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Special circumstances for measles, mumps, and rubella-containing immunizations[1]

Special circumstances for measles, mumps, and rubella-containing immunizations[1]
Circumstance Suggested approach
Recent receipt of blood or immune globulin
  • Delay MMR or MMRV for 3 to 11 months*
Current illness
  • Moderate to severe
  • Delay immunization until resolution except for measles postexposure prophylaxis
  • Mild
  • 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
  • Provide MMR as scheduled
Immunocompromised contact
  • Provide MMR/MMRV as scheduled
MMR immunization in children with JIA or who have been internationally adopted to the United States is discussed separately.
MMR: measles-mumps-rubella vaccine; MMRV: measles, mumps, rubella, and varicella virus vaccine; JIA: juvenile idiopathic arthritis; CD4: CD4+ T lymphocyte.
* The specific interval varies with the blood or immune globulin product.
¶ Absence of severe immunosuppression is defined according to age as follows:
  • ≤5 years – CD4 percentage is ≥15% for at least 6 months; or, if CD4 percentage not available, CD4 count ≥750/microL for at least 6 months while ≤12 months of age or CD4 count ≥500/microL for at least 6 months while 1 through 5 years of age
  • >5 years – CD4 percentage ≥15% and CD4 count of ≥200/microL for at least 6 months if both tests are available; or, if only 1 test is available, CD4 percentage ≥15% or CD4 count of ≥200/microL
MMRV is not recommended for children with HIV infection because it has not been studied in this population.
Reference:
  1. McLean HQ, Fiebelkorn AP, Temte JL, et al. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62:1.2.
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