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MMR vaccination has been launched in the Maldives on the World Health Day 2007. This is a fact sheet presenting the FAQs related to this vaccine. The Maldivian Medical Association welcomes this addition to Maldives EPI.
What is MMR?
By Dr Basma Ibrahim Sabir, MBBS
A combined vaccine containing live attenuated viruses against Measles, Mumps and Rubella contributing to the protection against all 3 diseases. Today this vaccine is being widely used around the world (since 1970s), used in 100 countries and more than 500 million vaccines have been given. Studies from around the world haven proven that it is highly effective and has an excellent safety record.
Why use MMR?
Measles is a major killer of children mainly in developing countries, accounting for around 875 000 deaths/year. Also highlighted is the importance of its use in developed countries where MMR vaccination effectively reduces Congenital Rubella Syndrome (CRS). CRS is a significant cause of cardiac abnormalities, deafness, blindness and mental retardation. It is estimated that more than 100 000 cases occur each year worldwide.
MMR News
The Lancet, Volume 369, Number 9557, 20 January 2007
A study in The Lancet Journal confirms that child deaths from measles have fallen by 60% following a massive global vaccination campaign, surpassing a UN target of halving deaths by 2005.
Vaccinations against measles given between 1999 and 2005 have prevented almost 7.5 million deaths. Additional routine immunizations against measles accounts for 2.3 million of these prevented deaths.
Statement WHO/02 25 January 2001
”WHO strongly endorses the use of MMR vaccine on the grounds of its convincing record of safety and efficacy. The combination vaccine is recommended rather than monovalent presentation when available and the disease burden justifies its use.
There has been no new scientific evidence that would suggest impaired safety of MMR. On the contrary, all results from vaccine trials published reaffirm the high safety and effectiveness of MMR vaccine.”
What are Measles, Mumps and Rubella?
All 3 diseases are contagious and spread airborne. Although children may recover it can be unpleasant or sometimes can cause serious illness.
Measles: causes rash, cough, runny nose, eye irritation and fever. It may cause pneumonia, seizures and very rarely subacute sclerosing panencephalitis which can lead to mental deterioration, coma culminating in death.
Mumps: causes fever, headache, swollen glands and may lead to deafness. In boys it may cause damage to testicles leading to sterility at a later stage.
Rubella / German Measles: causes mild fever, rash and arthritis (mostly women). It is a minor illness unless it occurs to a pregnant woman in her first trimester leading to miscarriages or if pregnancy proceeds causing significant congenital birth defects in the fetus. Abnormalities include cardiac defects, brain damage, blindness and deafness. This is called Congenital Rubella Syndrome
When and who should get Vaccinated?
Usually given in 2 doses: first dose at 12-15 months, second at 3-6 years. Students/adults starting college who have not had prior vaccination also may get vaccinated.
Some children are at particular risk from measles and should have the MMR vaccine. Children with:
- Cystic Fibrosis
- Congenital heart disease
- Kidney disease
- Downs syndrome
- Poor growth
Also children above one year of age who are in residential care or day care.
How is it given? Why is it not given as a single component?
It is given into the thigh or the upper arm. The medical opinion is that although side effects maybe reduced with 3 components given separately the spacing of the dose may not reduce adverse effects but increase the opportunity of infection by the 2 diseases not immunized against the first. Fewer children would be receiving all 3 vaccines some with delays increasing the chances of getting the disease.
Who shouldn’t get Vaccinated/Contraindications?
Individuals with:
- An allergy to gelatin or the antibiotic neomycin serious enough to require medical treatment
- An immunodeficiency caused by cancer, leukemia, lymphoma, or HIV
- An immunodeficiency caused by taking prednisone or other steroids, chemotherapy, radiation therapy, and other immunosuppressant drugs
- A woman who is or possibly may become, pregnant within the next 28 days.
Side effects and Safety of the Vaccine
Most children do not get it but some:
- Develop mild fever after few days and some get a measles type rash.
- Aching, swelling or stiffness of the joints (usually women).
- Lymphadenopathy or mumps like swelling
- Pain redness and swelling at the vaccination site
- Vomiting or cough
- Rarely febrile convulsions, thrombocytopenia
- Very rarely causes encephalitis/meningitis
- Acute disseminated Encephalomyelitis is a very rare adverse effect
The potential benefits from receiving the MMR vaccine far outweigh its potential adverse effects. The incidence of complications, compared to having the actual disease, is far greater than the potential of developing serious or moderate adverse effects due to the MMR vaccine.
How is it prepared?
DISEASE |
VACCINE COMPONENT |
VIRUS STRAIN |
MEASLES |
Attenuvax |
Enders' attenuated Edmonston strain |
MUMPS |
Mumpsvax |
Jeryl Lynn (B level) strain |
RUBELLA |
Meruvax II |
Wistar RA 27/3 strain of live attenuated virus |
Vaccines are manufactured by:
MERCK as MMR II -Jeryl Lynn (B level) strain. Freeze-dried (lyophilized) and contains live viruses. Before injection it is made with the solvent provided. Route is subcutaneous injection.
GSK biological as PRIORIX and Sanofi Pasteur as TRIMOVAX
References:
www.who.int/inf-pr-2001/en/state2001-02.html
www.cdc.gov/nip/vaccine/MMR/default.htm
http://en.wikipedia.org/wiki/MMR_vaccine.htm
www.cdc.gov/nip/publications/VIS/vis-mmr.pdf
www.mmrthefacts.nhs.uk/MMR the facts/
www.cispimmunize.org/fam/mmr/a_faq.html
www.medinfo.co.uk/immunisations/mmr.html
http://www.nlm.nih.gov/medlineplus/ency/article/002026.htm\
