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TPDN1989 Vol 49 No.30 P~c
must also be protected from light, which may
inactivate the virus. Vaccine must be shipped at
10 C (50 F) or colder and may be shipped on dry
ice. After reconstitution, the vaccine should be
stored in a dark place at 2-8 C (35.6-46.4 F) and
discarded if not used within 8 hours.
VACCINE USAGE
(See also the current ACIP statement, "General
Recommendations on Immunization." MMWR
1989; 38:205-14, 219-27.)
General Recommendations
Susceptible children, adolescents, and adults should
be vaccinated against mumps, unless vaccination
is contraindicated. Mumps vaccine is of particu-
lar value for children approaching puberty and
for adolescents and adults who have not had
mumps. MMR vaccine is the vaccine of choice
for routine administration and should be used in
all situations where recipients are also likely to
be susceptible to measles and/or rubella. The fa-
vorable benefit-cost ratio for routine mumps
immunization is more marked when vaccine is
administered as MMR. Persons should be consid-
ered susceptible to mumps unless they have
documentation of 1) physician-diagnosed mumps,
2) adequate immunization with live mumps virus
vaccine on or after their first birthday, or 3)
laboratory evidence of immunity. Because live
mumps vaccine was not used routinely before
1977 and because the peak age-specific incidence
was in 5- to 9-year-olds before the vaccine was
introduced, most persons born before 1957 are
likely to have been infected naturally between
1957 and 1977. Therefore, they generally may be
considered to be immune, even if they may not
have had clinically recognizable mumps disease.
However, this-cutoff date for susceptibility is
arbitrary. Although outbreak-control efforts
should be focused on persons born after 1956,
these recommendations do not preclude vaccina-
tion of possibly susceptible persons born before
1957 who may be exposed in outbreak settings.
Persons who are unsure of their mumps disease
history and/or mumps vaccination history should
be vaccinated. There is no evidence that persons
who have previously either received mumps
vaccine or had mumps are at any increased risk
of local or systemic reactions from receiving live
mumps vaccine. Testing for susceptibility before
vaccination, especially among adolescents and
complement-fixation antibody test) may be unre-
liable, and tests with established reliability
(neutralization, enzyme immunoassay, and ra-
dial hemolysis antibody tests) are not readily
available.
Dosage. A single dose of vaccine in the volume
specified by the manufacturer should be admini-
stered subcutaneously. While not recommended
routinely, intramuscular vaccination is effective
and safe.
Age. Live mumps virus vaccine is recommended
at any age on or after the first birthday for all
susceptible persons, unless a contraindication
exists. Under routine circumstances, mumps
vaccine should be given in combination with
measles and rubella vaccines as MMR, following
the currently recommended schedule for admini-
stration of measles vaccine. It should not be
administered to infants <12 months old because
persisting maternal antibody might interfere
with seroconversion. To insure immunity, all
persons vaccinated before the first birthday
should be revaccinated on or after the first
birthday.
Persons Exposed to Mumps
Use of Vaccine. When given after exposure to
mumps, live mumps virus vaccine may not pro-
vide protection. However, if the exposure did not
result in infection, vaccine should induce protec-
tion against infection from subsequent expo-
sures. There is no evidence that the risk of
vaccine-associated adverse events increases if
vaccine is administered to persons incubating
disease.
Use of Immune Globulin. Immune globulin (IG)
has not been demonstrated to be of established
value in postexposure prophylaxis and is not
recommended. Mumps immune globulin has not
been shown to be effective and is no longer
available or licensed for use in the US.
[Continued in PDN, Vol. 49, No. 31.1
young adults, is not necessary. In addition to the
expense, some tests (eg, mumps skin test and the
TPDN 1989, Vol. 49, No. 30
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