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MEASLES, MUMPS, RUBELLA VACCINE, LIVE: MMR-II Class: Vaccine Dosage Forms. Lyophilized Powder for Subcutaneous Injection: 0.5 mL after reconstitution with supplied diluent; also available in combination with varicella vaccine Common FDA Label Indication, Dosing, and Titration. 1. Prevention of measles, mumps, and rubella infections: Adults, one dose (second dose indicated for adults who are at high risk); Children, one dose at age 12 mo with a second dose at age 4-6 y, prior to entering school Off-Label Uses. None Drug Characteristics: Measles, Mumps, Rubella Vaccine, Live Pregnancy Category C ADME None known Lactation Generally considered safe during lactation Pharmacogenetics Not yet clinically relevant Contraindications Hypersensitivity to MMR vaccine or a component of the vaccine (egg, gelatin, neomycin); immunosuppression; pregnancy Black Box Warnings None Merck pictured Medication Safety Issues: Measles, Mumps, Rubella Vaccine, Live Suffixes Tall Man Letters Do Not Crush High Alert Confused Names MMR-II, MMRV No No No None Drug Interactions: Measles, Mumps, Rubella Vaccine, Live Typical Agents Mechanism Clinical Management Moderate- to high-dose corticosteroids Immunosuppression Delay MMR vaccine administration until corticosteroid therapy has been discontinued Immunosuppressing agents Immunosuppression Delay MMR vaccine administration until immunosuppressive therapy has been discontinued Immune globulin or blood products Interference with immune response to live vaccines Delay MMR vaccine administration for a period of time depending on type and dose of immune globulin or blood product 172 M Adverse Reactions: Measles, Mumps, Rubella Vaccine, Live Common (>10%) Less Common (1-10%) Rare but Serious (<1%) Fever, arthralgia (adult females) Rash Thrombocytopenia, anaphylaxis, Guillain-Barré syndrome, febrile seizure Efficacy Monitoring Parameters. Prevention of measles, mumps, and rubella infections; although antibody concentrations might be measured, routine measurement for vaccine response is not recommended. Toxicity Monitoring Parameters. Syncope within 15 min of vaccine administration. Key Patient Counseling Points. Some children may experience mild fever and rash 7-10 d after vaccine administration. Avoid pregnancy for 28 d following vaccine administration. Clinical Pearls. Individuals born before 1957 can be considered immune unless a female of childbearing potential. Administer to females found to be seronegative to rubella following completion of pregnancy. If not administered simultaneously, MMR must be separated by at least 4 wk from other live vaccines. Individuals vaccinated between 1963 and 1967 with killed measles vaccine should be revaccinated. Individuals vaccinated before 1979 with inactivated mumps vaccine should be revaccinated. Avoid confusion with MMRV, which also contains varicella vaccine. 172