M-M-R® II

Recommended and offered free on the New Zealand Immunisation schedule to all children at 15 months and 4 years of age.

Recommended and offered free on the New Zealand Immunisation Catch up Schedule to children, from 12 months of age, and NZ resident adults, born after 1969, who have not completed a course of two doses.

All children, from 12 months of age, and adults, born after 1969, who have not completed their course of two vaccinations.

Children and adults with an allergy to egg CAN have this vaccine.

Children and adults in close contact with pregnant or breast feeding women or someone who is immune suppressed CAN receive the M-M-R® II vaccine.

Occupational recommendations for this vaccine: early childhood services staff; health care assistants and long term facility carers; laboratory staff; medical, nursing, other health professional staff and students in training for these occupations.

Anyone with severe allergy (anaphylaxis) to a previous dose of this vaccine or a component of the vaccine.

People who have received another live vaccine within the previous four weeks e.g., varicella vaccine or children who have had a BCG.

People known to be immune suppressed e.g. have some types of cancer or on some treatments for cancer and autoimmune diseases.

Women who are currently pregnant. Women should delay pregnancy for one month after having the vaccine.

People who have had a blood transfusion or other blood products in the previous 11 months should speak to their nurse or doctor before having the vaccine.

Administration of M-M-R® II should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation.

This vaccine CAN be given to people with an allergy to egg.

People living in a household with someone who is pregnant or immune suppressed CAN have the M-M-R® II vaccine.

After a single M-M-R® II immunisation 90-95% of people will be protected from measles, 95-96% protected from mumps, and 90-97% protected from rubella.

After a second M-M-R® II almost everyone will be protected from measles, mumps and rubella.

For all vaccines, similar to most medications, an extremely rare allergic reaction called ‘anaphylaxis’ can occur. Anaphylaxis after immunisation occurs about 1-3 times in every one million vaccine doses. All vaccinators will have training and equipment to deal with this situation in the unlikely event of it occurring. One in 1 million recipients may develop encephalitis (inflammation of the brain) from the measles component of the vaccine.

Thrombocytopenia (bruising or bleeding) occurs after a first dose of MMR® at a rate of 1 in 30,000. This is self-limiting. Aseptic meningitis caused by the mumps component of the vaccine occurs once in 800,000 doses.

The possible effects of the vaccine on foetal development are unknown at this time. Women should delay pregnancy for one month after having the vaccine.

Children and adults can catch up missed doses of this vaccine anytime.

Adults born prior to 1969 are considered immune to measles, mumps and rubella.

Adults born between 1969 and 1981 should have one dose of MMR administered if they fulfil one of the following criteria:

• A worker in early childhood education.
• A student in post-secondary education.
• A health care worker with patient contact – all should be immune to measles, mumps and rubella but if a health care worker does not have a documented history of two doses of a measles-containing vaccine they should receive a single dose of MMR.
• Those in institutional care and those who care for them.
• A susceptible international traveller visiting a country in which measles is endemic.
• Health care workers and students without a documented history of two doses of MMR vaccine or documented rubella immunity are recommended and funded to receive one dose of MMR vaccine.

M-M-R® II

The vaccination course for M-M-R® II is two doses administered subcutaneously at least 28 days apart anytime after the age of 12 months.
The second M-M-R® II is a revaccination intended to seroconvert those who did not become immune to measles with dose one. The second M-M-R® II is not a booster dose.

During a measles outbreak a Medical Officer of Health may prescribe M-M-R® II for an infant aged 6-11 months of age who is a direct contact of a measles case. This is called “dose 0” and is in addition to the two doses required after 12 months of age.

Parents can request that the MMR vaccine be given any time after 12 months of age and no opportunity should be missed to achieve immunity.

Children with laboratory confirmed wild disease of any of the diseases contained in the vaccine should still receive two doses of M-M-R® II at least 28 days apart.

Any adult who is known to be susceptible to one or more diseases covered by M-M-R® II should be offered the vaccine.

Women of child-bearing age, who have a rubella antibody level below 15 IU/ml should be offered up to two doses of M-M-R® II if she does not already have two documented doses of a rubella containing vaccine.

No more than two documented doses of MMR vaccine are required however it is not harmful should a vaccinee ultimately receive more than two MMR doses, because of a lack of immunisation records.

Adults born before 1969 should be considered immune to measles.

Adults born between 1969 and 1981 should be offered a single dose of M-M-R® II if they are a student in post-secondary education; a health care worker; living in institutional care; caring for residents in institutional care or a susceptible international traveller visiting a country in which measles is epidemic.
M-M-R® II may prevent wild measles developing, may make wild disease more mild or may have no effect on the development of wild disease if it is administered within 72 hours of exposure to a measles case.

There is no clear evidence that M-M-R® II will affect the development of wild mumps or wild rubella if used within 72 hours of exposure to those diseases.

Administration into the outer aspect of the upper arm is the preferred site in children and adults.

M-M-R® II can be given to people with an allergy to egg.

Women who are breast feeding can safely have M-M-R® II. Studies have shown that the live attenuated rubella vaccine virus may secrete in the breast milk and be transmitted to breast-fed infants. One of the breast-fed infants with serological evidence of rubella infection exhibited a mild clinical illness typical of acquired rubella but none of the infants exhibited severe disease.
The vaccine can be given to those living in a household with a pregnant woman or someone immunesuppressed. Studies have shown that small amounts of the live attenuated rubella vaccine virus are excreted from the nose and throat in the majority of susceptible individuals for 7-28 days after vaccination. There is a theoretical risk of transmission of the rubella vaccine virus to a non-immune individual through close contact.

M-M-R® II can be administered concurrently with other vaccines, including all the National Immunisation Schedule vaccines. Separate syringes and different injection sites should be used. When M-M-R® II is not given concurrently with another live injectable vaccine e.g. varicella vaccine or BCG vaccine, then the live vaccines must be given four weeks apart.

A tuberculin skin test should be administered either before or concurrently with M-M-R® II as the vaccine may temporarily reduce the tuberculin skin sensitivity.

Store lyophilised vaccine between +2°C to +8°C. Protect from light. The diluent may be stored with the lyophilised vaccine or separately at room temperature. Once the vaccine has been reconstituted protect from light, store at +2°C to +8°C and discard if not used within 8 hours.

The expiry date of the vaccine is the last day of the month in the year indicated on the packaging.

Infants under 12 months of age may fail to respond to the measles component of the M-M-R® II vaccine due to persisting transplacental maternal measles antibodies from fetal life. The younger the infant the less likely it is they will develop protection against measles.

In children aged 12 months and over and adults 90-95% of vaccinees are protected from measles, 95-96% from mumps and 90-97% from rubella after a single M-M-R® II. After a second vaccination with M-M-R® II almost all recipients are immune to all three diseases.

Due to limits of detection levels of assays two documented doses of MMR are adequate presumptive evidence of immunity, even when serology is negative or equivocal for one or more of the diseases covered by the vaccine.

Secondary vaccine failure, waned immunity without an anamnestic (memory) response to the presence of wild or vaccine virus, occurs rarely for rubella and in only about 5% of recipients for measles but in about 26% of MMR vaccine recipients will lose immunity to, and become susceptible to, mumps over 20 years after vaccination.

When the vaccine course has been interrupted it may be resumed without repeating prior doses. The second dose of M-M-R® II can be administered anytime from 28 days after the first dose. In the absence of documented doses of an MMR vaccine, and dependent on the age and circumstances of the person, up to two doses of M-M-R® II should be given rather than perform serology.

A severe allergy (anaphylaxis) to a previous dose of this vaccine or a component of the vaccine, including gelatin.

Receipt of a live injectable vaccine e.g., varicella or BCG vaccine, administered anytime in the preceding 28 days.  This is to avoid the theoretical risk that the response to the first vaccine will reduce the response to the second vaccine. Inactivated/sub-unit vaccines can be given at anytime interval before or after live vaccines.

Women who are currently pregnant. Women should delay pregnancy for one month after having the vaccine.
Individuals receiving high-dose corticosteroids daily or on alternate days for more than 14 days (e.g., individuals receiving 2 mg/kg of prednisone, or 20 mg or more if the individual weighs more than 10 kg) should wait until the corticosteroid therapy has been discontinued for at least four weeks before receiving M-M-R® II.

Generally people known to be immune suppressed e.g. have some types of cancer or on some treatments for cancer and autoimmune diseases should not receive M-M-R® II. Vaccination should only be considered on an individual basis after careful consideration of the risks and benefits.

Receipt of a blood or immunoglobulin product in the preceding 11 months, with the exception of anti-D immunoglobulin post-partum, may be a contraindication for M-M-R® II. The recommended intervals between administration of various blood products and immunoglobulins and live viral vaccines vary. Health professionals should refer to table 1.5 in the  Immunisation Handbook 2011 (pages 36-37) for these intervals, a link to table 1.5 is also on this page.
People who developed thrombocytopenia after their first dose of M-M-R® II may develop thrombocytopenia after a subsequent M-M-R® II. Those with current thrombocytopaenia may develop more severe thrombocytopaenia following vaccination. In these situations serologic testing to determine immunity to all three diseases may be appropriate prior to vaccination/revaccination. Where a person is non-immune to any one of the three diseases vaccination should be considered on an individual basis after careful consideration of the risks and benefits.

Active untreated TB.

Administration of M-M-R® II should be postponed in individuals suffering from acute severe febrile illness (fever over 38°C).

The presence of a minor infection is not a contraindication.

M-M-R® II vaccine CAN be given to people with an allergy to egg.