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M-M-R II

Common name:

MMR, measles mumps rubella vaccine

Protects against measles, mumps and rubella.

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Overview

All cases of measles seen in New Zealand are the result of non-immune people bringing the virus into the country from overseas. Very high coverage of this vaccine is necessary to prevent the spread of measles, in particular, and no vaccination opportunity should be missed.

After a single dose of MMR vaccine 90–95 out of 100 people will be protected from measles, 69–81 protected from mumps and 90–97 from rubella. After a second dose of MMR vaccine the number of people protected from these diseases increases, almost everyone will be protected from measles and rubella, and up to 88% protected from mumps.

Due to the presence of antibodies transferred from the mother, the measles component of the vaccine may be less effective in children under 12 months of age. However, the Ministry of Health recommends that an infant aged 6–11 months who is travelling overseas to a country with a measles outbreak can receive one MMR vaccination before travelling. 

MMR vaccine is funded for children and adults, born on/after 1 January1969, who have not completed a two dose course of MMR vaccine.

Due to measles outbreaks this year, the demand for MMR vaccination is significantly higher than usual. An additional supply of the M-M-R II vaccine brand was distributed by the Auckland ProPharma store in place of the Priorix vaccine brand for the Auckland region. Distribution of M-M-R II in Auckland has now ended but the doses of the vaccine are still available in primary care. All ProPharma stores in New Zealand are distributing the Priorix brand of vaccine.

Responses to vaccine

M-M-R II (MMR)

Common Responses

  • Measles component: Fever and/or mild rash 6–12 days after immunisation
  • Mumps component: Fever and/or mild swelling under the jaw 10—14 days after immunisation
  • Rubella component: Fever, mild rash and/or swollen glands 2—4 weeks after immunisation
  • Temporary joint pain 2—4 weeks after immunisation is more common in adult women than children

Rare Responses

  • Temporary low platelet count
  • Encephalitis
  • Aseptic (infection free) meningitis
  • Convulsion associated with fever

As with any medicine, very rarely a severe allergic reaction (anaphylaxis) can occur following immunisation.

References

  • McLean, HQ, Fiebelkorn AP, Temte JL and Wallace GS. Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMRW 2013 62(RR04); 1-34 June 14. [accessed October 2016] Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm.
  • Ministry of Health. Immunisation Handbook 2017. Ministry of Health: Wellington. Available from: http://www.health.govt.nz/publication/immunisation-handbook-2017.
  • Reef SE, Plotkin SA. Rubella vaccines. In: Plotkin S, Orenstein W, Offit P, editors. Vaccines. 7th ed. London: W.B. Saunders; 2017. p. 970-1000.
  • World Health Organization. Meeting of the Strategic Advisory Group of Experts on Immunization, October 2015 – conclusions and recommendations. Weekly Epidemiology Record.2015, 90:50; 691 [cited October 2016] Available from: http://www.who.int/wer/2015/wer9050.pdf?ua=1.
In Depth

Other brands: Priorix®

Vaccine type: live attenuated viral

Schedule and administration

M-M-R® II is funded as part of the childhood immunisation schedule at 15 months and 4 years of age. The first dose of MMR vaccine can be given at any time from 12 months of age, and the second dose as early as 4 weeks later. After 1 July 2017, the Priorix® brand of measles, mumps and rubella vaccine will replace M-M-R II. The vaccines are fully interchangeable, a person who receives one M-M-R II can complete their course of vaccines with Priorix.

MMR vaccine is also recommended for some occupations: staff in early childhood services, healthcare assistant and long-term facility carers, laboratory staff, medical, nursing and other health professionals, and students in training for these occupations.

Special groups

MMR vaccine is funded for (re)-immunisation following immunosuppression. MMR vaccine is contraindicated in immunosuppressed individuals.

MMR vaccine is recommended for all HIV-positive children, whether symptomatic or asymptomatic, if the CD4+ lymphocyte percentage is 15 percent or greater. Asymptomatic children who are not severely immunocompromised are recommended to receive MMR vaccine from age 12 months to provide early protection against the three diseases.

Susceptible HIV-positive children and adults aged 14 years and older may receive MMR vaccine if the CD4+ lymphocyte count is 200 cells/mm3 or greater. Administration of MMR with CD4+ counts below these recommended levels has been associated with related pneumonitis (from the measles component).

Catch-up doses

This vaccine is funded for all children from 12 months of age and adults born 1 January 1969 or later who do not have not two documented doses of MMR vaccine given from 12 months of age and a miniumum of 4 weeks apart.

Storage and preparation

Store as per cold chain between 2°C to 8°C. Diluent may be stored with the lyophilised vaccine vial in the refrigerator or separately at room temperature at less than 25°C.

Administration

Two doses are administered subcutaneously, a minimum of 4 weeks (28 days) apart. The second dose is a revaccination intended for those who may not be fully protected following the first dose. It is not a booster dose.

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.

    M-M-R II can be administered concurrently with other vaccines, including varicella and all the National Immunisation Schedule vaccines. Separate syringes and different injection sites should be used. If not given at the same visit as varicella vaccine, a 4 week interval between the two live virus vaccines should be observed.

    In the case of an outbreak, the Medical Officer of Health may prescribe the vaccine for an infant aged 6–11 months who has been in direct contact with a measles case. This dose is called ‘dose zero’ or MMR0. A two further doses are required from 12 months of age as per the Schedule.

    Vaccine safety

    MMR vaccine can be given to:

    • A person in close contact with a newborn baby, or a pregnant woman or a person who is immune suppressed.
    • A person with egg allergy or anaphylaxis.
    • To a breastfeeding woman.

    Immunisation should be postponed in individuals suffering from a fever over 38°C. However, the presence of a minor infection is not a reason to delay immunisation.

    MMR vaccine should not be given to:

    • Anyone who has a severe weakness of the immune system.
    • Anyone who had a severe allergic response (anaphylaxis) to a previous dose of this vaccine or a component of this vaccine.
    • Women who are currently pregnant. Women are advised to delay pregnancy for 4 weeks after receipt of an MMR vaccine dose.
    • People who have received another live injected vaccine within the previous four weeks.

    Advice should be sought for the following groups:

    • People receiving high-dose steroid medicine, e.g. prednisone, for more than 14 days. They should wait for at least four weeks after their treatment has finished before receiving the vaccine.
    • People who are HIV-positive.
    • Children with idiopathic thrombocytopenic purpura (ITP) at the time of vaccination.
    • People who have received a blood product in the 11 months before immunisation.
    • People expecting to receive a blood product in the two months after immunisation. These should not be given for two months after immunisation unless their use outweighs the benefits of the immunisation.
    • Administration of MMR vaccine 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.

    Tuberculin skin testing (Mantoux test) should be avoided for 4–6 weeks following vaccination with Priorix. The measles vaccine component may temporarily suppress tuberculin skin sensitivity.

    Vaccine effectiveness

    Infants under 12 months of age may fail to respond to the measles component of MMR vaccine due to persisting transplacental maternal measles antibodies. 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, 69-81% from mumps and 90-97% from rubella after a single MMR vaccination. After a second dose of MMR vaccine the number of people protected from these diseases increases, almost everyone will be protected from measles and rubella, and up to 90% protected from mumps.

    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% recipients for measles, but about 26% of MMR vaccine recipients will become susceptible to mumps around 10–20 years after vaccination.

    A single MMR vaccination, administered to a measles non-immune individual within 72 hours of contact with a confirmed measkes case, may prevent the development of measles disease in the vacicne recipient. Receipt of an MMR vaccine will not make incubating disease worse.

    Last updated: Sep 2019