"Excretion of small amounts of the live attenuated
rubella virus from the
nose or throat has occurred in the majority of susceptible individuals 7-28
days after vaccination. There is no confirmed evidence to indicate that
such virus is transmitted to susceptible persons who are in contact with
the vaccinated individuals. Consequently, transmission through close
personal contact, while accepted as a theoretical possibility, is not
regarded as a significant risk. .24
However, transmission of the rubella
vaccine virus to infants via breast milk has been documented (see Nursing
Mothers.)
There are no reports of transmission of live attenuated measles on mumps
viruses from vaccinees to susceptible contacts."
Mosby's GenRx®, 10th ed.
Copyright © 2000 Mosby, Inc.
------------------------------------------------------------------------
Measles, Mumps and Rubella Virus Vaccine Live (001704)
CATEGORIES:
Indications: Immunization, measles; Immunization,
mumps; Immunization,
rubella
Pregnancy Category C
WHO Formulary
FDA Pre 1938 Drugs
FDA DRUG CLASS: Vaccines/Antisera
BRAND NAMES: Imovax-ROR (Greece); MMR II (Hong-Kong, Philippines, Taiwan,
South-Africa); M.M.R. II (Israel); M.M.R. Vaccine (Korea); M-M-R II (US);
M-M-R Vax (Germany, Austria); Morupar (Philippines); Mumeru Vax
(Philippines, Korea); Pluserix (Benin, Burkina-Faso, Ethiopia, Gambia,
Ghana, Guinea, Ivory-Coast, Kenya, Liberia, Malawi, Mali, Mauritania,
Mauritius, Morocco, Niger, Nigeria, Senegal, Seychelles, Sierra-Leone,
Sudan, Tanzania, Tunia, Uganda, Zambia, Zimbabwe, Germany, Belgium,
Greece); R.O.R. Vax (France); Trimovax (Bulgaria, Italy, Hong-Kong,
Thailand, Taiwan); Triviraten Berna (Hong-Kong, Malaysia, Philippines,
Thailand);
(International brand names outside U.S. in italics)
DESCRIPTION:
M-M-R II (Measles, Mumps, and Rubella Virus Vaccine Live) is a live virus
vaccine for immunization against measles (rubeola), mumps and rubella
(German measles).
M-M-R II is a sterile lyophilized preparation of (1) Attenuvax (Measles
Virus Vaccine Live), a more attenuated line of measles virus, derived from
Enders' attenuated Edmonston strain and grown in cell cultures of chick
embryo; (2) Mumpsvax (Mumps Virus Vaccine Live), the Jeryl Lynn (B level)
strain of mumps virus grown in cell cultures of chick embryo; and (3)
Meruvax II (Rubella Virus Vaccine Live), the Wistar RA 27/3 strain of live
attenuated rubella virus grown in human diploid cell (WI-38) culture.1,2The
vaccine viruses are the same as those used in the manufacture of Attenuvax
(Measles Virus Vaccine Live), Mumpsvax (Mumps Virus Vaccine Live) and
Meruvax II (Rubella Virus Vaccine Live). The three viruses are mixed before
being lyophilized. The product contains no preservative.
The reconstituted vaccine is for subcutaneous administration. When
reconstituted as directed, the dose for injection is 0.5 ml and contains
not less than the equivalent of 1,000 TCID50 (tissue culture infectious
doses) of the U.S. Reference Measles Virus; 20,000 TCID50of the U.S.
Reference Mumps Virus; and 1,000 TCID50of the U.S. Reference Rubella Virus.
Each dose contains approximately 25 mcg of neomycin. The product contains
no preservative. Sorbitol and hydrolyzed gelatin are added as stabilizers.
CLINICAL PHARMACOLOGY:
Clinical studies of 279 triple seronegative children, 11 months to 7 years
of age, demonstrated that M-M-R II is highly immunogenic and generally well
tolerated. In these studies, a single injection of the vaccine induced
measles hemagglutination-inhibition (HI) antibodies in 95 percent, mumps
neutralizing antibodies in 96 percent, and rubella HI antibodies in 99
percent of susceptible persons.
The RA 27/3 rubella strain in M-M-R II elicits higher immediate
postvaccination HI, complement-fixing and neutralizing antibody levels than
other strains of rubella vaccine3-9 and has been shown to induce a broader
profile of circulating antibodies including anti-theta and anti-iota
precipitating antibodies.10,11 The RA 27/3 rubella strain immunologically
simulates natural infection more closely than other rubella vaccine
viruses.11-13 The increased levels and broader profile of antibodies
produced by RA 27/3 strain rubella virus vaccine appear to correlate with
greater resistance to subclinical reinfection with the wild virus,11,13-15
and provide greater confidence for lasting immunity.
Vaccine induced antibody levels following administration of M-M-R II have
been shown to persist up to 11 years without substantial decline.16,43
Continued surveillance will be necessary to determine further duration of
antibody persistence.
INDICATIONS AND USAGE:
M-M-R II is indicated for simultaneous immunization against measles, mumps,
and rubella in persons 15 months of age or older. A second dose of M-M-R II
or monovalent measles vaccine is recommended (see Revaccination.)17,18,19
Infants who are less than 15 months of age may fail to respond to the
measles component of the vaccine due to presence in the circulation of
residual measles antibody of maternal origin, the younger the infant, the
lower the likelihood of seroconversion. In geographically isolated or other
relatively inaccessible populations for whom immunization programs are
logistically difficult, and in population groups in which natural measles
infection may occur in a significant proportion of infants before 15 months
of age, it may be desirable to give the vaccine to infants at an earlier
age. Infants vaccinated under these conditions at less than 12 months of
age should be revaccinated after reaching 15 months of age. There is some
evidence to suggest that infants immunized at less than one year of age may
not develop sustained antibody levels when later reimmunized. The advantage
of early protection must be weighed against the chance for failure to
respond adequately on reimmunization.20
Previously unimmunized children of susceptible pregnant women should
receive live attenuated rubella vaccine, because an immunized child will be
less likely to acquire natural rubella and introduce the virus into the
household.
Individuals planning travel outside the United States, if not immune, can
acquire measles, mumps or rubella and import these diseases to the United
States. Therefore, prior to International travel, individuals known to be
susceptible to one or more of these diseases can receive either a single
antigen vaccine (measles, mumps or rubella), or a combined antigen vaccine
as appropriate. However, M-M-R II is preferred for persons likely to be
susceptible to mumps and rubella; and if single-antigen measles vaccine is
not readily available, travelers should receive M-M-R II regardless of
their immune status to mumps or rubella.21,22,23
Non-Pregnant Adolescent and Adult Females: Immunization of susceptible
non-pregnant adolescent and adult females of childbearing age with live
attenuated rubella virus vaccine is indicated if certain precautions are
observed (see below and PRECAUTIONS). Vaccinating susceptible postpubertal
females confers individual protection against subsequently acquiring
rubella infection during pregnancy, which in turn prevents infection of the
fetus and consequent congenital rubella injury.24
Women of childbearing age should be advised not to become pregnant for
three months after vaccination and should be informed of the reasons for
this precaution.*
It is recommended that rubella susceptibility be determined by serologic
testing prior to immunization.** If immune, as evidenced by a specific
rubella antibody titer of 1:8 or greater (hemagglutination-inhibition
test), vaccination is unnecessary. Congenital malformations do occur in up
to seven percent of all live births.25 Their chance appearance after
vaccination could lead to misinterpretation of the cause, particularly if
the prior rubella-immune status of vaccinees is unknown.
Postpubertal females should be informed of the frequent occurrence of
generally self-limited arthralgia and/or arthritis beginning 2 to 4 weeks
after vaccination (see ADVERSE REACTIONS.)
Postpartum Women: It has been found convenient in many instances to
vaccinate rubella susceptible women in the immediate postpartum period.
(See Nursing Mothers.)
Revaccination: Children first vaccinated when younger than 12 months of age
should be revaccinated at 15 months of age.
The American Academy of Pediatrics (AAP), the Immunization Practices
Advisory Committee (ACIP), and some state and local health agencies have
recommended guidelines for routine measles revaccination and to help
control measles outbreaks.26.27***
*NOTE: The Immunization Practices Advisory Committee (ACIP) has recommended
"In view of the importance of protecting this age group against rubella,
reasonable precautions in a rubella immunization program include asking
females if they are pregnant, excluding those who say they are, and
explaining the theoretical risk to the others."24
**NOTE: The Immunization Practices Advisory Committee (ACIP)) has stated
"When practical, and when reliable laboratory services are available,
potential vaccinees of childbearing age can have serologic tests to
determine susceptibility to rubella.... However, routinely performing
serologic tests for all females of childbearing age to determine
susceptibility so that vaccine is given only to proven susceptibles is
expensive and has been ineffective in some areas. Accordingly, the ACIP
believes that rubella vaccination of a woman who is not known to be
pregnant and has no history of vaccination is justifiable without serologic
testing."24
***NOTE: A primary difference among these recommendations is the timing of
revaccination: the ACIP recommends routine revaccination at entry into
kindergarten or first grade, whereas the AAP recommends routine
revaccination at entrance to middle school or junior high school. In
addition, some public health jurisdictions mandate the age for
revaccination. The complete text of applicable guidelines should be
consulted.26,27
Vaccines available for revaccination include monovalent measles vaccine
(Attenuvax (Measles Virus Vaccine Live)) and polyvalent vaccines containing
measles (e.g., M-M-R II, M-R-VAX II (Measles and Rubella Virus Vaccine
Live)). If the prevention of sporadic measles outbreaks is the sole
objective, revaccination with a monovalent measles vaccine should be
considered (see appropriate product circular). If concern also exists about
immune status regarding mumps or rubella, revaccination with appropriate
monovalent or polyvalent vaccine should be considered after consulting the
appropriate product circulars. Unnecessary doses of a vaccine are best
avoided by ensuring that written documentation of vaccination is preserved
and a copy given to each vaccinee's parent or guardian.
Use with other Vaccines
Routine administration of DTP (diphtheria, tetanus, pertussis) and/or OPV
(oral poliovirus vaccine) concomitantly with measles, mumps, and rubella
vaccines is not recommended because there are limited data28relating to the
simultaneous administration of these antigens. M-M-R II should be given one
month before or after administration of other vaccines.
However, other schedules have been used. For example, the American Academy
of Pediatrics has noted that when the patient may not return, some
practitioners prefer to administer DTP, OPV, and M-M-R II on a single day.
If done, separate sites and syringes should be used for DTP and M-M-R
II.29The Immunization Practices Advisory Committee (ACIP) recommends
routine simultaneous administration of M-M-R II, DTP and OPV or inactivated
polio vaccine (IPV) to all children [Image] 15 months who are eligible to
receive these vaccines on the basis that there are equivalent antibody
responses and no clinically significant increases in the frequency of
adverse events when DTP, M-M-R II and OPV (or IPV are administered either
simultaneously at different sites or separately.* Administration of M-M-R
II at 15 months followed by DTP and OPV (or IPV) at 18 months remains an
acceptable alternative, especially for children with caregivers known to be
generally compliant with other health-care recommendations.
*NOTE: The Immunization Practices Advisory Committee (ACIP) recommends
administering M-M-R II concomitantly with the fourth dose of DTP and the
third dose of OPV to children 15 months of age or older providing that 6
months have elapsed since DTP-3; or, if fewer than three DTPs have been
received, at least 6 weeks have elapsed since the last dose of DTP and OPV.
CONTRAINDICATIONS:
Do not give M-M-R II to pregnant females; the possible effects of the
vaccine on fetal development are unknown at this time. If vaccination of
postpubertal females is undertaken, pregnancy should be avoided for three
months following vaccination. See PRECAUTIONS, Pregnancy.
Anaphylactic or anaphylactoid reactions to neomycin (each dose of
reconstituted vaccine contains approximately 25 mcg of neomycin).
History of anaphylactic or anaphylactoid reactions to eggs (see WARNINGS,
Hypersensitivity To Eggs.)
Any febrile respiratory illness or other active febrile infection.
Active untreated tuberculosis.
Patients receiving immunosuppressive therapy. This contraindication does
not apply to patients who are receiving corticosteroids as replacement
therapy, e.g., for Addison's disease.
Individuals with blood dyscrasias, leukemia, lymphomas of any type, or
other malignant neoplasms affecting the bone marrow or lymphatic systems.
Primary and acquired immunodeficiency states, including patients who are
immunosuppressed in association with AIDS or other clinical manifestations
of infection with human immunodeficiency viruses;30,31cellular immune
deficiencies; and hypogammaglobulinemic and dysgammaglobulinemic states.
Individuals with a family history of congenital or hereditary
immunodeficiency, until the immune competence of the potential vaccine
recipient is demonstrated.32
WARNINGS:
Hypersensitivity To Eggs
Live measles vaccine and live mumps vaccine are produced in chick embryo
cell culture. Persons with a history of anaphylactic, anaphylactoid, or
other immediate reactions (e.g., hives, swelling of the mouth and throat,
difficulty breathing, hypotension, or shock) subsequent to egg ingestion
should not be vaccinated. Evidence indicates that persons are not at
increased risk if they have egg allergies that are not anaphylactic or
anaphylactoid in nature. Such persons may be vaccinated in the usual
manner. There is no evidence to indicate that persons with allergies to
chickens or feathers are at increased risk of reaction to the vaccine.20
PRECAUTIONS:
General
Adequate treatment provisions including epinephrine, should be available
for immediate use should an anaphylactic or anaphylactoid reaction occur.
Due caution should be employed in administration of M-M-R II to persons
with a history of cerebral injury, individual or family histories of
convulsions, or any other condition in which stress due to fever should be
avoided. The physician should be alert to the temperature elevation which
may occur following vaccination. (See ADVERSE REACTIONS.)
Children and young adults who are known to be infected with human
immunodeficiency viruses but without overt clinical manifestations of
immunosuppression may be vaccinated; however, the vaccinees should be
monitored closely for vaccine-preventable diseases because immunization may
be less effective than for uninfected persons.30,31
Vaccination should be deferred for at least 3 months following blood or
plasma transfusions, or administration of human immune serum globulin.
Excretion of small amounts of the live attenuated rubella virus from the
nose or throat has occurred in the majority of susceptible individuals 7-28
days after vaccination. There is no confirmed evidence to indicate that
such virus is transmitted to susceptible persons who are in contact with
the vaccinated individuals. Consequently, transmission through close
personal contact, while accepted as a theoretical possibility, is not
regarded as a significant risk.24 However, transmission of the rubella
vaccine virus to infants via breast milk has been documented (see Nursing
Mothers.)
There are no reports of transmission of live attenuated measles on mumps
viruses from vaccinees to susceptible contacts.
It has been reported that live attenuated measles, mumps and rubella virus
vaccines given individually may result in a temporary depression of
tuberculin skin sensitivity. Therefore, if a tuberculin test is to be done
it should be administered either before or simultaneously with M-M-R II.
Children under treatment for tuberculosis have not experienced exacerbation
of the disease when immunized with live measles virus vaccine;33 no studies
have been reported to date of the effect of measles virus vaccines on
untreated tuberculous children.
As for any vaccine, vaccination with M-M-R II may not result in
seroconversion in 100% of susceptible persons given the vaccine.
Pregnancy Category C
Animal reproduction studies have not been conducted with M-M-R II. It is
also not known whether M-M-R II can cause fetal harm when administered to a
pregnant woman or can affect reproduction capacity. Therefore, the vaccine
should not be administered to pregnant females; furthermore, pregnancy
should be avoided for three months following vaccination (see
CONTRAINDICATIONS.)
In counseling women who are inadvertently vaccinated when pregnant or who
become pregnant within 3 months of vaccination, the physician should be
aware of the following: (1) In a 10 year survey involving over 700 pregnant
women who received rubella vaccine within 3 months before or after
conception (of whom 189 received the Wistar RA 27/3 strain), none of the
newborns had abnormalities compatible with congenital rubella syndrome;34
(2) Although mumps virus is capable of infecting the placenta and fetus,
there is no good evidence that it causes congenital malformations in
humans. Mumps vaccine virus also has been shown to infect the placenta, but
the virus has not been isolated from the fetal tissues from susceptible
women who were vaccinated and underwent elective abortions;35 and (3)
Reports have indicated that contracting of natural measles during pregnancy
enhances fetal risk. Increased rates of spontaneous abortion, stillbirth,
congenital defects and prematurity have been observed subsequent to natural
measles during pregnancy. There are no adequate studies of the attenuated
(vaccine) strain of measles virus in pregnancy. However, it would be
prudent to assume that the vaccine strain of virus is also capable of
inducing adverse fetal effects.
Nursing Mothers
It is not known whether measles or mumps vaccine virus is secreted in human
milk. Recent studies have shown that lactating postpartum women immunized
with live attenuated rubella vaccine may secrete the virus in breast milk
and transmit it to breast-fed infants.36In the infants with serological
evidence of rubella infection, none exhibited severe disease; however, one
exhibited mild clinical illness typical of acquired rubella.37,38 Caution
should be exercised when M-M-R II is administered to a nursing woman.
ADVERSE REACTIONS:
Burning and/or stinging of short duration at the injection site have been
reported.
The adverse clinical reactions associated with the use of M-M-R II are
those expected to follow administration of the monovalent vaccines given
separately. These may include malaise, sore throat, cough, rhinitis,
headache, dizziness, fever, rash, nausea, vomiting or diarrhea; mild local
reactions such as erythema, induration, tenderness and regional
lymphadenopathy; parotitis, orchitis, nerve deafness, thrombocytopenia and
purpura; allergic reactions such as wheal and flare at the injection site
or urticaria; polyneuritis; and arthralgia and/or arthritis (usually
transient and rarely chronic).
Anaphylaxis and anaphylactoid reactions have been reported.
Vasculitis has been reported rarely.
Otitis media and conjunctivitis have been reported.
Moderate fever (101-102.9°F (38.3-39.4°C)) occurs occasionally, and high
fever (above 103°F (39.4°C)) occurs less commonly. On rare occasions,
children developing fever may exhibit febrile convulsions. Afebrile
convulsions or seizures have occurred rarely following vaccination with
live attenuated measles vaccine. Syncope, particularly at the time of mass
vaccination, has been reported. Rash occurs infrequently and is usually
minimal, but rarely may be generalized. Erythema multiforme has also been
reported rarely.
Forms of optic neuritis, including retrobulbar neuritis, papillitis, and
retinitis may infrequently follow viral infections, and have been reported
to occur 1 to 3 weeks following inoculation with some live virus vaccines.
Clinical experience with live attenuated measles, mumps and rubella virus
vaccines given individually indicates that encephalitis and other nervous
system reactions have occurred very rarely. These might occur also with
M-M-R II.
Experience from more than 80 million doses of all live measles vaccines
given in the U.S. through 1975 indicates that significant central nervous
system reactions such as encephalitis and encephalopathy, occurring within
30 days after vaccination, have been temporally associated with measles
vaccine very rarely.39 In no case has it been shown that reactions were
actually caused by vaccine. The Center for Disease Control has pointed out
that "a certain number of cases of encephalitis may be expected to occur
in
a large childhood population in a defined period of time even when no
vaccines are administered". However, the data suggest the possibility that
some of these cases may have been caused by measles vaccines. The risk of
such serious neurological disorders following live measles virus vaccine
administration remains far less than that for encephalitis and
encephalopathy with natural measles (one per two thousand reported cases).
There have been rare reports of ocular palsies, Guillain-Barre syndrome, or
ataxia occurring after immunization with vaccines containing live
attenuated measles virus. The ocular palsies have occurred approximately
3-24 days following vaccination. No definite causal relationship has been
established between these events and vaccination. Isolated reports of
polyneuropathy including Guillain-Barre syndrome have also been reported
after immunization with rubella-containing vaccines.
There have been reports of subacute sclerosing panencephalitis (SSPE) in
children who did not have a history of natural measles but did receive
measles vaccine. Some of these cases may have resulted from unrecognized
measles in the first year of life or possibly from the measles vaccination.
Based on estimated nationwide measles vaccine distribution, the association
of SSPE cases to measles vaccination is about one case per million vaccine
doses distributed. This is far less than the association with natural
measles, 6-22 cases of SSPE per million cases of measles. The results of a
retrospective case-controlled study conducted by the Center for Disease
Control suggest that the overall effect of measles vaccine has been to
protect against SSPE by preventing measles with its inherent higher risk of
SSPE.40
Local reactions characterized by marked swelling, redness and vesiculation
at the injection site of attenuated live measles virus vaccines, and
systemic reactions including atypical measles, have occurred in persons who
received killed measles vaccine previously. M-M-R II was not given under
this condition in clinical trials. Rarely, more severe reactions that
require hospitalization, including prolonged high fevers and extensive
local reactions, have been reported.41Panniculitis has been reported rarely
following administration of measles vaccine.42
Arthralgia and/or arthritis (usually transient and rarely chronic), and
polyneuritis are features of natural rubella and vary in frequency and
severity with age and sex, being greatest in adult females and least in
prepubertal children. This type of involvement as well as myalgia and
paresthesia, have also been reported following administration of Meruvax II
(Rubella Virus Vaccine Live).
Chronic arthritis has been associated with natural rubella infection and
has been related to persistent virus and/or viral antigen isolated from
body tissues. Only rarely have vaccine recipients developed chronic joint
symptoms.
Following vaccination in children, reactions in joints are uncommon and
generally of brief duration. In women, incidence rates for arthritis and
arthralgia are generally higher than those seen in children (children:
0-3%; women: 12-20%),43 and the reactions tend to be more marked and of
longer duration. Symptoms may persist for a matter of months or on rare
occasions for years. In adolescent girls, the reactions appear to be
intermediate in incidence between those seen in children and in adult
women. Even in older women (35-45 years), these reactions are generally
well tolerated and rarely interfere with normal activities.
DOSAGE AND ADMINISTRATION:
FOR SUBCUTANEOUS ADMINISTRATION
Do not inject intravenously
The dosage of vaccine is the same for all persons. Inject the total volume
of the single dose vial (about 0.5 ml) or 0.5 ml of the 10 dose vial of
reconstituted vaccine subcutaneously, preferably into the outer aspect of
upper arm. Do not give immune globulin (IG) concurrently with M-M-R II.
During shipment, to insure that there is no loss of potency, the vaccine
must be maintained at a temperature of 10°C (50°F) or less.
Before reconstitution, store M-M-R II at 2-8°C (36-46°F).Protect from light
.
CAUTION: A sterile syringe free of preservatives, antiseptics, and
detergents should be used for each injection and/or reconstitution of the
vaccine because these substances may inactivate the live virus vaccine. A
25 gauge, 5/8" needle is recommended.
To reconstitute, use only the diluent supplied, since it is free of
preservatives or other antiviral substances which might inactivate the
vaccine.
Single Dose Vial --First withdraw the entire volume of diluent into the
syringe to be used for reconstitution. Inject all the diluent in the
syringe into the vial of lyophilized vaccine, and agitate to mix
thoroughly. Withdraw the entire contents into a syringe and inject the
total volume of restored vaccine subcutaneously.
It is important to use a separate sterile syringe and needle for each
individual patient to prevent transmission of hepatitis B and other
infectious agents from one person to another.
10 Dose Vial (available only to government agencies/institutions) Withdraw
the entire contents (7 ml) of the diluent vial into the sterile syringe to
be used for reconstitution, and introduce into the 10 dose vial of
lyophilized vaccine. Agitate to ensure thorough mixing. The outer labeling
suggests "For Jet Injector or Syringe Use". Use with separate sterile
syringes is permitted for containers of 10 doses or less. The vaccine and
diluent do not contain preservatives; therefore, the user must recognize
the potential contamination hazards and exercise special precautions to
protect the sterility and potency of the product. The use of aseptic
techniques and proper storage prior to and after restoration of the vaccine
and subsequent withdrawal of the individual doses is essential. Use 0.5 ml
of the reconstituted vaccine for subcutaneous injection.
It is important to use a separate sterile syringe and needle for each
individual patient to prevent transmission of hepatitis B and other
infectious agents from one person to another.
Each dose contains not less than the equivalent of 1,000 TCID50of the U.S.
Reference Measles Virus, 20,000 TCID50 of the U.S. Reference Mumps Virus
and 1,000 TCID50 of the U.S. Reference Rubella Virus.
Parenteral drug products should be inspected visually for particulate
matter and discoloration prior to administration. M-M-R II, when
reconstituted, is clear yellow.
Storage
It is recommended that the vaccine be used as soon as possible after
reconstitution. Protect vaccine from light at all times, since such
exposure may inactivate the virus. Store reconstituted vaccine in the
vaccine vial in a dark place at 2 - 8°C (36 - 46°F) and discard if not used
within 8 hours.
REFERENCES:
1) Plotkin, S. A.; Cornfeld, D.; Ingalls, T. H.: Studies of immunization
with living rubella virus: Trials in children with a strain cultured from
an aborted fetus, Am. J. Dis. Child. 110: 381-389, 1965. 2) Plotkin, S. A.;
Farquhar, J.; Katz, M.; Ingalls, T. H.: A new attenuated rubella virus
grown in human fibroblasts: Evidence for reduced nasopharyngeal excretion,
Am. J. Epidemiol. 86: 468-477,1967. 3) Fogel, A.; Moshkowitz, A.; Rannon,
L.; Gerichter, Ch. B.: Comparative trials of RA 27/3 and Cendehill rubella
vaccines in adult and adolescent females, Am. J. Epidemiol. 93: 392-393,
1971. 4) Andzhaparidze, O. G.; Desyatskova, R. G.; Chervonski, G. I.;
Pryanichnikova, L. V.: Immunogenicity and reactogenicity of live attenuated
rubella virus vaccines, Am. J. Epidemiol. 91: 527-530, 1970. 5) Freestone,
D. S.; Reynolds, G. M.; McKinnon, J. A.; Prydie, J.: Vaccination of
schoolgirls against rubella. Assessment of serological status and a
comparative trial of Wistar RA 27/3 and Cendehill strain live attenuated
rubella vaccines in 13-year-old schoolgirls in Dudley, Br. J. Prev. Soc.
Med. 29: 258-261, 1975. 6) Grillner. L.; Hedstrom, C. E.; Bergstrom, H.;
Forssman, L.; Rigner, A.; Lycke, E.: Vaccination against rubella of newly
delivered women,Scand. J. Infect. Dis. 5: 237-241, 1973. 7) Grillner, L.:
Neutralizing antibodies after rubella vaccination of newly delivered women:
a comparison between three vaccines, Scand. J. Infect. Dis. 7: 169-172,
1975. 8) Wallace, R. B.; Isacson, P.: Comparative trial of HPV-77, DE-5 and
RA 27/3 live-attenuated rubella vaccines, Am. J. Dis. Child. 124: 536-538,
1972. 9) Lalla, M.; Vesikari, T.; Virolainen, M.: Lymphoblast proliferation
and humoral antibody response after rubella vaccination, Clin. Exp.Immunol.
15: 193-202, 1973. 10) LeBouvier, G. L.; Plotkin, S. A.: Precipitin
responses to rubella vaccine RA 27/3, J. Infect. Dis. 123: 220-223, 1971.
11) Horstmann, D. M.: Rubella: The challenge of its control, J. Infect.
Dis. 123: 640-654, 1971. 12) Ogra, P. L.; Kerr-Grant, D.; Umana, G.;
Dzierba, J.; Weintraub, D.: Antibody response in serum and nasopharynx
after naturally acquired and vaccine-induced infection with rubella virus,
N. Engl. J. Med.285: 1333-1339, 1971. 13) Plotkin, S. A.; Farquhar, J. D.;
Ogra, P. L.: Immunologic properties of RA 27/3 rubella virus vaccine, J.
Am. Med. Assoc. 225: 585-590, 1973. 14) Liebhaber, H.; Ingalls, T. H.;
LeBouvier, G. L.; Horstmann, D.M.: Vaccination with RA 27/3 rubella
vaccine. Persistence of immunity and resistance to challenge after two
years, Am. J. Dis. Child. 123: 133-136, 1972. 15) Farquhar, J. D.:
Follow-up on rubella vaccinations and experience with subclinical
reinfection, J. Pediatr. 81: 460-465, 1972. 16) Weibel, R. E.; Carlson, A.
J.; Villarejos, V. M.; Buynak, E. B.; McLean, A. A.; Hilleman, M. R.:
Clinical and Laboratory Studies of Combined Live Measles, Mumps, and
Rubella Vaccines Using the RA 27/3 Rubella Virus, Proc. Soc. Exp. Biol.
Med. 165: 323-326, 1980. 17) Bottiger, M.; Christenson, B.; Romanus, V.;
Taranger, J.; Strandell, A.: Swedish experience of two dose vaccination
programme aiming at eliminating measles, mumps, and rubella, Brit. Med. J.
295 (14): 1264-1267, November, 1987. 18) Markowitz, L. E.; Preblud, S. R.;
Orenstein, W. A.; et al: Patterns of transmission in measles outbreaks in
the United States, 1985-1986, N. Engl. J. Med. 320 (2): 75-81, January 12,
1989. 19) Peltola, H.; Heinonen, O. P.; Valle, M.; et al: Five-year
experience in elimination of indigenous measles, mumps, and rubella in
Finland, Abstracts of the 29th ICAAC, Houston, Texas, Abstract #179, 130,
September, 1989. 20) American Academy of Pediatrics: Report of the
Committee on Infectious Disease, Evanston, III., AAP, p. 136-137, 1982. 21)
Recommendations of the Immunization Practices Advisory Committee (ACIP),
Measles Prevention, MMWR 36 (26): 409-425, July 10, 1987. 22) Jong, E. C.,
The Travel and Tropical Medicine Manual, W. B. Saunders Company, p. 12-16,
1987. 23) Committee on Immunization Council of Medical Societies, American
College of Physicians, Phila., PA, Guide for Adult Immunization, First
Edition, 1985. 24) Recommendation of the Immunization Practices Advisory
Committee (ACIP), Morbidity and Mortality Weekly Report 33 (22): 301-310,
315-318, June 8, 1984. 25) McIntosh, R,; Merritt, K. K.; Richards, M. R.;
Samuels, M. H.; Bellows, M. T.: The incidence of congenital malformations:
A study of 5,964 pregnancies, Pediatr. 14: 505-521, 1954. 26) American
Academy of Pediatrics, Committee on Infectious Diseases, Measles:
Reassessment of the Current Immunization Policy, Pediatrics 84 (6):
1110-1113, December, 1989. 27) Measles Prevention: Recommendations of the
Immunization Practices Advisory Committee (ACIP), Morbidity and Mortality
Weekly Report38 (S-9): 5-22, December 29, 1989. 28) Recommendations of the
Immunization Practices Advisory Committee (ACIP), General Recommendations
on Immunization, MMWR 38 (13) 205-228, April 7, 1989. 29) American Academy
of Pediatrics: Report of the Committee on Infectious Disease, Evanston,
III., 1982, p. 17. 30) Center for Disease Control: Immunization of Children
Infected with Human T-Lymphotropic Virus Type
III/Lymphadenopathy-Associated Virus, Annals of Internal Medicine,106:
75-78, 1987. 31) Krasinski, K.; Borkowsky, W.; Krugman, S.: Antibody
following measles immunization in children infected with human T-cell
lymphotropic virus type III/lymphadenopathy associated virus (HTLV-III/LAV)
(Abstract). In: Program and abstracts of the International Conference on
Acquired Immunodeficiency Syndrome, Paris, France, June 23-25, 1986. 32)
Recommendation of the Immunization Practices Advisory Committee (ACIP),
General Recommendations on Immunization, Morbidity and Mortality Weekly
Report 32 (1): 13, January 14, 1983. 33) Starr, S.; Berkovich, S.: The
effect of measles, gamma globulin modified measles, and attenuated measles
vaccine on the course of treated tuberculosis in children, Pediatrics 35:
97-102, January, 1965. 34) Rubella vaccination during pregnancy--United
States, 1971-1981. Morbidity and Mortality Weekly Report 31 (35): 477-481,
September 10, 1982. 35) Recommendation of the Immunization Practices
Advisory Committee (ACIP), Mumps Vaccine, Morbidity and Mortality Weekly
Report31 (46): 617-620, 625, November 26, 1982. 36) Losonsky, G. A.;
Fishaut, J. M.; Strussenber, J.; Ogra, P. L.: Effect or immunization
against rubella on lactation products. II. Maternal-neonatal interactions,
J. Infect. Dis. 145: 661-666, 1982. 37) Landes, R. D.; Bass, J. W.;
Millunchick, E. W.; Oetgen, W. J.: Neonatal rubella following postpartum
maternal immunization, J. Pediatr. 97: 465-467, 1980. 38) Lerman, S. J.:
Neonatal rubella following postpartum maternal immunization, J. Pediatr.
98: 668, 1981. (Letter) 39) CDC. Important Information about Measles,
Mumps, and Rubella, and Measles, Mumps, and Rubella Vaccines. 1980. 1983.
40) CDC, Measles Surveillance, Report No. 11, p. 14, September, 1982. 41)
Recommendation of the Immunization Practices Advisory Committee (ACIP),
Measles Prevention, Morbidity and Mortality Weekly Report 31 (17): 217-224,
229-231, May 7, 1982. 42) Buck, B. E.; Yang, L. C.; Caleb, M. H.; Green, J.
M.; South, M. A.: Measles virus panniculitis subsequent to vaccine
administration, J. Pediatrics 101 (3): 366-373, 1982. 43) Unpublished data
from the files of Merck Sharp and Dohme Research Laboratories.
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