Measles, Mumps, and Rubella

The measles virus is spread by airborne droplets, direct contact with nasal or throat secretions of infected persons, and less frequently by freshly contaminated articles. Following an incubation period of 7 to 18 days, the infected person experiences a prodrome of malaise, fever, coryza, and conjunctivitis before a generalized rash appears. The period of communicability is from the beginning of the prodromal period to about 4 days after the appearance of the rash.

The mumps virus spreads by airborne droplets and direct contact with saliva of infected persons. It has an incubation period of 12 to 25 days, and the virus may be shed into saliva 6 to 7 days before the onset of clinical illness. Mumps characterized by acute onset of unilateral or bilateral tender swelling of the parotid and/or other salivary glands. It is typically self-limiting and lasts two or more days. In the United States, a substantial number of mumps cases occur among adults 18-25 years old.

The rubella (German measles) virus is transmitted by airborne droplets and direct contact with nasopharyngeal secretions. An incubation period of about 18 days is followed by fever, conjunctivitis, lymphadenopathy, a generalized maculopapular rash, arthralgia, and arthritis. The period of communicability is from 7 days before to 4 days after the onset of rash. Congenital rubella syndrome in the U.S. is rare, but immunity in women of childbearing age should be a special concern.11,18-20

Active Immunization: Measles, Mumps, and Rubella Vaccines4,6,11

It is strongly recommended that OHCP be immune to measles, mumps, and rubella. OHCP are considered immune only if they have documentation of:

  1. physician-diagnosed measles, mumps, or rubella infection, or
  2. laboratory evidence of measles, mumps, or rubella immunity, or
  3. appropriate vaccination against measles, mumps, and rubella.

While separate monovalent formulation vaccines for measles, mumps, and rubella are available, the trivalent MMR vaccine (Table 3) is the vaccine of choice for routine adult vaccination. The MMR vaccine contains live attenuated measles and mumps virus grown in chick embryo and live attenuated rubella virus grown in human diploid cell culture. There is no evidence to support a causal association between the MMR vaccine and autism.21,22

Table 3. Measles, Mumps and Rubella Vaccine.4,6
VaccinesIndicationsSchedulesAdverse Effects
MMR IIPreexposure2 SC doses

28 days apart
Pain and erythema at the site of injection (7-29%); transient arthralgia (25%); fever and rash (5%); anaphylaxis in persons with history of allergic reaction to egg, neomycin, or gelatin.