The recommended age for the second
dose of MMR is now 4-6 years. Additional details, including the rationale
for change, will be discussed in the revised ACIP recommendations for MMR (6).
Routine Visit to Health-Care Providers for Adolescents Aged 11-12 Years
The routine visit to health-care providers for adolescents aged 11-12 years
remains an important time to ensure receipt of two doses of MMR beginning at or
after age 12 months and one dose of varicella vaccine, and that the hepatitis B
vaccine series has been initiated or completed. A shaded oval (Figure_1)
is used to distinguish this assessment from the need to routinely administer the
diphtheria and tetanus toxoids (Td) booster to all children at this age.
Additional changes have been made in the wording in the footnote to clarify this
American Academy of Pediatrics. Committee on Infectious
Diseases. Age for routine administration of the second dose of
American Academy of Pediatrics. Committee on Infectious Diseases.
The purpose of this statement is to
inform physicians of a modification in the recommendation of the appropriate
age for routine administration of the second dose of measles-mumps-rubella
(MMR) vaccine. The implementation of the two-dose measles vaccine
schedule has improved the control of measles, but some outbreaks continue to
occur in school children, although >/= to 95% of children in school have
received one dose of vaccine. Because
most measles vaccine failures are attributable to failure to respond to the
first dose, that all children receive two doses of measles-containing vaccine
is essential for the control of measles. Routine administration of the
second dose of MMR vaccine at school entry (4 to 6 years of age) will help
prevent school-based outbreaks. Physicians should continue to review the
records of all children 11 to 12 years of age to be certain that they have
received two doses of MMR vaccine after their first birthday. Documenting that
all school children have received two doses of measles-containing vaccine by
the year 2001 will help ensure the elimination of measles in the United States
and contribute to the global effort to control and possible eradicate measles.
The sustained decline of measles in the United States has been associated
with a shift in occurrence from children to infants and young adults. During
1990-1994, 47% of reported cases occurred in persons ages greater than or equal
to 10 years, compared with only 10% during 1960-1964 (CDC, unpublished data;
17). During the 1980s, outbreaks of measles occurred among school-age children
in schools with measles-vaccination levels of greater than or equal to 98% (18).
Primary vaccine failure was considered
the principal contributing factor in these outbreaks. As a result, beginning in
1989, a two-dose measles-vaccination schedule for students in primary schools,
secondary schools, and colleges and universities was recommended (18-20).
This two-dose vaccination schedule provides protection to greater than or equal
to 98% of persons vaccinated. Administration of a second dose of MMR at entry to
elementary school (i.e., at ages 4-6 years) or junior high or middle school
(i.e., at ages 11-12 years) is recommended (21-23). State policies for
implementing the two-dose strategy have varied; some states require the second
dose for entry into primary school, and others require it for entry into middle
school. Because the recommendation for a second dose of MMR was made in 1989,
many children born before 1985 (and some children born after 1985, depending on
local policy) may not have received the second vaccine dose. The routine visit
to providers at ages 11-12 years affords an opportunity to administer a second
dose of MMR to adolescents who have not received two doses of MMR at greater
than or equal to 12 months of age.
MMR should not be given to adolescents who are known to be pregnant or to
adolescents who are considering becoming pregnant within 3 months of
vaccination. Asking adolescents if they are pregnant, excluding those who say
they are, and explaining the theoretical risk of fetal infection to the other
female adolescents are recommended precautions.
ALL INFORMATION, DATA, AND
MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION
PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS
OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR
LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND
COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH
YOUR HEALTH CARE PROVIDER.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
“A sacred cow will not protect the herd.”
-- Sandy Gottstein
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"