Measles-Mumps-Rubella vaccination (MMR)

 

This page provides advice to healthcare providers about recommendations for MMR vaccinations. 

These are taken from the Australian Immunisation Handbook.

 

All children aged ≥12 months are recommended to receive 2 doses of measles-containing vaccine.

The vaccines usually received at each schedule point are:

  • 12 months of age — MMR (measles-mumps-rubella)
  • 18 months of age — MMRV (measles-mumps-rubella-varicella)

Age at 1st dose

Children can receive MMR vaccine from 6 months of age in certain circumstances, such as for post-exposure prophylaxis for Measles) and especially for overseas travel and during outbreaks (please see Travellers). If an infant receives MMR vaccine at <11 months of age, they still need to receive 2 vaccine doses from ≥12 months of age. 

The Australian Immunisation Register will record MMR vaccine given at ≥11 months of age as a valid dose to calculate immunisation status. A dose provided at ≥11 months (but before 12 months) of age may be sufficiently immunogenic, especially in infants born to mothers with measles antibody derived from vaccination rather than natural infection.

As such, doses are given at ≥11 months but <12 months may not need to be repeated.

Age at 2nd dose

Children >12 months of age who have received 1 dose of measles-containing vaccine can receive the 2nd dose of measles-containing vaccine early (if at least 4 weeks after the 1st dose has elapsed) if they are at risk of coming in contact with measles. See Public health management.

MMRV as 1st dose is not recommended

MMRV vaccine is not recommended as the 1st dose of measles-containing vaccine in children <4 years of age. This is due to a small but increased risk of fever and febrile seizures when MMRV vaccine is given as the 1st dose of measles-containing vaccine in this age group (please see Adverse events).

If MMRV vaccine is inadvertently given as dose 1 of measles-containing vaccine, the dose does not need to be repeated (providing it was given at ≥12 months of age). The scheduled 18-month dose of MMRV should still be given at the usual time. See Table. Minimum acceptable age for the 1st dose of scheduled vaccines in infants in special circumstances in Catch-up vaccination. Advise parents and carers about the small but increased risk of fever and febrile seizures (compared with that expected after MMR vaccine).

For more details about MMRV vaccine to prevent varicella disease, see Varicella.

Catch-up vaccination for measles

Children who have not received measles-containing vaccine at the recommended schedule points may need extra doses of vaccine and/or an alternative schedule. 

See Catch-up vaccination for more details, including minimum intervals between doses.  

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All adolescents and adults born during or since 1966 should have either:

  • documented evidence of 2 doses of measles-containing vaccine given at least 4 weeks apart and with both doses given at ≥12 months of age, or
  • serological evidence of immunity to measles, mumps and rubella

Adolescents and adults who have been incompletely vaccinated or do not have evidence of immunity to measles are recommended to receive measles-containing vaccine. Please see Catch-up vaccination for more details, including minimum intervals between doses.

People born before 1966 do not need to receive measles-containing vaccine (unless serological evidence indicates that they are not immune). This is because circulating measles virus and disease were prevalent before 1966, so most people would have acquired immunity from natural infection

However, confirmed cases of measles have occurred in people born before 1966. If in doubt about a person’s immunity, it may be faster and easier to vaccinate the person than conduct serological testing. See Serological testing for immunity to measles

Review vaccination records for all adolescents and young adults to ensure that they have received 2 doses of measles-containing vaccine. See Epidemiology.

People aged ≥14 years are not recommended to receive MMRV vaccine MMRV vaccine is not recommended for use in people ≥14 years of age. No data are available on safety, immunogenicity or efficacy in this age group.

If a person ≥14 years of age is inadvertently given a dose of MMRV vaccine, this dose does not need to be repeated.

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Healthcare workers born during or since 1966

Healthcare workers are strongly recommended to have received 2 doses of measles- containing vaccine. Measles can be transmitted in healthcare settings and infect staff and patients.

Healthcare workers do not need to receive measles-containing vaccine if they have either:

  • documented evidence of 2 doses of measles-containing vaccine given at least 4 weeks apart and with both doses given at ≥12 months of age, or
  • serological evidence of immunity to measles, mumps and rubella

See Serological testing for immunity to measles, and Recommended vaccines for people at increased risk of certain occupationally acquired vaccine-preventable diseases in Vaccinations for people at occupational risk.

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Childhood educators and carers

Childhood educators and carers are strongly recommended to have received 2 doses of measles-containing vaccine given at least 4 weeks apart. 

People who work in childhood education and care do not need to receive measles-containing vaccine if they have either:

  • documented evidence of 2 doses of measles-containing vaccine with doses given at least 4 weeks apart and with both doses given ≥12 months of age, or
  • serological evidence of immunity to measles, mumps and rubella

See Serological testing for immunity to measles, and Recommended vaccines for people at increased risk of certain occupationally acquired vaccine-preventable diseases in Vaccinations for people at occupational risk.

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People born during or since 1966 who work in long-term care facilities

People who work in long-term care facilities are strongly recommended to have received 2 doses of measles-containing vaccine given at least 4 weeks apart.

People who work in long-term care facilities do not need to receive measles-containing vaccine if they have either:

  • documented evidence of 2 doses of measles-containing vaccine given at least 4 weeks apart and with both doses given at ≥12 months of age, or
  • serological evidence of immunity to measles, mumps and rubella

See Serological testing for immunity to measles, and Recommended vaccines for people at increased risk of certain occupationally acquired vaccine-preventable diseases in Vaccinations for people at occupational risk.

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People born during or since 1966 who work in correctional facilities

People who work in correctional facilities are strongly recommended to have received 2 doses of measles-containing vaccine given at least 4 weeks apart. Measles can be transmitted in correctional facilities and cause outbreaks.

People who work in correctional facilities do not need to receive measles-containing vaccine if they have either:

  • documented evidence of 2 doses of measles-containing vaccine given at least 4 weeks apart and with both doses given at ≥12 months of age, or
  • serological evidence of immunity to measles, mumps and rubella

See Serological testing for immunity to measles, and Recommended vaccines for people at increased risk of certain occupationally acquired vaccine-preventable diseases in Vaccinations for people at occupational risk.

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Travellers are strongly recommended to have received 2 doses of measles-containing vaccine. Measles importation after international travel is the most significant source of measles cases in Australia.

People travelling overseas are recommended to have either:

  • documented evidence of 2 doses of measles-containing vaccine given at least 4 weeks apart and with both doses given at ≥ 12 months of age, or 
  • serological evidence of immunity to measles, mumps and rubella 

See Serological testing for immunity to measles.

Travellers aged <12 months 

Infants travelling to countries where measles is endemic, or where measles outbreaks are occurring, may receive  vaccine from as young as 6 months of age, after an individual risk assessment. 

However, this dose needs to be repeated, meaning that these infants need 2 further doses of measles-containing vaccine. They should receive the next dose of  vaccine at 12 months of age or 4 weeks after the 1st dose, whichever is later. They should receive their final dose of measles-containing vaccine as  vaccine at 18 months of age.

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Serological testing for immunity to measles (and mumps, rubella and varicella) is not recommended before or after routine administration of the 2-dose childhood schedule of these vaccines. 

However, serological testing for measles immunity can be done:

Alternatively, these people can receive MMR vaccine without serological testing. There is no known increase in adverse events from vaccinating people with pre-existing immunity to one or more of the vaccine antigens. See Adverse events.

Serological tests for immunity to measles can detect antibody produced by both previous natural infection and vaccination. Sensitivity varies by assay and clinical setting (including time since vaccination).

When interpreting serological testing results, it may be useful to discuss the results with the laboratory that performed the test, to ensure that decisions are based on all relevant clinical information.

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