Measles, Mumps, and Rubella - Centers for Disease Control and ...
Measles, Mumps, and Rubella - Centers for Disease Control and ... Measles, Mumps, and Rubella - Centers for Disease Control and ...
14 MMWR May 22, 1998should receive two doses of MMR vaccine. The first dose is administered routinelywhen the child is aged 12–15 months and the second before the child enters school(i.e., at age 4–6 years)(see Routine Vaccination).The clinical diagnosis of rubella is unreliable and should not be considered in assessingimmune status. Because many rash illnesses may mimic rubella infection andmany rubella infections are unrecognized, the only reliable evidence of previous rubellainfection is the presence of serum rubella immunoglobulin G (IgG). Laboratoriesthat regularly perform antibody testing generally provide the most reliable results becausetheir reagents and procedures are more likely to be strictly standardized (seeRubella Case Investigation and Outbreak Control).Postinfection immunity to rubella appears to be long-lasting and is probablylifelong. However, as with other viral diseases, re-exposure to natural rubella occasionallyleads to reinfection without clinical illness or detectable viremia. The risk forCRS among infants born to women reinfected with rubella during pregnancy is minimal(93,94 ). Although data from several studies indicate that levels of vaccineinducedrubella antibodies may decline with time, data from surveillance of rubellaand CRS suggest that waning immunity with increased susceptibility to rubella diseasedoes not occur (28 )(CDC, unpublished data).HI antibody testing was formerly the method most frequently used to screen forrubella antibodies. However, the HI test has been supplanted by other assays of equalor greater sensitivity. EIAs are the most commonly used of these newer commercialassays, but latex agglutination, immunofluorescence assay (IFA), passive hemagglutination,hemolysis-in-gel, and virus neutralization tests are also available.Any antibody level above the standard positive cutoff value of the assay with whichit is measured can be considered evidence of immunity, if the assay is licensed. Whenserum specimens from adults who did not produce antibodies detectable by HI aftervaccination were examined with an equivalently specific but more sensitive test, almostall had detectable antibody (95,96 ). A few children who initially developedantibody detectable by HI apparently “lost” this antibody during follow-up intervals ofup to 16 years (77,97,98 ). However, almost all had antibody detectable by more sensitivetests. In several of these cases, immunity was confirmed by documenting abooster response (i.e., absence of IgM antibody and a rapid rise in IgG antibody) afterrevaccination (62,99 ).Occasionally, persons with documented histories of rubella vaccination have rubellaserum IgG levels that are not clearly positive by ELISA. Such persons can beadministered a dose of MMR vaccine and need not be retested for serologic evidenceof rubella immunity.MumpsPersons generally can be presumed immune to mumps (Table 1) if they have documentationof vaccination with live mumps virus vaccine on or after the first birthday,laboratory evidence of mumps immunity, documentation of physician-diagnosedmumps, or were born before 1957.The demonstration of mumps IgG antibody by any commonly used serologic assayis acceptable evidence of mumps immunity. Persons who have an “equivocal” serologictest result should be considered susceptible to mumps unless they have other
Vol. 47 / No. RR-8 MMWR 15evidence of mumps immunity (Table 1) or subsequent testing indicates they are immune.All new cases of suspected mumps should be confirmed by an appropriateserologic assay (see Mumps Case Investigation, Laboratory Diagnosis).Live mumps vaccine was not used routinely before 1977. Before the vaccine wasintroduced, 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 infectednaturally between 1957 and 1977 and may be presumed immune, even if they havenot had clinically recognizable mumps disease. However, birth before 1957 does notguarantee mumps immunity. Therefore, during mumps outbreaks, MMR vaccinationshould be considered for persons born before 1957 who may be exposed to mumpsand who may be susceptible. Laboratory testing for mumps susceptibility before vaccinationis not necessary.ROUTINE VACCINATIONPreschool-Aged ChildrenChildren should receive the first dose of MMR vaccine at age 12–15 months (i.e., onor after the first birthday). In areas where risk for measles is high, initial vaccinationwith MMR vaccine is recommended for all children as soon as possible upon reachingthe first birthday (i.e., at age 12 months). An area where measles risk is high is definedas:• a county with a large inner city population,• a county where a recent measles outbreak has occurred among unvaccinatedpreschool-aged children, or• a county in which more than five cases of measles have occurred among preschool-agedchildren during each of the last 5 years.These recommendations may be implemented for an entire county or only withindefined areas of a county. This strategy assumes that the benefit of preventing measlescases among children aged 12–15 months outweighs the slightly reduced efficacyof the vaccine when administered to children aged
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- Page 5 and 6: Vol. 47 / No. RR-8 MMWR iiiAdvisory
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- Page 9 and 10: Vol. 47 / No. RR-8 MMWR 1Measles, M
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- Page 13 and 14: Vol. 47 / No. RR-8 MMWR 5Rubella El
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- Page 17 and 18: Vol. 47 / No. RR-8 MMWR 9Vaccine Sh
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- Page 29 and 30: Vol. 47 / No. RR-8 MMWR 21SPECIAL C
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- Page 33 and 34: Vol. 47 / No. RR-8 MMWR 25Passively
- Page 35 and 36: Vol. 47 / No. RR-8 MMWR 27are liste
- Page 37 and 38: Vol. 47 / No. RR-8 MMWR 29In 1994,
- Page 39 and 40: Vol. 47 / No. RR-8 MMWR 31women, th
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- Page 43 and 44: Vol. 47 / No. RR-8 MMWR 35a contact
- Page 45 and 46: Vol. 47 / No. RR-8 MMWR 37SteroidsS
- Page 47 and 48: Vol. 47 / No. RR-8 MMWR 39• is no
- Page 49 and 50: Vol. 47 / No. RR-8 MMWR 41Measles O
- Page 51 and 52: Vol. 47 / No. RR-8 MMWR 43Cases mee
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- Page 55 and 56: Vol. 47 / No. RR-8 MMWR 47Laborator
- Page 57 and 58: Vol. 47 / No. RR-8 MMWR 4927. Lee S
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Vol. 47 / No. RR-8 MMWR 15evidence of mumps immunity (Table 1) or subsequent testing indicates they are immune.All new cases of suspected mumps should be confirmed by an appropriateserologic assay (see <strong>Mumps</strong> Case Investigation, Laboratory Diagnosis).Live mumps vaccine was not used routinely be<strong>for</strong>e 1977. Be<strong>for</strong>e the vaccine wasintroduced, the age-specific incidence of the disease peaked among children aged 5–9 years. There<strong>for</strong>e, most persons born be<strong>for</strong>e 1957 are likely to have been infectednaturally between 1957 <strong>and</strong> 1977 <strong>and</strong> may be presumed immune, even if they havenot had clinically recognizable mumps disease. However, birth be<strong>for</strong>e 1957 does notguarantee mumps immunity. There<strong>for</strong>e, during mumps outbreaks, MMR vaccinationshould be considered <strong>for</strong> persons born be<strong>for</strong>e 1957 who may be exposed to mumps<strong>and</strong> who may be susceptible. Laboratory testing <strong>for</strong> mumps susceptibility be<strong>for</strong>e vaccinationis not necessary.ROUTINE VACCINATIONPreschool-Aged ChildrenChildren should receive the first dose of MMR vaccine at age 12–15 months (i.e., onor after the first birthday). In areas where risk <strong>for</strong> measles is high, initial vaccinationwith MMR vaccine is recommended <strong>for</strong> all children as soon as possible upon reachingthe first birthday (i.e., at age 12 months). An area where measles risk is high is definedas:• a county with a large inner city population,• a county where a recent measles outbreak has occurred among unvaccinatedpreschool-aged children, or• a county in which more than five cases of measles have occurred among preschool-agedchildren during each of the last 5 years.These recommendations may be implemented <strong>for</strong> an entire county or only withindefined areas of a county. This strategy assumes that the benefit of preventing measlescases among children aged 12–15 months outweighs the slightly reduced efficacyof the vaccine when administered to children aged
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