 Dear Immunization Partners,
Please share this information with staff and colleagues.
The purpose of this message is to provide guidance to questions regarding administration of MMR vaccine to children outside of the routine recommended schedule, especially in the absence of a declared measles outbreak.
Several states across the U.S. continue to experience a daily increase in the number of measles cases; however, at this time, Michigan is not considered a state with an active outbreak. By definition, a measles outbreak must involve a minimum of three epi-linked cases. The cases that have been recently reported in both Western and Southeast Michigan are isolated and independent from one another and thus do not meet the case definition for a measles outbreak.
Vaccinating providers should review the Centers for Disease Control and Prevention’s guidance on Routine MMR Vaccination Recommendations. However, in situations where a parent or guardian requests MMR vaccination for a child outside of the routine recommended schedule during the absence of an active measles outbreak, providers will need to counsel patients regarding the off-label usage of MMR vaccine.
When off-label administration of MMR vaccine occurs, private vaccine must be used; regardless of the patient’s Vaccines for Children (VFC) eligibility. Per Medicaid, immunization policy indicates that MMR vaccine is only considered a covered service when provided in accordance with ACIP recommendations. Any use of the MMR vaccine outside of ACIP recommendations is not a covered service. All billable expenses related to vaccine cost and administration, must be communicated to patients prior to vaccine administration.
Please see the guidance below regarding questions related to off-label use of MMR vaccine:
1.) Should a child traveling to a county where an outbreak is occurring receive measles, mumps, rubella (MMR) vaccine between 6 and 11 months of age?
- MDHHS does not routinely recommend that infants under 12 months of age who are traveling within the United States be vaccinated, unless there is travel to an outbreak area and there is a chance of encountering the affected outbreak population or community.
- On a case-by-case basis, the provider should assess the risk during an outbreak and evaluate the likelihood that one might encounter a case.
- The provider should use their clinical discretion on whether to vaccinate.
- Note: Doses given before 12 months of age cannot be counted toward the routine 2-dose series for MMR.
- For a child to be fully vaccinated, they need to receive 2 doses of MMR vaccine when they are 12 months of age and older.
- The routine schedule for MMR vaccine is at 12-15 months and at 4-6 years.
2.) Should a child traveling to a county where an outbreak is occurring be administered their 2nd dose of MMR vaccine earlier than 4 through 6 years of age?
- Providers should follow the routine recommended schedule per the Centers for Disease Control and Prevention (CDC). The 2nd dose of MMR vaccine should be given at 4 through 6 years of age.
- However, the minimum interval between 2 doses of MMR vaccine must be maintained. The minimum interval between 2 doses is 28 days.
- In an outbreak situation or if travel to a high-risk area is anticipated, providers should use their clinical discretion and assess each case for their risk of exposure. If there is a high chance of encountering the affected outbreak population or community, then the provider would assess the need for MMR vaccine.
- The 2nd dose of MMR can be given as soon as 28 days after the 1st In this situation, the series would be considered complete.
3.) Can VFC vaccine be used to vaccinate those 6 through 11 months of age or as the accelerated 2nd dose?
- If a patient is VFC-eligible (i.e., VFC insurance criteria are met) and the patient is identified as potentially encountering measles in an outbreak area or is travelling internationally, the healthcare provider may vaccinate and may use VFC vaccine.
- The 6- through 11-month MMR dose may be covered by VFC on a case-by-case basis and after appropriate medical assessment.
- VFC vaccine cannot be used for privately insured patients.
In the event that Michigan declares a measles outbreak, further guidance regarding the use of MMR vaccine stock will be communicated accordingly. Please visit the MI Department of Health and Human Services (MDHHS) webpage dedicated to providing timely updates on measles occurring across the state and the U.S.
Questions regarding this notification can be directed to checcimms@michigan.gov.
Thank you,
Oakland County Health & Human Services, Immunization Action Plan
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