Selective Vaccines
MMR
In 2014 the US experienced a record number of measles outbreaks with 667 cases among 27 states. This was the largest number of cases reported since measles was said to be “eliminated” in 2000. Subsequently in 2015 the US experienced a multi-state measles outbreak with 189 cases report among 24 states.5 For this reason it is important to ensure adults have been vaccinated with at least one dose of MMR. You should also consider post-exposure prophylaxis within 72 hours for anyone exposed to measles virus.
What to know in clinic:
Adults born before 1957 are considered immune and don’t need vaccinated
Adults born after 1957 need documentation of >1 dose of MMR vaccine (documentation of provider-diagnosed disease is not acceptable)
If unvaccinated adults, give at least 1 dose of MMR. Give a second dose 1 month later if adults are students in postsecondary educational institutions, work in a healthcare facility, plan to travel internationally
Rubella immunity should be determined in women of childbearing age. If no immunity non-pregnant women should be vaccinated
Contraindications: Pregnancy, known severe immunodeficiency
Precautions: Recent recipient of antibody containing blood products, history of thrombocytopenia or thrombocytopenia purpura, need for TB skin testing