MMR Vaccine is a live attenuated vaccine against measles, mumps, and rubella viruses. Seroconversion after a single dose is 94% for Mumps, 96% for measles, and 99% for Rubella. It is used in the prevention of measles, mumps, and rubella viral infections.

MMR Vaccine (Measles, mumps, and rubella vaccines) Uses:

• Prevention:

  • Vaccinations are administered actively to patients who are one year of age or older.
  • The following are recommended as routine immunisation candidates by the Advisory Committee on Immunization Practices (ACIP):
    • All young children (first dose given at 12 to 15 months of age)
    • People born after 1957 (without evidence of immunity or documentation of vaccination).
    • Adults who were born before 1957 and do not have a medical condition that would preclude them from receiving the MMR vaccine are eligible.
    • Unless there is reliable proof of immunity existing, adults who are more likely to be exposed to and transmit measles, mumps, and rubella should be given special consideration for vaccination.
    • This includes those who travel internationally, attend universities or other institutions of higher learning, and work in healthcare facilities.

Dose in Adults:

Note: There must be at least 28 days between each dose of the MMR vaccination.

Immunization:

• SubQ:
  • 0.5% of a dosage 
  • 1 or 2 doses given at least 28 days apart depending on the following factors
  • Although it is believed that adults born before 1957 are resistant to measles, mumps, and rubella, they are still able to get one or two doses of the vaccine if there are no contraindications. It is not believed that adults who were born before 1957 are immune to rubella while they are pregnant.
  • Unless they have alternative documentation of immunity, adults who were born in 1957 or after should receive one dose of the vaccine.
  • Adults who received an unspecified type of measles or inactivated vaccine between 1963 and 1967:
    • One or two doses of MMR.
  • Health care personnel:
    • Unvaccinated people born before 1957 should also think about taking 2 doses of MMR for measles and mumps or 1 dose of MMR for rubella, unless they have laboratory evidence or laboratory confirmation of disease.
    • Unless they have alternative documentation of immunity, anyone who were born in 1957 or after should take 2 doses of the immunisation.
  • Adults at high risk who had the inactivated or unidentified kind of measles vaccination before 1979:
    • Two doses of MMR.
  • Women of childbearing potential:
    • Unless they can demonstrate immunity, they will only need one dose of the MMR.
    • Pregnancy should not be the time for vaccinations.
  • HIV infection (without severe immunosuppression):
    • MMR should be given twice unless there is proof of immunity.
  • Students:
    • Anyone enrolling in post-high school educational facilities should have 2 doses of MMR unless they can demonstrate proof of immunity prior to enrolment.
  • Household/close contacts of immunocompromised persons:
    • A second dose of MMR should be administered unless there is strong evidence of immunity.
  • Measles, mumps, or rubella outbreak (healthcare facility):
    • During a measles or mumps outbreak, unvaccinated medical staff who lack proof of immunity should receive two doses, and during a rubella outbreak, one dose.
  • International travelers:
    • MMR twice prior to travel, unless there is strong evidence of immunity.
  • Measles, mumps, or rubella outbreak (community):
    • During a rubella epidemic, one dosage of a vaccine that contains the disease is thought to be sufficient.
    • If the epidemic affects adults, it may be necessary to administer a second dosage of MMR to those who only had one dose.
    • People born before 1957 who are at risk of exposure to the mumps and who lack proof of immunity should also think about getting vaccinated.
    • For those at risk who have already had two doses of the MMR vaccination, the third dose is advised during a mumps outbreak.

Dose in Children:

Note: The MMR vaccination requires a minimum 28-day gap between doses.

Dose for Primary immunization:

• Children over 12 months:

  • SubQ: 0.5 mL per dose for a total of 2 doses given as follows:
    • It is recommended that the second dose be taken before entering kindergarten or first grade, and should be taken between the ages of 4 and 6 years old.
    • The second dose may be administered after the first treatment has been received for at least 28 days.

Measles outbreak without acceptable evidence of immunity and at risk for exposure:

Note:  Should be administered within 72 hours of exposure.

• Children 1-4 years:

  • It might be appropriate to give children who only received one dose of MMR a second vaccination if the outbreak affects preschool-aged children (0.5 mL SubQ).

• Infants 6-11 months:

  • SubQ: 0.5 mL administered once a day.
  • Children should begin a regular 2-dose course of vaccinations at age 12 or earlier.

Dose for Catch-up immunization:

• School-aged Children and Adolescents:
  • Make certain that two dosages were administered at least 28 days apart.

Dose in Mumps outbreak (eg, community):

• Children and teenagers (who have had two doses of the vaccine to be fully protected); local outbreak: 

  • The third MMR dose may be taken into consideration.

• Young children aged 1 to 4 (without sufficient proof of immunity and at risk for exposure): 

  • Children who have already received one dose of the MMR should be pondered about obtaining a second vaccination if the pandemic impacts preschool-aged children (0.5 mL SubQ).

Vaccine for household or close contacts of immunocompromised persons without acceptable evidence of immunity:

• Children less than 12 months of age and Adolescents:

  • SubQ: 0.5 mL per dose for a total of 2 doses given at least 28 days apart, unless there is proof of immunity.

Dose for International travellers, without evidence of immunity:

• Infants 6-11 months:

  • SubQ: Each dosage is 0.5 mL.
  • Give the MMR vaccine to infants once before they leave the country; after that, they should get two doses: one between the ages of 12 and 15 months (and at least 28 days after the previous dose; aim for 12 months if the child stays in an area with a high disease risk), and the second dose at least 28 days later.

HIV infection without evidence of MMR immunity:

• Children less than 12 months of age and Adolescents:

  • Those with prenatal HIV infection who received their MMR vaccinations before starting effective ART should have two further doses of the vaccine. Those kids and teenagers with HIV infection who don't have a lot of immunosuppression should get
  • SubQ: Each dosage is 0.5 mL.

Pregnancy Risk Category: C

MMR Vaccine is a live-attenuated vaccine and should be avoided in pregnancy (contraindicated per WHO statement) [Ref].

• No adverse effects have been observed, according to information gathered after an accidentally administered injection during pregnancy.
• The potential dangers are not totally eliminated. Pregnant people and those who are trying to get pregnant should avoid the immunisation, though.
• The vaccine's manufacturer advises against getting pregnant for three months after receiving it.
• For 28 days following immunisation in pregnant women, the Advisory Committee on Immunization Practices advises against conception.
• Congenital rubella syndrome is less likely to occur after immunisation than the infection that follows.
• Therefore, it is not a sign to terminate a pregnancy if you accidentally administer MMR during pregnancy.
• Unvaccinated pregnant women can experience adverse effects from natural infection.
• Preterm labor and spontaneous abortion are all possible outcomes of measles infection in pregnancy.
• Miscarriages and stillbirths can result from rubella infection during the first trimester.
• Intrauterine growth retardation, neurologic problems, and auditory, ocular, and cardiac impairments are all potential outcomes of congenital rubella syndrome.
• Fetal rubella infection is possible  during pregnancy.
• The risk of spontaneous abortion and intrauterine death is higher for mothers with mumps infection in the first trimester.
• Natural mumps infection can also cause sterility in males and infertility for prepubescent women.
• All pregnant women with rubella immune deficiency should be screened prenatally.
• If a woman is expecting and does not have proof that she has received a rubella vaccine, she should acquire one.
• For women with childbearing potential, it is acceptable to show evidence of immunity by proving birth after 1957.
• Pregnant women should get immunised following or at the end of their pregnancy and before giving birth.
• Women who are pregnant may have their household contacts vaccinated.

Use of rubella, measles and mumps vaccines during breastfeeding

• Breastfeeding mothers may secrete rubella components of the vaccine into their breast milk.
• After maternal immunization, there has been evidence of rubella infection in breastfed infants.
• Infants with rubella infection serology don't usually develop severe disease.
• However, mild clinical signs that are typical of acquired rubella have been observed in some cases.
• It is unknown if breast milk contains the measles and mumps components of this vaccine.
• Nursing women should be cautious when using this product, according to the manufacturer.
• It is not contraindicated to breastfeed.
• Infants who are being breastfed must receive their necessary vaccinations on time.

Dose in Kidney Disease:

No dosage adjustments provided by the manufacturer.

Dose in Liver disease:

No dosage adjustments provided by manufacturer

Side effects:

• Miscellaneous:

  • Febrile Seizures
  • Fever

• Cardiovascular:

  • Syncope
  • Vasculitis

• Central Nervous System:

  • Guillainbarré Syndrome
  • Headache
  • Paresthesia
  • Polyneuropathy
  • Ataxia
  • Dizziness
  • Malaise
  • Seizure
  • Retrobulbar Neuritis
  • Subacute Sclerosing Panencephalitis
  • Irritability
  • Acute Disseminated Encephalomyelitis
  • Sensorineural Hearing Loss
  • Transverse Myelitis

• Endocrine & Metabolic:

  • Diabetes Mellitus
•  

• Dermatologic:

  • IgA Vasculitis (Henoch-Schnolein Purpura and Acute Hemorrhagic Edema Of Infancy)
  • Pruritus
  • Urticaria
  • Rash
  • Morbilliform Rash
  • Erythema Multiforme
  • Stevens-Johnson Syndrome

• Gastrointestinal:

  • Diarrhea
  • Sore Throat
  • Nausea
  • Vomiting
  • Parotitis
  • Pancreatitis

• Hematologic & Oncologic:

  • Purpura
  • Thrombocytopenia
  • Lymphadenopathy (Regional)
  • Leukocytosis

• Genitourinary:

  • Orchitis
  • Epididymitis

• Hypersensitivity:

  • Angioedema
  • Anaphylaxis
  • Anaphylactoid Reaction

• Local:

  • Injection Site Reaction Including
    • Tenderness
    • Vesiculation
    • Wheal And Flare
    • Stinging
    • Swelling
    • Burning
    • Induration
    • Redness

• Infection:

  • Atypical Measles

• Ophthalmic:

  • Optic Neuritis
  • Conjunctivitis
  • Oculomotor Nerve Paralysis
  • Optic Papillitis
  • Retinitis

• Neuromuscular & Skeletal:

  • Arthropathy
  • Myalgia
  • Panniculitis

• Respiratory:

  • Pneumonia
  • Bronchospasm
  • Cough
  • Rhinitis

• Otic:

  • Otitis Media

Contraindications:

• Hypersensitivity to any ingredient in the formulation, including neomycin, or to the measles, mumps, or rubella vaccination.
• Respiratory sickness that is now feverish or another febrile infection.
• Corticosteroids are not given to patients receiving immunosuppressive treatment.
• Both congenital and acquired immunological deficiencies.
• Those who have leukaemia, lymphomas, or any other cancers that affect the lymphatic and bone marrow systems, such as blood disorders.
• Congenital and inherited immunodeficiency in the family (until immunity competence is demonstrated in the vaccine recipient).
• Pregnancy

Warnings and precautions

• Anaphylactoid reactions and hypersensitivity reactions

  • Immediate treatment (including epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions must be available during vaccine use.

• Syncope

  • Syncope can be caused by injectable vaccines. It is most commonly reported in adolescents and young adults within 15 minutes of vaccination.
  • To avoid injury from falling, and to restore cerebral perfusion in the event of syncope, precautions should be taken.

• Acute illness:

  • The degree of the symptoms and the cause will determine whether or not immunisation is necessary.
  • Treatment should be postponed for patients who are experiencing severe or moderate acute sickness (fever).
  • Although the manufacturer considers fever to be a contraindication, current recommendations allow administration to mild acute illnesses (without fever).

• CNS disorders:

  • It is not advisable to use patients who have a history of seizures, brain damage, or any other condition where stress is brought on by fever.

• Exposure to measles:

  • The vaccine is safe for everyone.
  • Some protection may be provided if you use it within 72 hours.

• Mumps exposure:

  • Postexposure immunisation has not been proven to be successful in preventing or treating illness after mumps exposure.

• Rubella exposure:

  • It has not been proven that postexposure immunisation prevents or modifies sickness in any way following rubella exposure.

• Thrombocytopenia:

  • Patients who have thrombocytopenia or who develop it after receiving the first dosage should exercise caution. The symptoms can get worse.

• Tuberculosis

  • Patients with active tuberculosis should not be delayed in getting vaccines.

Monitoring parameters:

• After injection, observe for 15 minutes for anaphylaxis and syncope.
• Keep the patient in a supine or Trendelenburg position if seizure-like behaviour associated with syncope occurs to preserve appropriate cerebral perfusion.

How to administer?

In the outside of the upper arm, a SubQ injection is used to give it.

"Not for IV administration"

A minimum of 28 days must pass between each dose of the MMR vaccination. Use different needles and syringes for each injection; do not combine with other injections or immunizations. Patients should get their vaccinations while sitting or lying down to reduce the risk of syncope-related injuries.

Priorix (Canadian product, not available in the US):

• Although intramuscular (IM) administration in the deltoid muscle or the anterolateral region of the thigh is less preferred, it is nevertheless possible.

Mechanism of action:

The MMR vaccination, which protects against illnesses brought on by rubella, measles, and mumps viruses, is a live, attenuated vaccine.

onset of action:

• For measles, rubella, and mumps, the median seroconversion after a single immunisation dose is 96%, 99%, and 94%, respectively.

Time:

• All components of the vaccine have a median immunity duration of >=15 years after two doses.

International Brand Names:

• M-M-R II
• Priorix
• M-M-R Vax
• M-M-R Vaxpro
• M.R. Vaccine
• MMR II
• Morupar
• Mumeru Vax
• Pluserix
• Priorix
• O.R. Vax
• Trimovax
• Triviraten Berna

Measles, mumps, and rubella vaccines in Pakistan:

It is provided by WHO in designated centers.