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

10 MMWR May 22, 1998Dosage and Route of AdministrationThe lyophilized live MMR vaccine (and its component vaccines) should be reconstitutedand administered as recommended by the manufacturer. All measles-, rubella-,or mumps-containing vaccines available in the United States should be administeredsubcutaneously in the recommended standard single-dose volume of 0.5 mL.Simultaneous Administration of VaccinesIn general, simultaneous administration of the most widely used live and inactivatedvaccines does not impair antibody responses or increase rates of adversereactions (80 ). The antibody responses of persons vaccinated with MMR are similar tothose of persons vaccinated with single-antigen measles, mumps, and rubella vaccinesat different sites or at different times.ACIP encourages routine simultaneous administration of MMR, diphtheria andtetanus toxoids and acellular pertussis (DTaP) or diphtheria and tetanus toxoids andwhole-cell pertussis (DTP) vaccine, Haemophilus influenzae type b (Hib) vaccine, andoral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) to children whoare at the recommended age to receive these vaccines. Antibody responses wereequivalent and no clinically significant increases in the frequency of adverse eventsoccurred when MMR vaccine, DTaP (or DTP), Hib vaccine, hepatitis B vaccine, and IPVor OPV were administered either simultaneously at different sites or at separate times(87 ). Likewise, seroconversion rates, antibody levels, and frequencies of adverse reactionswere similar in two groups, one of which was administered MMR and varicellavaccines simultaneously at separate sites and the other of which received the vaccines6 weeks apart (88 )(Merck Research Laboratories, unpublished data).Live measles and yellow fever vaccines can be administered simultaneously atseparate anatomical sites in separate syringes (89 ). Limited data also indicate that theimmunogenicity and safety of inactivated Japanese encephalitis vaccine are not compromisedby simultaneous administration with live measles vaccine (90 ). Limiteddata exist concerning concurrent administration of MMR vaccine and other vaccinesthat are often recommended for international travelers (e.g., meningococcal vaccine,typhoid vaccines). However, neither theoretical considerations nor practical experienceindicate that the simultaneous administration at separate anatomic sites of MMRand other live or inactivated vaccines will produce a diminished immune response orincrease the incidence of adverse events among vaccinated persons.DOCUMENTATION OF IMMUNITYOnly doses of vaccine for which written documentation of the date of administrationis presented should be considered valid. Neither a self-reported dose nor a historyof vaccination provided by a parent is, by itself, considered adequate documentation.No health-care worker should provide a vaccination record for a patient unlessthat health-care worker has administered the vaccine or has seen a record that documentsvaccination. Persons who may be immune to measles, mumps, or rubellabut who lack either adequate documentation of vaccination or other acceptable evidenceof immunity (Table 1) should be vaccinated. Vaccination status and date of