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| MMR |
A combined live measles, mumps, and rubella vaccine (MMR vaccine) is being widely used instead of monovalent vaccines with an aim to eliminate measles, mumps, and rubella (and congenital rubella syndrome). Every child should receive two doses of MMR vaccine by entry to primary school, unless there is a valid contra-indication (see below). MMR vaccine should be given irrespective of previous measles, mumps or rubella infection.
The first dose of MMR vaccine is given to children aged more than 12 months (between 12-18 months). A second dose is given before starting school at 3-5 years of age. When protection against measles is required urgently (e.g. during a measles outbreak), the second dose of MMR vaccine can be given 1 month after the first dose.
Children presenting for pre-school booster who have not received the first dose of MMR vaccine should be given a dose of MMR vaccine followed 3 months later by a second dose. At school-leaving age or at entry into further education, MMR immunization should be offered to individuals of both sexes who have not received both doses. In a young adult who has received only a single dose of MMR in childhood, a second dose is recommended to achieve full protection.
MMR vaccine should be used to protect against rubella in seronegative women of child-bearing age. Vaccination should never be given during pregnancy and pregnancy should be avoided during one month of vaccination. MMR vaccine may also be offered to previously unimmunised and seronegative post-partum women. Vaccination a few days after first delivery is important because about 60% of congenital abnormalities from rubella infection occur in babies of women who have borne more than one child.
MMR vaccine may also be used in the control of out breaks of measles and should be offered to susceptible; children aged over 6 months who are contacts of a case, within 3 days of exposure to infection; these children should still receive routine MMR vaccinations at the, recommended ages. Household contacts of a case, aged between 6 and 9 months may receive normal immunoglobulin. MMR vaccine is not suitable for prophylaxis following exposure to mumps or rubella since the antibody response to the mumps and rubella components is too slow for effective prophylaxis.
Children and adults with impaired immune response should not receive live vaccines. If they have been exposed to measles infection they should be given normal immunoglobulin.
Unimmunised travellers, including children over 6 months, to areas where measles is endemic or epidemic should receive MMR vaccine. Children immunized before 12 months of age should still receive second dose of MMR at the recommended ages.
Contra-indications to MMR include:
- Children with severe immunosuppression
- Children who have received another live vaccine by injection within 4 weeks;
- Children who have had an anaphylactic reaction to excipients such as gelatin and neomycin;
- Pregnancy should be avoided for 1 month.
- Within three months of an immunoglobulin injection.
It has been recommended in no uncertain terms avoiding rubella vaccination during pregnancy. MMR vaccine should not be given within 3 months of an immunoglobulin injection because response to the measles component may be reduced.
Measles/Mumps/Rubella triple (MMR) or measles/rubella (MR) vaccine is given in many countries instead of monovalent measles vaccine. In industrialized countries, measles vaccination is usually given at the age of 12–15 months, when seroconversion rates in excess of 90% are expected. In most developing countries, high attack rates and serious disease among infants necessitate early vaccination, usually at 9 months of age, despite the relatively low (80–85%) seroconversion rates following vaccination in this age group. To ensure optimum population immunity, all children should be given a second opportunity for measles immunization. Although generally administered at school entry (age 4–6 years), the second dose may be given as early as one month following the first dose, depending on the local programmatic and epidemiological situation.
Special attention must be paid to all children and adolescent/young adult travelers who have not been vaccinated against measles at the appropriate time. Measles is still common in many countries and travel in densely populated areas may favour transmission. For infants travelling to countries where measles is endemic, a dose of vaccine may be given as early as 6 months of age. |
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