Measles-mumps-rubella vaccination in high-risk adults
- Patricia L Hibberd, MD, PhD
Patricia L Hibberd, MD, PhD
- Chair, Department of Global Health
- Boston University School of Public Health
The national goals of Healthy People 2020 include a continued focus on adult immunization, particularly increasing immunization rates. Despite some progress, approximately 50,000 adults and a few hundred children in the United States die each year from vaccine-preventable diseases. There are also communities with pockets of unvaccinated and under-vaccinated populations that are at increased risk for outbreaks of vaccine-preventable disease [1,2].
The combination MMR vaccine includes the measles, mumps, and rubella live virus vaccines. Single antigen preparations of these vaccines are no longer available in the United States .
The rationale and risk-benefit considerations for administration of MMR vaccines will be reviewed here. The principles behind adult immunization and the recommended schedule for healthy adults as well as the rationale and risk-benefits for influenza and pneumococcal vaccine and tetanus-diphtheria toxoid are discussed separately (see "Approach to immunizations in healthy adults" and "Seasonal influenza vaccination in adults" and "Pneumococcal vaccination in adults" and "Tetanus-diphtheria toxoid vaccination in adults").
Immunizations for select groups such as immunocompromised individuals, healthy women who are pregnant or breastfeeding, healthcare workers, and international travelers are also discussed separately. (See appropriate topic reviews.)
MEASLES, MUMPS, AND RUBELLA
Which adults are at risk and is protection important to healthy adults? — The live attenuated measles vaccine was introduced in 1967 and by 1985 had prevented about 52 million cases of measles, 5200 deaths, and 17,400 cases of mental retardation attributable to measles . During the years 1989 to 1991, measles cases started to increase again, and the United States Public Health Service responded by recommending a two-dose immunization schedule . The rationale for the second dose of the measles vaccine was not to serve as a booster but rather to immunize the 5 to 20 percent of people who had not responded to the first dose of the vaccine.
- Centers for Disease Control and Prevention. Healthy People 2010: Volume 1, Objectives for Improving Health http://www.healthypeople.gov/Document/tableofcontents.htm#volume1 (Accessed on August 13, 2009).
- Healthy People 2020. http://www.healthypeople.gov/2020/default.aspx (Accessed on July 18, 2013).
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- National Center forImmunization and Respiratory Diseases, Division of Viral Diseases. Documentation and Verification of Measles, Rubella and Congenital Rubella Syndrome Elimination in the Region of the Americas: United States National Report, March 28, 2012. http://www.cdc.gov/measles/downloads/Report-elimination-measles-rubella-crs.pdf (Accessed on July 22, 2013).
- Watson JC, Hadler SC, Dykewicz CA, et al. Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1998; 47:1.
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- Dykewicz CA, Kruszon-Moran D, McQuillan GM, et al. Rubella seropositivity in the United States, 1988-1994. Clin Infect Dis 2001; 33:1279.
- Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (CDC). Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.
- American College Physicians Task Force on Adult Immunization and Infectious Diseases Society of America. Guide for adult immunization. Philadelphia. American College of Physicians, 1994.
- Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C. Vaccines for measles, mumps and rubella in children. Cochrane Database Syst Rev 2012; :CD004407.
- Centers for Disease Control and Prevention (CDC). Revised ACIP recommendation for avoiding pregnancy after receiving a rubella-containing vaccine. MMWR Morb Mortal Wkly Rep 2001; 50:1117.
- Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15:1143.
- MEASLES, MUMPS, AND RUBELLA
- Which adults are at risk and is protection important to healthy adults?
- Which adults should receive the MMR vaccine and how should it be administered?
- How should an unimmunized person exposed to measles, mumps, or rubella be treated?
- How safe and effective is MMR and what are the contraindications to immunization?
- SUMMARY AND RECOMMENDATIONS