Measles, mumps and rubella vaccination

MMR vaccination contains live, attenuated strains of measles, mumps and rubella viruses. It is administered intramuscularly into the upper arm or anterolateral thigh. Deep subcutaneous injections are used for patients with bleeding disorders to minimize the risk of bleeding (1).

• usually given in two doses at appropriate intervals for all eligible individuals (1)
• this was introduced into the UK in 1988, with a target of 90% uptake in 1 to 2 year olds
• efficacy
  • a single dose of the measles, mumps and rubela vaccination (MMR) protects approximately 90% of children against measles
  • a single dose of a rubella-containing vaccine confers around 95-100% protection
  • a single dose of a mumps-containing vaccine used in the UK confers between 61% and 91% protection against mumps
  • therefore, two doses of MMR are required to produce satisfactory protection against measles, mumps and rubella.
• a second dose of MMR vaccine became routine in 1996. The prime aim of this dose is not to act as a booster, but to protect those who were not protected by the first (2). The second MMR vaccine can be given at any time after the first MMR vaccine, as long as at least three months have elapsed

There is no evidence to support the suggestions that MMR or MR vaccines cause autism or Crohn's disease (3,4).

MMR vaccine can be given at the same time as other vaccines such as DTaP/ IPV, Hib/MenC, PCV and hepatitis B:

• the vaccine should be given at a separate site, preferably in a different limb. If given in the same limb, they should be given at least 2.5cm apart (1)

MMR should ideally be given at the same time as other live vaccines, such as BCG

• if live vaccines are given simultaneously, then each vaccine virus will begin to replicate and an appropriate immune response is made to each vaccine. After a live vaccine is given, natural interferon is produced in response to that vaccine
  • if a second live vaccine is given during this response, the interferon may prevent replication of the second vaccine virus
    • may attenuate the response to the second vaccine
    • recommended interval between live vaccines is currently four weeks
      • if live vaccines cannot be administered simultaneously, a four-week interval is recommended

MMR and tuberculin testing (Mantoux test)

• four weeks should be left between giving MMR vaccine and carrying out tuberculin testing
  • measles vaccine component of MMR can reduce the delayed-type hypersensitivity response
    • could give a false negative response to tuberculin testing

Check uptodate details in the The Green Book before prescribing/administering MMR vaccine.

Check the Summary of Product Characteristics (SPC) of the influenza vaccination before prescribing/administering MMR vaccine.

Notes (5):

• children with egg allergy should have MMR vaccine
  • data suggest that anaphylactic reactions to MMR vaccine are not associated with hypersensitivity to egg antigens but to other components of the vaccine, such as gelatin
  • if there is a history of confirmed anaphylactic reaction to egg-containing food, paediatric advice should be sought with a view to immunisation under controlled conditions such as admission to hospital as a day case

Reference:

• (1) Department of health 2019. Immunisation against infectious disease - "The Green Book". Chapter 23 – mumps
• (2) Prescriber (2000), 11 (13), 65-69.
• (3) CSM (June 1999). Current Problems in Pharmacovigilance, 25, 9-12.
• (4) Drug and Therapeutics Bulletin (2003), 41 (4), 25-9.
• (5) Immunisation Against Infectious Disease - "The Green Book".Chapter 21 Measles (April 2019)