Family medical clinics : Y ou can go to your family medical clinic for vaccinations. Either your doctor or a nurse can give the vaccination. Pharmacies : Many pharmacies are offering a free vaccination service for the MMR vaccine.
Usually no appointment is necessary and some pharmacies have longer opening hours than family medical clinics. A pharmacist can check your vaccination record and give the vaccination.
Phone them first to make sure they can help you with the vaccination you need. Vaccines on the National Immunisation Schedule are free. Other vaccines are funded only for people at particular risk of disease. You can choose to pay for vaccines that you are not eligible to receive for free. After a single dose of MMR vaccine, 90—95 out of people will be protected from measles, 69—81 protected from mumps and 90—97 from rubella.
The MMR vaccine is given as an intramuscular injection injected into a muscle in your thigh or upper arm. It is given as 2 doses, usually at 12 months and 15 months of age. Like all medicines, vaccines can cause side effects, although not everyone gets them. Most side effects are mild and short lived.
The chance of a severe reaction from MMR is very small, but the risks from not being vaccinated are very serious. Because the MMR vaccine combines 3 separate vaccines measles, mumps, rubella in 1 injection, each vaccine can cause reactions at different times after the injection. Vaccines do not cause autism. The confusion came about because in a British doctor thought there was a link between the MMR vaccine and autism. It has since been found that the doctor had changed the patient data and the laboratory reports were incorrect.
There are now many well-conducted studies that have addressed this issue, and some studies have more than one million children in them. These studies strongly show no evidence of any connection between autism and the MMR vaccine, even among at-risk individuals. The MMR vaccine is very safe. Read more:. This section will be of most interest to clinicians eg, nurses, doctors, pharmacists and specialists. Looking for Where to get medical help A health professional or service Patient portals Newsletters View all.
Measles : The infection can be serious, with 1 in 10 needing to go to hospital. Complications include diarrhoea which can lead to dehydration , ear infections which can cause hearing loss , pneumonia which is the most common cause of death and encephalitis brain inflammation , which can cause brain damage.
Read more about measles. Mumps : The symptoms of mumps are usually mild, such as swollen salivary glands at the side of your face , headache and fever, but it can cause serious complications such as deafness, swollen testicles or ovaries, and meningitis.
Read more about mumps. Rubella also called German measles : This is usually a mild infection that gets better within about 7—10 days, but it becomes a serious concern if a pregnant woman catches the infection during the first 20 weeks of pregnancy.
This is because the rubella virus can affect the development of the baby and cause severe health problems such as eye problems, deafness, heart abnormalities and brain damage. Read more about rubella. Should older children who have missed one or both doses of the MMR vaccine still have the vaccine?
Children who have had measles : These children still need to receive the MMR vaccine. Two doses of MMR vaccine are recommended to protect the child from mumps and rubella.
About a 6—10 days after the MMR injection, some children get a very mild form of measles. This includes a rash, high temperature, loss of appetite and a general feeling of being unwell for about 2 or 3 days.
This recommendation is intended to protect people who may have received killed measles vaccine which was available in the United States in through and was not effective. People vaccinated before with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection such as people who work in a healthcare facility should be considered for revaccination with 2 doses of MMR vaccine.
I understand that ACIP changed its definition of evidence of immunity to measles, rubella, and mumps in Please explain.
In the revision of its MMR vaccine recommendations ACIP includes laboratory confirmation of disease as evidence of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Physician diagnosis of disease had not previously been accepted as evidence of immunity for rubella. With the decrease in measles and mumps cases over the last 30 years, the validity of physician-diagnosed disease has become questionable.
In addition, documenting history from physician records is not a practical option for most adults. Is there anything that can be done for unvaccinated people who have already been exposed to measles, mumps, or rubella? Measles vaccine, given as MMR, may be effective if given within the first 3 days 72 hours after exposure to measles. Immune globulin may be effective for as long as 6 days after exposure. Postexposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella.
However, if the exposed person does not have evidence of mumps or rubella immunity they should be vaccinated since not all exposures result in infection. What are the current ACIP recommendations for use of immune globulin IG for measles, mumps, and rubella post-exposure prophylaxis? The dose of IGIM is 0. Alternatively, MMR vaccine can be given instead of IGIM to infants age 6 through 11 months, if it can be given within 72 hours of exposure.
Other people who do not have evidence of measles immunity can receive an IGIM dose of 0. Give priority to people who were exposed to measles in settings where they have intense, prolonged close contact such as household, child care, classroom, etc.
IG is not indicated for persons who have received 1 dose of measles-containing vaccine at age 12 months or older unless they are severely immunocompromised. IG should not be used to control measles outbreaks. IG has not been shown to prevent mumps or rubella infection after exposure and is not recommended for that purpose.
What type of vaccine should these students receive? Single antigen vaccine is no longer available in the U. If a college student or other person at increased risk of exposure cannot produce written documentation of either immunization or disease, and titers are negative, they should receive two doses of MMR.
I have patients who claim to remember receiving MMR vaccine but have no written record, or whose parents report the patient has been vaccinated. Should I accept this as evidence of vaccination? Self-reported doses and history of vaccination provided by a parent or other caregiver are not considered to be valid. You should only accept a written, dated record as evidence of vaccination. Under what circumstances should adults be considered for testing for measles-specific antibody prior to getting vaccinated?
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? Yes, as a healthcare professional, this person should get a second dose of MMR to ensure she is immune to rubella. There is no harm in providing MMR to a person who is already immune to one or more of the components. If she developed measles only one day after getting her first MMR, she must have been exposed to the disease prior to vaccination.
What are the contraindications and precautions for MMR vaccine? See www. We have many patients who are immunocompromised and cannot get the MMR vaccine. How should we advise our patients? People with medical conditions that contraindicate measles immunization depend on high MMR vaccination coverage among those around them. To help prevent the spread of measles virus, make sure all your staff and patients who can be vaccinated are fully vaccinated according to the U. Also, encourage patients to remind their family members and other close contacts to get vaccinated if they are not immune.
If your vaccination records are not available, or do not exist, it will not harm you to have the MMR vaccine again. You should also avoid becoming pregnant for 1 month after having the MMR vaccine. Evidence suggests there will be no harm to your baby, but it's better to let them know. The MMR vaccine is not recommended for people with a severely weakened immune system. For example, people receiving chemotherapy. If you have a medical condition, or are taking medicine that may affect your immune system, check with your healthcare provider if it's safe for you to have the MMR vaccine.
It's best to have vaccines on time, but you can still catch up on most vaccines if you miss them. The MMR vaccine is given as 2 doses of a single injection into the muscle of the thigh or upper arm. Single vaccines for measles, mumps and rubella are not available on the NHS and are not recommended. Combined vaccines like the MMR vaccine are safe and help to reduce the number of injections your child needs. Some private clinics in the UK offer single vaccines against measles, mumps and rubella, but these vaccines are unlicensed.
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.
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