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Due caution should be employed in administration of ATTENUVAX (measles virus vaccine live) to persons with a history of cerebral injury, individual or family histories of convulsions, or any other condition in which stress due to fever should be avoided. The physician should be alert to the temperature elevation which may occur following vaccination (see ADVERSE REACTIONS).
This product contains albumin, a derivative of human blood. Based on effective donor screening and product manufacturing processes, it carries an extremely remote risk for transmission of viral diseases. Although there is a theoretical risk for transmission of Creutzfeldt-Jakob disease (CJD), no cases of transmission of CJD or viral disease have ever been identified that were associated with the use of albumin.
Hypersensitivity to Eggs
Live measles vaccine is produced in chick embryo cell culture. Persons with a history of anaphylactic, anaphylactoid or other immediate reactions (e.g., hives, swelling of the mouth and throat, difficulty breathing, hypotension and shock) subsequent to egg ingestion may be at an enhanced risk of immediate-type hypersensitivity reactions after receiving vaccines containing traces of chick embryo antigen. The potential risk to benefit ratio should be carefully evaluated before considering vaccination in such cases. Such individuals may be vaccinated with extreme caution, having adequate treatment on hand should a reaction occur (see PRECAUTIONS).25
However, the American Academy of Pediatrics (AAP) has stated, “Most children with a history of anaphylactic reactions to eggs have no untoward reactions to measles or MMR vaccine. Persons are not at increased risk if they have egg allergies that are not anaphylactic, and they should be vaccinated in the usual manner. In addition, skin testing of egg-allergic children with vaccine has not been predictive of which children will have an immediate hypersensitivity reaction. Persons with allergies to chickens or chicken feathers are not at increased risk of reaction to the vaccine.”24
Hypersensitivity to Neomycin
The AAP states, “Persons who have experienced anaphylactic reactions to topically or systemically administered neomycin should not receive measles vaccine. Most often, however, neomycin allergy manifests as a contact dermatitis, which is a delayed-type (cell-mediated) immune response rather than anaphylaxis. In such persons, an adverse reaction to neomycin in the vaccine would be an erythematous, pruritic nodule or papule, 48 to 96 hours after vaccination. A history of contact dermatitis to neomycin is not a contraindication to receiving measles vaccine.” 24
Individuals with current thrombocytopenia may develop more severe thrombocytopenia following vaccination. In addition, individuals who experienced thrombocytopenia with the first dose of M-M-R II (or its component vaccines) may develop thrombocytopenia with repeat doses. Serologic status may be evaluated to determine whether or not additional doses of vaccine are needed. The potential risk to benefit ratio should be carefully evaluated before considering vaccination in such cases (see ADVERSE REACTIONS).
Adequate treatment provisions including epinephrine injection (1:1000), should be available for immediate use should an anaphylactic or anaphylactoid reaction occur.
Special care should be taken to ensure that the injection does not enter a blood vessel.
Children and young adults who are known to be infected with human immunodeficiency viruses and are not immunosuppressed may be vaccinated. However, vaccinees who are infected with HIV should be monitored closely for vaccine-preventable diseases because immunization may be less effective than for uninfected persons (see CONTRAINDICATIONS).22,23
Vaccination should be deferred for 3 months or longer following blood or plasma transfusions, or administration of immune globulin (human).24
There are no reports of transmission of live attenuated measles virus from vaccinees to susceptible contacts.
It has been reported that attenuated measles virus vaccine live may result in a temporary depression of tuberculin skin sensitivity.24 Therefore, if a tuberculin test is to be done, it should be administered either before or simultaneously with ATTENUVAX (measles virus vaccine live) .
Children under treatment for tuberculosis have not experienced exacerbation of the disease when immunized with live measles virus vaccine;26 no studies have been reported to date of the effect of measles virus vaccines on untreated tuberculous children. However, individuals with active untreated tuberculosis should not be vaccinated.
As for any vaccine, vaccination with ATTENUVAX (measles virus vaccine live) may not result in protection in 100% of vaccinees.
The health care provider should determine the current health status and previous vaccination history of the vaccinee. The health care provider should question the patient, parent or guardian about reactions to a previous dose of ATTENUVAX (measles virus vaccine live) or other measles-containing vaccines.
Carcinogenesis, Mutagenesis, Impairment of Fertility
ATTENUVAX (measles virus vaccine live) has not been evaluated for carcinogenic or mutagenic potential, or potential to impair fertility.
Pregnancy Category C
Animal reproduction studies have not been conducted with ATTENUVAX (measles virus vaccine live) . It is also not known whether ATTENUVAX (measles virus vaccine live) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Therefore, the vaccine should not be administered to pregnant females; furthermore, pregnancy should be avoided for 3 months following vaccination (see CONTRAINDICATIONS).
In counseling women who are inadvertently vaccinated when pregnant or who become pregnant within 3 months of vaccination, the physician should be aware that reports have indicated that contracting natural measles during pregnancy enhances fetal risk. Increased rates of spontaneous abortion, stillbirth, congenital defects and prematurity have been observed subsequent to natural measles during pregnancy.33,34 There are no adequate studies of the attenuated (vaccine) strain of measles virus in pregnancy. However, it would be prudent to assume that the vaccine strain of virus is also capable of inducing adverse fetal effects.
It is not known whether measles vaccine virus is secreted in human milk. Therefore, because many drugs are excreted in human milk, caution should be exercised when ATTENUVAX (measles virus vaccine live) is administered to a nursing woman.
Safety and effectiveness in infants below the age of 6 months have not been established (see also CLINICAL PHARMACOLOGY).
Clinical studies of ATTENUVAX (measles virus vaccine live) did not include sufficient numbers of seronegative subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger subjects.
22. Center for Disease Control: Immunization of Children Infected with Human T-Lymphotropic Virus Type III/Lymphadenopathy-Associated Virus, Annals of Internal Medicine, 106: 75-78, 1987.
23. Krasinski, K.; Borkowski, W.; Krugman, S.: Antibody following measles immunization in children infected with human T-cell lymphotropic virus-type III/lymphadenopathy associated virus (HTLV-III/LAV) [Abstract]. In: Program and abstracts of the International Conference on Acquired Immunodeficiency Syndrome, Paris, France, June 23-25, 1986.
24. Peter, G.; et al (eds): Report of the Committee on Infectious Diseases, Twenty-fourth Edition, American Academy of Pediatrics, 344-357, 1997.
25. Isaacs, D.; Menser, M.: Modern Vaccines, Measles, Mumps, Rubella, and Varicella, Lancet335: 1384-1387, June 9, 1990.
26. Starr, S.; Berkovich, S.: The effect of measles, gammaglobulin modified measles, and attenuated measles vaccine on the course of treated tuberculosis in children, Pediatrics 35: 97-102, Jan. 1965.
27. Vaccine Adverse Event Reporting System — United States, MMWR 39(41): 730-733, October 19, 1990.This monograph has been modified to include the generic and brand name in many instances.
Last reviewed on RxList: 12/2/2008
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