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

Vol. 47 / No. RR-8 MMWR 35a contact dermatitis), rather than anaphylaxis. In persons who have such a sensitivity,the adverse reaction to the neomycin in the vaccine is an erythematous, pruritic noduleor papule appearing 48–96 hours after vaccination. A history of contact dermatitisto neomycin is not a contraindication to receiving MMR vaccine. MMR vaccine doesnot contain penicillin and therefore a history of penicillin allergy is not a contraindicationto MMR vaccination.Although anaphylaxis after vaccination is extremely rare and no anaphylaxisdeaths associated with administration of MMR vaccine have been reported, thisadverse event can be life threatening (150 ). Epinephrine should be available forimmediate use at any site where vaccines are administered in case symptoms of anaphylaxisoccur.ThrombocytopeniaChildren who have a history of thrombocytopenia or thrombocytopenic purpuramay be at increased risk for developing clinically significant thrombocytopenia afterMMR vaccination (172,175 ). Although thrombocytopenia can be life threatening, nodeaths have been reported as a direct consequence of vaccine-induced thrombocytopenia.The decision to vaccinate with MMR should depend on the benefits ofimmunity to measles, mumps, and rubella and the risks for recurrence or exacerbationof thrombocytopenia after vaccination or during natural infection with measles or rubella.The benefits of primary immunization are usually greater than the potentialrisks, and administration of MMR vaccine is justified, particularly with regard to theeven greater risk for thrombocytopenia after measles or rubella disease. However,avoiding a subsequent dose of MMR vaccine may be prudent if an episode of thrombocytopeniaoccurred within approximately 6 weeks after a previous dose of thevaccine. Serologic evidence of measles immunity among such persons may besought in lieu of MMR vaccination.Recent Administration of Immune GlobulinsRecent evidence indicates that high doses of immune globulins can inhibit the immuneresponse to measles and rubella vaccine for 3 or more months (221, 222 ). Theduration of this interference with the immune response depends on the dose of immuneglobulin administered. The effect of immune globulin preparations on theresponse to mumps vaccine is unknown. Blood (e.g., whole blood, packed red bloodcells, and plasma) and other antibody-containing blood products (e.g., IG, specificimmune globulins, and IGIV) can reduce the immune response to MMR or its componentvaccines. Therefore, these vaccines should be administered to persons who havereceived an immune globulin preparation only after the recommended intervalshave elapsed (Table 3) (80 ). However, postpartum administration of MMR or rubellavaccine to women who are susceptible to rubella should not be delayed because anti-Rho(D) immune globulin (human) or any other blood product was received during thelast trimester of pregnancy or at delivery. Such rubella-susceptible women should bevaccinated immediately after delivery and tested at least 3 months later to ensure thatthey are immune to rubella and measles.Immune globulin preparations generally should not be administered simultaneouslywith MMR or its component vaccines. If administration of an immune globulin