Immunization Schedule, Adults (cont.)
- Measles: In the past, measles was a common childhood disease. It was a major worldwide cause of illness and death. Measles is a viral infection transmitted through the air. Symptoms similar to upper respiratory infections (nasal congestion, sneezing, sore throat) and high fevers lasting five to seven days mark the initial stage. Tiny white spots appear on the inside of the cheeks two days before the appearance of a rash. The rash first appears on the face and behind the ears. It then spreads to the trunk, followed by the extremities, including the palms and soles. It fades in the order of appearance. Complications include inflammation of the brain (encephalitis), seizures, and death.
- According to the CDC, before the development of the
live vaccine in 1963, about 500,000 cases of measles and 500 associated
deaths were reported annually in the United States.
- By 1983, the development and implementation of the measles vaccine decreased the annual number of reported cases to 3,600.
- Mumps: Mumps is caused by the mumps virus. Usual symptoms include fever, weakness, and body aches. The most distinctive feature of mumps is swelling of one or both parotid glands (salivary glands). The illness generally runs its course without complications, but meningitis (inflammation of the lining of the brain) may appear in 15% of cases. Although swelling of the testicles may occur in 20-30% of males, sterility is rare. One person in 20,000 cases will suffer deafness in one ear.
- The incubation period is generally 14-18 days. Most
cases occur in the spring. The virus is spread through infected salivary or
- The introduction of the vaccine in the late 1960s dramatically decreased the occurrence of mumps by 98% over the next 20 years.
- Rubella: Rubella is a viral disease caused by inhalation of virus-containing droplets in the air. It is characterized by rash, fever, and painful swollen lymph nodes. There may be a variety of other symptoms. The most devastating complication is infection of the fetus during the first trimester of pregnancy. This usually leads to development of congenital rubella. Exposed babies can later develop a variety of disorders such as cataracts at a young age, glaucoma, hearing loss, retardation, and heart defects. Pregnant women may also have an increased rate of miscarriage. In 1967, the licensing of the vaccine dramatically decreased the number of reported cases.
- Who gets the vaccine: The measles, mumps, and rubella vaccines contain live viruses. They are usually combined into a single vaccine (MMR) given as a first dose to children aged 12-15 months; the second dose is given prior to kindergarten (or the first opportunity thereafter). In adults, the MMR vaccine is recommended for these groups:
- Adults born in 1957 or later and who are older
than 18 years should receive one dose.
- High-risk groups, such as health-care workers,
college entrants, and international travelers, should receive two doses
- Adults born before 1957 are typically considered immune
to mumps and measles if proof is provided.
- Females of childbearing age (regardless of age and year of birth) without evidence of immunity should be immunized. Women should not receive an MMR vaccination while pregnant or if they may become pregnant within four weeks of receiving the vaccine.
- Side effects: Rash, itching, fever, and joint pains are common. Anyone who has had a previous reaction to the vaccine should avoid it. Women anticipating pregnancy within four weeks of vaccination and people with weakened immune systems should also avoid it. Breastfeeding is not a contraindication. Allow four to six weeks between doses.
Gregory L Walker, MD, FACEP, Ped EM
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