Target population^[1]

All children should be given the first dose prior to school entry, unless contra-indicated. See separate article Immunisation Schedule (UK).

• The optimum age for the first dose is 12-13 months.
• A booster dose should be given between ages 3 years and four months to 5 years.
• If the child has missed the first dose, give two doses, three months apart. Give the vaccine irrespective of previous history of infection.
• If a dose of MMR is given before the child's first birthday, either because of travel to an endemic country or because of a local outbreak, then this dose should be ignored, and two further doses given at the recommended times (ie between 12 and 13 months of age and at 3 years and four months to 5 years of age).
• Check immunisation status when giving the school-leaving age immunisations (does not normally include MMR). Give an MMR booster if only one dose has been given previously, and two doses, three months apart if no previous dose has been given.
• Where protection against measles is urgently required, the second dose can be given one month after the first.
• If the child is given the second dose less than three months after the first dose and at less than 18 months of age, then the routine preschool dose (a third dose) should be given in order to ensure full protection.

Special groups

Apart from the more routine vaccination of children as above, there are also target groups worthy of special mention. The immunisation can be given to individuals of any age. The decision on whether or not to vaccinate should take into account:

• Past immunisation history.
• The likelihood of an individual remaining susceptible.
• The future risk of exposure and disease.

These children should be specifically contacted rather than left to the routine recall procedure:

• Premature babies should be immunised after two months, irrespective of prematurity.
• HIV-positive individuals. For severely immunocompromised patients, check with a specialist.
• Women of childbearing age who are seronegative for rubella and who are not currently pregnant, should be given the vaccine.
• Other unimmunised groups:
  • Healthcare workers - should be given the vaccine for their own benefit and to protect vulnerable unimmunised patients and their own unimmunised partners.
  • Unimmunised seronegative postpartum women should be offered the vaccine a few days after delivery.
  • Immigrants arriving after school age of immunisation are particularly likely to require immunisation.
• During outbreaks of measles:
  • The vaccine should be given to susceptible children aged over 6 months in contact with a case, within three days of exposure.
  • These children should still have routine MMR at the usual age.
  • Note that MMR vaccination is not suitable for prophylaxis against mumps or rubella following exposure to either, as the antibody response is too slow.

Contra-indications^[1]

• Acute illness (postpone until the condition has resolved), but note that minor illness without fever or systemic upset - eg mild otitis media, upper respiratory tract infection (URTI) and diarrhoea - is not a contra-indication.
• Severe local or generalised reaction to a previous dose of MMR vaccine - when in doubt, seek specialist advice.
• Allergy to neomycin or gelatin.
• Untreated malignant disease or impaired immunity - eg immunosuppression, steroids, radiotherapy, cytotoxic drugs or within six months of receiving such treatment (immunisation can still be possible in some circumstances depending on dosage and combination of drugs - check with the specialist treating the condition or the local community paediatrician).
• Within three months of receiving blood products, such as immunoglobulin.
• If immediate protection against measles is required in someone who has recently received a blood product, MMR vaccine should still be given. To confer longer-term protection, MMR should then be repeated after three months.
• Pregnancy - but note that the Department of Health does not recommend termination, as studies failed to demonstrate a link between rubella immunisation in early pregnancy and fetal damage.

Note that the following are NOT contra-indications:

• Family history of any adverse reactions following immunisation.
• Previous history of infection with pertussis, measles, rubella or mumps.
• Contact with an infectious disease.
• Asthma, eczema, hay fever or rhinitis.
• Treatment with antibiotics or locally acting (eg topical or inhaled) steroids.
• The child's mother being pregnant.
• The child being breast-fed.
• History of jaundice after birth.
• Being over the age recommended in the immunisation schedule.
• 'Replacement' corticosteroids.
• Allergy to eggs (although, if there is a history of anaphylaxis to dietary eggs, immunisation by a paediatrician under controlled conditions is advisable).
• Neurological conditions are not a contra-indication although, if the condition is poorly controlled (eg epilepsy), immunisation should be deferred.
• MMR should ideally be given at the same time as other live vaccines, such as BCG. However, if live vaccines cannot be administered simultaneously, a four-week interval is recommended.

Adverse reactions^[1]

Adverse reactions are considerably less common after a second dose of MMR vaccine than after the first dose.

Common

• Fever or a rash may occur one week after immunisation. It lasts 2-3 days and is more common after the first immunisation than after the second.
• Parotid swelling occurs in 1% of children of all ages up to four years. It is most common at the third week, occasionally later.

Rare

• Febrile convulsion may occur on the 6th-11th day after immunisation . The incidence is 1 in 1,000 children. This is less than the incidence after an infection of measles. There is no evidence that epilepsy occurs more frequently after febrile convulsion caused by MMR than after any other febrile convulsion.
• Idiopathic thrombocytopenic purpura occurs in 1 in 24,000 children, usually within six weeks of the first dose. The child should undergo serological testing before the next dose is given. This is offered free by the Health Protection Agency (HPA) Virus Reference Laboratory.
• Arthropathy (arthralgia or arthritis) has also been reported to occur rarely after MMR immunisation, probably due to the rubella component. It occurs between 14 and 21 days after immunisation.

There is overwhelming evidence that there is no link between the MMR vaccine and autism or bowel disease.^[2][3][4] Some private clinics offer single vaccines, but the Department of Health recommends that parents be discouraged from using them. One study identified four cases of anaphylaxis following single component measles or rubella vaccine.^[5]