Updated August 2022
The HIV/AIDS Bureau reviewed previous versions of the Performance Measures and revised the text and references. Key updates include the following:
- Added comparison data reference to the Healthy People 2030 and the HIV Quality Measures (HIVQM) Module.
- Updated links to the U.S. Department of Health and Human Services (US DHHS) Clinical Practice Guidelines.
- Updated US DHHS Clinical Practice Guidelines language.
- Included reference to Healthy People 2030 within the “Use in Other Federal Programs” section.
- Updated the HRSA contact email address in the Accessibility section.
Performance Measure: MMR Vaccination
National Quality Forum #: None
Description: Percentage of pediatric patients /children with HIV1 who have had at least one dose of the Measles, Mumps, and Rubella (MMR) vaccine administered between 12-24 months of age
Numerator: Number of pediatric patients/children with HIV who had at least one dose of the MMR vaccine administered2 between 12-24 months of age
Denominator: Number of children with HIV > 2 years and < 3 years of age who had a medical visit with a provider with prescribing privileges3 at least once in the measurement year
Patient Exclusions:
- Pediatric patients with CD4 <15% between 12-24 months of age
- Pediatric patients newly enrolled after 2 years of age
Data Elements: Is the pediatric patient a child with HIV? (Y/N)
- If yes, was the patient > 2 years and < 3 years of age at any time in the measurement year? (Y/N)
- If yes, was the patient seen by a provider with prescribing privileges during the measurement year? (Y/N)
- If yes, did the patient receive at least one dose of MMR vaccine between 12-24 months of age? (Y/N)
- If yes, list the date of immunization or serology
- If yes, did the patient receive at least one dose of MMR vaccine between 12-24 months of age? (Y/N)
- If yes, was the patient seen by a provider with prescribing privileges during the measurement year? (Y/N)
Data Sources:
- Electronic Medical Record/Electronic Health Record
- CAREWare, Lab Tracker or other electronic database
- Medical record data abstraction of a sample of records
- Billing records
National Goals, Targets, or Benchmarks for Comparison: Healthy People 2030 goal:4 In 2017, MMR vaccination coverage level of one dose of the MMR vaccine in children by age 2 years were 90.4 percent. The target for Healthy People 2030 is 90.8 percent.
The HIV Quality Measures (HIVQM) Module is a tool within the Ryan White HIV/AIDS Services Report portal. It allows recipients to enter aggregate data specific to HRSA HAB Performance Measures. The HIVQM Module allows recipients to conduct point-in-time benchmarking across Ryan White HIV/AIDS Programs that use the module.
Outcome Measures for Consideration:
- Rate of measles in the clinic population
- Rate of mumps in the clinic population
- Rate of rubella in the clinic population
U.S. Department of Health and Human Services Guidelines:
Panel on Opportunistic Infections in Children with and Exposed to HIV: “Children with HIV infection should be protected from vaccine- preventable diseases. Most vaccines recommended for routine use can be administered safely to children who are exposed to or have contracted HIV. The recommended vaccination schedule for children aged 0 to 18 years who are HIV-exposed or HIV-positive corresponds to the ACIP-approved schedule for all children with ACIP-approved additions specific to children with HIV incorporated (see Figure 1).”5
The child and adolescent immunization schedule is published annually to consolidate and summarize updates to ACIP recommendations on vaccination of children and adolescents and assist health care providers in implementing current ACIP recommendations. Specifically, for children with HIV infection aged 0 – 18 years, the recommended immunization schedule for measles, mumps, and rubella (MMR) include the following:
Routine vaccination (Minimum age: 12 months for routine vaccination):
- “Administer two doses of MMR vaccine for all individuals with HIV infection aged ≥ 12 months who do not have evidence of current severe immunosuppression as defined by the Advisory Committee on Immunization Practices (see ACIP Recommendations for the Prevention of Measles Rubella Congenital Rubella Syndrome and Mumps (PDF - 750 KB)).
- The first dose should be administered at age 12 months through 15 months and the second dose at age 4 years through 6 years (or as early as 28 days after the first dose).
- Individuals with perinatal HIV infection who were vaccinated prior to establishment of effective antiretroviral therapy (ART) should receive two appropriately spaced doses of MMR vaccine once effective ART has been established and there is no evidence of current severe immunosuppression as defined by ACIP (see ACIP Recommendations for the Prevention of Measles Rubella Congenital Rubella Syndrome and Mumps (PDF - 750 KB)).”5
Centers for Disease Control & Prevention: 6,7,8
- Catch-up vaccination: Unvaccinated children and adolescents may have the 2-dose series at least 4 weeks apart.
- The MMR vaccination is not recommended/contraindicated for children with HIV infection and a CD4 cell count <15% or total CD4 cell count of <200/mm3.
Use in Other Federal Programs: This measure is linked to an exact or similar indicator within Healthy People 2030.
References/Notes:
1 “Pediatric patient”/ “Children with HIV” includes all patients younger than 13 years.
2 Documentation of vaccination can include any of the following: 1) immunization record from another provider; 2) personal record of immunization; or 3) serologic evidence of antibody titers. If serology is used, titers must have been drawn before 2 years of age.
3 A “provider with prescribing privileges” is a health care professional who is certified in his/her jurisdiction to prescribe medications.
4US Department of Health and Human Services Healthy People 2030. Available online. Accessed March 2024.
5 Panel on Opportunistic Infections in Children with and Exposed to HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV. Department of Health and Human Services. Available online. Accessed March 2024.
6 Panel on Opportunistic Infections in Children with and Exposed to HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Children with and Exposed to HIV (PDF - 4 MB). Department of Health and Human Services. Available online. Accessed March 2024. JJ-4.
7 Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger — United States, 2021. MMWR; February 12, 2021 / 70(6). Accessed January 2024.
8 Centers for Disease Control and Prevention. Vaccines in the Child and Adolescent Immunization Schedule, United States 2021 (PDF - 316 KB). Available online. Tables 2-3. Accessed January 2024.
Accessibility: If you need an alternative means of access to any information above, please contact us at RWHAPQuality@hrsa.gov. Please let us know the nature of your accessibility problem and the Web address of the requested information.