Measles, Mumps, and Rubella Virus Vaccine

• It is used to prevent measles, mumps, and rubella.

• If you have an allergy to measles, mumps, and rubella virus vaccine or any part of this medicine.
• If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
• If you are pregnant or plan to get pregnant within the next 3 months. Do not take measles, mumps, and rubella virus vaccine if you are pregnant or if you are planning to get pregnant within the next 3 months.
• If you have any of these health problems: A blood disease, a weak immune system like HIV or AIDS, active TB (tuberculosis) that is not being treated, an illness with a fever, cancer in the bone marrow or lymph systems like leukemia or lymphoma, or low blood levels of gamma globulin.
• If a family member has had immune system problems.
• If you are taking any drugs to suppress your immune system. This may be certain doses of steroids like prednisone. This does not apply to people taking steroids for certain health problems like Addison's disease. There are many drugs that can suppress your immune system. Ask your doctor or pharmacist if you are not sure.
• If you have had any of these within the past 3 months: Blood transfusion, plasma transfusion, or immune globulin.

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take measles, mumps, and rubella virus vaccine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Change in how you act.
• Very bad dizziness or passing out.
• Seizures.
• Very bad headache.
• Swelling of the testicles.
• Any unexplained bruising or bleeding.
• Trouble walking.

• Vaccine
• Vaccine, Live (Viral)

The median duration of immunity after 2 doses is ≥15 years for all components of the vaccine (CDC/ACIP [McLean 2013]).

Note: The minimum interval between 2 doses of MMR vaccine is 28 days (CDC/ACIP [McLean 2013]).

Immunization: SubQ: 0.5 mL per dose; 1 or 2 doses administered at least 28 days apart based upon the following criteria (CDC/ACIP [McLean 2013]):

Adults born in or after 1957 should be vaccinated unless they have acceptable evidence of immunity.

Adults born prior to 1957 are considered immune to measles, mumps, and rubella but may be vaccinated if they do not have contraindications to the vaccine. Pregnant adults born prior to 1957 are not considered immune to rubella.

Healthcare personnel: Persons born in or after 1957 should have 2 doses of vaccine unless they have acceptable evidence of immunity. Unvaccinated persons born prior to 1957 should also consider vaccination with 2 doses unless they have laboratory evidence or laboratory confirmation of disease.

HIV infection (without severe immunosuppression): Two doses of MMR unless there is acceptable evidence of immunity.

Household/close contacts of immunocompromised persons: Two doses of MMR unless there is acceptable evidence of immunity.

International travelers: Two doses of MMR prior to travel unless there is acceptable evidence of immunity.

Measles, mumps, or rubella outbreak (community): Adults who received 1 dose of MMR should be considered for a second dose if the outbreak involves measles or mumps in adults. Vaccination should also be considered for persons born prior to 1957 without evidence of immunity who may be exposed to mumps. A single dose of a rubella-containing vaccine is considered adequate vaccination during a rubella outbreak.

Measles, mumps, or rubella outbreak (healthcare facility): Unvaccinated health care personnel without evidence of immunity regardless of birth year should receive 2 doses during a measles or mumps outbreak and one dose during a rubella outbreak.

Students: Persons entering post high school educational facilities should receive 2 doses of MMR unless they have acceptable evidence of immunity prior to enrollment.

Women of childbearing potential: One dose of MMR unless they have acceptable evidence of immunity. Vaccination should not be given during pregnancy and pregnancy should be avoided for 28 days after vaccine administration.

To maintain potency, the lyophilized vaccine must be stored between -50°C to 8˚C (-58°F to 46˚F). Temperatures below -50°C (-58°F) may occur if stored in dry ice. Prior to reconstitution, store the powder at 2°C to 8°C (36°F to 46°F). Protect from light. Diluent may be stored in refrigerator or at room temperature. Do not freeze diluent. Use as soon as possible following reconstitution, may be stored under refrigeration for up to 8 hours.

Monitor for syncope for 15 minutes following administration (NCIRD/ACIP 2011). If seizure-like activity associated with syncope occurs, maintain patient in supine or Trendelenburg position to reestablish adequate cerebral perfusion.

Animal reproduction studies have not been conducted. It is not known whether this vaccine can cause fetal harm or affect reproduction capacity. Based on information collected following inadvertent administration during pregnancy, adverse events have not been observed following use of rubella vaccine. However, theoretical risks cannot be ruled out; use of this vaccine is contraindicated in pregnant females and should not be administered to women trying to conceive. The manufacturer recommends that pregnancy be avoided for 3 months after vaccine administration. The Advisory Committee on Immunization Practices (ACIP) recommends that pregnancy should be avoided for 28 days following vaccination. The risk of congenital rubella syndrome following vaccination is significantly less than the risk associated following infection; therefore, inadvertent administration of MMR during pregnancy is not considered an indication to terminate pregnancy.

Adverse consequences of natural infection in unvaccinated pregnant women have been reported. Measles infection during pregnancy may increase the risk of premature labor, preterm delivery, spontaneous abortion and low birth weights. Rubella infection during the first trimester may lead to miscarriages, stillbirths, and congenital rubella syndrome (includes auditory, ophthalmic, cardiac and neurologic defects; intrauterine and postnatal growth retardation); fetal rubella infection can occur during any trimester of pregnancy. Maternal mumps infection during the first trimester may increase the risk of spontaneous abortion or intrauterine fetal death. Sterility in males and infertility in prepubescent females may also occur with natural mumps infection.

Prenatal screening is recommended for all pregnant women who lack evidence of rubella immunity. Women of childbearing age without documentation of rubella vaccination or serologic evidence of immunity should be vaccinated (for women of childbearing potential, birth prior to 1957 is not acceptable evidence of immunity to rubella). Women who are pregnant should be vaccinated upon completion or termination of pregnancy, prior to discharge. Household contacts of pregnant women may be vaccinated (CDC/ACIP [McLean, 2013]).