MMR

MMR is the combined vaccine that protects against the following diseases:

• measles,
• mumps, and
• rubella.

The vaccine was introduced in 1988. Since then the number of children catching these diseases has fallen to an all-time low.

Measles, mumps and rubella are diseases with serious complications:

• Measles causes a range of symptoms, from ear infection and bronchitis to convulsions (fits) or brain damage, and can be fatal.
• Mumps used to be the main cause of viral meningitis in children. It also causes temporary deafness, miscarriage, inflammation of the pancreas, and pain and swelling in the testicles in older males.
• Rubella can lead to painful joints, blood disorders and/or swelling of the brain (encephalitis). It damages unborn babies, and may cause miscarriage if the mother catches the disease while pregnant. Babies born with congenital rubella syndrome may have some degree of deafness, blindness, and damaged heart or brain functioning.

There has been some controversy about the MMR vaccine in recent years, owing to a study published in The Lancet in 1998 by Dr Andrew Wakefield. His initial study appeared to show a link between the MMR vaccine and autism and/or bowel disease. But subsequent work and other studies have been unable to prove any association with these conditions.

The first MMR vaccination is given to children at around 13 months of age, with a booster dose given before they start school (usually between 3 and 5 years old).

Between 5 and 10% of children are not fully immune after the first dose, so the booster gives increased protection resulting in less than 1% remaining at risk.

Women who may be considering pregnancy should ask their GP to screen them (using a simple blood test) to check whether they are fully immune to rubella. Women who were born before 1988 were only given one vaccination against rubella, compared to those born later who received the recommended two doses of MMR.

Women who find that their protection from rubella is low or uncertain are routinely offered a single rubella vaccination. However, if this is not available, they may be offered MMR to provide the immunity they need.

Rubella in pregnancy can cause serious problems in the developing baby. Doctors advise women to avoid pregnancy for one month after a rubella vaccination. Pregnant women who have not been screened prior to conceiving and find out (through routine antenatal blood tests) that their immunity is low will be offered a rubella vaccination after delivery of the baby, normally at their six-week postnatal check.

In the event of a measles outbreak, MMR can be used to protect people who may have come into contact with the disease within the previous 72 hours (3 days). This is because the development of measles antibodies following vaccination is faster than as a result of natural infection.

Current advice states that there are no ill effects from vaccinating people who are already immune (e.g. if there is any doubt whether they have already been vaccinated).

Parents or carers of children aged around 13 months and/or at pre-school age will be invited to arrange an appointment with their GP surgery for the MMR vaccination.

The vaccine is given as one injection in the upper arm. There may be some redness and swelling of the injection site but this should soon disappear.

Single vaccines for the separate diseases (measles, mumps and rubella) are available at some private clinics. Having single vaccines usually involves scheduling them several weeks or months apart. However, the Government strongly recommends the MMR vaccine to prevent putting children at risk of these serious illnesses while waiting to complete a course of single injections.

Currently, there are no licensed single vaccines in the UK for either measles or mumps. The official licensing process is a form of quality testing to ensure that the products are safe and effective.

Very few children are unable to have the MMR vaccine for medical reasons.

People are not given the MMR vaccine if they:

• are very ill,
• have already had a severe reaction to MMR in the past,
• are pregnant - women should avoid becoming pregnant for one month after having the MMR vaccine,
• have had an injection of immunoglobulin or another blood product in the previous three months,
• know that they may react severely to the antibiotic preparations neomycin or kanamycin, or
• have an untreated malignant disease or altered immunity.

MMR contains three separate vaccines in one injection. Each vaccine has different side effects at different times:

• About a week to 10 days after the MMR immunisation some children get a very mild form of measles with a rash, a high temperature, loss of appetite and general feeling of being unwell for about two or three days.
• About three to four weeks after the injection, a child (one in 50) can develop a mild form of mumps with swelling of the glands in the cheek, neck or under the jaw. This only lasts a day or two.
• Very rarely, the child may get a small rash of bruise-like spots about two weeks after the injection. This side effect, linked to the rubella part of the vaccine, is known as idiopathic thrombocytopenic purpura (ITP). It has been estimated that ITP develops in less than one in every 22,000 doses of the MMR vaccine, and that there is a greater risk of developing the condition from the diseases that the vaccine prevents. ITP usually gets better on its own, but as with any rash, you should seek advice from your doctor as soon as possible.
• Very rarely, children can have severe allergic reactions straight after any immunisation (about one in 100,000 immunisations for MMR). If the child is treated quickly, he or she will recover fully. People giving immunisations are trained to deal with allergic reactions to vaccines.
• Some adult women may experience painful, stiff or swollen joints one to three weeks after receiving the rubella vaccine, usually lasting around three days.

People who have been recently immunised cannot infect others with the viruses contained in the MMR vaccine.