All you have to know about MMR vaccine

By Prof. Jennifer Perera

The Measles Mumps Rubella vaccine is the most recently introduced vaccine to the National Programme of Immunisation in Sri Lanka. The MMR vaccine protects against three diseases - measles, mumps, and rubella, caused by viruses that are potentially serious in childhood.

Measles is caused by a virus which causes a rash, cough, runny nose, eye irritation and fever in most children. It can also lead to ear infection, pneumonia, seizures, brain damage, and death in some cases.

The mumps virus causes a swollen face, fever, headache, and painful swelling of salivary glands. It can also lead to deafness, meningitis, encephalitis, painful swelling of testicles or ovaries leading to sub-fertility in some and rarely death in some cases. Rubella, also known as the German measles, is generally a mild disease.

It causes a rash and mild fever and arthritis (mostly in women). Rubella is responsible for birth defects (congenital rubella syndrome of newborns) if the mother gets infected during pregnancy. Therefore women of reproductive age who have not received the MMR vaccination should receive a dose of the MMR vaccine prior to becoming pregnant.

These diseases can have complications that lead to lifetime disability or even death.

What is the vaccine made of?

The MMR vaccine comprises live, attenuated (or weakened) strains of the measles, mumps, and rubella viruses.

How is this vaccine given?

This vaccine is given as an injection subcutaneously (in the fatty layer of tissue under the skin) and is given as two doses with a minimum interval of 4 weeks.

Why should you give two doses of the vaccine?

Children should receive 2 doses of the MMR vaccine, the first at 12 – 15 months of age and the second at 3-5 yrs of age.

The MMR vaccine is required by some countries for students travelling overseas for studies. If immunization records on MMR vaccine are not available for them, one can still go ahead with vaccination as there is no evidence that adverse reactions are increased when MMR is given to a person who is already immune to one or more of the components of the vaccine. The vaccine is also indicated for healthcare workers as they are at high risk of acquiring these diseases from patients.

How effective is this vaccine?

The first dose of MMR vaccine produces good immunity to measles (95–98%), mumps (97%), and rubella (95%). The second dose of MMR is intended to produce immunity in those who did not respond to the first dose, but a very small percentage of people may not be protected even after a second dose.

What are the risks and adverse effects of the MMR vaccine?

Most people who receive the MMR will have no problems from it. The safety record of the vaccine is excellent. Others may have minor problems, such as soreness and redness where the injection was given, or fever. Serious adverse effects from receiving the MMR are rare. It is recommended that the children remain in the clinic for at least 30 minutes after receiving the vaccine.

Mild side effects include: Fever, rash, swelling of glands in the cheeks or neck (rare). If a rash develops without other symptoms, no treatment is needed. It should go away within 2-3 days. These problems occur within 7 – 12 days after the injection. They occur less often after the second dose.

Moderately severe adverse effects include: Temporary joint pain and stiffness, mostly in young women and temporary low platelet count/bleeding.

Severe side effects such as allergic reactions are extremely rare. The potential benefits from receiving the MMR vaccine far outweigh the potential risks.

What should you look for if you suspect a moderate or severe reaction?

Look for high fever, weakness, or behaviour changes. If an allergic reaction is suspected look for breathing difficulty, hoarseness or wheezing, paleness, weakness, dizziness or a fast heart rate.
Take the patient to a doctor or call a doctor immediately and tell the doctor about the vaccine type, date and time of vaccination etc. In the event of an adverse reaction, the doctor is expected to fill an adverse events following immunization form (AEFI form).

Who should consult a doctor regarding MMR vaccination?

Severely immune-compromised people should consult their doctor about getting the MMR vaccine. This includes people with conditions such as congenital immunodeficiency, AIDS, leukemia, lymphoma, generalized malignancy. Persons receiving treatment for cancer with drugs, radiation, and those having low platelet counts and those receiving corticosteroids should consult their doctor prior to vaccination. Household contacts of immune-compromised people should be vaccinated according to the recommended schedule.

Although people with AIDS or HIV infection with signs of serious immune-suppression should not be given MMR, people with HIV infection without symptoms can and should be vaccinated against measles. People who have received transfusions or other blood products (including immuno globulin) or who have a blood disorder should discuss the proper timing of the MMR vaccine with their health care provider.

Who should avoid receiving the MMR vaccine ?

Anyone who had a severe allergic reaction (e.g., generalized rash, swelling of the lips, tongue, or throat, difficulty breathing) following the first dose of MMR should not receive a second dose. Anyone knowing they are allergic to an MMR component (e.g., gelatin, neomycin) should not receive this vaccine.
As with all live virus vaccines, women known to be pregnant should not receive the MMR vaccine, and pregnancy should be avoided for four weeks following vaccination with MMR. Children and other household contacts of pregnant women should be vaccinated according to the recommended schedule. Women who are breast-feeding can be vaccinated.

Can MMR be given on the same day as other live virus vaccines (e.g., varicella)?

Yes. Two live vaccines can be given on the same day injected at two different sites of the body. If two live vaccines (e.g., MMR, varicella,) are not administered on the same day, they should be separated by an interval of at least 28 days.

Can the second dose of MMR be given earlier than 3 years to young children travelling to countries where there are measles cases?

Yes. The second dose of MMR can be given at a minimum period of 28 days after the first dose when necessary.

If MMR is given to an infant traveller (below 1 year), will that dose be considered valid ?

No. MMR vaccine administered before the first birthday should not be counted as part of the series. MMR should be repeated when the child is 12 to 15 months of age (12 months if the child remains in an area where disease risk is high). The second dose should be administered at least 28 days after the first dose.

If someone says that she had the rubella disease, but never had the MMR vaccine, what should be done?

She should receive two doses of MMR, separated by at least 28 days. A personal history of measles and mumps is NOT acceptable as proof of immunity. Acceptable evidence of measles and mumps immunity includes a positive serologic test for antibody or written documentation of vaccination. For rubella, only serologic evidence or documented vaccination should be accepted as proof of immunity.

If a vaccinated person develops a rash and low-grade fever after MMR vaccine, is s/he infectious?

No. Approximately 5% of people who receive MMR vaccine will develop a low-grade fever and/or mild rash 7-12 days after vaccination. However, the person is not infectious, and no special precautions (e.g., exclusion from work/school) need to be taken.

Is there any evidence that MMR causes autism?

There is no evidence supporting an association between MMR vaccine and the development of autism.

(The writer is President, Vaccine Forum of Sri Lanka)

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