measles mumps and rubella vaccine, live (Rx)

Brand and Other Names:M-M-R-II
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

measles virus/mumps virus/rubella virus

injection, lyophilized powder for reconstitution

  • ≥1000 TCID50/≥12,500 TCID50/≥1000 TCID50

Immunization Against Measles, Mumps & Rubella

Adults born before 1957 are considered immune to measles and mumps; all adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless contraindicated, or laboratory evidence of immunity to each of the 3 diseases

19-49 years old: 0.5 mL SC; second dose administered 28 days later for high risk adults (see 2nd dose recommendations below)

>50 years old: 0.5 mL SC; administer 1 dose only

2nd dose recommendations

  • Student in postsecondary eduction
  • Recent exposure
  • Occupational risk
  • Previously vaccinated with killed measles vaccine
  • Vaccinated with unknown type of measles vaccine during 1963-67
  • International travelers
  • Healthcare personnel should consider receiving 2 doses of MMR vaccine at the appropriate interval for measles and mumps or 1 dose of MMR vaccine for rubella

Additional dose during mumps outbreak

  • CDC ACIP recommendations MMWR January 12, 2018:67(1);33-38
  • Increased risk for acquiring mumps are individuals who are more likely to have prolonged or intense exposure to droplets or saliva from a person infected with mumps, (eg, close contact or sharing of drinks or utensils)
  • During an outbreak, persons identified as being at increased risk who have received ≤2 doses of mumps virus-containing vaccine or have unknown vaccination status should receive 1 dose

Immunization in Pregnancy

Pregnant women who do not have evidence of immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the health-care facility

Pregnancy should be avoided for 28 days following vaccine administration

Vaccination Schedules

Up-to-date vaccination schedules available at www.cdc.gov/nip/publications

Dosage Forms & Strengths

measles virus/mumps virus/rubella virus

injection, lyophilized powder for reconstitution

  • ≥1000 TCID50/≥12,500 TCID50/≥1000 TCID50

Immunization Against Measles, Mumps & Rubella

Routine vaccination: First dose of 0.5 mL SC between age 12-15 months; administer second dose between 4-6 yr

Minimum age for 1st dose is 12 months

International travel

  • 6-12 months: Administer 1 dose of MMR before departure from the United States for international travel; revaccinate with 2 doses of MMR, the first at age 12-15 months (12 months if the child remains in an area where disease risk is high), and the second dose at least 4 weeks later
  • >12 months: Administer 2 doses of MMR before departure from the United States for international travel; the first dose should be administered on or after age 12 months and the second dose at least 4 weeks later

Catch-up vaccination

  • Ensure all school-aged children and adolescents received 2 doses (0.5 mL SC each)
  • Minimum time between 1st and 2nd dose is 4 wk

Perinatal HIV infection

  • Revaccinate persons who were vaccinated before establishment of effective antiretroviral therapy with 2 appropriately spaced doses of MMR vaccine once effective ART has been established

12 months or older with HIV infection

  • Vaccinate all persons with HIV infection who do not have evidence of current severe immunosuppression

Additional dose during mumps outbreak

  • CDC ACIP recommendations
    • MMWR January 12, 2018:67(1);33-38
    • Increased risk for acquiring mumps are individuals who are more likely to have prolonged or intense exposure to droplets or saliva from a person infected with mumps, (eg, close contact or sharing of drinks or utensils)
    • During an outbreak, persons identified as being at increased risk who have received ≤2 doses of mumps virus-containing vaccine or have unknown vaccination status should receive 1 dose
  • Infants aged 6-12 months
    • Local health authorities may recommend measles vaccination of infants in outbreak situations
    • This population may fail to respond to the components of the vaccine; safety and effectiveness of mumps and rubella vaccine in infants aged <12 months have not been established
    • The younger the infant, the lower the likelihood of seroconversion
    • Such infants should receive a second dose of MMR between aged 12-15 months followed by revaccination at elementary school entry
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Interactions

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            Adverse Effects

            Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967

            Frequency Not Defined

            Fever

            Syncope

            Ataxia

            Pain at site

            Headache

            Rash

            Lymphadenopathy

            Myalgia

            Stevens-Johnson syndrome

            Thrombocytopenia

            Optic neuritis

            Encephalitis

            Malaise

            Irritability

            Guillain-Barre synd

            Subacute sclerosing panencephalitis (rare)

            Seizures

            Parotitis

            Bronchospasm

            Leukocytosis

            Conjunctivitis

            Otitis media

            Nerve deafness

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            Warnings

            Contraindications

            Pregnancy (see Pregnancy and Lactation)

            Hypersensitivity

            • History of anaphylactic reaction to neomycin (may consult allergist/immunologist if absolutely necessary, give in setting where anaphylactic reaction can be immediately controlled)
            • Hypersensitivity to gelatin or any other component

            Immunosuppression

            • Individuals with blood dyscrasias, leukemia, lymphomas of any type, or malignancy affecting bone marrow/lymphatic system
            • Primary and acquired immunodeficiency states including AIDS, cellular immune deficiencies, hypogammaglobulinemic and dysgammaglobulinemic states, or family history of congenital or hereditary immunodeficiency
            • Individuals taking immunosuppressive drugs; may be used with topical corticosteroids or low-dose corticosteroids (as commonly used for asthma prophylaxis) or in patients who are receiving corticosteroids as replacement therapy (eg, Addison disease)

            Concurrent illness

            • Active untreated TB
            • Fever >101.3°F (38.5°C)

            Cautions

            Caution when administering MMRV to persons with a history of cerebral injury, individual or family history of convulsions, or any other condition in which stress due to fever should be avoided

            History of anaphylactic or other immediate hypersensitivity reactions (eg, hives, laryngeal edema, difficulty breathing, hypotension, or shock) subsequent to egg ingestion may be at an enhanced risk of immediate-type hypersensitivity reactions after receiving vaccines containing traces of chick embryo antigen; carefully evaluate the potential risk-to-benefit ratio before considering vaccination

            Neomycin allergy most often manifests as contact dermatitis, which is not a contraindication to receiving the vaccine

            Caution in children with thrombocytopenia, of those who experienced thrombocytopenia after vaccination

            Safety and efficacy for postexposure prophylaxis have not been established

            Safety and efficacy in HIV-infected children have not been established

            Postmarketing reports suggest transmission of vaccine virus may occur to high risk individuals (eg, immunocompromised, pregnant women without positive varicella history or vaccination, or newborn infants of mothers without positive varicella history)

            Contains albumin; theoretical risk for transmission Creutzfeldt-Jacob disease

            Febrile seizures

            • Administration of MMRV (dose 1) to children aged 12-23 months who have not been previously vaccinated against measles, mumps, rubella, or varicella, nor had a history of the wild-type infections, is associated with higher rates of fever and febrile seizures at 5-12 days after vaccination when compared with children vaccinated with dose 1 of both MMR and varicella vaccine administered separately

            Drug interactions overview

            • Immune globulins and transfusion
              • Immune globulins (IG) coadministered with MMRV contain antibodies that may interfere with vaccine virus replication and decrease the expected immune response
              • Defer vaccination; appropriate suggested interval between transfusion or IG administration and vaccination will vary with the type of transfusion or indication for, and dose of, IG (eg, 5 months for varicella zoster immune globulin)
              • Refer to prescribing information for specific recommendations
            • Salicylates
              • Reye syndrome reported following salicylate administration during wild-type varicella infection
              • Avoid salicylates for 6 weeks after vaccination
            • Corticosteroids and immunosuppressive drugs
              • Do not administer to individuals receiving immunosuppressive doses of corticosteroids or other immunosuppressive drugs
              • Can result in a more extensive vaccine-associated rash or disseminated disease in individuals on immunosuppressive drugs (see Contraindications)
            • Use with other vaccines
              • At least 1 month should elapse between a dose of a measles-containing vaccine (eg, MMR) and a dose of MMRV, and at least 3 months should elapse between administration of 2 doses of MMRV or varicella-containing vaccines
            • Lab tests
              • MMR vaccine given individually may result in a temporary depression of tuberculin skin sensitivity
              • Therefore, if a tuberculin test is to be done, it should be administered either any time before, simultaneously with, or at least 4 to 6 weeks after MMRV
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            Pregnancy & Lactation

            Pregnancy

            Contraindicated during pregnancy; avoid pregnancy for 3 months following vaccination

            In a 10-year survey involving over 700 pregnant women who received rubella vaccine within 3 months before or after conception (of whom 189 received the Wistar RA 27/3 strain), none of the newborns had abnormalities compatible with congenital rubella syndrome

            Mumps infection during the first trimester of pregnancy may increase the rate of spontaneous abortion

            Although mumps vaccine virus has been shown to infect the placenta and fetus, there is no evidence that it causes congenital malformations in humans

            Reports have indicated that contracting wild-type measles during pregnancy enhances fetal risk; increased rates of spontaneous abortion, stillbirth, congenital defects and prematurity have been observed subsequent to infection with wild-type measles during pregnancy

            There are no adequate studies of the attenuated (vaccine) strain of measles virus in pregnancy; however, it would be prudent to assume that the vaccine strain of virus is also capable of inducing adverse fetal effects

            Lactation

            Unknown if measles or mumps vaccine is secreted in human milk

            The prescribing information describes studies that have shown lactating postpartum women immunized with live attenuated rubella vaccine may secrete the virus in breast milk and transmit it to breastfed infants

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Live, attenuated viruses stimulate active immunity to disease caused by measles, rubella, and mumps viruses

            Pharmacokinetics

            Duration: >15 years after 2 doses

            Onset: Active immunity detected after 1 dose

            Pharmacogenomics

            HLA-B7, HLA-B51, HLA-DRB1*13, and HLADQA1*01 is associated with a measles vaccine response

            Homozygosity at HLA-B, HLA-DR, and HLA-DQA1 has been associated with a measles vaccine nonresponse

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            Administration

            SC Preparation

            Single-dose vial

            • Withdraw entire volume of supplied diluent into the syringe to be used for reconstitution
            • Inject all the diluent into the vial of lyophilized vaccine, and agitate to mix thoroughly; if the lyophilized vaccine cannot be dissolved, discard
            • Resulting solution should appear clear yellow
            • Withdraw entire vial contents into syringe

            SC Administration

            25 gauge, 5/8-inch needle recommended

            Inject SC into outer aspect of upper arm

            Storage

            Unopened vials

            • Store frozen/refrigerated at -58°F to +46°F (-50°C to +8°C)
            • Protect from light at all times, since light exposure may inactivate the viruses
            • Before reconstitution, refrigerate the lyophilized vaccine at 36-46°F (2-8°C)
            • Store the diluent refrigerated or separately at room temperature; do not freeze diluent

            Reconstituted vials

            • Use as soon as possible after reconstitution
            • May store reconstituted vaccine in the vaccine vial in a dark place at 36-46°F (2-8°C) for up to 8 hr; discard if not used within 8 hr
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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
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