General 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 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. Nursing Mothers 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. Pediatric Use Safety and effectiveness in infants below the age of 6 months have not been established (see also CLINICAL PHARMACOLOGY). Geriatric Use 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. REFERENCES 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. Last reviewed on RxList: 12/2/2008
This monograph has been modified to include the generic and brand name in many instances.