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                            MEDICAL DIRECTIVES

CATEGORY:    Administration of Immunization          NUMBER:      HPD XIII 026

SUBJECT:     Measles, Mumps and Rubella              PAGE:        1 of 3
             Combined Vaccine Live Attenuated
             (MMR II, PRIORIX)

ISSUED BY:   Medical Officer of Health               DATE:        May 2003

PREFACE:     Measles is the most contagious vaccine preventable infection in humans.
             Measles has been markedly reduced with the widespread use of vaccine,
             but continues to be a serious and common disease in many parts of the
             world. Mumps is an acute infectious disease caused by a virus. Before
             the widespread use of mumps vaccine, mumps was a major cause of viral
             meningitis. Rubella is a viral disease that results in a transient rash,
             lymphadenopathy, arthralgia and low-grade fever. The main goal of
             immunization is the prevention of rubella infection in pregnancy, which
             may give rise to congenital rubella syndrome.

MEDICAL      Within the context of the WDGHU Immunization Clinic, school or
DIRECTIVE:   community clinic, the Medical Officer of Health authorize the PHN/RN to
             provide clients with Measles, Mumps and Rubella vaccine provided the
             following conditions are met:

                 1. Clients must complete the Assessment and Informed Consent for
                    Immunization and Mantoux Testing (HPDVP(F)35).

                 2. The PHN/RN will assess the client’s health history according to
                    HPD VP 090 Assessment of Individuals for Immunization.

                 3. When Measles, Mumps and Rubella vaccine is indicated the
                    PHN/RN will assess the client’s personal history to ensure that
                    the following contraindications are not present:
                       • Acute febrile illness
                       • Known severe allergy to neomycin
                       • Known severe allergy to any component of the vaccine
                            (including gelatin)
                       • Impaired immune function, primary or secondary
                       • Pregnancy, breastfeeding mothers
                       • Children under 6 months of age
                       • Active untreated tuberculosis
                                              Wellington Dufferin Guelph Health Unit
                                        Medical Directives, Health Protection Division
                                                                        HPD XIII 026
                                                                          Page 2 of 3

        •   Blood transfusion or gamma globulin administration within
            the past 3 months
        •   Administration of other live vaccines must be given at the
            same time or separated by a minimum of 4 weeks

 4. The PHN/RN administering Measles, Mumps and Rubella vaccine
    should be aware of the following precautions:

        •   Infants below the age of 12 months may not develop a
            sufficient response to the measles component of the
            vaccine. When vaccine is administered to children under
            12 months of age, revaccination should be offered.
        •   In children with a history or family history of convulsions,
            febrile seizures can occur after vaccination. However, the
            risk of this occurring is low, and the benefit of immunization
            outweighs the risk associated with febrile seizures.
        •   It is generally accepted that other vaccines such as Td,
            TdP, IPV, QUADRACEL, PENTACEL, and Hib can all be
            given at the same time as the Measles Mumps and
            Rubella vaccine if they are administered at separate
            injection sites.

 5. The PHN/RN will review with the client the fact sheet for the
    vaccine, including the schedule for administration of Measles,
    Mumps and Rubella vaccine and review all potential side effects.

 6. The PHN/RN will administer the vaccine by Subcutaneous
    Injection according to the following schedule:


0.5 ml as a single injection given SC on or after the first birthday.

In Ontario, the routine schedule is 2 doses given at least 4 weeks
apart as follows:
0.5 ml on or after the first birthday
0.5 ml given at 18 months of age

Routine immunization is recommended for adults born after 1957
without a history of 2 doses of vaccine or history of natural immunity.

** For single dose vials the entire contents of the vial should be
administered after reconstitution (0.5 – 0.7 ml.)
                                                                  Wellington Dufferin Guelph Health Unit
                                                            Medical Directives, Health Protection Division
                                                                                            HPD XIII 026
                                                                                              Page 3 of 3

Criteria for      Clients of the immunization clinic should be referred to a physician for any
Referral:         contraindications listed above, and any situation where the PHN/RN feels
                  that risk /benefit assessment by a physician is necessary.

Approved by:

In Effect:     May 14, 2003

Revised:       May 26, 2005   _______

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