M-M-R II VACCINE (measles,mumps&rubella vaccine/pf)

Drug overview for M-M-R II VACCINE (measles,mumps&rubella vaccine/pf):

Generic name: MEASLES,MUMPS&RUBELLA VACCINE/PF (MEE-zulz/mumps/ roo-BEL-a)
Drug class: Measles Vaccine
Therapeutic class: Biologicals

Measles virus vaccine live is a preparation of live, attenuated measles Mumps virus vaccine live is a preparation of live, attenuated organisms of Rubella virus vaccine live is a preparation of live, attenuated rubella the Jeryl Lynn (B level) strain of mumps virus that stimulates active virus that stimulates active immunity to measles infection. Measles virus virus that stimulates active immunity to rubella infection. Rubella virus immunity to mumps infection.

Mumps virus vaccine live is commercially vaccine live is commercially available as a fixed-combination vaccine available as a fixed-combination vaccine containing mumps, measles, and containing measles, mumps, and rubella antigens (MMR; M-M-R(R) II) and a containing measles, mumps, and rubella antigens (MMR; M-M-R(R) II) and as a fixed-combination vaccine containing measles, mumps, rubella, and varicella rubella antigens (MMR; M-M-R(R) II) and as a fixed-combination vaccine antigens (MMRV; ProQuad(R)). For information on MMRV, see Varicella Virus containing mumps, measles, rubella, and varicella antigens (MMRV; ProQuad(R)). For information on MMRV, see Varicella Virus Vaccine Live Vaccine Live 80:12. 80:12.

Measles virus vaccine live is used to stimulate active immunity to measles Mumps virus vaccine live is used to stimulate active immunity to mumps. Rubella virus vaccine live is used to stimulate active immunity to rubella (German measles). Monovalent rubella virus vaccine live (Meruvax(R) II) is (rubeola).

Monovalent measles virus vaccine live (Attenuvax(R)) is no Monovalent mumps virus vaccine live (Mumpsvax(R)) is no longer commercially available in the US. Mumps virus vaccine live is commercially available in longer commercially available in the US. Measles virus vaccine live is no longer commercially available in the US.

Rubella virus vaccine live is commercially available in the US as a fixed-combination vaccine containing the US as a fixed-combination vaccine containing measles, mumps, and measles, mumps, and rubella antigens (MMR; M-M-R(R) II) for use in adults, rubella antigens (MMR; M-M-R(R) II) for use in adults, adolescents, and adolescents, and children 12 months of age or older and as a children 12 months of age or older and as a fixed-combination vaccine containing measles, mumps, rubella, and varicella antigens (MMRV; fixed-combination vaccine containing measles, mumps, rubella, and varicella antigens (MMRV; ProQuad(R)) for use in children 12 months through 12 years ProQuad(R)) for use in children 12 months through 12 years of age. of age. The US Public Health Service Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy The major objective of rubella immunization is to prevent rubella infection The US Public Health Service Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), the American Academy of during pregnancy and resultant congenital rubella infection and congenital of Family Physicians (AAFP) recommend universal immunization against mumps Family Physicians (AAFP), and the National Vaccine Advisory Committee for all susceptible children, adolescents, and adults, unless mumps virus rubella syndrome (CRS).

Congenital rubella infection may cause miscarriage, (NVAC) recommend universal immunization against measles for all susceptible abortion, stillbirth, fetal anomalies, or asymptomatic infection in the vaccine live is contraindicated. (See Cautions: Precautions and children, adolescents, and adults, unless measles virus vaccine live is Contraindications.) infant. (See Pharmacology: Rubella Virus and Infection.) Because many contraindicated.

(See Cautions: Precautions and Contraindications.) countries do not have rubella vaccination programs or have only recently implemented such programs, many adults throughout the world remain The ACIP, AAP, and AAFP state that the fixed-combination vaccine containing measles, mumps, and rubella vaccine live (MMR) is preferred over monovalent Most individuals born before 1957 are likely to have been infected susceptible. Adults in the US who were born in countries where routine mumps virus vaccine live (no longer commercially available in the US) for naturally with measles and generally can be considered immune. Individuals rubella vaccination was not offered are at higher risk for contracting born in 1957 or later should be considered immune to measles only if there both primary immunization and revaccination to assure immunity to all 3 rubella and having infants with CRS compared with adults born in the US.

diseases. Alternatively, in children 12 months through 12 years of age when is documentation of adequate immunization against measles (2 doses of MMR a dose of MMR and a dose of varicella virus vaccine live are indicated for or measles-containing vaccine for school aged-children in grades K-12, The US Public Health Service Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy college students, health-care personnel, international travelers), natural primary immunization, use of the fixed-combination vaccine containing MMR and varicella virus vaccine live (MMRV; ProQuad(R)) can be considered. For measles infection diagnosed by a health-care provider, or serologic of Family Physicians (AAFP) recommend universal immunization against evidence of measles immunity.

Individuals who lack adequate documentation information on MMRV, see Varicella Virus Vaccine Live 80:12. rubella for all susceptible children, adolescents, and adults, unless of immunity should be considered susceptible to measles and should be rubella virus vaccine live is contraindicated. (See Cautions: Precautions A killed mumps virus vaccine was available in the US from 1950-1978, and and Contraindications.) vaccinated, unless measles virus vaccine live is contraindicated.

A parental report of measles vaccination, by itself, is not considered while this vaccine induced antibody to the mumps virus, the resultant mumps adequate documentation of immunization. Clinicians should not provide immunity was transient. Therefore, individuals who previously received The ACIP, AAP, and AAFP state that the fixed-combination vaccine containing documentation of immunization for a patient unless they administered the killed mumps virus vaccine may benefit from revaccination with MMR.

measles, mumps, and rubella vaccine live (MMR) is preferred over monovalent rubella virus vaccine live (no longer commercially available in the US) for vaccine to the patient or have seen a record documenting vaccination. Adults born before 1957 are likely to have been infected naturally with both primary immunization and revaccination to assure immunity to all 3 diseases. Alternatively, in children 12 months through 12 years of age when mumps and generally can be considered immune, even if they did not have Previously, individuals who received a single dose of any live measles a dose of MMR and a dose of varicella virus vaccine live are indicated for clinically recognizable disease.

Other individuals can be considered immune virus vaccine when 12 months of age or older were considered to be adequately immunized against measles. In 1989, because of increased measles primary immunization, use of the fixed-combination vaccine containing MMR to mumps if there is documentation of adequate immunization against mumps (2 doses of MMR or mumps virus-containing vaccine for school aged-children and varicella virus vaccine live (MMRV; ProQuad(R)) can be considered. For outbreaks in school-aged children in the US, the ACIP and AAP revised their in grades K-12, college students, health-care personnel, international information on MMRV, see Varicella Virus Vaccine Live 80:12.

recommendations to specify that routine primary immunization against measles generally should consist of 2 doses of measles virus vaccine live travelers; at least 1 dose in preschool-aged children, adults not at high given at least 1 month (i.e., at least 28 days) apart. This recommendation Individuals generally can be considered immune to rubella if they have risk), physician-diagnosed natural mumps infection, or serologic evidence of mumps immunity. Adults born in 1957 or later who lack adequate serologic (i.e., laboratory) evidence of rubella immunity, documentation of was made because primary vaccine failure was considered to be a principal adequate immunization with at least one dose of live rubella contributing factor to these measles outbreaks, and it was further documentation of immunity should receive 1 dose of MMR to provide immunity against mumps, unless MMR is contraindicated.

strengthened in 1998 to unequivocally recommend that a 2-dose primary virus-containing vaccine at 12 months of age or older, or were born before 1957 (except women of childbearing potential). Birth before 1957 is not immunization series be completed prior to entry into kindergarten or first acceptable for evidence of immunity in women who may become pregnant grade (i.e., by 4 through 6 years of age). Individuals with an equivocal serologic test should be considered because it provides only presumptive evidence of rubella immunity and does susceptible to mumps unless they have other evidence of mumps immunity or a not guarantee that an individual is immune.

Rubella infection can occur in subsequent serologic test indicates mumps immunity. The demonstration of The ACIP, AAP, AAFP, and NVAC state that MMR is preferred over monovalent measles virus vaccine live (no longer commercially available in the US) for mumps immunoglobulin G (IgG) by any commonly used serologic assay is some unvaccinated individuals born before 1957 and congenital rubella and acceptable evidence of mumps immunity. It is not necessary to test for both primary immunization and revaccination to assure immunity to all 3 CRS can occur among offspring of women infected with rubella during diseases.

Alternatively, in children 12 months through 12 years of age when pregnancy. Individuals with an equivocal serologic test should be susceptibility prior to administration of MMR since there is no evidence a dose of MMR and a dose of varicella virus vaccine live are indicated for considered susceptible to rubella unless they have adequate evidence of that individuals already immune because of previous vaccination or natural disease are at any unusual risk of local or systemic reactions to the primary immunization, use of the fixed-combination vaccine containing MMR vaccination or a subsequent serologic test result indicates rubella and varicella virus vaccine live (MMRV; ProQuad(R)) can be considered. For immunity.

Although only one dose of live rubella virus-containing vaccine vaccine. Any individual who is unsure about their mumps disease history and/or mumps vaccination history should be vaccinated with MMR. information on MMRV, see Varicella Virus Vaccine Live 80:12.

is required as acceptable evidence of rubella immunity, recommendations for routine childhood immunization include a 2-dose regimen of MMR. The ACIP states that clinical diagnosis of rubella is unreliable and should not be considered in assessing immunity to the disease. Because many rash illnesses may mimic rubella and many rubella infections are unrecognized, the only reliable evidence of previous rubella infection is the presence of serum rubella immunoglobulin G (IgG).

Although tests for immunoglobulin (IgM) antibody have been used to diagnose acute and recent rubella infection, IgM tests should not be used to determine rubella immunity since false-positive results can occur. Laboratories that regularly perform antibody testing generally provide the most reliable results because their reagents and procedures are more likely to be strictly standardized. There is no conclusive evidence that individuals who are already immune to rubella when vaccinated are at any increased risk of vaccine-associated adverse effects, and therefore there is no need to test for susceptibility to rubella infection before administering the vaccine.

Although routine serologic testing for rubella antibody in women of childbearing potential during clinic visits for routine health care, premarital evaluation, family planning, or diagnosis and treatment of sexually transmitted diseases may identify women who are not immune to rubella before they become pregnant, such testing is not useful unless it is linked to timely follow-up and vaccination of women who are susceptible. Hemagglutination-inhibiting (HI) antibody testing formerly was the method most frequently used to screen for rubella antibodies. However, this method has been replaced by other assays of equal or greater sensitivity.

Enzyme immunoassays (EIAs) are the most commonly used of the newer commercial assays, but latex agglutination, immunofluorescence assay (IFA), passive hemagglutination, hemolysis-in-gel, and virus neutralization tests also are available. Any antibody level above the standard positive cutoff value for the specific assay method can be considered acceptable evidence of immunity. Occasionally, individuals with documented histories of rubella vaccination have serum rubella IgG levels that are not clearly positive by enzyme-linked immunosorbent assay (ELISA); such individuals can be given another dose of MMR and need not be retested for serologic evidence of rubella immunity.

Efforts to vaccinate rubella-susceptible, postpubertal individuals, especially women of childbearing age, should be intensified, particularly among women who emigrated from areas outside the US where routine rubella vaccination may have been unlikely. Therefore, in addition to immunization of children, the following strategies should be followed to hasten the elimination of rubella and CRS in the US: making the general public and health-care providers more aware of the dangers of rubella infection; ensuring that patients are vaccinated as part of routine medical and gynecologic care; ensuring vaccination of all women visiting family planning clinics; ensuring vaccination of unimmunized women immediately after undergoing childbirth, miscarriage, or abortion; vaccinating susceptible women identified during occasions when their children undergo routine examinations or vaccinations; vaccinating susceptible women identified by premarital serology; routinely vaccinating susceptible women before discharge from hospitals, birthing centers, or other medical facilities, unless a specific contraindication exists; requiring proof of immunity (i.e., positive serologic evidence or documented rubella vaccination) for college entry; and requiring proof of immunity for all hospital personnel who might be exposed to patients with rubella or who might be in contact with pregnant patients. The number of cases of rubella reported in the US has decreased 99% since the licensure of rubella vaccine in 1969 (57,686 cases in 1969 and fewer than 25 cases in 2001); however, the epidemiology of the disease has changed.

Since the beginning of the 1990s, most reported cases of rubella in the US have occurred among adults (86% of cases in 1999) and most have involved foreign-born individuals, especially those from Mexico and South America. Although the number of cases of CRS in the US also has declined, CRS now disproportionately affects infants born to foreign-born women (92% of infants with CRS during 1997-1999 had foreign-born mothers). Before the mid-1990s, rubella outbreaks in the US generally occurred among children and adults in religious communities that did not accept vaccination and in unvaccinated individuals in schools, jails, and other closed environments.

Rubella outbreaks in several areas of the US (e.g., California, Massachusetts, Connecticut, North Carolina) have occurred principally in Hispanic women, and the risk for both rubella and CRS is increased in this ethnic group, particularly those born outside the US where routine rubella vaccination may not occur. Outbreaks also have been reported in workplaces that employ large numbers of foreign-born workers (e.g., poultry and meat processing plants). An average of 5 CRS cases per year was reported in the US between 1995 and 2000; since 2001, an average of one CRS case per year has been reported. In 2004, a panel of experts stated that rubella is no longer endemic in the US.