Measles, Mumps, and Rubella - Centers for Disease Control and ...

Vol. 47 / No. RR-8 MMWR 9Vaccine Shipment and StorageAdministration of improperly stored vaccine may fail to provide protection againstdisease from measles, rubella, and/or mumps. These live virus vaccines are suppliedin lyophilized form and should be stored at 2–8 C (35.6–46.4 F) or colder. They must beshipped at 10 C (50 F) or colder and may be shipped on dry ice. The vaccines must beprotected from light, which may inactivate the vaccine viruses. Reconstituted vaccinealso must be protected from light, must be stored at 2–8 C (35.6–46.4 F), and must notbe frozen. Reconstituted vaccine must be discarded if not used within 8 hours.VACCINE USAGETwo doses of MMR vaccine separated by at least 1 month (i.e., a minimum of28 days) and administered on or after the first birthday are recommended for all childrenand for certain high-risk groups of adolescents and adults. The recommended1 month interval between successive doses of MMR or other measles-containing vaccineis based on the principle that live virus vaccines not administered at the sametime should be separated by at least 1 month (80 ).MMR is the vaccine of choice when protection against any of these three diseasesis required on or after the first birthday, unless any of its component vaccines is contraindicated.The purpose of the two-dose vaccination schedule is to produceimmunity in the small proportion of persons who fail to respond immunologically toone or more of the components of the first dose. Studies indicate that two doses ofmeasles vaccine are necessary to develop adequate population immunity to preventmeasles outbreaks among school-aged and older persons. Mumps can occur in highlyvaccinated populations; in these outbreaks, substantial numbers of cases have occurredamong persons who had previously received a single dose of mumpscontainingvaccine (33,81 ). Although primary rubella vaccine failure rarely occurs, thepotential consequences of failure (i.e., CRS) are substantial.Almost all persons who do not respond to the measles component of the first doseof MMR vaccine will respond to the second dose (82 ) (CDC, unpublished data). Fewdata regarding the immune response to the rubella and mumps components of a seconddose of MMR vaccine are available, but most persons who do not respond to therubella or mumps components of the first dose would be expected to respond to thesecond (82–84 ) (CDC, unpublished data). The second dose is not generally considereda booster dose because a primary immune response to the first dose provides longtermprotection. Although some persons who develop normal antibody titers inresponse to a single dose of MMR vaccine will develop higher antibody titers to thethree component vaccines when administered a second dose of vaccine, these increasedantibody levels typically do not persist (57 ).Use of combined MMR vaccine for both measles doses and all other indicationsshould provide an additional safeguard against primary vaccine failures and facilitateelimination of rubella and CRS and continued reduction of mumps incidence. Dataalso indicate that the favorable benefit/cost ratio for routine measles, rubella, andmumps vaccination is even greater when the vaccines are administered as combinedMMR vaccine (85,86 ).