Circumstance | Suggested approach |
Recent receipt of blood or immune globulin | - Delay MMR or MMRV for 3 to 11 months*
|
Current illness |
| - Delay immunization until resolution except for measles postexposure prophylaxis
|
| - Do not delay immunization
|
Tuberculosis testing | - Perform before, at the same visit as, or 4 to 6 weeks after MMR/MMRV vaccination
|
Planned immunosuppressive therapy | - Provide MMR/MMRV ≥4 weeks before initiation of immunosuppressive therapy (if possible)
- Avoid MMR/MMRV within 2 weeks of initiation of immunosuppressive therapy
|
History of thrombocytopenia | - First dose: Shared decision-making with caregivers
- Second dose: Perform serologic testing
- Protective antibody to measles, mumps, and rubella: Second dose not necessary
- Lack of protective antibody to measles, mumps, or rubella: Shared decision-making with caregivers
|
Antiviral medications active against herpesviruses (eg, acyclovir, valacyclovir) | - Discontinue ≥24 hours before MMRV
- Avoid for 14 days after MMRV
- Provide MMR; delay varicella vaccine until antiviral medication is discontinued
|
Egg allergy | - Skin testing or special protocols are not necessary before administration
|
History of measles, mumps, or rubella infection | - Laboratory confirmed: Child is considered immune to whichever disease was confirmed; will need to be vaccinated against the others
- Not laboratory confirmed: Provide MMR/MMRV as if unvaccinated
|
HIV infection without severe immunosuppression¶ | |
Immunocompromised contact | - Provide MMR/MMRV as scheduled
|