR can be given a minimum of 28 days after the first dose if necessary. If I give MMR to an infant traveler younger than age 1 year, will that dose be considered valid for the U. A measles-containing vaccine administered more than 4 days before the first birthday should not be counted as part of the series. MMR should be repeated when the child is age 12 through 15 months 12 months if the child remains in an area where disease risk is high.
The second dose should be administered at least 28 days after the first dose. Live measles vaccine given prior to the application of a TST can reduce the reactivity of the skin test because of mild suppression of the immune system.
An year-old college student says he had both measles and mumps diseases as a preschooler, but never had MMR vaccine. Is rubella vaccine recommended in such a situation? This student should receive two doses of MMR, separated by at least 28 days.
A personal history of measles and mumps is not acceptable as proof of immunity. Acceptable evidence of measles and mumps immunity includes a positive serologic test for antibody, birth before , or written documentation of vaccination. For rubella, only serologic evidence or documented vaccination should be accepted as proof of immunity. Additionally, people born prior to may be considered immune to rubella unless they are women who have the potential to become pregnant.
When not given on the same day, is the interval between yellow fever and MMR vaccines 4 weeks 28 days or 30 days? I have seen the yellow fever and live virus vaccine recommendations published both ways. The CDC travel health website recommends that yellow fever vaccine and other parenteral or nasal live vaccines should be separated by at least 30 days if possible. Either interval is acceptable. What is the recommendation for MMR vaccine for healthcare personnel?
ACIP recommends that all HCP born during or after have adequate presumptive evidence of immunity to measles, mumps, and rubella, defined as documentation of two doses of measles and mumps vaccine and at least one dose of rubella vaccine, laboratory evidence of immunity, or laboratory confirmation of disease. During an outbreak of measles or mumps, healthcare facilities should recommend 2 doses of MMR separated by at least 4 weeks for unvaccinated healthcare personnel regardless of birth year who lack laboratory evidence of measles or mumps immunity or laboratory confirmation of disease.
During outbreaks of rubella, healthcare facilities should recommend 1 dose of MMR for unvaccinated personnel regardless of birth year who lack laboratory evidence of rubella immunity or laboratory confirmation of infection or disease. Would you consider healthcare personnel with 2 documented doses of MMR vaccine to be immune even if their serology for 1 or more of the antigens comes back negative? Healthcare personnel HCP with 2 documented doses of MMR vaccine are considered to be immune regardless of the results of a subsequent serologic test for measles, mumps, or rubella.
Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. In contrast, HCP who do not have documentation of MMR vaccination and whose serologic test is interpreted as "indeterminate" or "equivocal" should be considered not immune and should receive 2 doses of MMR vaccine minimum interval 28 days.
ACIP does not recommend serologic testing after vaccination. However, the person is not infectious, and no special precautions such as exclusion from work need to be taken. A year-old female is going to pharmacy school and the school wants her to have a second dose of MMR vaccine. She had the first dose as a child and developed measles within 24 hours of receiving the vaccine.
Recent serologic testing showed she is immune to mumps and measles but not immune to rubella. Can I give her a second dose of the MMR with her having measles after the first dose? This means there are no checks on their safety and effectiveness. The NHS does not keep a list of private clinics. UK has more about why the NHS uses a combined vaccine. People who are vaccinated against mumps, but still catch it, are less likely to have serious complications or be admitted to hospital.
Protection against measles, mumps and rubella starts to develop around 2 weeks after having the MMR vaccine. The MMR vaccine is very safe. Most side effects are mild and do not last long, such as:.
Some children might also cry and be upset immediately after the injection. This is normal and they should feel better after a cuddle. It's important to remember that the possible complications of infectious conditions, such as measles, mumps and rubella, are much more serious. As there are 3 separate vaccines within a single injection, different side effects can happen at different times. Around 7 to 11 days after the injection, some children get a very mild form of measles.
This includes:. These symptoms are not infectious, so your child will not pass anything on to non-vaccinated children. Around 3 to 4 weeks after the injection, 1 in 50 children develop a mild form of mumps.
This includes swollen glands in the cheeks, neck or under the jaw which can last for up to 2 days. Around 1 to 3 weeks after the injection, some adult women experience painful, stiff or swollen joints for up to 3 days. Rarely, a child may get a small rash of bruise-like spots about 2 weeks after having the MMR vaccine.
This side effect is linked to the rubella vaccine and is known as idiopathic thrombocytopenic purpura ITP. However, the risk of developing ITP from measles or rubella infection is far greater than from having the vaccine. ITP usually gets better without treatment but, as with any rash, you should get advice from your GP as soon as possible.
There's a small chance of having a seizure fit 6 to 11 days after the MMR vaccine. This can be caused by having a high temperature in response to the measles vaccine virus. It may sound alarming but having a seizure after the MMR vaccine is rare.
Older children also can get the vaccine if they didn't get it when they were younger. The U. An outbreak is when a disease happens in greater numbers than expected in a particular area. During an outbreak, doctors may recommend a third vaccine dose for some people. If you have questions about vaccinating your family during an outbreak, call your doctor or your state or local health department. Measles, mumps, and rubella are infections that can lead to serious illness.
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