Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know

CDC recommends that people get MMR vaccine to protect against measles, mumps, and rubella. Children should get two doses of MMR vaccine, starting with the first dose at 12 to 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination. Two MMR vaccines are available for use in the United States, M-M-R II and PRIORIX.  M-M-R II and PRIORIX are fully interchangeable for all indications for which MMR vaccination is recommended. Children may also get MMRV vaccine , which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

  • Who Should Get MMR Vaccine?

CDC recommends all children get two doses of MMR (measles-mumps-rubella) vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose earlier as long as it is at least 28 days after the first dose.

Learn about MMRV vaccine , which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Students at post-high school educational institutions

Students at post-high school educational institutions who do not have presumptive  evidence of immunity need two doses of MMR vaccine, separated by at least 28 days.

Adults who do not have presumptive  evidence of immunity should get at least one dose of MMR vaccine.

Certain adults may need 2 doses. Adults who are going to be in a setting that poses a high risk for measles or mumps transmission should make sure they have had two doses separated by at least 28 days. These adults include

  • students at post-high school education institutions
  • healthcare personnel
  • international travelers

International travelers

People 6 months of age and older who will be traveling internationally should be protected against measles. Before any international travel—

  • Infants 6 through 11 months of age should receive one dose of MMR vaccine. Infants who get one dose of MMR vaccine before their first birthday should get two more doses (one dose at 12 through 15 months of age and another dose separated by at least 28 days).
  • Children 12 months of age and older should receive two doses of MMR vaccine, separated by at least 28 days.
  • Teenagers and adults who do not have presumptive  evidence of immunity against measles should get two doses of MMR vaccine separated by at least 28 days.

See also, Travel Information ( Measles | Mumps | Rubella )

Healthcare personnel

Healthcare personnel should have documented presumptive  evidence of immunity , according to the recommendations of the Advisory Committee on Immunization Practices [48 pages] . Healthcare personnel without evidence of immunity should get two doses of MMR vaccine, separated by at least 28 days.

Who Should Not Get MMR Vaccine?

Who does not need mmr vaccine, how well does the mmr vaccine work, what is mmrv vaccine, should you get vaccinated after being exposed to measles, mumps, or rubella, what are the childcare and school requirements for mmr vaccine, how can parents pay for mmr vaccine, educational materials, for healthcare providers.

  • Measles information for Healthcare Providers
  • Measles Outbreak Communication Toolkits

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Planning a trip outside the U.S.?

Find out if you need measles vaccine

Women of Childbearing Age

Women of childbearing age should check with their doctor to make sure they are vaccinated before they get pregnant. Women of childbearing age who are not pregnant and do not have presumptive evidence of immunity should get at least one dose of MMR vaccine.

It is safe for breastfeeding women to receive MMR vaccination. Breastfeeding does not interfere with the response to MMR vaccine, and the baby will not be affected by the vaccine through breast milk.

Groups at increased risk for mumps because of a mumps outbreak

During a mumps outbreak, public health authorities might recommend an additional dose of MMR vaccine for people who belong to groups at increased risk for getting mumps. These groups are usually those who are likely to have close contact, such as sharing sport equipment or drinks, kissing, or living in close quarters, with a person who has mumps. Your local public health authorities or institution will communicate to the groups at increased risk that they should receive this dose. If you already have two doses of MMR, it is not necessary to seek out vaccination unless you are part of this group.

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Measles, Mumps, and Rubella (MMR) vaccine

Some people should not get MMR vaccine or should wait.

Tell your vaccine provider if the person getting the vaccine:

  • Has any severe, life-threatening allergies. A person who has ever had a life-threatening allergic reaction after a dose of MMR vaccine, or has a severe allergy to any part of this vaccine, may be advised not to be vaccinated. Ask your health care provider if you want information about vaccine components.
  • Is pregnant or thinks she might be pregnant. Pregnant women should wait to get MMR vaccine until after they are no longer pregnant. Women should avoid getting pregnant for at least 1 month after getting MMR vaccine.
  • Has a weakened immune system due to disease (such as cancer or HIV/AIDS) or medical treatments (such as radiation, immunotherapy, steroids, or chemotherapy).
  • Has a parent, brother, or sister with a history of immune system problems.
  • Has ever had a condition that makes them bruise or bleed easily.
  • Has recently had a blood transfusion or received other blood products. You might be advised to postpone MMR vaccination for 3 months or more.
  • Has tuberculosis.
  • Has gotten any other vaccines in the past 4 weeks. Live vaccines given too close together might not work as well.
  • Is not feeling well. A mild illness, such as a cold, is usually not a reason to postpone a vaccination. Someone who is moderately or severely ill should probably wait. Your doctor can advise you.

This information was taken directly from the MMR (Measles, Mumps & Rubella) Vaccine information Statement (VIS) dated 2/12/2018.

Learn who should not get MMRV vaccine , which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

You do not need measles, mumps, and rubella (MMR) vaccine if you meet any of these criteria for presumptive evidence of immunity*:

  • at least one dose of a measles, mumps, and rubella virus-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk for exposure and transmission
  • two doses of measles and mumps virus-containing vaccine for school-age children and adults at high risk for exposure and transmission, including college students, healthcare personnel, international travelers, and groups at increased risk during outbreaks
  • You have laboratory confirmation of past infection or had blood tests that show you are immune to measles, mumps, and rubella.
  • You were born before 1957.**

If you do not have presumptive evidence of immunity against measles, mumps, and rubella, talk with your doctor about getting vaccinated. If you’re unsure whether you’ve been vaccinated, you should first try to find your vaccination records . If you do not have written documentation of MMR vaccine, you should get vaccinated. The MMR vaccine is safe, and there is no harm in getting another dose if you may already be immune to measles, mumps, or rubella.

If you received a measles vaccine in the 1960s, you may not need to be revaccinated. People who have documentation of receiving LIVE measles vaccine in the 1960s do not need to be revaccinated. People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect those who may have received killed measles vaccine, which was available in 1963-1967 and was not effective.

*Except during a mumps outbreak. During a mumps outbreak public health authorities might recommend an additional dose of MMR vaccine for people who belong to groups at increased risk for getting mumps, regardless if they meet the criteria listed above.

**Birth before 1957 provides only presumptive evidence for measles, mumps, and rubella. Before vaccines were available, nearly everyone was infected with measles, mumps, and rubella viruses during childhood. The majority of people born before 1957 are likely to have been infected naturally and therefore are presumed to be protected against measles, mumps, and rubella. Healthcare personnel born before 1957 without laboratory evidence of immunity or disease should consider getting two doses of MMR vaccine.

MMR vaccine is very effective at protecting people against measles, mumps, and rubella, and preventing the complications caused by these diseases. People who receive MMR vaccination according to the U.S. vaccination schedule are usually considered protected for life against measles and rubella. While MMR provides effective protection against mumps for most people, immunity against mumps may decrease over time and some people may no longer be protected against mumps later in life. An additional dose may be needed if you are at risk because of a mumps outbreak.

One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella.

Two doses of MMR vaccine are 97% effective against measles and 88% effective against mumps.

MMR is an attenuated (weakened) live virus vaccine. This means that after injection, the viruses cause a harmless infection in the vaccinated person with very few, if any, symptoms before they are eliminated from the body. The person’s immune system fights the infection caused by these weakened viruses, and immunity (the body’s protection from the virus) develops.

Some people who get two doses of MMR vaccine may still get measles, mumps, or rubella if they are exposed to the viruses that cause these diseases. Experts aren’t sure why; it could be that their immune systems didn’t respond as well as they should have to the vaccine or their immune system’s ability to fight the infection decreased over time. However, disease symptoms are generally milder in vaccinated people.

  • About 3 out of 100 people who get two doses of MMR vaccine will get measles if exposed to the virus. However, they are more likely to have a milder illness, and are also less likely to spread the disease to other people.
  • Two doses of MMR vaccine are 88% (range 32% to 95%) effective at preventing mumps. Mumps outbreaks can still occur in highly vaccinated U.S. communities, particularly in settings where people have close, prolonged contact, such as universities and close-knit communities. During an outbreak, public health authorities may recommend an additional dose of MMR for people who belong to groups at increased risk for mumps. An additional dose can help improve protection against mumps disease and related complications.
  • While there are not many studies available, most people who do not respond to the rubella component of the first MMR dose would be expected to respond to the second dose.

MMRV vaccine protects against four diseases: measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children 12 months through 12 years of age.

CDC recommends that children get one dose of MMRV vaccine at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Children can receive the second dose of MMRV vaccine earlier than 4 through 6 years. This second dose of MMRV vaccine can be given 3 months after the first dose. A doctor can help parents decide whether to use this vaccine or MMR vaccine.

MMRV is given by shot and may be given at the same time as other vaccines.

Please see the MMRV Vaccine Information Statement (VIS) for more information about who should not get MMRV vaccine or should wait.

For more information, see

  • Factsheet: Two Options for Protecting Your Child Against Measles, Mumps, Rubella, and Varicella (MMRV)
  • Measles, Mumps, Rubella, and Varicella (MMRV) Vaccine
  • Frequently Asked Questions about Multiple Vaccinations and the Immune System
  • Varicella (Chickenpox) Vaccination

If you do not have immunity against measles , mumps , and rubella  and are exposed to someone with one of these diseases, talk with your doctor about getting MMR vaccine. It is not harmful to get MMR vaccine after being exposed to measles, mumps, or rubella, and doing so may possibly prevent later disease.

If you get MMR vaccine within 72 hours of initially being exposed to measles, you may get some protection against the disease, or have milder illness. In other cases, you may be  given a medicine called immunoglobulin (IG) within six days of being exposed to measles, to provide some protection against the disease, or have milder illness.

Unlike with measles, MMR has not been shown to be effective at preventing mumps or rubella in people already infected with the virus (i.e., post-exposure vaccination is not recommended).

During outbreaks of measles or mumps, everyone without presumptive evidence of immunity should be brought up to date on their MMR vaccination. And some people who are already up to date on their MMR vaccination may be recommended to get an additional dose of MMR for added protection against disease.

All 50 states and the District of Columbia (DC) have state laws that require children entering childcare or public schools to have certain vaccinations. There is no federal law that requires this.

The Advisory Committee on Immunization Practices recommends that all states require children entering childcare, and students starting school, college, and other postsecondary educational institutions to be up to date on MMR vaccination:

  • 1 dose is recommended for preschool-aged children 12 months or older
  • 2 doses are recommended for school-aged children in kindergarten through grade 12 as well as students attending colleges or other post-high school educational institutions

For more information, see State Vaccination Requirements .

Most health insurance plans cover the cost of vaccines. But you may want to check with your health insurance provider before going to the doctor. Learn how to pay for vaccines.

If you don’t have insurance or if your insurance does not cover vaccines for your child, the Vaccines for Children (VFC) Program  may be able to help. This program helps families of eligible children who might not otherwise have access to vaccines. To find out if your child is eligible, visit the VFC website or ask your child’s doctor. You can also contact your state VFC coordinator .

  • Measles ( In English | En Español )
  • Mumps  (In English | En Español )
  • Rubella (In English | En Español )
  • Information on vaccines.gov ( Measles | Mumps | Rubella | Varicella )
  • Measles: Vaccine for Measles
  • Mumps: Be Sure Your Child Is Fully Immunized
  • Rubella: Make Sure Your Child Gets Vaccinated
  • What Would Happen If We Stopped Vaccinations?
  • Questions and Answers, Immunization Action Coalition ( Measles [4 pages] | Mumps [4 pages] | Rubella [4 pages] )
  • Measles, mumps, and rubella are serious diseases…Make sure your child is protected!, Immunization Action Coalition ( In English [1 page] | En Español [1 page] | по-русски [1 page] )
  • MMR=measles, mumps, and rubella combination vaccine
  • MMRV = measles, mumps, rubella, and varicella combination vaccine
  • Measles=Rubeola
  • Measles = ”10-day,” “hard” and “red” measles
  • Rubella = also called “German” or “3-day” measles
  • CRS = Congenital Rubella Syndrome

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  • Section 7 - Traveling Safely with Infants & Children
  • Section 7 - International Adoption

Vaccine Recommendations for Infants & Children

Cdc yellow book 2024.

Author(s): Michelle Weinberg

Vaccinating children for travel requires careful evaluation. Whenever possible, children should complete routine childhood immunizations on a normal schedule. Travel at an earlier age, however, might require accelerated vaccine schedules. Not all travel-related vaccines are effective in infants, and some are specifically contraindicated.

See recommended childhood and adolescent immunization schedules . The Centers for Disease Control and Prevention (CDC) provides a catch-up schedule for children and adolescents who start a vaccination schedule late or who are >1 month behind. Tables also describe the recommended minimum intervals between doses for children who need to be vaccinated on an accelerated schedule, which could be necessary before international travel.

Country-specific vaccination recommendations and requirements for departure and entry vary over time. For example, proof of yellow fever vaccination is required for entry into certain countries. Meningococcal vaccination is required for travelers entering Saudi Arabia for Umrah or the annual Hajj pilgrimage. The World Health Organization (WHO) has issued temporary vaccination recommendations for residents of and long-term visitors to countries with active circulation of wild or vaccine-derived poliovirus. Some countries might require coronavirus disease 2019 (COVID-19) vaccine, testing, or both for entry. Check the CDC Travelers’ Health website for current requirements and recommendations.

Additional information about diseases and routine vaccination is available in the disease-specific chapters in Section 5. See tools for determining routine and catch-up childhood vaccination .

Modifying Immunization Schedules for Infants & Young Children Before International Travel

Several factors influence recommendations for the age at which a vaccine is administered, including age-specific risks for the disease and its complications, age-dependent ability to develop an adequate immune response to a vaccine, and potential interference with the immune response by passively transferred maternal antibodies.

Immunization schedules for infants and children in the United States do not provide guidance on modifications for people traveling internationally before the age when specific vaccines are routinely recommended. Age limits for vaccine administration are based on the risk for potential adverse events (e.g., yellow fever vaccine), lack of efficacy data or inadequate immune response (e.g., influenza vaccine, polysaccharide vaccines), maternal antibody interference and immaturity of the immune system (e.g., measles-mumps-rubella [MMR] vaccine), or lack of safety data.

To help parents decide when to travel with an infant or young child, advise them that the earliest opportunity to receive routinely recommended immunizations in the United States (except for doses of hepatitis B vaccine at birth and age 1 month) is when the baby is 6 weeks old. In general, live-virus vaccines (MMR, varicella, yellow fever) should be administered on the same day or spaced ≥28 days apart.

Routine Infant & Childhood Vaccines

Children should be vaccinated against diphtheria, Haemophilus influenzae type b (Hib), hepatitis A and hepatitis B virus, human papillomavirus, influenza, measles, mumps, Neisseria meningitidis , pertussis, polio, rotavirus, rubella, Streptococcus pneumoniae , tetanus, and varicella. To complete a vaccine series before travel, doses can be administered at the minimum ages and dose intervals. Inform parents that infants and children who have not received all recommended vaccine doses might not be fully protected. Rotavirus vaccine is unique among the routine vaccines given to infants in the United States because it has maximum ages for both the first and last doses; specifically consider the timing of travel so that the infant will be able to receive the complete vaccine series, if possible.

Coronavirus Disease 2019

The COVID-19 pandemic continues to evolve, and CDC’s vaccination recommendations are updated regularly. See the most current recommendations for children and teens . COVID-19 vaccines available for use in the United States can be administered simultaneously with all other vaccines.

Hepatitis A

Hepatitis A infection is usually mild or asymptomatic in infants and children <5 years old. Infected children can, however, transmit the infection to older children and adults, age groups at greater risk for severe disease. Ensure vaccination for all children traveling to areas with an intermediate or high risk for hepatitis A (see Sec. 5, Part 2, Ch. 7, Hepatitis A ). Routine hepatitis A vaccination for children aged ≥12 months consists of 2 doses, separated by ≥6 months. Ideally, the first dose should be administered ≥2 weeks before travel. When protection against hepatitis A is recommended, infants aged 6–11 months should receive 1 dose of hepatitis A vaccine before travel outside the United States.

Hepatitis A vaccine is considered safe and immunogenic in infants; doses administered before 12 months of age, however, can result in a suboptimal immune response, particularly in infants with passively acquired maternal antibody. Therefore, doses administered to infants <12 months old are not considered to provide long-term protection; initiate the 2-dose hepatitis A vaccine series at age 12 months according to the routine immunization schedule.

Hepatitis A Immune Globulin

When protection against hepatitis A is recommended, infants <6 months old should receive immune globulin (IG) before travel. One dose of 0.1 mL/kg intramuscularly provides protection for ≤1 month. Infants who do not receive vaccination who will be traveling for >1 month but ≤2 months should receive an IG dose of 0.2 mL/kg. If the traveler remains in a high-risk setting, IG (0.2 mL/kg) should be administered every 2 months until hepatitis A vaccine can be given at ≥6 months of age, if not contraindicated.

For optimal protection, children aged ≥1 year who are immunocompromised or who have chronic medical conditions, and who will be traveling to a high-risk area in <2 weeks, should receive the initial dose of hepatitis A vaccine and IG at separate anatomic injection sites.

Recommended Dosing Intervals for Coadministration of Live-Virus Vaccines

Hepatitis A IG is an antibody-containing product that does not interfere with the immune response to yellow fever vaccine but can inhibit the response to other injected live-virus vaccines (e.g., MMR, varicella) for up to 6 months after administration (see Sec. 2, Ch. 3, Vaccination & Immunoprophylaxis—General Principles ).

MMR vaccine is recommended for all infants aged 6–11 months traveling internationally. Because measles in infancy is a more severe disease than hepatitis A, administer hepatitis A vaccine and MMR vaccine simultaneously to infants aged 6–11 months to provide protection against hepatitis A and measles, but do not give hepatitis A IG.

If the interval between MMR or varicella vaccine administration and subsequent administration of an antibody-containing product is <14 days, repeat vaccination after the recommended interval unless serologic testing indicates a protective antibody response. For information about dosing intervals, see The Timing and Spacing of Immunobiologics, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices, Table 3-4 ) and Table 3-5 .

Hepatitis B

For certain age groups, hepatitis B vaccine can be administered with an accelerated schedule of 4 doses of vaccine given at 0, 1, 2, and 12 months; the last dose can be given after the child returns from travel (see Sec. 5, Part 2, Ch. 8, Hepatitis B , for details).

Influenza viruses circulate predominantly in the winter months in temperate regions (typically November–April in the Northern Hemisphere and April–September in the Southern Hemisphere) but can occur year-round in tropical climates (see Sec. 5, Part 2, Ch. 12, Influenza ). Because influenza viruses can circulate any time of the year, travelers aged ≥6 months who were not vaccinated during the influenza season in their country of residence should be vaccinated ≥2 weeks before departure if vaccine is available.

Children aged 6 months–8 years who have never received influenza vaccine, or who have not previously received a lifetime total of ≥2 doses, should receive 2 doses separated by ≥4 weeks. See annually updated recommendations about seasonal influenza vaccination .

Measles-Mumps-Rubella or Measles-Mumps-Rubella-Varicella

Children traveling abroad need to be vaccinated against measles, mumps, and rubella at an age earlier than what is routinely recommended. Infants 6–11 months old should receive 1 MMR vaccine dose. Infants vaccinated before age 12 months must be revaccinated on or after their first birthday with 2 doses of MMR vaccine (separated by ≥28 days) or measles-mumps-rubella-varicella (MMRV) vaccine (separated ≥3 months). The minimum interval between any varicella-containing vaccine (MMRV or monovalent varicella) is 3 months.

MMRV vaccine is licensed for use in children aged 12 months–12 years and should not be given outside this age group. Recipients of a first dose of MMRV vaccine have a greater risk for febrile seizures compared with recipients of MMR and varicella vaccines administered concomitantly. Unless the caregiver expresses a preference for MMRV, CDC recommends administering separate MMR and varicella vaccine for the first dose of MMR and varicella vaccination for children 12–47 months.

Meningococcal

Quadrivalent conjugate.

Children aged 2 months–18 years who travel to or reside in areas of sub-Saharan Africa known as the meningitis belt during the dry season (December–June) should receive quadrivalent meningococcal conjugate (MenACWY) vaccine (see Sec. 5, Part 1, Ch. 13, Meningococcal Disease ). In addition, travelers are required to have meningococcal vaccination to enter Saudi Arabia when traveling to Mecca for Umrah or the annual Hajj pilgrimage. The CDC Travelers’ Health website provides annual health requirements and recommendations for US travelers going to Mecca for Umrah or Hajj (also see Sec. 10, Part 1, Ch. 2, Saudi Arabia: Hajj & Umrah Pilgrimages ).

The schedule for primary series meningococcal vaccine and booster doses varies depending on the vaccine administered.

Meningococcal B

Unless an outbreak of serogroup B disease has been reported, vaccination with a serogroup B meningococcal (MenB) vaccine is not routinely recommended for travel to the meningitis belt or other regions of the world. Although MenB vaccine is not licensed in the United States for children <10 years of age, some European countries recently introduced MenB vaccine as a routine immunization for infants. Some countries might have other meningococcal vaccines available. Consider meningococcal vaccination for infants residing in these countries according to the routine infant immunization recommendations of that country.

Polio vaccine is recommended for travelers going to countries with evidence of wild poliovirus (WPV) or vaccine-derived poliovirus circulating during the last 12 months, and for travelers with a high risk for exposure to someone with imported WPV infection when traveling to some countries that border areas with WPV circulation. Refer to the CDC Travelers’ Health website destination pages for current polio vaccine recommendations.

Ensure that travelers complete the recommended age-appropriate polio vaccine series and receive a single lifetime booster dose, if necessary. Infants and children should receive an accelerated schedule to complete the routine series. See Sec. 5, Part 2, Ch. 17, Poliomyelitis , and CDC’s Immunization Schedules website for information about accelerated schedules.

People ≥18 years of age traveling to areas where polio vaccine is recommended and who have received a routine series with either inactivated polio vaccine (IPV) or live oral polio vaccine in childhood should receive a single lifetime booster dose of IPV before departure. Available data do not indicate the need for more than a single lifetime booster dose with IPV. Requirements for long-term travelers might apply, however, when departing from certain countries.

Long-Term Travelers to Countries With Poliovirus Transmission

In May 2014, the World Health Organization (WHO) declared the international spread of polio to be a Public Health Emergency of International Concern under the authority of the International Health Regulations (2005). To prevent further spread of disease, WHO issued temporary polio vaccine recommendations for long-term travelers (staying >4 weeks) and residents departing from countries with WPV transmission (“exporting WPV” or “infected with WPV”) or with circulating vaccine-derived polioviruses types 1 or 3.

Long-term travelers and residents could be required to show proof of polio vaccination when departing from these countries for any destination. All polio vaccination administration should be documented on an International Certificate of Vaccination or Prophylaxis (ICVP). See ordering information and instructions on how to fill out the ICVP . The polio vaccine must be received 4 weeks–12 months before the date of departure from the polio-infected country.

Country requirements can change, so clinicians should check for updates on the CDC Travelers’ Health website.

Travel Vaccines for Infants & Children

Dengue can cause mild to severe illness (see Sec. 5, Part 2, Ch. 4, Dengue ). Although many people have asymptomatic infections, for some children dengue can be life-threatening. Travelers should adhere to mosquito protection measures during travel to dengue-endemic areas (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ).

In June 2021, the Advisory Committee on Immunization Practices (ACIP) recommended the use of a live attenuated dengue virus vaccine, Dengvaxia (Sanofi Pasteur), to prevent disease in children aged 9–16 years. Children eligible to receive the vaccine include those with laboratory-confirmed previous dengue virus infection who live in areas of the United States, including the US territories of American Samoa, Puerto Rico, and the US Virgin Islands; and freely associated states, the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau. Dengvaxia is not approved for use in US travelers who are visiting but who do not live in areas where dengue is endemic.

Only people who test positive for previous dengue infection or who have other laboratory-confirmed evidence of a previous dengue infection are eligible for vaccination with Dengvaxia. In people without previous dengue infection, Dengvaxia can increase the risk for severe illness and hospitalization if the person gets infected after vaccination. Serodiagnostic tests recommended by health authorities with acceptable performance (≥75% sensitivity, ≥98% specificity) are available to test for evidence of previous dengue infection.

The vaccine is a series of 3 doses, administered 6 months apart at month 0, 6, and 12 months.

Japanese Encephalitis

Japanese encephalitis (JE) virus is transmitted by mosquitoes and is endemic throughout most of Asia and parts of the western Pacific. JE risk can be seasonal in temperate climates and year-round in more tropical climates. Risk to short-term travelers and those who confine their travel to urban centers is considered low. JE vaccine is recommended for travelers who plan to spend ≥1 month in endemic areas during JE virus transmission season. Consider JE vaccine for short-term (<1 month) travelers whose itinerary or activities could increase their risk for JE virus exposure. The decision to vaccinate a child should follow the more detailed recommendations found in Sec. 5, Part 2, Ch. 13, Japanese Encephalitis .

An inactivated Vero cell culture–derived JE vaccine (IXIARO) was licensed by the US Food and Drug Administration (FDA) in 2009 for use in the United States for travelers aged ≥17 years. In 2013, the recommendations were expanded, and the vaccine was licensed for use in children ≥2 months of age. For children aged 2 months–17 years, the primary series consists of 2 intramuscular doses administered 28 days apart. For travelers who received their primary JE vaccine series ≥1 year prior to potential JE virus exposure, ACIP recommends providing a booster dose before departure. See information on age-appropriate dosing .

Rabies virus causes an acute viral encephalitis that is virtually 100% fatal. Traveling children can be at increased risk for rabies exposure, mainly from dogs that roam the streets in low- and middle- income countries. Bat bites carry a potential risk for rabies throughout the world. In addition to taking measures to avoid animal bites and scratches (see Sec. 4, Ch. 7, Zoonotic Exposures: Bites, Stings, Scratches & Other Hazards ), preexposure and postexposure rabies prophylaxis is part of a broader approach to preventing this disease. Follow the recommendations in Sec. 5, Part 2, Ch. 18, Rabies , when making decisions about whether to provide rabies preexposure prophylaxis for children.

Preexposure Prophylaxis

In June 2021, to align with the recently revised adult schedule, ACIP adjusted the number of recommended doses of rabies preexposure prophylaxis in children downward, from 3 to 2. For immunocompetent children <18 years old, administer the first dose of vaccine on day 0 and a second dose 7 days later (see Sec. 5, Part 2, Ch. 19, . . . perspectives: Rabies Immunization ).

The advantages of the revised schedule are that it is both less expensive and easier to complete prior to travel. There are, however, no data on the duration of protection afforded by this 2-dose series. Because of this uncertainty, travelers with a sustained risk for rabies exposure should either have a titer drawn or receive a third dose of vaccine within 3 years of the initial series. Travelers unlikely to visit an at-risk destination after 3 years require no further titers or boosters unless they have a subsequent exposure.

Postexposure Prophylaxis

Children who have not received preexposure immunization and who might have been exposed to rabies require a weight-based dose of human rabies immune globulin (RIG) and a series of 4 rabies vaccine doses on days 0, 3, 7, and 14. Decisions about any changes in how to manage postexposure prophylaxis, schedule deviations for pre- or postexposure prophylaxis, and postexposure prophylaxis initiated abroad are expected from the ACIP.

Tick-Borne Encephalitis

Tick-borne encephalitis (TBE) is a viral disease transmitted by Ixodes ticks in parts of Asia and Europe. Rare in US travelers, TBE is usually asymptomatic but can appear as a biphasic illness with central nervous system involvement (see Sec. 5, Part 2, Ch. 23, Tick-Borne Encephalitis ). Although TBE infection tends to be less severe in children, residual symptoms and neurologic deficits have been described.

Most infections result from the bite of infected tick, typically acquired when a person is bicycling, camping, hiking, or participating in other outdoor activities in brushy or forested areas. TBE also can be acquired by ingesting unpasteurized dairy products from infected animals, or, rarely, from direct person-to-person spread via blood transfusion, solid organ transplantation, or breastfeeding.

In August 2021, the FDA approved a TBE vaccine for people aged ≥1 year ; in February 2022, ACIP approved recommendations for vaccine use among people traveling or moving to a TBE-endemic area who will have extensive tick exposure based on planned outdoor activities and itinerary. Primary vaccination consists of 3 doses; the schedule varies by age. For children 1–15 years old, give the second dose 1–3 months after the first dose; for children aged ≥16 years, give the second dose 14 days–3 months after the first dose. All children should receive the third dose 5–12 months after receiving their second dose of the vaccine. A booster (fourth) dose can be given ≥3 years after completion of the primary immunization series if ongoing exposure or reexposure is expected.

Typhoid fever is caused by the bacterium Salmonella enterica serotype Typhi (see Sec. 5, Part 1, Ch. 24, Typhoid & Paratyphoid Fever ). Travelers can avoid typhoid fever by following safe food and water precautions and frequently washing hands. Typhoid vaccine is recommended for travelers going to areas with a recognized risk for Salmonella Typhi exposure.

Two typhoid vaccines are licensed for use in the United States: Vi capsular polysaccharide vaccine (ViCPS) administered intramuscularly, and oral live attenuated vaccine (Ty21a). Both vaccines induce a protective response in 50%–80% of recipients. The ViCPS vaccine can be administered to children aged ≥2 years, who should receive a booster dose 2 years later if continued protection is needed. The Ty21a vaccine consists of a series of 4 capsules (1 taken orally every other day), which can be administered to children aged ≥6 years. Do not open capsules for administration; capsules must be swallowed whole. All 4 doses should be taken ≥1 week before potential exposure. A booster series for Ty21a should be taken every 5 years, if indicated.

Yellow Fever

Yellow fever, a disease transmitted by mosquitoes, is endemic to certain areas of Africa and South America (see Sec. 5, Part 2, Ch. 26, Yellow Fever ). Proof of vaccination against yellow fever is required for entry into some countries (see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country ). Infants and children ≥9 months old and without contraindications should be vaccinated before traveling to countries where yellow fever is endemic.

Infants aged <9 months are at greater risk for developing encephalitis from yellow fever vaccine, which is a live-virus vaccine. Studies conducted during the early 1950s identified 4 cases of encephalitis out of 1,000 children aged <6 months who received yellow fever vaccine. An additional 10 cases of encephalitis associated with yellow fever vaccine administered to infants aged <4 months were reported worldwide during the 1950s.

Advise travelers with infants aged <9 months against traveling to areas where yellow fever is endemic. ACIP advises against administering yellow fever vaccine to infants aged <6 months. Infants aged 6–8 months should be vaccinated only if they must travel to areas of ongoing epidemic yellow fever, and if a high level of protection against mosquito bites is not possible. Clinicians considering vaccinating infants aged 6–8 months can consult their respective state health departments or CDC toll-free at 800-CDC-INFO (800-232-4636).

The following authors contributed to the previous version of this chapter: Michelle S. Weinberg

Bibliography

Centers for Disease Control and Prevention. Japanese encephalitis vaccine: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2019;68(2):1–33.

Centers for Disease Control and Prevention. Meningococcal vaccination: recommendations of the Advisory Committee on Immunization Practices, 2020. MMWR Recomm Rep. 2020;69(9):1–41.

Centers for Disease Control and Prevention. Prevention of Hepatitis A virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2020;69(5):1–38.

Centers for Disease Control and Prevention. Use of a Modified Preexposure Prophylaxis Vaccination Schedule to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices—United States, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:619–27.

Centers for Disease Control and Prevention. Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2015;64(23):647–50.

Global Polio Eradication Initiative. Public health emergency status: IHR public health emergency of international concern. Temporary recommendations to reduce international spread of poliovirus. Geneva: Global Polio Eradication Initiative; 2021. Available from: https://polioeradication.org/polio-today/polio-now/public-health-emergency-status .

Jackson BR, Iqbal S, Mahon B; Centers for Disease Control and Prevention (CDC). Updated recommendations for the use of typhoid vaccine—Advisory Committee on Immunization Practices, United States, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(11):305–8.

Kimberlin DW, Barnett E, Lynfield R, Sawyer MH, editors. Red Book 2021–2024. Report of the Committee on Infectious Diseases, 32nd edition. Elk Grove Village (IL): American Academy of Pediatrics; 2021.

Paz-Bailey G, Adams L, Wong JM, Poehling KA, Chen WH, McNally V, et al. Dengue vaccine: recommendations of the Advisory Committee on Immunization Practices, United States, 2021. MMWR Recomm Rep. 2021;70(6);1–16.

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Immunizations - travel: Scenario: Rapid vaccination courses and vaccination at short notice

Last revised in July 2023

Covers advice for people who require travel vaccinations at short notice.

Scenario: Rapid vaccination courses and vaccination at short notice

From age 2 months onwards.

Rapid vaccination courses and vaccination at short notice

  • Hepatitis B vaccine may be given as an accelerated course over 3 weeks. For further information, see the section on Hepatitis B vaccination .
  • Tick-borne encephalitis vaccine may be given as two doses 2 weeks apart. For further information, see the section on Tick-borne encephalitis vaccination .
  • Japanese encephalitis   vaccine may be given to people over the age of 3 years as two doses 7 days apart (instead of the usual 28 days). For further information, see the section on Japanese encephalitis vaccination .
  • Rabies vaccine can be given as an accelerated course over 1 week. For further information, see the section on Rabies vaccination .
  • Previously unimmunized people who require tetanus and polio vaccination should be given the maximum number of doses that the travel departure date allows, and the course should be completed upon return. For further information, see the sections on Hepatitis A vaccination ,  Tetanus vaccination , and  Polio vaccination .
  • Typhoid vaccination can be considered up to the day of departure. Full immunity can take up to 1 month to develop, although a four-fold rise in antibody against Vi antigen has been detected 7 days following primary immunization with Vi vaccine. For further information, see the section on Typhoid vaccination .
  • Meningococcal vaccine may be beneficial for some people up to the day of departure, depending on whether the area being visited is considered high risk, and their length of stay. In a study cited by the manufacturer of Menveo ® , bactericidal antibodies were observed in at least 64% of people at 1-week post-vaccination. Vaccination must be given not less than 10 days before arrival in Saudi Arabia for entry to be granted. For further information, see the section on Meningococcal vaccination .
  • Yellow fever vaccine may be given up to the day of departure if there is a risk of contracting yellow fever. Full immunity develops 10 days after vaccine administration and anyone receiving the vaccine at short notice should therefore be counselled about the importance of insect bite avoidance. People requiring a valid yellow fever vaccination certificate at their destination need to be vaccinated at least 10 days prior to travel. For further information, see the section on Yellow fever vaccination .
  • Telephone: 0845 602 6712, Monday to Friday, 13:00 to 15:00.

Basis for recommendation

The recommendations on vaccination at short notice are largely based on the relevant chapters in the Department of Health publication Immunisation against infectious disease (The Green Book) [ PHE, 2021 ], and from data provided by the manufacturer of Menveo ® [ ABPI, 2020b ].

Tetanus and polio vaccines

  • The recommendation that previously unimmunized people who require tetanus and polio vaccination should be given the maximum number of doses of vaccines that the travel departure date allows, and the course should be completed upon return is pragmatic, based on what CKS considers to be good medical practice.

The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care) . By using CKS, you agree to the licence set out in the CKS End User Licence Agreement .

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green book mmr travel

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Typhoid: the green book, chapter 33

Typhoid immunisation information for public health professionals, including updates.

green book mmr travel

Ref: UKHSA gateway number: 2019305

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This document provides information on typhoid fever, as well as the history and epidemiology of the disease.

Typhoid fever is a systemic infection caused by the gram-negative bacterium Salmonella enterica, subspecies enterica, serotype typhi.

Paratyphoid fever is an illness clinically similar but usually less severe than typhoid and is caused by S. paratyphi A, B and C.

The green book contains further chapters on vaccines and vaccination procedures in the UK.

Added revised chapter: Ty21a / Vivotif vaccine supplier contact details updated.

Updated chapter to include information on the background and epidemiology of the disease.

Change of manufacturer for Vivotif (oral typhoid vaccine).

Uploaded updated chapter 33 and patch to chapter, dated 24 October 2014.

Updated the Body text to include a link to National Archives (chapter update patches) and NHS Choices.

First published.

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