الحصبة، النكاف، الحصبة الألمانية

التطعيم الروتيني:

• جميع الأطفال: جرعتان من MMR

• الجرعة الأولى: 12–15 شهراً (9 أشهر في بعض البرامج العربية ومناطق الفاشيات)

• الجرعة الثانية: 15–18 شهراً أو 4–6 سنوات

تطعيم استدراكي للبالغين:

• البالغون المولودون بعد 1957 بدون وثائق تطعيم أو مناعة مخبرية: جرعة واحدة أو جرعتان

• العاملون في الرعاية الصحية: جرعتان مع فحص أجسام مضادة

• النساء في سن الإنجاب: فحص مناعة الحصبة الألمانية — جرعة قبل الحمل إذا غير محصنات

• طلاب الجامعات والسفر الدولي: جرعتان

سياق الحج:

• توصي وزارة الصحة السعودية بالتأكد من تطعيم MMR كامل للحجاج والمعتمرين

• فاشيات الحصبة المرتبطة بالتجمعات الدينية الكبيرة: حدثت تاريخياً

Pregnancy: CONTRAINDICATED — live vaccine.

MMR vaccine is a live attenuated vaccine and is contraindicated during pregnancy.

• Women should avoid conception for 4 weeks after MMR vaccination.

• Inadvertent vaccination during pregnancy is NOT an indication for termination — no cases of congenital rubella syndrome have been reported following inadvertent vaccination of pregnant women (CDC, WHO).

• Pre-conception: check rubella immunity (anti-rubella IgG) and vaccinate non-immune women before pregnancy.

• Post-partum: vaccinate rubella-seronegative women before hospital discharge.

Breastfeeding: Safe.

MMR vaccine is safe during breastfeeding. Rubella vaccine virus may be excreted in breast milk and transmitted to the infant, but this does not cause disease and is not a reason to defer vaccination. CDC and WHO recommend post-partum MMR for susceptible breastfeeding mothers.

Pediatric use:

• Routine schedule: Dose 1 at 12–15 months, Dose 2 at 4–6 years.

• Minimum age: 6 months (for international travel to measles-endemic areas — counts as dose 0; repeat standard 2-dose series from 12 months).

• HIV-positive children with CD4 ≥15% should receive MMR (recommendation from WHO and ACIP).

• Available as MMR (M-M-R II, Priorix) or MMRV (ProQuad — includes varicella; approved from 12 months to 12 years).

• MMRV at dose 1: slightly increased risk of febrile seizures (1 extra per 2,300–2,600 doses) compared to separate MMR + V.

Geriatric use:

• Adults born before 1957 are generally considered immune to measles and mumps (through natural infection).

• However, serological testing may be warranted for healthcare workers or travelers regardless of birth year.

• No upper age limit for MMR vaccination in susceptible adults.

• Immune response is adequate in healthy elderly adults. Live vaccine caution applies to severely immunocompromised elderly.