MMR Vaccine for Mumps – Technical Q&A
Who should receive MMR vaccine?
The principal strategy to prevent mumps is to achieve and maintain high immunization levels. The Advisory Committee on Immunization Practices (ACIP) recommends that
- All preschool aged children 12 months of age and older receive one dose of measles-mumps-rubella vaccine (MMR)
- All school-aged children receive two doses of MMR
- All adults have evidence of immunity against mumps.
As noted below, two doses of mumps vaccine are more effective than a single dose. Consequently, during outbreaks and for at-risk populations, ensuring high vaccination coverage with two doses is encouraged. For example, healthcare workers may be at increased risk of acquiring mumps and transmitting it to patients and thus should receive two doses of MMR vaccine or provide proof of immunity. Since vaccination is the cornerstone of mumps prevention, public and private health entities concerned about spread of mumps in a population can review the vaccination status of populations of interest and work to address gaps in vaccination.
See MMWR article: Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome & Control of Mumps: Recommendations of ACIP
May 22, 1998 / 47(RR-8);1-57
NOTE: The combination MMRV vaccine is not licensed for those over 12 years old.
In one study, 86.6% of vaccinees had evidence of mumps seroconversion at 4 weeks after immunization and 93.3% had evidence of seroconversion after 5 weeks. However, seroconversion may not result in immunity. About 80% of persons who have received one dose can be considered protected and 90% after two doses.
Live mumps vaccine was not used routinely before 1967. Before the vaccine was introduced, the age-specific incidence of the disease peaked among children aged 5-9 years. Therefore, most persons born before 1957 are likely to have been infected naturally between 1957 and 1977 and may be presumed to be immune, even if they have not had clinically recognizable mumps disease. However, birth before 1957 does not guarantee mumps immunity. Therefore, during mumps outbreaks, MMR vaccination should be considered for persons born before 1957 who may be exposed to mumps and who may be susceptible. Laboratory testing for mumps susceptibility before vaccination is not necessary. (For more information see page 15 of the MMWR article Vaccine Use and Strategies for Elimination of Measles, Rubella, and Congenital Rubella Syndrome & Control of Mumps: Recommendations of ACIP May 22, 1998 / 47(RR-8);1-57)
Can healthcare workers (HCW's) get the MMR vaccine and continue to work?
Yes. There are no reports of transmission of live attenuated measles or mumps viruses from vaccinees to susceptible contacts. For more information see, Prevention & Control of Mumps Among Healthcare Personnel.
Who should not be given MMR vaccine?
Women known to be pregnant should not receive MMR vaccine. Pregnancy should be avoided for four weeks following MMR vaccine. Close contact with a pregnant woman is NOT a contraindication to MMR vaccination of the contact. Breastfeeding is NOT a contraindication to vaccination of either the woman or the breastfeeding child.
MMR is not recommended for those with evidence of severe immunosuppression.
No. Any changes would depend on the epidemiology and age groups affected by an outbreak. Unless otherwise advised, children should be vaccinated according to the vaccination schedule. Preschool-aged children should receive the first dose of MMR vaccine as close to age 12 months as possible (i.e., on or after the first birthday). The second dose of MMR vaccine is recommended when children are aged 4-6 years (i.e., before a child enters kindergarten or first grade). This recommended timing for the second dose of MMR vaccine has been adopted jointly by ACIP, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).
If an outbreak affects the 1 to 4 year old age group, then those children should receive their second MMR dose, provided 28 days have passed since receipt of their first dose of MMR.
A two dose vaccine schedule for measles vaccine administered as MMR was recommended in 1989. In 1998, states were strongly encouraged to take immediate steps to ensure that, by 2001, all children in grades kindergarten through 12 have received two doses of MMR vaccine.
If required, the second MMR dose should be administered as soon as possible, but no sooner than 28 days after the first dose.
Mumps vaccine has not been shown to be effective in preventing mumps in already infected persons.
Should an IgG be drawn after two doses of MMR?
No. After vaccination, it is not necessary to test patients for IgG to confirm immunity.
Are there special vaccination recommendations for colleges and other post-high school education institutions?
Risks for transmission of measles, rubella, and mumps at post-high school educational institutions can be high because these institutions bring together large concentrations of persons who may be susceptible to these diseases. Therefore, colleges, universities, technical and vocational schools, and other institutions for post-high school education should require that all undergraduate and graduate students have received two doses of MMR vaccine or have other acceptable evidence of measles, rubella, and mumps immunity before enrollment.
Students who do not have documentation of MMR vaccination or other acceptable evidence of immunity at the time of enrollment should be admitted to classes only after receiving the first dose of MMR vaccine. These students should be administered a second dose of MMR vaccine one month later (but no sooner than 28 days after the first dose).
Other references not mentioned above.
- Pink book chapter on mumps
- VPD Surveillance manual chapter on mumps (removed while being revised)
- Red Book online chapter on mumps
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