Rubella
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Rubivirus
stain of rubella

Rubella is a viral illness. It is spread through respiratory secretions. Up to 50% of people infected with rubella will have no symptoms but can still spread the virus. Rubella virus can be spread from 7 days before to about 7 days after the rash appears.

Symptoms of rubella begin about 2 weeks after exposure and may be very mild or absent. In children, rash is usually the first symptom. However, in older children and adults, there may be a 1 to 5 day prodrome with low-grade fever, malaise, swollen glands, and upper respiratory symptoms followed by a rash. The rash of rubella is maculopapular. It starts on the face and then progresses downward. Joint pain occurs frequently in adults, especially females.

If a pregnant woman becomes ill with rubella, the infection can be passed to the fetus (unborn baby). The infant may be born with congenital rubella syndrome (CRS), which can cause birth defects in up to 85% of births or even fetal death. CRS is one of the main reasons for rubella vaccine programs in the United States.

Treatment of rubella is based on relief of symptoms. MMR vaccine and immune globulin given after exposure does not prevent development of symptoms.

About the Vaccine

Although in the past measles, mumps and rubella were available as individual (single antigen) vaccines, the manufacturer is no longer making these individual vaccines. Instead measles, mumps, and rubella vaccines are given as combined MMR vaccine or as MMRV vaccine (combined MMR vaccine and varicella vaccine).

Measles, Mumps, and Rubella Vaccines Licensed for Use in the U.S.

Product: M-M-R II® (Measles, Mumps, and Rubella)
Manufacturer: Merck & Co
Year licensed: 1971
Product Insert

Combination Vaccines Containing Measles, Mumps, and Rubella Vaccines Licensed for Use in the U.S.

Product: ProQuad® (Measles, Mumps, Rubella, and Varicella)
Manufacturer: Merck & Co
Year licensed: 2005
Product Insert

Indications Contraindications and precautions
Child
  • All infants and children 12 months of age and older.
  • Susceptible adolescents without documented evidence of immunity.
Adult
  • Adults born in 1957 or later.
  • Military personnel.
  • College students.
  • International travelers.
  • Healthcare personnel.
  • All non-pregnant women of childbearing age who do not have evidence of immunity or vaccination.
  • People who have had a severe allergic reaction to a previous dose of MMR vaccine or an MMR vaccine component.* If you are administering MMR combined with varicella vaccine also check for a history of severe allergic reaction to a previous dose of varicella vaccine.
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication.
  • Pregnancy or the possibility of pregnancy within 4 weeks.
  • People who are immune compromised due to disease, treatment, or medication.
  • People who have recently received blood products or immune globulin.
  • Unless the parent or caregiver expresses a preference for MMRV vaccine, separate MMR and varicella vaccines should be administered for the first dose for children 12 through 47 months of age.
  • A personal or family history of seizures is a precaution to MMRV vaccination.

* MMR vaccine contains egg protein, neomycin, and gelatin (see package insert). However, allergy to eggs in not a contraindication or precaution to MMR vaccine.

Vaccine Ages Dose/Route Routine Administration Schedule
M-M-R II 12 months through 18 years of age Dose: 0.5 ml

Route: Subcutaneous
2 doses at 12-15 months and 4-6 years of age. Minimum interval between doses is 4 weeks.
Adult born in 1957 or later and:
  • attending college
  • working in health care
  • traveling outside the United States
  • military personnel
2 doses given 28 days apart.
Adults born in 1957 or later 1 dose.
ProQuad
(MMRV)
12 months through 12 years of age Dose: 0.5 ml

Route: Subcutaneous
2 doses at 12-15 months and 4-6 years of age. Minimum interval between doses is 3 months.
Unless the parent or caregiver expresses a preference for MMRV vaccine, separate MMR and varicella vaccines should be administered for the first dose for children 12 through 47 months of age.     
MMR Side Effects*
  • Fever (up to 1 person out of 6).
  • Mild rash (about 1 person out of 20).
  • Swelling of glands in the cheeks or neck (rare).
  • Seizure caused by fever (about 1 out of 3,000 doses).
  • Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 25%).
  • Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses).
  • Severe allergic reaction (very rare).

Notes:
*When MMR antigens are given in combination with other antigens (e.g., variciella) in one vaccine, the other antigens in the vaccine may cause other side effects. For more information about these possible side effects, go to the varicella pages on the Vaccines section of this website.

Product Name Supplied Storage and Handling
M-M-R II
Merck & Co
10 dose multidose vial with diluent (1 set per package). Store refrigerated between 2° to 8°C (35° to 46°F) and protect from light. The diluent may be stored in the refrigerator with the lyophilized vaccine or separately at room temperature.

M-M-R II is a clear yellow liquid after reconstitution. Discard reconstituted vaccine if not used within 8 hours.
ProQuad
Merck & Co
0.5 mL single dose vials with diluent (10 sets per package). Store in freezer between 50°C and -15°C (58°F and +5°F) until it is reconstituted. Protect from light. ProQuad may be stored at refrigerator temperature (36° to 46°F, 2° to 8°C) for up to 72 hours prior to reconstitution. Discard any ProQuad vaccine stored at 36° to 46°F which is not used within 72 hours of removal from 5°F (-15°C) storage. The diluent may be stored in the refrigerator with the lyophilized vaccine or separately at room temperature.

ProQuad is a clear pale yellow to light pink liquid after reconstitution. Discard reconstituted vaccine if not used within 30 minutes.     
Other diseases in this vaccine group: Measles, Mumps
Information Paper
Healthcare professionals are invited to join us as we discuss Measles, Mumps, Rubella (MMR) Vaccination Updates. Maj Troy W. Baker, USAF, MC (Director of Medical Education, 779th Medical Group, Chief, Allergy/Immunology) will provide information on clinical features, ACIP recommendations, policy updates, and issues/challenges. (Recorded on 16 Oct 2013)
GENADMIN PDF 21 Jun 13
III MEF FORCE HEALTH PROTECTION (FHP) REQUIREMENTS 2014
Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Recommendations of the Advisory Committee on Immunization Practices
National Foundation for Infectious Diseases
Package Insert - Vaccine
Package Insert - Vaccine
MMQC-12-1407 29 Jun 12
MERCK / M-M-R II (MEASLES, MUMPS, AND  RUBELLA VIRUS VACCINE, LIVE) / VOLUNTARY RECALL
Vaccine Information Statement (Interim)
Vaccine Information Statement (Interim)