Measles Mumps and Rubella (MMR) Vaccination

MMR is a freeze-dried preparation containing live attenuated measles, mumps and rubella viruses. It provides protection for approximately 90% of recipients for measles and mumps, and over 95% for rubella.¹

• All children should be given the first dose prior to school entry, unless contra-indicated. The optimum age for the first dose is 12-15 months.² A booster dose should be given at 3-5 years.
• If the child has missed the first dose, give two doses, three months apart. Give the vaccine irrespective of previous history of infection.
• A dose should be given at school-leaving age if no previous dose has been given. If only one dose has been received previously, give a booster.
• Children at special risk of measles should be specifically contacted rather than left to the vagaries of the routine recall procedure. These include children with chronic conditions such as congenital heart or kidney disease, cystic fibrosis, Down's syndrome, failure to thrive, and those in residential or day care.
• Premature babies should be immunised after 2 months, irrespective of prematurity.
• HIV positive individuals, even if symptomatic are likely to benefit, although occasional cases of measles caused by MMR have been seen.³ For severely immunocompromised patients, check with a specialist.
• Seronegative women of child-bearing age who are not currently pregnant should be given the vaccine.
• Unimmunised healthcare workers who might put unimmunised women at risk should be given the vaccine.
• Unimmunised sero-negative post-partum women should be offered the vaccine a few days after delivery. 60% of congenital abnormalities occur in babies born to women who have more than one child.
• 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 over 6 months in contact with a case, within three days of exposure (these children should still have routine MMR at usual age).It is not suitable for prophylaxis against mumps or rubella, as the antibody response too slow.

• 1st dose @ 13 months
• 2nd dose @ 3 years 4 months to 5 years

• Acute illness (postpone until condition resolved), but note that minor illness without fever or systemic upset, e.g. mild otitis media, upper respiratory tract infection (URTI) and diarrhoea - is not a contra-indication
• Severe local or generalised reaction to a previous dose - when in doubt seek specialist advice
• Allergy to neomycin, kanamycin or gelatin
• Untreated malignant disease or impaired immunity - e.g. immunosuppression, steroids, radiotherapy, cytotoxic drugs or within 6 months of receiving such treatment (vaccination still be possible in some circumstances depending on dosage and combination of drugs - check with specialist treating condition or local community paediatrician)
• Children who have received another live vaccine, including BCG, within three weeks
• Within three months of an immunoglobulin injection
• Pregnancy - but note Department of Health do not recommend termination as studies failed to demonstrate a link between rubella vaccination in early pregnancy and foetal damage

Note that the following are NOT contra-indications:

• Family history of any adverse reactions following vaccination
• Previous history of pertussis, measles, rubella or mumps infection
• Contact with an infectious disease
• Asthma, eczema, hay fever or rhinitis
• Treatment with antibiotics or locally-acting (eg topical or inhaled) steroids
• Child's mother is pregnant
• Child being breast fed
• History of jaundice after birth
• Over the age recommended in vaccination schedule
• 'Replacement' corticosteroids
• Allergy to eggs⁵

Common

• Fever or a rash may occur one week after vaccination. It lasts 2-3 days and is commoner after the first vaccination than the second.
• Parotid swelling occurs in 1 per cent of children all ages up to four years. it is commonest at the third week, occasionally later.

Rare

• Febrile convulsion may occur on 6th-11th day after vaccination . The incidence is 1 in 1000 children.
• Idiopathic thrombocytopaenic purpura occurs in 1 in 24,000 children, usually within 6 weeks of the first dose. The child should undergo serological testing before next dose given. This is offered free by the Specialist and Reference Microbiology Division, Health Protection Agency.⁶

Reassurance can be given on the following:

• Meningo-encephalitis - this was rare, and recovery was complete. It occurred with the previous Urabe mumps vaccine, but is no longer reported now that it has been replaced with the Jeryl Lynn vaccine.¹
• Link between MMR, bowel disease and autism - a Cochrane systematic review and several independent studies have found no evidence to support a link to the combined MMR vaccine.^7,8,9 Some private clinics offer single vaccines, but the Department of Health recommends that parents be discouraged from using them. The safety of single vaccines cannot be guaranteed, and the evidence suggests that MMR provides better protection.¹⁰