The Australian Immunisation Handbook 10th Edition 2013

evaccinated later at the appropriate time following the product (as indicated in
Table 3.3.6), or be tested for immunity 6 months later and then revaccinated if
seronegative.
Rh (D) immunoglobulin (anti-D) may be given at the same time in different sites
with separate syringes or at any time in relation to MMR vaccine, as it does not
interfere with the antibody response to the vaccine.
4.18.11 Adverse events
Adverse events following administration of MMR-containing vaccines are
generally mild and well tolerated. 3 Adverse events are much less common after
the 2nd dose of MMR or MMRV vaccine than after the 1st dose.
Mild adverse events such as fever, sore throat, lymphadenopathy, rash, arthralgia
and arthritis may occur following MMR vaccination. 1,7 Symptoms most often
begin 1 to 3 weeks after vaccination and are usually transient.
Thrombocytopenia (usually self-limiting) has been very rarely associated with
the rubella or measles component of MMR vaccine, occurring in 3 to 5 per 100 000
doses of MMR vaccine administered. 7,57-59 This is considerably less frequent than
after natural measles, mumps and rubella infections. 59
For further information on adverse events related to MMR and MMRV vaccines,
see 4.9 Measles and 4.22 Varicella.
4.18.12 Public health management of rubella
Rubella is a notifiable disease in all states and territories in Australia.
Further instructions about the public health management of rubella, including
management of cases of rubella and their contacts, should be obtained from state/
territory public health authorities (see Appendix 1 Contact details for Australian, state
and territory government health authorities and communicable disease control).
Rubella-containing vaccine does not provide protection if given after exposure to
rubella. 7 However, if the exposure did not result in infection, the vaccine would
induce protection against subsequent infection. Normal human immunoglobulin
(NHIG) has been shown not to be of value in post-exposure prophylaxis for
rubella. 7 However, NHIG may be recommended in certain circumstances (see ‘Use
of normal human immunoglobulin in pregnant women exposed to rubella’ below).
Suspected rubella contacts
All contacts of persons with suspected rubella infection should be identified,
especially those who are pregnant (see ‘Pregnant women with suspected rubella
or exposure to rubella’ below).
Contacts >12 months of age without adequate proof of immunity should receive
1 dose of MMR vaccine (or MMRV vaccine, if appropriate). This will not prevent
rubella disease if already exposed. If vaccination is refused, the contact should
avoid further contact with cases until at least 4 days after onset of the rash in the
394 The Australian Immunisation Handbook 10th edition