MMR (Measles, Mumps and Rubella) vaccine

  • Before immunisation was available, measles, mumps and rubella were fairly common diseases that could have very serious complications
  • The most common complications of measles infection are otitis media, pneumonia, blindness and encephalitis (inflammation of the brain) 1 .
  • Mumps can cause complications ranging from inflammation of the pancreas and reproductive organs to deafness, meningitis (inflammation of the covering of the brain and spinal cord) and encephalitis.
  • Rubella can cause birth defects such as deafness and heart defects in babies whose mothers contract the illness while pregnant.

The role of MMR vaccine in preventing meningitis

Before MMR vaccine was introduced, mumps was the main cause of viral (or aseptic) meningitis - about 1,200 people (mainly children) in the UK were hospitalised each year with mumps 2 . Most of these cases had meningitis. Mumps was also the most frequent cause of viral encephalitis.

Measles encephalitis occurs in approximately 1 in 1000 cases of measles infection 3 and can be fatal.

Since the introduction of MMR in 1988, mumps and measles meningitis and encephalitis have virtually been eliminated.

Vaccine Uptake

Following adverse publicity about MMR in 1998, uptake of the vaccine in England fell from over 90% to around 80%, causing widespread concern among health professionals about the risk of outbreaks of these diseases. Similar patterns were seen in Scotland 4 , Wales 5 , Northern Ireland 6 and the Ireland 7 .

Cases of Measles

As a result of the decline in MMR uptake, outbreaks of measles occurred in the Ireland in 2000 leading to at least two deaths 8 In England and Wales in 2006, at least one child has died following outbreaks of measles, the majority of which have been seen in Surrey, Sussex and South Yorkshire 9. Fortunately, parents' acceptance of MMR seems to be improving again and uptake rates look to be increasing 9 .

Separate Vaccines

MMR* is given as two injections, one at 13 months (12 - 15 months in Ireland) and one between 3 - 5 years. Separate vaccines against measles, mumps and rubella would have to be given as six injections over a long period of time. Children would be left without protection in the gaps between injections and there would also be a fall in vaccine coverage as children may not complete the course of injections.

In particular, there is concern about the use of single vaccines and the impact on the occurrence of mumps and its complications. This is because, when seeking separate mumps immunisation, parents may find the vaccine they have obtained is the wrong sort. There are three strains of mumps vaccine available in Western Europe as single vaccines:

  • Urabe, which does not have a license in the UK and was withdrawn from use here in 1992 as the vaccine itself was responsible for a higher than acceptable risk of aseptic meningitis 10
  • Rubini which has been shown to be between only 1% and 22% effective 11
  • Pavivac, which is not licensed in the UK because there are questions about its safety 12 .

The mumps component of the MMR vaccine is the Jeryl Lynn strain, which is safe and effective but not often possible to obtain as a single vaccine either in the UK or mainland Europe. Children's health could be jeopardised if inappropriate vaccine is given.

Safety of MMR vaccine

Although MMR vaccination has had much adverse publicity, there is no factual basis for this.

Although no medicine is 100% safe, vaccines undergo stricter testing than other medicines. Over 30 years, more than 500 million doses of MMR have been given in over 100 countries, and it has an excellent safety record.

Articles published in medical journals and in the national press claiming that MMR vaccination causes autism and bowel disease have been thoroughly investigated and the evidence from several studies has shown no link between these conditions and MMR or measles vaccines.

There is no evidence that supports getting measles, mumps and rubella vaccinations separately-MMR vaccination is safer and more effective.

In recent years, many myths surrounding vaccination have developed and speculative media stories have understandably raised parental anxiety. Vital signs, Vital issues contains a large section which attempts to dispel these myths. This booklet can be downloaded from our website .

* The MMR vaccines used in the UK are M-M-RTMII and Priorix.

References

  1. Perry RT and Halsey NA. The clinical significance of measles: a review. Journal of Infectious Disease. May 2004; 189. (accessed 28 June 2006)
  2. Department of Health. Immunisation against infectious diseases. 1996. http://www.dh.gov.uk/assetRoot/04/07/29/84/04072984.pdf (accessed 28 June 2006)
  3. NHS Health Scotland. Ready Steady Baby http://www.hebs.scot.nhs.uk/readysteadybaby/moreinfo/hebs_pub4.cfm?TxtTCode=1172 (accessed 28 June 2006)
  4. Scottish Health Statistics. Latest Primary Immunisation uptake rates. May 2006. http://www.isdscotland.org/isd/info3.jsp?p_applic=CCC&p_service=Content.show&pContentID=1652& (accessed 28 June 2006)
  5. Local Health Board. Neath Port Talbort. Board Meeting, 6th May 2004. http://www.wales.nhs.uk/sites3/documents/245/DirectorOfPublicHealth.PDF#search='uptake%20of%20mmr%20in%20wales (accessed 28 June 2006)
  6. CDSC NI. Communicable Diseases Monthly Report. March 2003. http://www.cdscni.org.uk/publications/MonthlyReports/Volume_12_2003/No_1.pdf#search='uptake%20of%20mmr%20northern%20ireland' (accessed 28 June 2006)
  7. NDSC. Immunisation Uptake Statistics for Ireland. May 2002. http://www.ndsc.ie/A-Z/VaccinePreventable/Vaccination/Publications/ImmunisationUptakeStatistics/2001/File,926,en.pdf#search='fall%20in%20mmr%20uptake' (accessed 28 June 2006)
  8. Parliament of Ireland. Report on Childhood Immunisation. 7 December 2000. http://www.irlgov.ie/Committees-01/c-health/rep-childhood/071200.htm (accessed 28 June 2006)
  9. Health Protection Agency. Measles cases so far in 2006. June 2006. http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/060615_measles.htm (accessed 28 June 2006)
  10. Dourado I, Cunha S, Teixeira MG, Farrington CP, Melo A, Lucena R, Barreto ML. Outbreak of aseptic meningitis associated with mass vaccination with a urabe-containing measles-mumps-rubella vaccine: implications for immunization programs. Am J Epidemiol March 2000; 151(5):524-530 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10707922&query_hl=24&itool=pubmed_docsum (accessed 28 June 2006)11.
  11. Goncalves G, de Araujo A, Monteiro Cardoso ML. Outbreaks of mumps associated with poor vaccine efficacy - Oporto Portugal 1996. Eurosurveillance 1998; 3(12):119-121 http://www.eurosurveillance.org/em/v03n12/0312-222.asp (accessed 28 June 2006)
  12. NHS. Ban on import of Pavivac mumps vaccine extended. January 2003. http://www.mmrthefacts.nhs.uk/news/newsitem.php?id=38 (accessed 28 June 2006)