MMR: ACIP Vaccine Recommendations, Japan Rubella Outbreak

Larry Hand

June 18, 2013

Clinicians have new guidance for scheduling patient vaccinations, courtesy of an updated report from the Advisory Committee on Immunization Practices (ACIP). The recommendations were published online June 14 in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention (CDC).

Huong Q. McLean, PhD, from the Marshfield Clinic Research Foundation in Wisconsin, and colleagues provide the first published summary recommendations adopted during an October 24, 2012, ACIP meeting. A working group of ACIP members and specialists from 10 other organizations, including the CDC, developed the recommendations.

ACIP-adopted recommendations include:

  • Making laboratory confirmation of disease, rather than physician-diagnosed disease, a criterion for "acceptable evidence of immunity for measles, rubella, and mumps."

  • Expanding vaccinations to all persons with HIV 1 year old or older who are not currently immunosuppressed; revaccinating persons with perinatal HIV who were vaccinated before development of effective antiretroviral therapy with 2 spaced doses of measles, mumps, and rubella (MMR) if antiretroviral therapy has been established; and changing the timing of the doses to ages 12 to 15 months and 4 to 6 years.

  • Expanding the use of immune globulin administered intramuscularly (IGIM) to include infants from birth to age 6 months if they have been exposed to measles, increasing the recommended dose of IGIM for immunocompetent persons, and using immune globulin administered intravenously for severely immunocompromised persons and pregnant women who do not have evidence of measles immunity but have been exposed to it.

Although the United States has virtually eliminated measles and rubella and made great progress in lessening the burden of mumps, the authors write, the diseases "are still common diseases in many countries. Importations will continue to occur and cause outbreaks in communities that have clusters of unvaccinated persons."

The authors also write that studies have shown that current vaccines are safe, effective, and cost-effective.

Current Outbreak

In a report published in the same issue of Morbidity and Mortality Weekly Report, Keiko Tanaka-Taya, MD, from the National Institute of Infectious Diseases of Japan, and colleagues write that an outbreak of rubella there involved 5442 cases reported between January 1 and May 1 this year. Of those, 3936 (72.3%) were laboratory confirmed infections. Males accounted for more than three quarters of the cases 4213 (77.4%), and nearly all (92.0%) of those were in men older than 20 years. For 1904 reported rubella cases for which vaccination records existed, 1566 (82%) occurred in unvaccinated individuals.

Japan began a vaccine program targeted at junior-high-aged girls in 1976 and introduced a MMR vaccine for children aged 12 to 72 months in 1989; that vaccine was withdrawn in 1993. A MR combined vaccine was reintroduced in 2006. However, adult males aged 20 to 39 years have not been targeted for rubella vaccination.

Japan also has had 10 cases of congenital rubella syndrome reported since October 2012, after having only 3 cases reported between 2008 and 2011. Japan's Ministry of Health, Labor, and Welfare has advised authorities to provide rubella and congenital rubella syndrome information to family members of pregnant women and vaccinations to women planning to get pregnant. About 100 cities and local governments are funding vaccination programs.

Morb Mortal Wkly Rep. 2013;62:1-46, 457-462. McLean full text, Tanaka-Taya full text

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