Usage
- The mumps virus vaccine is prescribed for active immunization against mumps. It is most commonly administered as a combined measles, mumps, and rubella (MMR) vaccine or measles, mumps, rubella, and varicella (MMRV) vaccine. MMRV is generally only given to children aged 1-12 years.
- Pharmacological Classification: Vaccine (Viral, Live Attenuated)
- Mechanism of Action: The MMR vaccine introduces weakened (attenuated) forms of the measles, mumps, and rubella viruses into the body. These attenuated viruses stimulate an immune response without causing the actual diseases. This immune response leads to the production of antibodies specific to these viruses, providing long-lasting immunity.
Alternate Names
- Mumps Vaccine
- MMR Vaccine (Measles, Mumps, and Rubella Vaccine)
- MMRV Vaccine (Measles, Mumps, Rubella, and Varicella Vaccine)
- Brand Names: M-M-R II®, Priorix®
How It Works
- Pharmacodynamics: The MMR vaccine mimics a natural infection, triggering the body’s immune system to produce antibodies against measles, mumps, and rubella viruses. This generates immunological memory, protecting against future exposure to these viruses.
- Pharmacokinetics: The vaccine is administered subcutaneously or intramuscularly. The live attenuated viruses replicate locally at the injection site and stimulate an immune response. Further details on absorption, distribution, metabolism, and elimination of the attenuated viruses are not typically assessed for vaccines in the same way as for traditional drugs.
- Mode of Action: The attenuated viruses in the vaccine replicate within the body, but at a much lower rate than wild-type viruses. This limited replication is sufficient to stimulate B-cells to produce antibodies, and T-cells to create cellular immunity against measles, mumps, and rubella.
- Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: Specific receptor binding or enzyme interactions of the attenuated viruses are not commonly discussed in the context of vaccine mechanisms. The primary focus is on the stimulation of an appropriate immune response.
- Elimination Pathways: The attenuated viruses are cleared by the immune system as the immune response develops.
Dosage
Standard Dosage
Adults:
- 0.5 mL subcutaneously or intramuscularly.
- Most adults require only one dose unless they are at high risk (e.g., healthcare workers, international travelers). High-risk individuals may require two doses separated by at least 28 days (4 weeks).
Children:
- 0.5 mL subcutaneously or intramuscularly.
- Two doses are recommended: the first at 12-15 months of age and the second at 4-6 years of age (or at least 28 days after the first dose).
- For children traveling internationally, the first dose can be given at 6-11 months. These children will still need the routine 2 doses as per schedule.
- Pediatric Safety Considerations: Febrile seizures have been reported more frequently in children receiving MMRV as the first dose compared to separate MMR and varicella vaccines.
Special Cases:
- Elderly Patients: Adults born before 1957 are generally considered immune and don’t need the vaccine. Those born later should receive at least one dose.
- Patients with Renal Impairment: No dose adjustment is necessary.
- Patients with Hepatic Dysfunction: No dose adjustment is necessary.
- Patients with Comorbid Conditions: Patients with certain immunodeficiencies (e.g., HIV, leukemia) or who are on immunosuppressive therapy generally should not receive the MMR vaccine, except for specific situations where the benefits outweigh the risks.
Clinical Use Cases
- The MMR vaccine is used for pre-exposure prophylaxis of measles, mumps, and rubella.
- It can also be used for post-exposure prophylaxis for measles if given within 72 hours of exposure.
Dosage Adjustments
- Dose adjustments are not typically made for renal or hepatic impairment.
- For immunocompromised individuals, the MMR vaccine is generally contraindicated, although exceptions may be made on a case-by-case basis.
Side Effects
Common Side Effects:
- Injection site reactions (pain, swelling, redness)
- Fever
- Mild rash
- Swollen glands in the cheeks or neck (especially with mumps component)
Rare but Serious Side Effects:
- Allergic reactions (anaphylaxis)
- Febrile seizures
- Thrombocytopenia (low platelet count)
- Encephalitis (brain inflammation)
Long-Term Effects:
- Long-term side effects from the MMR vaccine are rare.
Adverse Drug Reactions (ADR):
- Severe allergic reactions
Contraindications
- Severe allergy to any component of the vaccine, including neomycin and gelatin.
- Pregnancy
- Severe immunodeficiency (e.g., leukemia, lymphoma, congenital immunodeficiency).
- Current immunosuppressive therapy (except for replacement corticosteroid therapy).
Drug Interactions
- Immune Globulins and Blood Transfusions: Receiving immune globulins or a blood transfusion may interfere with the immune response to the MMR vaccine.
- Corticosteroids and Immunosuppressive Drugs: High doses of corticosteroids or other immunosuppressive medications can reduce the effectiveness of the vaccine.
- Tuberculin Skin Testing: MMR vaccine can temporarily suppress tuberculin skin test reactivity.
- Other Live Viral Vaccines: Other live viral vaccines should generally be administered at least 4 weeks apart from MMR.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: Contraindicated
- MMR vaccine should not be given during pregnancy due to the theoretical risk of congenital rubella syndrome.
- Pregnant women should be vaccinated postpartum if not already immune.
- Breastfeeding: MMR vaccine can be given to breastfeeding women.
Drug Profile Summary
- Mechanism of Action: Stimulates active immunity against measles, mumps, and rubella through the introduction of live attenuated viruses.
- Side Effects: Injection site reactions, fever, rash, swollen glands. Rarely, severe allergic reactions or febrile seizures.
- Contraindications: Pregnancy, severe allergy to vaccine components, severe immunodeficiency.
- Drug Interactions: Immune globulins, blood transfusions, immunosuppressants.
- Pregnancy & Breastfeeding: Contraindicated in pregnancy; safe in breastfeeding.
- Dosage: 0.5 mL SC/IM, two doses for children, one or two doses for adults.
- Monitoring Parameters: Monitor for adverse reactions, especially fever and allergic symptoms.
Popular Combinations
- MMR is combined with varicella vaccine to create MMRV vaccine.
Precautions
- Screen for contraindications before administration.
- Pregnant Women: Do not administer. Vaccinate postpartum.
- Breastfeeding Mothers: Safe to administer.
- Children & Elderly: Follow age-specific dosing guidelines.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for the MMR vaccine?
A: 0.5 mL administered subcutaneously or intramuscularly. Children require two doses: first at 12-15 months, second at 4-6 years. Most adults need one dose; high-risk adults may require two doses separated by at least 28 days.
Q2: Can pregnant women receive the MMR vaccine?
A: No, MMR vaccine is contraindicated during pregnancy.
Q3: What are the common side effects of the MMR vaccine?
A: Common side effects include injection site reactions (pain, redness, swelling), fever, mild rash, and swollen glands.
Q4: Is the MMR vaccine safe for breastfeeding mothers?
A: Yes, the MMR vaccine is considered safe for breastfeeding mothers.
Q5: What should I do if a patient has a severe allergic reaction to the MMR vaccine?
A: Administer epinephrine and provide supportive care as needed.
Q6: Can the MMR vaccine be given at the same time as other vaccines?
A: Yes, MMR can generally be administered concurrently with other inactivated vaccines. However, live vaccines should be separated by at least 4 weeks.
Q7: Is there a risk of contracting measles, mumps, or rubella from the MMR vaccine?
A: No, the MMR vaccine contains attenuated (weakened) viruses that cannot cause the diseases in healthy individuals.
Q8: Who should not receive the MMR vaccine?
A: Individuals with severe allergies to vaccine components, pregnant women, and those with severe immunodeficiencies should not receive the MMR vaccine.
Q9: What if a child receives the first dose of MMR before their first birthday?
A: The child should still receive two additional doses, one at 12-15 months of age and another at 4-6 years of age.
