It is preferable to administer MMR immediately after reconstitution. If reconstituted MMR is not used within 8 hours it must be discarded. MMR should always be refrigerated and should never be left at room temperature.

I misplaced the diluent for the MMR dose so I used sterile water instead. Is there any problem with doing this?

Only the diluent supplied with the vaccine should be used to reconstitute any vaccine

If MMR was given by the wrong route (IM instead of SC), Should these doses be repeated?

All live injected vaccines (MMR, varicella, and yellow fever) are recommended to be given subcutaneously. However, intramuscular administration is not likely to decrease immunogenicity, and doses given IM do not need to be repeated.

Why is a second dose of MMR necessary?

About 2%-5% of persons do not develop measles immunity after the first dose of vaccine. This occurs for a variety of reasons. The second dose is to provide another chance to develop measles immunity for persons who did not respond to the first dose.

If you can give the second dose of MMR as early as 28 days after the first dose, why do we routinely wait until kindergarten entry to give the second dose?

The second dose of MMR may be given as early as a month after the first dose, and be counted as a valid dose if both doses were given after the first birthday. It is convenient to give the second dose at school entry, since the child will have an immunization visit for other school entry vaccines. The risk of measles is higher in school-age children than those of preschool age, so it is important to receive the second dose by school entry. The second dose is not a "booster"; it is intended to produce immunity in the small number of persons who fail to respond to the first dose.

What is the recommended length of time a woman should wait after receiving rubella (or MMR) vaccine before becoming pregnant?

Four weeks. In October 2001, ACIP voted to change its recommendation for the waiting interval following the administration of rubella vaccine. The interval was reduced from 3 months to 4 weeks. The waiting period for measles and mumps vaccine was already one month.

If a pregnant woman had a positive rubella titer in the past, and now has a negative rubella titer, she would not need another MMR vaccination. Doesn't the negative rubella titer mean her immunity has waned and she needs a booster dose?

Rubella antibody levels may decline with time, and may even fall below the level of detection of standard screening tests. However, data from surveillance of rubella and congenital rubella syndrome suggest that waning immunity with increased susceptibility to rubella disease does not occur (MMWR 1998;47[RR-8]:14). Studies of persons who have "lost" detectable rubella antibody indicate that almost all had antibody detectable by more sensitive tests, or demonstrated a booster-type response (absence of IgM antibody and a rapid rise in IgG antibody) after revaccination.

If a woman has a negative rubella titer during her first pregnancy, should she be given MMR vaccine or only rubella vaccine alone prior to hospital discharge?

She should be given MMR, unless she has documentation of immunity to measles and mumps (birth before 1957, documented vaccination, or serologic evidence of immunity).

Is it true that egg allergy is no longer considered a contraindication to MMR vaccine?

Several studies have documented the safety of measles and mumps vaccine (which are grown in chick embryo tissue culture) in children with severe egg allergy. The AAP's "Red Book" Committee no longer considers egg allergy a contraindication to MMR vaccination. The new ACIP statement on MMR also recommends routine vaccination of egg-allergic children without the use of special protocols or desensitization procedures.

Is it contraindicated to give MMR to a breastfeeding mother or to a breastfed infant?

No. Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding her infant poses no risk to the infant being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the infant is asymptomatic.

What are the side-effects of MMR?

MMR contains three separate vaccines in one injection. The vaccines have different side-effects at different times.

About a week to 10 days after the MMR some children become feverish and they may develop a measles-like rash and go off their food.  This is because the measles part of the vaccine is starting to work.

About three to four weeks after the injection a child might occasionally get a mild form of mumps as the mumps part of the MMR kicks in.

In the six weeks after the MMR your child may, very rarely, get a rash of small bruise-like spots which may be caused by the measles or rubella parts of the immunisation.  This usually gets better on its own, but if you see spots like this, show them to your doctor. 

Very rarely, children can have severe allergic reactions straight after any immunisation ( about 1 in 100 000 immunisations for MMR ). Signs of a serious allergic reaction include difficulty breathing, hoarseness, or wheezing, hives, paleness, weakness, a fast heart beat or dizziness, and swelling of the throat. If the child is treated quickly, he or she will recover fully. People giving immunisations are trained to deal with allergic reactions.