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MMR Vaccine Resource Center

Frequently Asked Questions (FAQ) about the current measles outbreak
and MMR vaccine policy and recommendations


Measles disease picture

Measles is a highly contagious acute viral respiratory illness caused by a single-stranded, enveloped RNA virus with 1 serotype. Humans are the only natural hosts of measles virus.

Transmission of the measles virus is through direct contact with infectious droplets or by airborne spread when an infected person breathes, coughs, or sneezes. Measles virus can remain infectious in the air for up to two hours after an infected person leaves an area.

Clinical features include a prodrome marked by high fever followed by the onset of cough, runny nose, and red, watery eyes (conjunctivitis). Koplik spots may be seen on mucous membranes in the mouth; these lesions present as blue and white spots on bright red background and appear a few days before and after the measles rash. The characteristic measles rash appears as maculopapular lesions that start on the head and gradually proceed down the body over 5-6 days.

Complications develop in approximately 30% of measles cases, which are most common in children younger than 5 years and adults 20 years and older. Complications include ear infections, diarrhea, pneumonia, or encephalitis (brain inflammation), and rarely death.

There is no cure for measles. Treatment is symptomatic and supportive.


Mumps disease picture

Mumps is an acute viral illness caused by an enveloped RNA virus that belongs to the genus Rubulavirus, in the family Paramyxoviridae.  Humans are the only natural hosts for mumps virus, which is usually spread by respiratory droplets, saliva, or contact with contaminated fomites. The incubation period of mumps averages 16–18 days, with a range of about 2–4 weeks.

Mumps infection may present with primarily respiratory symptoms or may be asymptomatic. However, clinical features of mumps usually include unilateral or bilateral, parotitis, with single or multiple salivary glands affected. Parotitis occurs within the first 2 days and may first be noted as earache and tenderness on palpation of the angle of the jaw. Symptoms tend to decrease after 1 week and usually resolve after 10 days. Nonspecific prodromal symptoms may precede parotitis by several days, including low-grade fever which may last three to four days, myalgia, anorexia, malaise, and headache.

Complications of mump infections are more likely to be serious when adults are infected. Complications of mumps can include meningitis (in up to 15% of cases), orchitis, and deafness. Very rarely, mumps can cause encephalitis and permanent neurological damage.


Rubella disease pictureRubella, also called German measles, is a contagious viral infection caused by rubella virus.  Humans are the only natural hosts of rubella virus, which is transmitted through person-to-person contact or droplets shed from the respiratory secretions of infected people. People may shed virus from 7 days before the onset of the rash to approximately 5–7 days after rash onset. Transmission from mother to fetus can also occur, with the highest risk of congenital rubella syndrome (CRS) if infection occurs in the first trimester. Infants with CRS can transmit virus for up to 1 year after birth. 

Symptoms of rubella are often mild, and up to 50% of infections may be subclinical or inapparent.  Rubella usually presents as a nonspecific, maculopapular, generalized rash that lasts ≤3 days with generalized lymphadenopathy. Rash may be preceded by low-grade fever, malaise, anorexia, mild conjunctivitis, runny nose, and sore throat. Adolescents and adults, especially women, can also present with transient arthritis. Infection during early pregnancy can lead to miscarriage, fetal death, or the fetus can develop Congenital Rubella Syndrome (CRS), which can affect virtually all organ systems, with deafness being the most common outcome. Up to 85% of infants are affected if infection occurs during the first trimester of pregnancy.

Complications of rubella are not common, and generally occur more often in adults than in children.  Arthralgia or arthritis may occur in up to 70% of adult women who contract rubella, and tend to occur about the same time or shortly after appearance of the rash, lasting for up to 1 month.  Additional complications that can occur are encephalitis, orchitis, neuritis, and a late syndrome of progressive panencephalitis. Complications that do occur more often in children than adults are hemorrhagic manifestations (approximately one per 3,000 cases) that may be secondary to low platelets and vascular damage, with thrombocytopenic purpura being the most common manifestation. Gastrointestinal, cerebral, or intrarenal hemorrhage may occur. Effects may last from days to months, and most patients recover.

M-M-R®II is a live-virus vaccine which includes antigens for measles, mumps, and rubella, licensed for persons 12 months and older. Two doses of MMR vaccine are routinely recommended for children, starting with the first dose at age 12 through 15 months and the second dose at age 4 through 6 years before school entry. Children can receive the second dose earlier as long as it is at least 28 days after the first dose.

Teens and adults should also be up to date on MMR vaccinations. MMR vaccination is especially important for:

  • Students at post-high school educational institutions
  • International travelers
  • Healthcare professionals
  • Women of childbearing age who are not pregnant
  • People who care for or are around immunocompromised people
  • People living with HIV without evidence of severe immunosuppression

After vaccination, it is not necessary to test patients for antibodies to confirm immunity.

ProQuad® (MMRV) is a live-virus combination vaccine which includes antigens for measles, mumps, rubella, and varicella. ProQuad® is licensed for children 12 months through 12 years of age. If MMRV vaccine is used, at least 3 months should elapse between doses of varicella-containing vaccine.

Resource Center

You will find below all of the resources you will need about the measles-mumps-rubella vaccine. More will be added as they are published or released.

Information Paper Date
MMR Infections and the MMR Vaccine
March 21, 2023
Cold Chain Management of MMR Vaccine
Jan. 31, 2023
Standing Orders Date
Measles Mumps Rubella (MMR) Vaccine (Pediatric)
May 15, 2023
Measles Mumps Rubella Varicella (MMRV) Vaccine (Pediatric)
May 15, 2023
Measles Mumps Rubella (MMR) Vaccine (Adult)
May 15, 2023
Vaccine Information Statements (VIS) Date
MMR Vaccine: What You Need to Know
Aug. 6, 2021
MMRV Vaccine: What You Need to Know
Aug. 6, 2021
Manufacturer Package Inserts Date
Feb. 27, 2023
June 3, 2022
ProQuad (MMRV) (frozen)
Feb. 27, 2023
Advisory Committee on Immunization Practices (ACIP) Recommendations Date
MMR Vaccine
Nov. 18, 2022
MMRV Vaccine
May 7, 2010

You also may be interested in...

Global Routine Vaccination Coverage — 2017


Global coverage with vaccines to prevent diphtheria, tetanus, pertussis, polio, and measles has remained at 84%–85% since 2010. Prioritizing countries with the highest number of unvaccinated children to implement context-specific strategies has the potential to increase immunization coverage globally.

Measles Outbreak in a Highly Vaccinated Population — Israel, July–August 2017


During July and August 2017, nine measles cases occurred among vaccinated Israeli soldiers. The primary patient had recently traveled to Europe. All other cases occurred in his direct contacts. All patients had mild illness; no tertiary cases occurred.

Mumps Outbreak in a Marshallese Community — Denver Metropolitan Area, Colorado, 2016–2017


An outbreak of 47 mumps cases occurred in the Denver metropolitan area, mostly among members of a Marshallese community. Public health response included early active surveillance, public education, and prompt implementation of MMR vaccination clinics.

Sentinel Surveillance for Congenital Rubella Syndrome — India, 2016–2017


India is committed to eliminating measles and controlling rubella and congenital rubella syndrome (CRS) by 2020. CRS surveillance in five sentinel sites from 2016 identified 207 suspected CRS cases; 72 (34.8%) were laboratory-confirmed.

Notes from the Field: Mumps Outbreak Associated with Cheerleading Competitions — North Texas, December 2016–February 2017


Twelve mumps cases in five Texas counties were identified in persons who were nonathlete participants or attendees at three cheerleading competitions or were household contacts of mumps patients.

Notes from the Field: Mumps Outbreak — Alaska, May 2017–July 2018


Almost 400 confirmed or probable cases of mumps have been reported during this outbreak, mostly in residents of Anchorage, AK.

Mumps Outbreaks at Four Universities — Indiana, 2016


In 2016, large mumps outbreaks occurred at four Indiana universities. At some universities documentation of receipt of 2 doses of measles, mumps, and rubella vaccine (MMR) was not available and required substantial personnel time to verify.

Measles-Rubella Supplementary Immunization Activity Readiness Assessment — India, 2017–2018


Readiness assessments for supplemental immunization activities were conducted in the South-East Asia Region prior to efforts to immunize more than 500 million children with measles-rubella vaccine by 2019.

Progress Toward Rubella and Congenital Rubella Syndrome Control — South-East Asia Region, 2000–2016


With more South-East Asian countries introducing rubella-containing vaccine into routine immunization programs since 2000, at least four countries are likely to have controlled rubella and congenital rubella syndrome. Rubellla incidence decreased 37 percent from 2010-2016.

Progress Toward Measles Elimination — Western Pacific Region, 2013–2017


During 2013–2016, a resurgence of measles occurred in the World Health Organization Western Pacific Region (WPR), with several large-scale outbreaks. However, with control of the outbreaks, in 2017, incidence decreased to a new historic low (5.2 per million).

Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak


The ACIP has recommended a third dose of a mumps virus–containing vaccine for persons previously vaccinated with 2 doses who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak.

Public Health Economic Burden Associated with Two Single Measles Case Investigations — Colorado, 2016–2017


During July 2016–January 2017, two single, unrelated measles cases were diagnosed in the Denver metropolitan area, each exposing hundreds of persons, prompting a complex and coordinated response by multiple public health agencies, costing in excess of $68,000.

Progress in Rubella and Congenital Rubella Syndrome Control and Elimination — Worldwide, 2000–2016


Increased rubella vaccine coverage globally resulted in a decrease in reported rubella cases from 670,894 cases in 2000, to 22,361 cases in 2016.

Progress Toward Regional Measles Elimination — Worldwide, 2000–2016


For the first time, annual estimated measles deaths were fewer than 100,000, in 2016, down 84 percent from 2000.

Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year


This report summarizes 2016–17 school year MMR, DTaP, and varicella vaccination coverage reported by immunization programs in 49 states.

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Last Updated: May 17, 2023
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