• Introduction
• Why should it be done?
• When should it be done?
• How is it performed?
• Side effects
• Frequently asked Questions
• Selected links
• Useful Article?

Introduction

MMR is the combined vaccine that protects against measles, mumps and rubella.

Since the vaccine was introduced in 1988, the number of children who develop these diseases has fallen to an all-time low.

Measles, mumps and rubella are highly infectious, common conditions that can have serious complications, including meningitis, deafness and swelling of the brain (encephalitis). They can also lead to complications in pregnancy that affect the unborn baby and can lead to miscarriage. 

Read more about why the MMR vaccine is needed.

Why should it be done?

MMR is needed to protect against measles, mumps and rubella, which are highly infectious viral conditions that can have serious complications.

Measles can be a fatal illness and can cause a range of symptoms, including: 

• ear infections,
• diarrhoea
• bronchitis,
• convulsions (fits) 
• brain damage

There have been several recent outbreaks of measles in European countries, such as in Bulgaria (2010) and France (2011). If you're planning a holiday or you're attending a camp or music festival in mainland Europe, it's recommended that you seek advice from your GP about the MMR vaccination.

Mumps can cause viral meningitis in children.  It can also cause:

• temporary deafness
• miscarriage
• inflammation of the pancreas (pancreatitis)
• pain and swelling in the testicles in men

Rubella can cause:

• painful joints (arthritis)
• blood disorders 
• swelling of the brain (encephalitis) 

Rubella also damages unborn babies and may cause miscarriage. If the woman develops rubella while pregnant, the baby might be born with congenital rubella syndrome (CRS), which can cause some degree of deafness, blindness and damage to the heart or brain.

Autism link discredited

There has been some controversy about the MMR vaccine following a study published in The Lancet in 1998 by Dr Andrew Wakefield.  He claimed that his initial findings appeared to show a link between the MMR vaccine and autism and bowel disease.

Subsequent studies during the last eight years have been unable to find a link between MMR and autism or bowel disease. There is now overwhelming evidence that MMR doesn't cause either condition.

However, Andrew Wakefield’s findings have been completely discredited. Following a General Medical Council (GMC) hearing at the beginning of 2010, he was found guilty of serious professional misconduct and was struck off the medical register.

When should it be done?

When the MMR vaccine should be given 

The MMR vacccine is given as part of the routine vaccination schedule for children and in the event of a measles outbreak.  There are also several other groups who need to be protected against measles, mumps and rubella.

Children

The first dose of the MMR vaccination should ideally be given to children between 12 and 13 months of age. 

Children are given the second booster dose before they start school, usually between three and five years of age, although the second dose can be given three months after the first. 

Between 5 and 10% of children are not fully immune after the first dose. The booster gives increased protection, with less than 1% of children remaining at risk after having it.

Teenagers and adults

School leavers are offered a booster vaccine to ensure that everyone has received both doses. Anyone who missed the first dose can have both doses within a month of each other.

Some adults may not have received full protection due to changes in the MMR vaccine. Those born between 1980 and 1990 may not have received a mumps vaccine. Those born between 1970 and 1979 may only have had a measles vaccine. These groups should be offered the MMR vaccine.

The MMR vaccine can be given at any age. Adults may be offered immunisation checks upon entering university, military service or prison.

Anyone who is travelling to an area that's known to have had outbreaks of measles, mumps or rubella should ensure that they're fully immunised.

Pregnancy

Women who may be considering becoming pregnant should ask their GP to check whether they are fully immune to rubella by using a simple blood test.  Women who were born before 1988 were only given one vaccination against rubella, compared to those born later who received the recommended two doses of MMR. 

Women whose protection from rubella is low or uncertain are routinely offered a single rubella vaccination.  However, if this is not available, they may be offered MMR to provide the immunity they need. 

Rubella in pregnancy can cause serious problems in the developing baby.  Doctors advise women to avoid becoming pregnant for one month after having a rubella vaccination.  Pregnant women who were not screened before conceiving and who find out (through routine antenatal blood tests) that their immunity is low, will be offered a rubella vaccination after of the baby, normally at their six-week postnatal check.

Protecting people in a measles outbreak

In the event of a measles outbreak, the MMR vaccine can be given to protect people who have come into contact with the disease within the previous 72 hours (3 days). This is because measles antibodies develop more quickly following vaccination than they do following natural infection.

Current advice states that there are no negative effects from vaccinating people who are already immune.  For example, if there is any doubt whether they have already been vaccinated, there's no harm in them having a booster dose.

If my child didn't respond to the first MMR jab, will they respond to the second?

A second dose of vaccine has been shown to significantly increase protection. Among children who did not respond to a first dose of MMR vaccine, over 90% have a good response to a second dose. If children have low levels of antibodies after the first dose, their levels are boosted by a second dose.

How is it performed?

Parents or carers of children aged around 13 months, or who are pre-school age, will be invited to arrange an appointment at their GP surgery to have the MMR vaccine.

The MMR vaccine is given as a single injection into the muscle of the thigh or upper arm.  There may be some redness and swelling where the injection is given, but this should soon disappear.

The second booster dose is usually given between the ages of three and five. In adults, the second dose must be given at least one month after the first.

Single vaccines for the three separate diseases (measles, mumps and rubella) are not available on the NHS but are available at some private clinics.  However, having single vaccines usually involves scheduling them several weeks or months apart and the Government recommends that children should have the MMR vaccine within a set timescale.

Using single vaccinations increases the risk of fewer children receiving all the necessary injections. The delay between the six separate injections required would also put more children at risk of developing measles, mumps or rubella as well as increasing the risk of side effects.

Currently, there are no licensed single vaccines in the UK for either measles or mumps.  The licensing process is a form of quality testing to ensure that the products are safe and effective.

When is the MMR vaccine not given?

Very few people are unable to have the MMR vaccine for medical reasons. If there's any doubt, you should discuss your concerns with your GP.

People aren't given the MMR vaccine if they:

• are pregnant (women should avoid becoming pregnant for one month after having the MMR vaccine)
• have had an injection of immunoglobulin (antibodies to help fight infection) or another blood product in the previous three months
• have already had a severe allergic reaction to neomycin (an antibiotic) or gelatin (a substance that's used in foods such as jelly)
• have a weakened immune system (the body’s natural defence against infection and illness)

If you've previously had an allergic reaction to the MMR vaccine, you may not be able to have another dose. A specialist will discuss with you the risks of not having the full dose of MMR against the likelihood and potential severity of having another allergic reaction if you have another dose.

Side effects

The MMR vaccine combines three separate vaccines in one injection. Each vaccine can cause different side effects that can happen at different times:

Common side effects

Side effects tend to be less common after the second dose of MMR than the first.

About a week to 11 days after the MMR injection, some children get a very mild form of measles.  This includes a rash, high temperature, loss of appetite and general feeling of being unwell for about two or three days. 

About three to four weeks after the MMR injection, 1 in 50 children develop a mild form of mumps.  This includes swelling of the glands in the cheek, neck or under the jaw.  It lasts for a day or two. 

One to three weeks after receiving the rubella vaccine, some adult women experience painful, stiff or swollen joints, which lasts around three days.

Rare side effects

In rare cases, a child may get a small rash of bruise-like spots about two weeks after having the MMR vaccine. This side effect, linked to the rubella vaccine, is known as idiopathic thrombocytopenic purpura (ITP).

It has been estimated that ITP develops in one in every 24,000 doses of the MMR vaccine that are given. There is a greater risk of developing ITP from measles or rubella infection than from having the vaccine.  ITP usually gets better without treatment, but, as with any rash, seek advice from your doctor as soon as possible.

There's a small chance of seizures (fits) occurring 6 to 11 days after having the MMR vaccine. They occur in about 1 in every 1,000 doses and are less frequent than fits that result directly from a measles infection.

In very rare cases, children can have a severe allergic reaction straight after having the MMR vaccine. This happens in about one in 100,000 doses of the MMR vaccine. If the child is treated quickly, they will recover fully. Medical staff who give immunisations are trained to deal with allergic reactions.

People who have been recently immunised cannot infect others with the viruses contained in the MMR vaccine.

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine that you are taking. It is run by a medicines safety watchdog called the Medicines and Healthcare Products Regulatory Agency (MHRA). See the Yellow Card Scheme website for more information. 

Frequently asked Questions

Can my child have the Hib/MenC jab together with the MMR and pneumococcal jabs?

Selected links

NHS Direct Wales links

Childhood immunisations

Measles

Mumps

Rubella

External links

HPA: MMR vaccine

Yellow Card Scheme