Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013
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| Recommendations and Reports Volume 62, No. RR-4 June 14, 2013 | | |
Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Recommendations and Reports
June 14, 2013 / 62(RR04);1-34
Corresponding preparer: Amy Parker Fiebelkorn, MSN, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC. Telephone: 404-639-8235; E-mail: aparker@cdc.gov.
Summary
This report is a compendium of all current recommendations for the prevention of measles, rubella, congenital rubella syndrome (CRS), and mumps. The report presents the recent revisions adopted by the Advisory Committee on Immunization Practices (ACIP) on October 24, 2012, and also summarizes all existing ACIP recommendations that have been published previously during 1998–2011 (CDC. 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 1998;47[No. RR-8]; CDC. Revised ACIP recommendation for avoiding pregnancy after receiving a rubella-containing vaccine. MMWR 2001;50:1117; CDC. Updated recommendations of the Advisory Committee on Immunization Practices [ACIP] for the control and elimination of mumps. MMWR 2006;55:629–30; and, CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60[No. RR-7]).Currently, ACIP recommends 2 doses of MMR vaccine routinely for children with the first dose administered at age 12 through 15 months and the second dose administered at age 4 through 6 years before school entry. Two doses are recommended for adults at high risk for exposure and transmission (e.g., students attending colleges or other post-high school educational institutions, health-care personnel, and international travelers) and 1 dose for other adults aged ≥18 years. For prevention of rubella, 1 dose of MMR vaccine is recommended for persons aged ≥12 months.At the October 24, 2012 meeting, ACIP adopted the following revisions, which are published here for the first time. These included:
- For acceptable evidence of immunity, removing documentation of physician diagnosed disease as an acceptable criterion for evidence of immunity for measles and mumps, and including laboratory confirmation of disease as a criterion for acceptable evidence of immunity for measles, rubella, and mumps.
- For persons with human immunodeficiency virus (HIV) infection, expanding recommendations for vaccination to all persons aged ≥12 months with HIV infection who do not have evidence of current severe immunosuppression; recommending revaccination of persons with perinatal HIV infection who were vaccinated before establishment of effective antiretroviral therapy (ART) with 2 appropriately spaced doses of MMR vaccine once effective ART has been established; and changing the recommended timing of the 2 doses of MMR vaccine for HIV-infected persons to age 12 through 15 months and 4 through 6 years.
- For measles postexposure prophylaxis, expanding recommendations for use of immune globulin administered intramuscularly (IGIM) to include infants aged birth to 6 months exposed to measles; increasing the recommended dose of IGIM for immunocompetent persons; and recommending use of immune globulin administered intravenously (IGIV) for severely immunocompromised persons and pregnant women without evidence of measles immunity who are exposed to measles.
Introduction
Measles, rubella, and mumps are acute viral diseases that can cause serious disease and complications of disease but can be prevented with vaccination. Vaccines for prevention of measles, rubella, and mumps were licensed and recommended for use in the United States in the 1960s and 1970s. Because of successful vaccination programs, measles, rubella, congenital rubella syndrome (CRS), and mumps are now uncommon in the United States. However, recent outbreaks of measles (1) and mumps (2,3) have occurred from import-associated cases because these diseases are common in many other countries. Persons who are unvaccinated put themselves and others at risk for these diseases and related complications.Two live attenuated vaccines are licensed and available in the United States to prevent measles, mumps, and rubella: MMR vaccine (measles, mumps, and rubella [M-M-R II, Merck & Co., Inc.]), which is indicated routinely for persons aged ≥12 months and infants aged ≥6 months who are traveling internationally and MMRV vaccine (measles, mumps, rubella, and varicella [ProQuad, Merck & Co., Inc.]) licensed for children aged 12 months through 12 years. For the purposes of this report, MMR vaccine will be used as a general term for measles, mumps, and rubella vaccination; however, age-appropriate use of either licensed vaccine formulation can be used to implement these vaccination recommendations.
For the prevention of measles, mumps, and rubella, vaccination is recommended for persons aged ≥12 months. For the prevention of measles and mumps, ACIP recommends 2 doses of MMR vaccine routinely for children with the first dose administered at age 12 through 15 months and the second dose administered at age 4 through 6 years before school entry. Two doses are recommended for adults at high risk for exposure and transmission (e.g., students attending colleges or other post-high school educational institutions, health-care personnel, and international travelers) and 1 dose for other adults aged ≥18 years. For prevention of rubella, 1 dose of MMR vaccine is recommended for persons aged ≥12 months. This report is a compendium of all current recommendations for the prevention of measles, rubella, congenital rubella syndrome (CRS), and mumps. The report presents the recent revisions adopted by the Advisory Committee on Immunization Practices (ACIP) on October 24, 2012, and also summarizes all existing ACIP recommendations that have been published previously during 1998–2011 (4–6). As a compendium of all current ACIP recommendations, the information in this report is intended for use by clinicians as guidance for scheduling of vaccinations for these conditions and considerations regarding vaccination of special populations.
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