# Situation: A nurse manages the National Immunization Program (NIP) at a Rural Health Unit (RHU) that serves 12 barangays. A 15-month-old girl has received all NIP vaccines except MMR, having missed both the 9-month and 12-month visits. She is well and has no contraindication. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627256  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A nurse manages the National Immunization Program (NIP) at a Rural Health Unit (RHU) that serves 12 barangays.

A 15-month-old girl has received all NIP vaccines except MMR, having missed both the 9-month and 12-month visits. She is well and has no contraindication. What should the nurse do?

## 보기

1. Give a single MMR dose today, since she is past 12 months
2. Wait for the measles-rubella dose given in Grade 1
3. Give MMR 1 today and MMR 2 at least 4 weeks later **✔ 정답**
4. Give MMR 1 today and MMR 2 after she turns 2 years

**정답: 3**

## 해설

Under the NIP, MMR can be caught up until 2 years of age. The child still needs both doses: the first today and the second after the minimum interval of 4 weeks between doses of the same vaccine, which falls well before her second birthday. Waiting leaves her unprotected against measles.

## 심화 해설

Two doses of MMR, caught up before age 2
Under the National Immunization Program (NIP), the measles, mumps, and rubella (MMR) vaccine is scheduled at 9 months and 12 months. A child who missed both visits can still be caught up, and MMR catch-up in the NIP runs until 2 years of age. This 15-month-old girl is well, has no contraindication, and has received every other vaccine. She needs both doses: MMR 1 today and MMR 2 at least 4 weeks later, before her second birthday.

Why the minimum interval is 4 weeks
Two doses of a live vaccine such as MMR must be separated by at least 4 weeks so that the first dose's immune response does not interfere with the second. The second dose is not a booster in the usual sense; it gives a second chance to respond for the small share of children who do not develop immunity after the first dose. With MMR 1 today at 15 months, MMR 2 can be given from about 16 months onward, which leaves ample time before age 2.

| Situation | Action |
| --- | --- |
| Routine schedule | MMR at 9 months and 12 months |
| Missed doses, under 2 years | Catch up both doses |
| Interval between doses | At least 4 weeks |
| This child at 15 months | MMR 1 today, MMR 2 four or more weeks later |

Why the other plans are wrong
A single MMR dose because she is past 12 months reduces a two-dose schedule to one and leaves some children unprotected. Waiting for the measles-rubella dose given in Grade 1 leaves her unprotected for years, during which measles outbreaks can occur. Giving MMR 2 only after she turns 2 years goes beyond the NIP catch-up period for MMR. Watch out! Being older than the scheduled age is a reason to catch up promptly, not to skip doses or wait.

Exam takeaway
Missed vaccines are not restarted and not skipped; give them as soon as possible, respecting minimum intervals and catch-up age limits. The nurse records the dose in the immunization card and target client list, sets the return date for MMR 2, explains the importance of the second dose, and reviews why the family missed the earlier visits so that barriers can be addressed. Tracking defaulters through barangay health workers helps prevent missed doses.

## 임상 시나리오

MMR Catch-UpMissed 9-month and 12-month doses
MMR is due at 9 and 12 months; catch-up in the NIP runs until 2 years of age.

Give MMR 1 today and MMR 2 at least 4 weeks later, before the second birthday.

Record the dose, set the return date, and address the reasons for the missed visits.

CautionDo not give only one dose or wait for the school measles-rubella dose; both leave the child unprotected.

## 핵심 개념

- **Catch-up immunization** — Giving missed vaccine doses to a child who is behind schedule.
- **Minimum interval** — The shortest time allowed between doses of a vaccine for the later dose to count.
- **MMR vaccine** — A live attenuated vaccine against measles, mumps, and rubella.
- **Defaulter** — A child who has missed scheduled immunization visits.

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