Prevention of Measles, Rubella, Congenital Rubella ...

1 Recommendations and Reports / Vol. 62 / No. 4 June 14, 2013 Prevention of Measles, Rubella , Congenital Rubella Syndrome, and Mumps, 2013 Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP) Department of Health and Human ServicesCenters for Disease Control and PreventionMorbidity and Mortality Weekly ReportRecommendations and ReportsFront cover photos: (Left) A thin-section transmission electron micrograph (TEM) that shows the ultrastructural appearance of a single virus particle, or virion, of measles virus. (Center) A transmission electron micrograph (TEM) that shows the presence of numerous paramyxovirus virions, which in this instance, were responsible for a case of the mumps.

2 (Right) A transmission electron micrograph (TEM) that shows a number of Rubella MMWR series of publications is published by the Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, Atlanta, GA Citation: Centers for Disease Control and Prevention . [Title]. MMWR 2013;62(No. RR-#):[inclusive page numbers].Centers for Disease Control and PreventionThomas R. Frieden, MD, MPH, DirectorHarold W. Jaffe, MD, MA, Associate Director for ScienceJames W. Stephens, PhD, Director, Office of Science QualityDenise M. Cardo, MD, Acting Deputy Director for Surveillance, Epidemiology, and Laboratory ServicesStephanie Zaza, MD, MPH, Director, Epidemiology and Analysis Program OfficeMMWR Editorial and Production StaffRonald L.

3 Moolenaar, MD, MPH, Editor, MMWR SeriesChristine G. Casey, MD, Deputy Editor, MMWR SeriesTeresa F. Rutledge, Managing Editor, MMWR SeriesDavid C. Johnson, Lead Technical Writer-EditorDenise Williams, MBA, Project EditorMartha F. Boyd, Lead Visual Information SpecialistMaureen A. Leahy, Julia C. Martinroe, Stephen R. Spriggs, Terraye M. StarrVisual Information SpecialistsQuang M. Doan, MBA, Phyllis H. KingInformation Technology SpecialistsMMWR Editorial BoardWilliam L. Roper, MD, MPH, Chapel Hill, NC, ChairmanMatthew L. Boulton, MD, MPH, Ann Arbor, MIVirginia A. Caine, MD, Indianapolis, INBarbara A. Ellis, PhD, MS, Atlanta, GAJonathan E. Fielding, MD, MPH, MBA, Los Angeles, CADavid W.

4 Fleming, MD, Seattle, WAWilliam E. Halperin, MD, DrPH, MPH, Newark, NJKing K. Holmes, MD, PhD, Seattle, WATimothy F. Jones, MD, Nashville, TNRima F. Khabbaz, MD, Atlanta, GADennis G. Maki, MD, Madison, WIPatricia Quinlisk, MD, MPH, Des Moines, IAPatrick L. Remington, MD, MPH, Madison, WIJohn V. Rullan, MD, MPH, San Juan, PRWilliam Schaffner, MD, Nashville, TNCONTENTSI ntroduction ..2 Methods ..2 Background and Epidemiology of Measles ..2 Background and Epidemiology of Rubella and Congenital Rubella Syndrome ..4 Background and Epidemiology of Mumps ..6 Vaccines for Prevention of Measles, Rubella , and Dosage, Administration, and and of MMR and MMRV Vaccine ..14 Immune Globulin for Prevention of Measles.

5 17 Evidence of Immunity ..18 Rationale for Measles, Rubella , and Mumps Vaccination ..20 Recommendations for Vaccination for Measles, Rubella , and Mumps ..20 Recommendations during Outbreaks of Measles, Rubella , or Mumps ..23 Future Directions ..25 Acknowledgments ..25 References ..25 CDC Adoption of ACIP Recommendations for MMWR Recommendations and Reports, MMWR Policy Notes, and Immunization Schedules (Child/Adolescent, Adult)ACIP is chartered as a federal advisory committee to provide expert external advice and guidance to the Director of the Centers for Disease Control and Prevention (CDC) on use of vaccines and related agents for the control of vaccine-preventable diseases in the civilian population of the United States.

6 Recommendations for routine use of vaccines in children and adolescents are harmonized to the greatest extent possible with recommendations made by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG). Recommendations for routine use of vaccines in adults are harmonized with recommendations of AAFP, ACOG, and the American College of Physicians (ACP). ACIP recommendations adopted by the CDC Director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report (MMWR).Recommendations and ReportsMMWR / June 14, 2013 / Vol.

7 62 / No. 4 1 Prevention of Measles, Rubella , Congenital Rubella Syndrome, and Mumps, 2013 Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP)Huong Q. McLean, PhD1 Amy Parker Fiebelkorn, MSN2 Jonathan L. Temte, MD3 Gregory S. Wallace, MD21 Marshfield Clinic Research Foundation, Marshfield, Wisconsin2 Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC3 School of Medicine and Public Health, University of Wisconsin, Madison, WisconsinSummaryThis report is a compendium of all current recommendations for the Prevention of measles, Rubella , Congenital Rubella syndrome (CRS), and mumps. The report presents the recent revisions adopted by the Advisory Committee on Immunization Practices (ACIP) on October 24, 2012, and also summarizes all existing ACIP recommendations that have been published previously during 1998 2011 (CDC.)

8 Measles, mumps, and Rubella vaccine use and strategies for elimination of measles, Rubella , and Congenital Rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 1998;47[No. RR-8]; CDC. Revised ACIP recommendation for avoiding pregnancy after receiving a Rubella -containing vaccine. MMWR 2001;50:1117; CDC. Updated recommendations of the Advisory Committee on Immunization Practices [ACIP] for the control and elimination of mumps. MMWR 2006;55:629 30; and, CDC. Immunization of health-care personnel: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60[No. RR-7]).Currently, ACIP recommends 2 doses of MMR vaccine routinely for children with the first dose administered at age 12 through 15 months and the second dose administered at age 4 through 6 years before school entry.

9 Two doses are recommended for adults at high risk for exposure and transmission ( , students attending colleges or other post-high school educational institutions, health-care personnel, and international travelers) and 1 dose for other adults aged 18 years. For Prevention of Rubella , 1 dose of MMR vaccine is recommended for persons aged 12 the October 24, 2012 meeting, ACIP adopted the following revisions, which are published here for the first time. These included: For acceptable evidence of immunity, removing documentation of physician diagnosed disease as an acceptable criterion for evidence of immunity for measles and mumps, and including laboratory confirmation of disease as a criterion for acceptable evidence of immunity for measles, Rubella , and mumps.

10 For persons with human immunodeficiency virus (HIV) infection, expanding recommendations for vaccination to all persons aged 12 months with HIV infection who do not have evidence of current severe immunosuppression; recommending revaccination of persons with perinatal HIV infection who were vaccinated before establishment of effective antiretroviral therapy (ART) with 2 appropriately spaced doses of MMR vaccine once effective ART has been established; and changing the recommended timing of the 2 doses of MMR vaccine for HIV-infected persons to age 12 through 15 months and 4 through 6 years. For measles postexposure prophylaxis, expanding recommendations for use of immune globulin administered intramuscularly (IGIM) to include infants aged birth to 6 months exposed to measles; increasing the recommended dose of IGIM for immunocompetent persons.