Tríplice Viral (Sarampo, Caxumba, Rubéola)

PNV (vacinação universal):

• 1.ª dose (VASPR1): aos 12 meses de idade

• 2.ª dose (VASPR2): aos 5 anos de idade

Recuperação em adultos (DGS):

• Adultos nascidos após 1970 sem documentação de 2 doses de VASPR ou sem evidência serológica de imunidade ao sarampo — recomendadas 2 doses (intervalo mínimo de 4 semanas)

• Profissionais de saúde: 2 doses documentadas obrigatórias (independentemente da idade)

• Mulheres em idade fértil: verificar imunidade à rubéola; vacinar se IgG negativa (com contraceção eficaz durante 1 mês pós-vacinação)

Viajantes:

• Verificar e completar o esquema de VASPR antes de viagens internacionais, especialmente para países com surtos ativos de sarampo (consultar alertas ECDC)

• Em situação de surto: antecipar a 1.ª dose para os 6 meses de idade (dose "zero", não contabilizada no esquema)

Profilaxia pós-exposição ao sarampo:

• A VASPR administrada nos primeiros 72 horas após exposição pode prevenir ou atenuar a doença

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.