Measles, mumps, and rubella immunization in infants, children, and adolescents

●Measles, mumps, and rubella disease – Measles, mumps, and rubella infections may have serious complications (eg, encephalitis, orchitis and oophoritis, congenital rubella syndrome). 

●Vaccine effectiveness – Introduction of routine measles, mumps, and rubella immunization in the United States reduced the numbers of cases of measles, mumps, and rubella infections. Measles vaccine is >95 percent effective, and mumps vaccine is >85 percent effective after two doses; rubella vaccine is approximately 90 percent effective after one dose.

●Indications and schedules in the United States

•Routine immunization – For susceptible children ≥12 months, we recommend routine measles, mumps, and rubella vaccination (Grade 1A). These diseases may have serious complications, and the vaccines are safe and effective.

The routine schedule measles-mumps-rubella vaccine (MMR) or measles-mumps-rubella-varicella virus vaccine (MMRV) consists of two doses: the first at age 12 through 15 months and the second at age 4 through 6 years. 

•Catch-up immunization – Catch-up MMR immunization is necessary for children whose immunization status is unknown or who lack appropriate evidence of immunity.

•Other indications – Other indications for routine or early MMR immunization include international travel, outbreaks, and measles postexposure prophylaxis. 

●Indications and schedules in other countries – MMR immunization schedules for other countries are available through the European Center for Disease Prevention and Control or the World Health Organization.

●Administration

•Contraindications – The table summarizes contraindications to MMR and MMRV.

•Special circumstances – The table summarizes circumstances that may affect the timing of routine immunization 

•Choice between MMR and MMRV:

–When administering the first dose to a child <48 months old or any dose of vaccine to a child who has a personal or family history of seizures, we suggest separate MMR and varicella vaccines (Grade 2C). MMRV is a reasonable alternative for children without a personal/family history of seizures if the caregivers wish to avoid an extra injection.

–When administering the vaccine to a child ≥48 months old, we suggest MMRV (Grade 2C). 

•Route and dose – MMR and MMRV are administered subcutaneously, usually in the upper outer triceps for children ≥12 months of age and the lateral thigh for infants <12 months of age. The dose is 0.5 mL. 

●Adverse effects – Adverse effects of MMR and MMRV are more common with the first than the second dose. They include fever, rash, lymphadenopathy, joint complaints, hypersensitivity reactions, immune thrombocytopenia, and seizures. 

Multiple studies have failed to demonstrate an association between MMR and autism or other chronic diseases.