Vaccine Topics - Immunization Program

Measles-Mumps-Rubella Vaccine

Vaccine Information Statement (VIS) Update - Measles-Mumps-Rubella (MMR)

May 1, 2012 -- The Centers for Disease Control and Prevention (CDC) has published a new MMR vaccine information statement (VIS). This interim VIS has been updated with minor changes throughout, and this new version will be the basis for a "final" edition, which should be available in several months. As always, it is preferable to begin using the new edition immediately, but since there are no major changes, existing stores of the MMR VIS may be used.

Summary of Changes

A sentence in Section 2 has been added noting that children younger than 12 months of age who are traveling overseas should get a dose of MMR.
In Section 3, a note has been added asking the patient to tell their provider if they received another vaccine within the past 4 weeks (to alert the provider of the possibility of administering two live vaccines too close together).
In Section 4, the statement that minor problems usually occur 7-12 days after the shot was changed to the more accurate 6-14 days, and the box noting the risk of adverse events following MMRV was removed, as it is not relevant for patients receiving MMR.

This is the first VIS to feature a 2D barcode (located on the back near the edition date). Barcodes will be added to existing and updated VISs. They will be located on the back of the VIS near the edition date, in a box labeled "Office Use Only." These barcodes will allow providers with the necessary hardware and software to scan the VIS name and edition date into patients' electronic medical records. Use of these barcodes is not required; it is simply an alternative to entering the information manually. For more information, visit the CDC's VIS barcode webpage.

VIS are information sheets produced by the CDC that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine. Federal law requires that VIS be handed out when (before each dose) certain vaccinations are given.

This updated VIS has been integrated into the Florida SHOTS™ (Florida State Health Online Tracking System), so registry users can access them electronically.

Healthcare providers should periodically access the VIS electronically and print out a supply for routine distribution. If necessary, bureau staff can FAX copies to providers without internet access.

CDC Health Alert: High Number of Reported Measles Cases in the U.S. in 2011--Linked to Outbreaks Abroad

June 22, 2011 -- The Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) issued the following advisory on Wednesday, June 22, 2011. The complete advisory is available online at emergency.cdc.gov/HAN/han00323.asp?source=govdelivery. Please take a moment to read the HAN and be aware that you may be serving or advising at-risk populations.

The U.S. is experiencing a high number of reported measles cases in 2011, many of which were acquired during international travel. From January 1 through June 17 this year, 156 confirmed cases of measles were reported to the CDC. This is the highest reported number since 1996. Most cases (136) were associated with importations from measles-endemic countries or countries where large outbreaks are occurring. The imported cases involved unvaccinated U.S. residents who recently traveled abroad, unvaccinated visitors to the U.S, and people linked to these imported cases.

Recommendations for Healthcare Providers

Ensure all patients are up-to-date on measle-mumps-rubella (MMR) vaccine* and other vaccines.
For those who travel abroad, the CDC recommends that all U.S. residents older than 6 months of age be protected from measles and receive MMR vaccine, if needed, prior to departure.
- Infants 6 through 11 months of age should receive 1 dose of MMR vaccine before departure.†
- Children 12 months of age or older should have documentation of 2 doses of MMR vaccine (separated by at least 28 days).
- Teenagers and adults without evidence of measles immunity** should have documentation of 2 appropriately spaced doses of MMR vaccine.
Consider measles as a diagnosis in anyone with a febrile rash illness lasting 3 days or more, a temperature of 101°F (38.3°C) or higher, and clinically compatible symptoms (cough, coryza, and/or conjunctivitis) who has recently traveled abroad or who has had contact with someone with a febrile rash illness. Immunocompromised patients may not exhibit rash or may exhibit an atypical rash. The incubation period for measles from exposure to fever is usually about 10 days (range, 7 to 12 days) and from exposure to rash onset is usually 14 days (range, 7 to 21 days).
Isolate suspect measles case-patients and immediately report cases to local County Health Departments to ensure a prompt public health response.
Obtain specimens for testing, including viral specimens for confirmation and genotyping.

* Children 1 through 12 years of age may receive measles-mumps-rubella-varicella (MMRV) vaccine for protection against measles, mumps, rubella, and varicella; however, MMRV vaccine is currently unavailable.

† Infants who receive a dose of MMR vaccine before their first birthday should receive 2 more doses of MMR vaccine, the first of which should be administered when the child is 12 through 15 months of age and the second at least 28 days later.

** One of the following is considered evidence of measles immunity for international travelers:

Birth before 1957.
Documented administration of 2 doses of live measles virus vaccine (MMR, MMRV, or measles vaccines).
Laboratory (serologic) proof of immunity.
Documentation of physician-diagnosed measles.

For additional information relating to increased measles activity in the U.S., refer to Measles--United States, January-May 20, 2011. Morbidity and Mortality Weekly Report (MMWR) May 27, 2011; 60(20);666-668.

Vaccine Information Statement News

May 26, 2010 -- The Bureau of Immunization is pleased to highlight the recent publication of the measles-mumps-rubella-varicella (MMRV) interim Vaccine Information Statement (VIS). The MMRV interim VIS dated 5/21/2010 is now available. It is the preferred VIS for children getting MMRV vaccine, as it contains more detailed information about the risk of febrile seizures.

Details can be found on the "VIS News" webpage: www.cdc.gov/vaccines/pubs/vis/vis-news.htm.

Healthcare providers should periodically access the VIS electronically and print out a supply for routine distribution. If necessary, Bureau staff can FAX copies to providers without internet access.

Links to the latest VIS can be found at:

ACIP Recommendations for Use of Combination Measles-Mumps-Rubella-Varicella Vaccine

May 13, 2010 -- The Bureau of Immunization is pleased to bring to your attention an important report published by the Centers for Disease Control and Prevention (CDC) on May 7, 2010, in the Morbidity and Mortality Weekly Report (MMWR Weekly / Vol. 59 / No. RR3). The report, Use of Combination Measles, Mumps, Rubella, and Varicella Vaccine - Recommendations of the Advisory Committee on Immunization Practices (ACIP) (page 1 - 12), presents the recommendations and use of the combination measles-mumps- rubella-varicella vaccine (MMRV, ProQuad, Merck & Co., Inc.).

We encourage providers to read these recommendations and guidance carefully, since we include only excerpts here.

In June 2009, the CDC's Advisory Committee on Immunization Practices (ACIP) adopted new recommendations regarding use of the combination MMRV vaccine. MMRV vaccine was licensed in the U.S. in September 2005 and may be used instead of measles-mumps-rubella vaccine (MMR, M-M-RII, Merck & Co., Inc.) and varicella vaccine (VARIVAX, Merck & Co., Inc.) to implement the recommended 2-dose vaccine schedule for prevention of measles, mumps, rubella, and varicella among children 12 months through 12 years of age. At the time of its licensure, use of MMRV vaccine was preferred for both the first and second doses over separate injections of equivalent component vaccines (MMR vaccine and varicella vaccine), which was consistent with the ACIP's 2006 general recommendations on use of combination vaccines (CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2006;55;[No. RR-15]). Since July 2007, supplies of MMRV vaccine have been temporarily unavailable as a result of manufacturing constraints unrelated to efficacy or safety. MMRV vaccine is now available in the U.S. again.

After consideration of the postlicensure data and other evidence, the ACIP adopted the following summized new recommendations regarding use of MMRV vaccine for the first and second doses and identified a personal or family (i.e., sibling or parent) history of seizure as a precaution for use of MMRV vaccine:

The routinely recommended ages for measles, mumps, rubella and varicella vaccination continue to be 12 to 15 months of age for the first dose and 4 to 6 years of age for the second dose.
For the first dose of measles, mumps, rubella, and varicella vaccines at 12 to 47 months of age, either measles, mumps, and rubella (MMR) vaccine and varicella vaccine or MMRV vaccine may be used. Providers who are considering administering MMRV vaccine should discuss the benefits and risks of both vaccination options with the parents or caregivers. Unless the parent or caregiver expresses a preference for MMRV vaccine, the CDC recommends that MMR vaccine and varicella vaccine should be administered for the first dose in this age group.
For the second dose of measles, mumps, rubella, and varicella vaccines at any age (15 months to 12 years) and for the first dose at greater than 48 months of age, use of MMRV vaccine generally is preferred over separate injections of its equivalent component vaccines (i.e., MMR vaccine and varicella vaccine). Considerations should include provider assessment, patient preference, and the potential for adverse events.
A personal or family (i.e., sibling or parent) history of seizures of any etiology is a precaution for MMRV vaccination. Children with a personal or family history of seizures of any etiology generally should be vaccinated with MMR vaccine and varicella vaccine.

MMRV vaccine may be administered simultaneously with other vaccines recommended for children 12 to 15 months of age and 4 to 6 years of age. If simultaneous administration is not possible, MMRV vaccine may be administered at any time before or after an inactivated vaccine but at least 28 days before or after another live, attenuated vaccine, except varicella vaccine, for which a minimum interval of 3 months is recommended.

Effective Monday, May 10, 2010, Merck ProQuad, MMR-V, NDC 00006-4999-00, 10-pack single dose vial became available for ordering through the Vaccines for Children (VFC) Program. A separate Vaccine Information Statement (VIS) for MMRV is in draft form and is expected to be available later this year. Both MMR and varicella VISs include information about MMRV and are available at: http://www.cdc.gov/vaccines/pubs/vis/.

Update: Measles: United States, January through July 2008

August 25, 2008 -- The Florida Department of Health, Bureau of Immunization announces publication of the Centers for Disease Control and Prevention's (CDC), Morbidity and Mortality Weekly Report (MMWR); August 22, 2008 / 57(33);893-896 - Update: Measles --- United States, January--July 2008.

During January through July 2008, 131 measles cases were reported to the CDC, compared with an average of 63 cases per year during 2000-2007. This report updates an earlier report on measles in the United States during 2008 and summarizes two recent U.S outbreaks among unvaccinated school-aged children. Among those measles cases reported during the first 7 months of 2008, 76% were in persons less than 20 years of age, and 91 percent were in persons who were unvaccinated or of unknown vaccination status. Of the 131 cases, 89% were imported from or associated with importations from other countries, particularly countries in Europe, where several outbreaks are ongoing. The findings demonstrate that measles outbreaks can occur in communities with a high number of unvaccinated persons and that maintaining high overall measles, mumps, and rubella (MMR) vaccination coverage rates in the U.S. is needed to continue to limit the spread of measles.

Of particular interest is figure 2, showing that from January until July 2008, 2/3 of measles cases in the U.S. occurred in persons who were not immunized due to religious or philosophical exemption.

Fact Sheet and Talking Points: Measles United States, January 1 - April 25, 2008

The Florida Department of Health, Bureau of Immunization announces publication of the Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) Early Release 2008; volume 57; 1-4 on May 1, 2008, concerning important information regarding measles outbreaks in the U.S. The outbreak information includes 64 measles cases in 9 states, with outbreaks in 4 states from January 1 through April 24, 2008. While none of the cases are in Florida, a number of county health departments are conducting surveillance with contacts to the cases referenced in the attachment.

These cases and outbreaks resulted primarily from failure to vaccinate, many because of personal or religious belief exemption. This fact highlights:

Ongoing risk of measles in unvaccinated persons.
Risk that unvaccinated persons may transmit measles to others, including infants too young to be vaccinated, and the importance of maintaining high levels of vaccination.

Transmission has occurred in community and healthcare settings, including homes, childcare centers, schools, hospitals, emergency rooms, and physicians' offices. The majority of cases are associated with importation from other countries.

Immunization with the measles-mumps-rubella (MMR) vaccine is the most effective preventive measure. Unless there is other evidence of measles immunity, two doses of MMR vaccine are recommended for all school students, students in postâhigh school educational facilities, healthcare personnel, and international travelers who are older than 12 months of age (NOTE: infants 6 to 11 months of age should receive one dose prior to travel abroad).

The MMWR: Measles --- United States, January 1--April 25, 2008 can be accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e501a1.htm. Further information is available in the CDC Fact Sheet: Measles, United States, January 1--April 25, 2008 [PDF 91 KB].

The MMWR can be accessed on the web at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5733a1.htm?s_cid=mm5733a1_e.

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