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Trade Names:
M-M-R-II
- Powder for Injection Mixture of 3 viruses: at least 1,000 measles TCID ₅₀ (tissue culture infectious doses), at least 20,000 mumps TCID ₅₀ and at least 1,000 rubella TCID ₅₀ per 0.5 mL dose

Mechanism of Action

Pharmacology

Induces protective antibodies against measles, mumps, and rubella viruses.

Indications and Usage

Vaccination of individuals known to be susceptible to measles, mumps, or rubella; prevention of occurrence of congenital rubella syndrome (CRS) among offspring of women who contract rubella during pregnancy. Preferred immunizing agent for most children and many adults.

Contraindications

Pregnancy; moderate to severe hypersensitivity reaction to eggs; immunosuppressive therapy; blood dyscrasia, leukemia, lymphoma of any type or other malignant neoplasms affecting the bone marrow or lymphatic systems; primary or acquired immunodeficiency; active untreated tuberculosis; family history of congenital or hereditary immunodeficiency, until immune competence of potential vaccine recipient is demonstrated.

Vaccinate asymptomatic children with HIV infection.

Dosage and Administration

Subcutaneous 0.5 mL. Optimal schedule: Give first dose at 12 to 15 mo; revaccinate routinely at 5 to 6 yr of age or 11 to 12 yr of age.

General Advice

• Reconstitute using supplied diluent.
• With 25-gauge ⅝-inch needle, inject total volume of reconstituted vaccine subcutaneously, preferably into outer aspect of upper arm.

Storage/Stability

Store in refrigerator (36° to 46°F). Protect from light. Discard unused reconstituted vaccine if not used within 8 h.

Drug Interactions

To avoid inactivating vaccine, give MMR 2 to 4 wk before or 3 to 11 mo after AGIV, depending on dose. Susceptible postpartum women who received blood products or Rho(D) immune globulin may receive rubella vaccine prior to discharge, provided that rubella titer is measured 6 to 8 wk after vaccination to ensure seroconversion.

May inhibit response to MMR vaccine.

Laboratory Test Interactions

May cause delayed hypersensitivity skin tests (eg, tuberculin, histoplasmin) to appear falsely negative. Effect may persist for several weeks after vaccination. Methacoline inhalation challenge may be falsely positive for a few days.

Adverse Reactions

CNS

Fever; headache; encephalitis; dizziness; polyneuritis; arthralgia; arthritis (rarely chronic); convulsions or seizures.

Dermatologic

Urticaria; rash; erythema multiforme.

EENT

Sore throat; optic neuritis.

GI

Nausea; vomiting; diarrhea.

Hematologic

Thrombocytopenia; purpura.

Miscellaneous

Local pain, induration, erythema or allergic reaction at injection site; mild regional lymphadenopathy; malaise.

Precautions

Pregnancy

Category C (contraindicated).

Lactation

Excreted in breast milk (vaccine-strain rubella).

Acute febrile illness

Defer immunization during course of any acute febrile illness.

Patient Information

• Advise patient that tenderness, redness, swelling, and warmth at site of injection may occur.
• Applying warm compress to site will decrease these symptoms.
• Instruct patient to notify health care provider if local symptoms persist.
• Caution sexually active women to avoid pregnancy for 3 mo after vaccination.