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

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18 MMWR May 22, 1998evaluation, family planning, or diagnosis <strong>and</strong> treatment of sexually transmitted diseasesmay identify women who are not immune to rubella be<strong>for</strong>e they becomepregnant. Such routine serologic testing is not useful unless it is linked to timely follow-up<strong>and</strong> vaccination of women who are susceptible (103 ).Prenatal Screening <strong>and</strong> Postpartum Vaccination. Prenatal serologic screening ofwomen who have acceptable evidence of rubella immunity is generally not necessary,but is indicated <strong>for</strong> all pregnant women who lack acceptable evidence of rubella immunity(Table 1). Upon completion or termination of their pregnancies, women whodo not have serologic evidence of rubella immunity or documentation of rubella vaccinationshould be vaccinated with MMR be<strong>for</strong>e discharge from the hospital, birthingcenter, or abortion clinic (104 ). They should be counseled to avoid conception <strong>for</strong>3 months after vaccination. Postpartum rubella vaccination of all women not known tobe immune could prevent up to half of CRS cases (105–108 ) ( CDC, unpublished data).Colleges <strong>and</strong> Other Post-High School Educational InstitutionsRisks <strong>for</strong> transmission of measles, rubella, <strong>and</strong> mumps at post-high school educationalinstitutions can be high because these institutions may bring together largeconcentrations of persons susceptible to these diseases (109–113 ). There<strong>for</strong>e, colleges,universities, technical <strong>and</strong> vocational schools, <strong>and</strong> other institutions <strong>for</strong>post-high school education should require that all undergraduate <strong>and</strong> graduate studentshave received two doses of MMR vaccine or have other acceptable evidence ofmeasles, rubella, <strong>and</strong> mumps immunity (Table 1) be<strong>for</strong>e enrollment.College entry requirements <strong>for</strong> measles immunity substantially reduce the risk <strong>for</strong>measles outbreaks on college campuses where they are implemented <strong>and</strong> en<strong>for</strong>ced(111 ). State requirements <strong>for</strong> pre-enrollment vaccination ensure the best protectionagainst widespread measles transmission among students at college campuses <strong>and</strong>other post-high school educational institutions. States are strongly encouraged toadopt such regulations. Students who do not have documentation of live measles,rubella, or mumps vaccination or other acceptable evidence of immunity at the timeof enrollment (Table 1) should be admitted to classes only after receiving the first doseof MMR vaccine. These students should be administered a second dose of MMR vaccine1 month (i.e., at least 28 days) later. Students who have documentation of havingreceived only one dose of measles-containing vaccine on or after the first birthdayshould receive a second dose of MMR be<strong>for</strong>e enrollment, provided at least 1 monthhas elapsed since the previous dose. Students who have a medical contraindication toreceiving any of the components of MMR vaccine should be given a letter of explanationto present to the health officials of their educational institution.Health-Care FacilitiesWhen measles virus is introduced into a community, persons who work in healthcarefacilities are at increased risk <strong>for</strong> acquiring measles compared with the generalpopulation (92,114,115 ). During 1985–1991, at least 795 measles cases (1.1% of allreported cases) occurred among adult health-care workers. Of these, 29% occurredamong nurses, 15% among physicians, 11% among persons in other health-careoccupations (e.g., laboratory <strong>and</strong> radiology technicians, etc.), 11% among clerks,

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