Measles, Mumps, Rubella Vaccine (PRIORIX): Recommendations of ... - CDC

Please note: This report has been corrected. An erratum will be published.

Elisabeth Krow-Lucal, PhD1; Mona Marin, MD1; Leah Shepersky, MPH1; Lynn Bahta, MPH2; Jamie Loehr, MD3; Kathleen Dooling, MD1 (View author affiliations)

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Summary

What is already known about this topic?

Since 1978, M-M-R II has been the only measles, mumps, and rubella (MMR) combination vaccine used in the United States. In June 2022, the Food and Drug Administration licensed an additional MMR vaccine, PRIORIX.

What is added by this report?

The Advisory Committee on Immunization Practices recommends PRIORIX as an additional option to prevent MMR according to existing vaccine recommendations and off-label uses.

What are the implications for public health practice?

Both vaccines are interchangeable for all indications for which MMR vaccination is recommended. Availability from multiple manufacturers safeguards U.S. vaccine supply.

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Vaccination is the main means for preventing measles, mumps, and rubella virus infections and their related complications (1,2). Achieving and maintaining high 2-dose measles, mumps, and rubella vaccination coverage in the United States has led to elimination of endemic measles in 2000, rubella and congenital rubella syndrome in 2004, and a sharp decrease in mumps cases. However, measles and rubella remain endemic in many countries, leading to importations of cases and occasional local transmission within the United States (3). Reported U.S. mumps cases declined >99% from the prevaccine period (4); however, mumps is endemic worldwide, and since 2006, the number of mumps cases and mumps outbreaks has increased in the United States, with wider geographic spread since 2016 (4). Given the risk for importation of measles and rubella and the resurgence of mumps, maintaining high measles, mumps, and rubella (MMR) vaccination coverage is important. Since 1978, only one MMR vaccine, M-M-R II (Merck and Co., Inc.), has been available in the United States. On June 6, 2022, the Food and Drug Administration approved a second MMR vaccine, PRIORIX (GlaxoSmithKline Biologicals), for the prevention of measles, mumps, and rubella in persons aged ≥12 months. The three live attenuated viruses contained in PRIORIX are genetically similar or identical to the corresponding components in M-M-R II (Table) (5–7). On June 23, 2022, the Advisory Committee on Immunization Practices (ACIP) unanimously recommended PRIORIX as an option to prevent measles, mumps, and rubella according to the existing recommended schedules and for off-label uses (i.e., indications not included in the package insert)* (1,2). ACIP considered PRIORIX to be safe, immunogenic, and noninferior to M-M-R II. Both PRIORIX and M-M-R II are fully interchangeable for all indications for which MMR vaccination is recommended. This report contains ACIP recommendations specific to PRIORIX and supplements the existing ACIP recommendations for MMR use (1,2).

During January–June 2022, the ACIP Measles, Mumps, and Rubella Vaccine Work Group (Work Group) held monthly conference calls to review and assess the safety and immunogenicity of PRIORIX and to discuss implementation issues. The Work Group identified the following outcomes of interest for evaluation: 1) prevention of measles, mumps, and rubella; 2) short-term humoral immunity; 3) persistence of the humoral immune response; 4) reactogenicity of grade 3 or higher†; 5) vaccine-related serious adverse events (SAEs)§; and 6) additional adverse events of interest (i.e., rate of febrile seizures, aseptic meningitis, and immune thrombocytopenic purpura [ITP]). SAEs and reactogenicity of grade 3 or higher were evaluated only in studies conducted at or above the licensed U.S. potency for PRIORIX. Additional adverse events and immunogenicity were evaluated at any potency of PRIORIX. The Evidence to Recommendations (EtR) framework was used to organize Work Group deliberations.**

Data on the outcomes of interest were summarized based on findings from a systematic review of the literature in PubMed, Medline, Embase, Scopus, Cochrane databases, and clinicaltrials.gov. Search terms for the literature review, study inclusion criteria, and supporting evidence are available online. All studies conducted with PRIORIX at the U.S. potency were included. For studies conducted at a potency different from that for the U.S.-licensed product, the evidence reviewed was restricted to the highest level of evidence: experimental design (i.e., randomized controlled clinical trials) or high-quality reviews (i.e., Cochrane reviews, systematic reviews, or meta-analyses).

The Work Group reviewed all included studies of PRIORIX to assess the safety and immunogenicity of PRIORIX and discussed implementation issues. Summaries of Work Group discussions were presented to ACIP on February 23, 2022 and on June 23, 2022. At the June 2022 meeting, a proposed recommendation was presented to the committee and, after a public comment period, was unanimously approved by the voting ACIP members. PRIORIX is recommended according to the existing recommended schedules and off-label uses as an option to prevent measles, mumps, and rubella.

Summary of Key Findings

SAEs related to administration of PRIORIX were assessed using findings from four randomized controlled clinical trials at the licensed U.S. potency of PRIORIX and one Cochrane review with PRIORIX at any potency (8–12). Four additional observational studies and one additional systematic review addressed additional adverse events of interest (i.e., rate of febrile seizures, aseptic meningitis, and ITP) (13–17). Outcomes for PRIORIX were compared with those for M-M-R II. In the four randomized controlled clinical trials at the U.S. potency of PRIORIX, safety profiles among 1,960 subjects receiving 1 or 2 doses of PRIORIX were compared with those among 933 subjects randomized to receive 1 or 2 doses of M-M-R II. The subjects ranged in age from 12 months to 12 years, with 90% aged 12–15 months. The frequency of vaccine-related SAEs was similar across the vaccine groups: 0.0%–0.2% among subjects receiving PRIORIX and 0.0%–0.3% among those receiving M-M-R II (8–11). No significant difference in frequency of vaccine-related SAEs was observed within each individual study; pooled estimates were not calculated.

The rate of febrile seizures is highest during the 6–11 days after vaccination for all MMR vaccines and is estimated to be 3.3–8.7 per 10,000 doses, based on two studies conducted in the United Kingdom, which included both PRIORIX and M-M-R II (13,15). In the clinical trials with PRIORIX of any potency that GlaxoSmithKline Biologicals conducted in the United States, after receipt of a first dose of MMR (PRIORIX or M-M-R II) at age 12–15 months, the rate of febrile seizures attributable to vaccination among 8,386 PRIORIX recipients was 9.5 per 10,000 (95% CI = 4.4–19.6) compared with 14.0 per 10,000 (95% CI = 5.2–34.8) among 3,561 M-M-R II recipients. These studies included coadministration of recommended age-appropriate vaccines, and all found the differences in rates of febrile seizures between the two vaccines to be nonsignificant (10,11,18,19). Similarly, the time course of fever was comparable for both vaccines across all studies, with most instances observed 5–12 days postvaccination (Remon Abu-Elyazeed, MD, PhD, GlaxoSmithKline Biologicals, personal communication, March 2022). No evidence of an association of aseptic meningitis with MMR vaccination was reported in the literature for vaccines containing Jeryl Lynn or Jeryl Lynn–derived mumps strains, which are included in both M-M-R II and PRIORIX for immunization against mumps (12,15,20).

ITP is associated with the receipt of live attenuated measles vaccines (12,14,16,17). In the four randomized controlled clinical trials at the U.S. potency of PRIORIX, one case of ITP was identified among 1,960 PRIORIX recipients and one case among 933 M-M-R II recipients. From a previous postmarketing study conducted in the United States, the rate of ITP after M-M-R II is estimated at 2.5 per 100,000 doses (14). However, strain- or vaccine formulation–specific data on ITP risk are sparse. Based on the clinical trials and the literature (12,14,16,17), the rates of ITP after vaccination were considered similar for PRIORIX and M-M-R II.

Short-term humoral immunity was assessed using data from 13 randomized controlled trials (8–11,18,19,21–27), four at the licensed U.S. potency of PRIORIX, and nine at a lower potency of PRIORIX used in other countries. Serologic response thresholds were achieved for all three antigens in all studies. Antibodies in all studies were more than 8.8-fold higher than the predefined seroresponse threshold for measles (200 mIU per mL; correlate of protection 120 mIU per mL) and more than 4.2-fold higher than the rubella correlate (10 IU per mL). Although an antibody correlate of protection has not been established for mumps, the anti-mumps antibody level was ≥3.3-fold higher than the mumps seroconversion threshold (10 IU per mL). The four studies conducted with PRIORIX at the U.S. potency found no significant difference in anti-measles, anti-mumps, or anti-rubella geometric mean concentrations (GMC) after the first dose between PRIORIX and M-M-R II recipients. Among the nine studies at a lower PRIORIX potency, eight showed no statistically significant difference between anti-measles or anti-rubella GMC levels, and seven showed no statistically significant difference between anti-mumps GMC levels. One study reported on persistence of the humoral immune response (2 years after vaccination) and found no difference between vaccines (8). None of the four studies that reported on GMC after a second dose noted a significant difference for any antigen at any potency after a second dose between PRIORIX or M-M-R II recipients (9,18,21,28).

Additional data reviewed within the EtR framework included findings from a focus group conducted with state immunization managers and a survey of pediatric and general practitioners regarding the feasibility for use and acceptability of PRIORIX. Both the focus group and the survey findings supported the interchangeability of M-M-R II and PRIORIX and the benefit of having a second MMR vaccine option available.

Rationale for Recommendation

Given the similarities in potency (Table) and vaccine components, and evidence for similar safety and immunogenicity, as well as stakeholder support, PRIORIX and M-M-R II are considered fully interchangeable, including for all off-label recommended uses. Either vaccine may be administered in any situation in which an MMR virus–containing vaccine is indicated. Two interchangeable vaccines from different manufacturers will help safeguard vaccine supply in the United States to maintain measles and rubella elimination and mitigate mumps cases and outbreaks.

ACIP Recommendation

PRIORIX is recommended according to the existing MMR recommended schedules and off-label uses (1,2) as an option to prevent measles, mumps, and rubella.

Clinical Guidance

PRIORIX is supplied as a single-dose vial of lyophilized antigen to be reconstituted with the accompanying prefilled syringe of sterile water diluent. A single dose after reconstitution is approximately 0.5 mL. PRIORIX is formulated without preservatives and is administered as subcutaneous injection (the same as M-M-R II) (5,29).

PRIORIX may be used according to the existing MMR recommendations for both on- and off-label use for prevention of measles, mumps, and rubella†† (1,2). For routine vaccination, 2 doses are recommended, the first at age 12–15 months, and the second at age 4–6 years. For catch-up vaccination of previously unvaccinated children and adolescents, 2 doses should be administered ≥4 weeks apart. Before international travel, infants aged 6–11 months should receive a single dose. Travelers aged ≥12 months who have not received 2 doses of MMR should receive 2 doses separated by ≥28 days.

During a measles outbreak, infants aged 6–11 months should receive a single dose of MMR. For measles postexposure prophylaxis in unvaccinated persons, 1 dose of MMR should be administered within 72 hours of exposure to a person with infectious measles, and the 2-dose series (i.e., the second of 2 MMR doses) should be completed ≥28 days later. During mumps outbreaks, a third dose of MMR is recommended for persons identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak.

Interchangeability

PRIORIX and M-M-R II are fully interchangeable. ACIP General Best Practices states a preference that doses of vaccine in a series come from the same manufacturer; however, vaccination should not be deferred when the manufacturer of the previously administered vaccine is unknown or when the vaccine from the same manufacturer is unavailable (30). Studies have shown that PRIORIX is safe and immunogenic when administered as a second dose after M-M-R II (10,21).

Timing of Vaccination and Coadministration with Other Vaccines

PRIORIX can be administered concomitantly, at different anatomic sites, with other routine childhood vaccines. Concomitant administration of PRIORIX with other live and nonlive vaccines§§ has been studied; results indicated no safety concerns or evidence for interference in the immune response to either (8,10,11,18,19,21,28). Additional live virus vaccines not administered on the same day should be separated by ≥4 weeks (30).

Precautions and Contraindications

Before administering PRIORIX, health care providers should consult the package insert for precautions, warnings, and contraindications (5,29). Contraindications for PRIORIX are the same as those for M-M-R II. PRIORIX should not be administered to persons with a history of severe allergic reactions (e.g., anaphylaxis) to any component of the vaccine or after a previous dose of any measles, mumps, and rubella virus–containing vaccine (unlike M-M-R II, PRIORIX does not contain gelatin); persons with severe humoral or cellular (primary or acquired) immunodeficiency; or women who are pregnant. Pregnancy should be avoided for 1 month after receipt of MMR. Additional information on warnings and precautions can be found in the package insert and previous vaccine recommendations (1,5,29).

Reporting of Vaccine Adverse Events

Adverse events following administration of any vaccine should be reported to the Vaccine Adverse Event Reporting System (VAERS). Reports can be submitted to VAERS online, by fax, or by mail. Additional information about VAERS is available by telephone (1-800-822-7967) or online (https://vaers.hhs.gov). Any future revisions to this ACIP recommendation will be dictated by reported adverse events and new research evidence.

Acknowledgments

Contributors to the ACIP Measles, Mumps and Rubella Vaccine Work Group; Thomas Clark, Stephen N. Crooke, Laurie Elam-Evans, Paul Gastañaduay, LaTreace Harris, Holly Hill, Andrew Kroger, Tatiana M. Lanzieri, Jessica Leung, Megan Lindley, Jessica MacNeil, Olufunto Olusanya, Bhavini Patel, Paul Rota, Ryan Saelee, Lauren Shaw, David Sugerman, Stephanie Thomas, Elizabeth Zell, National Center for Immunization and Respiratory Diseases, CDC; Satoshi Kamidani, Emory University School of Medicine and National Center for Immunization and Respiratory Diseases, CDC; Joanna Taliano, Office of Library Science, Office of Science, CDC; Amber Gedlinske, Aaron Scherer, University of Iowa; Claire Hannan, Aleah Jensen, Lydia Luther, Jasmine Murray, Association of Immunization Managers.

Advisory Committee on Immunization Practices Measles, Mumps, and Rubella Vaccine Work Group

Work Group Chair: Lynn Bahta, Minnesota Department of Health; Work Group Members: Jamie Loehr, Cayuga Family Medicine; Juventila Liko, Association of Immunization Managers; Laura Morris, American Academy of Family Physicians; Nadine Peart Akindele, Robin Wisch, Food and Drug Administration; Adam J. Ratner, American Academy of Pediatrics; Patsy Stinchfield, National Association of Pediatric Nurse Practitioners.

1Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; 2Minnesota Department of Health; 3Cayuga Family Medicine, Ithaca, New York.


References

  1. McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS. CDC. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013;62(No. RR-04):1–34. PMID:23760231
  2. Marin M, Marlow M, Moore KL, Patel M. Recommendation of the Advisory Committee on Immunization Practices for use of a third dose of mumps virus–containing vaccine in persons at increased risk for mumps during an outbreak. MMWR Morb Mortal Wkly Rep 2018;67:33–8 . https://doi.org/10.15585/mmwr.mm6701a7 PMID:29324728
  3. Mathis AD, Clemmons NS, Redd SB, et al. Maintenance of measles elimination status in the United States for 20 years despite increasing challenges. Clin Infect Dis 2022;75:416–24 . https://doi.org/10.1093/cid/ciab979 PMID:34849648
  4. Marlow M, Leung J, Marin M, et al. Mumps [Chapter 9]. In: Manual for the surveillance of vaccine-preventable diseases. Atlanta, GA: US Department of Human Services, CDC; 2021. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt09-mumps.pdf
  5. Food and Drug Administration. Package insert: PRIORIX (measles, mumps, and rubella vaccine, live). Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2022. https://www.fda.gov/media/158941/download
  6. Bankamp B, Takeda M, Zhang Y, Xu W, Rota PA. Genetic characterization of measles vaccine strains. J Infect Dis 2011;204(Suppl 1):S533–48 . https://doi.org/10.1093/infdis/jir097 PMID:21666210
  7. Tillieux SL, Halsey WS, Sathe GM, Vassilev V. Comparative analysis of the complete nucleotide sequences of measles, mumps, and rubella strain genomes contained in Priorix-Tetra and ProQuad live attenuated combined vaccines. Vaccine 2009;27:2265–73 . https://doi.org/10.1016/j.vaccine.2009.01.112 PMID:19428841
  8. Berry AA, Abu-Elyazeed R, Diaz-Perez C, et al. Two-year antibody persistence in children vaccinated at 12–15 months with a measles-mumps-rubella virus vaccine without human serum albumin. Hum Vaccin Immunother 2017;13:1516–22 . https://doi.org/10.1080/21645515.2017.1309486 PMID:28481690
  9. Gothefors L, Bergström E, Backman M. Immunogenicity and reactogenicity of a new measles, mumps and rubella vaccine when administered as a second dose at 12 y of age. Scand J Infect Dis 2001;33:545–9 . https://doi.org/10.1080/00365540110026593 PMID:11515768
  10. MMR-162 Study Group. Safety and immunogenicity of an upper-range release titer measles-mumps-rubella vaccine in children vaccinated at 12 to 15 months of age: a phase III, randomized study. Hum Vaccin Immunother 2018;14:2921–31 . https://doi.org/10.1080/21645515.2018.1502527 PMID:30118386
  11. Mufson MA, Diaz C, Leonardi M, et al. Safety and immunogenicity of human serum albumin-free MMR vaccine in US children aged 12–15 months. J Pediatric Infect Dis Soc 2015;4:339–48 . https://doi.org/10.1093/jpids/piu081 PMID:26582873
  12. Pietrantonj CD, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2021;4:CD004407. https://doi.org/10.1002/14651858.cd004407.pub4
  13. Farrington P, Rush M, Miller E, et al. A new method for active surveillance of adverse events from diphtheria/tetanus/pertussis and measles/mumps/rubella vaccines. Lancet 1995;345:567–9 . https://doi.org/10.1016/S0140-6736(95)90471-9 PMID:7619183
  14. France EK, Glanz J, Xu S, et al.; Vaccine Safety Datalink Team. Risk of immune thrombocytopenic purpura after measles-mumps-rubella immunization in children. Pediatrics 2008;121:e687–92. PMID:18310189
  15. Miller E, Andrews N, Stowe J, Grant A, Waight P, Taylor B. Risks of convulsion and aseptic meningitis following measles-mumps-rubella vaccination in the United Kingdom. Am J Epidemiol 2007;165:704–9 . https://doi.org/10.1093/aje/kwk045 PMID:17204517
  16. O'Leary ST, Glanz JM, McClure DL, et al. The risk of immune thrombocytopenic purpura after vaccination in children and adolescents. Pediatrics 2012;129:248–55 . https://doi.org/10.1542/peds.2011-1111 PMID:22232308
  17. Perez-Vilar S, Weibel D, Sturkenboom M, et al.; WHO Global Vaccine Safety-Multi Country Collaboration. Enhancing global vaccine pharmacovigilance: proof-of-concept study on aseptic meningitis and immune thrombocytopenic purpura following measles-mumps containing vaccination. Vaccine 2018;36:347–54 . https://doi.org/10.1016/j.vaccine.2017.05.012 PMID:28558983
  18. MMR-161 Study Group. Immunogenicity and safety of measles-mumps-rubella vaccine at two different potency levels administered to healthy children aged 12–15 months: a phase III, randomized, non-inferiority trial. Vaccine 2018;36:5781–8 . https://doi.org/10.1016/j.vaccine.2018.07.076 PMID:30104117
  19. Klein NP, Abu-Elyazeed R, Povey M, et al. Immunogenicity and safety of a measles-mumps-rubella vaccine administered as a first dose to children aged 12 to 15 months: a phase III, randomized, noninferiority, lot-to-lot consistency study. J Pediatric Infect Dis Soc 2020;9:194–201 . https://doi.org/10.1093/jpids/piz010 PMID:30849175
  20. World Health Organization. Global Advisory Committee on Vaccine Safety, 11–12 June 2003. Wkly Epidemiol Rec 2003;78:282–4 https://cdn.who.int/media/docs/default-source/a-future-for-children/wer7832_2003_vol78-32.pdf?sfvrsn=b423a847_1&download=true.
  21. Abu-Elyazeed R, Jennings W, Severance R, et al. Immunogenicity and safety of a second dose of a measles-mumps-rubella vaccine administered to healthy participants 7 years of age or older: a phase III, randomized study. Hum Vaccin Immunother 2018;14:2624–31. PMID:29902133
  22. Gatchalian S, Cordero-Yap L, Lu-Fong M, et al. A randomized comparative trial in order to assess the reactogenicity and immunogenicity of a new measles mumps rubella (MMR) vaccine when given as a first dose at 12–24 months of age. Southeast Asian J Trop Med Public Health 1999;30:511–7. PMID:10774661
  23. Lee C-Y, Tang R-B, Huang F-Y, Tang H, Huang L-M, Bock HL. A new measles mumps rubella (MMR) vaccine: a randomized comparative trial for assessing the reactogenicity and immunogenicity of three consecutive production lots and comparison with a widely used MMR vaccine in measles primed children. Int J Infect Dis 2002;6:202–9. PMID:12718836
  24. Lee H, Kim HW, Cho HK, Park EA, Choi KM, Kim KH. Reappraisal of MMR vaccines currently used in Korea. Pediatr Int 2011;53:374–80 . https://doi.org/10.1111/j.1442-200X.2010.03244.x PMID:20831649
  25. Usonis V, Bakasenas V, Chitour K, Clemens R. Comparative study of reactogenicity and immunogenicity of new and established measles, mumps and rubella vaccines in healthy children. Infection 1998;26:222–6. PMID:9717679
  26. Usonis V, Bakasenas V, Denis M. Neutralization activity and persistence of antibodies induced in response to vaccination with a novel mumps strain, RIT 4385. Infection 2001;29:159–62 . https://doi.org/10.1007/s15010-001-1098-7 PMID:11440387
  27. Usonis V, Bakasenas V, Kaufhold A, Chitour K, Clemens R. Reactogenicity and immunogenicity of a new live attenuated combined measles, mumps and rubella vaccine in healthy children. Pediatr Infect Dis J 1999;18:42–8 . https://doi.org/10.1097/00006454-199901000-00011 PMID:9951979
  28. MMR-158 Study Group. A second dose of a measles-mumps-rubella vaccine administered to healthy four-to-six-year-old children: a phase III, observer-blind, randomized, safety and immunogenicity study comparing GSK MMR and MMR II with and without DTaP-IPV and varicella vaccines co-administration. Hum Vaccin Immunother 2019;15:786–99 . https://doi.org/10.1080/21645515.2018.1554971 PMID:30785357
  29. Food and Drug Administration. Package insert: M-M-R II (measles, mumps, and rubella virus vaccine live). Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2022. https://www.fda.gov/media/75191/download
  30. Kroger A, Bahta L, Hunter P. Timing and spacing of immunobiologics. Atlanta, GA: US Department of Health and Human Services, CDC; 2022. Accessed August 1, 2022. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/downloads/general-recs.pdf
TABLE. Components and infectious dosage* of measles, mumps, and rubella vaccines† licensed in the United StatesReturn to your place in the text
Vaccine characteristic Viral component
Measles Mumps Rubella
M-M-R II
Strain Enders' Edmonston Jeryl Lynn (B level) Wistar RA 27/3
Infectious dose, minimum and maximum release potencies ≥103.0–103.8 TCID50 ≥104.1–104.8 TCID50 ≥103.0–103.6 TCID50
PRIORIX
Strain Schwarz RIT4385 Wistar RA 27/3
Infectious dose, minimum and maximum release potencies ≥103.4–104.5 CCID50 ≥104.2–105.6 CCID50 ≥103.3–104.4 CCID50

Abbreviations: CCID50 = cell culture infectious dose; TCID50 = tissue culture infectious dose.
* TCID50 and CCID50 are closely related measures describing how much infectious virus is contained in a vaccine product.
† Both the measles and rubella strains in M-M-R II and PRIORIX are 100% identical on a nucleotide level. The Jeryl Lynn strain used in M-M-R II is a mixture of two viral lineages, JL1 and JL2. RIT4385 is a pure clone of JL1 and is 100% identical on a protein level to M-M-R II's JL1 component.


Suggested citation for this article: Krow-Lucal E, Marin M, Shepersky L, Bahta L, Loehr J, Dooling K. Measles, Mumps, Rubella Vaccine (PRIORIX): Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:1465–1470. DOI: http://dx.doi.org/10.15585/mmwr.mm7146a1.

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