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Encyclopaedia


MMR

Introduction

MMR

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.

When is the MMR given?

The first MMR vaccination is given to children as part of the routine vaccination schedule usually within a month of their first birthday. A booster dose is given before they start school (usually between three and five years of age). 

The MMR can sometimes be given earlier than their first birthday if you think that your child has been exposed to the measles virus.  

The vaccine is given as a single injection into the muscle of the thigh or upper arm.

As well as young children needing the MMR vaccine, women who are thinking about getting pregnant may also need to be vaccinated if they have low levels of rubella antibodies or they haven't had a rubella vaccination or MMR. Also needing the vaccine are people born between 1970 and 1979 who may have only been vaccinated against measles, as well as people born between 1980 to 1990 who may not be protected against mumps.

Check with your GP if you're not sure whether you've had rubella or MMR.

Read more about when the MMR vaccine is needed.

The MMR vaccine

The MMR vaccine contains weakened versions of live measles, mumps and rubella viruses.

The vaccine triggers the immune system (the body’s natural defence against infection and illness) to produce antibodies against measles, mumps and rubella.

If you then come into contact with one of the diseases, your immune system will recognise it and immediately produce the antibodies needed to fight it.

It is not possible for people who have recently had the vaccine to infect other people.

MMR and autism

There has been some controversy about the MMR vaccine and autism following a study published 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.

Andrew Wakefield’s work has been completely discredited. Subsequent studies during the last eight years have found no link between the MMR vaccine and autism or bowel disease.

Single vaccines

Single vaccines are not routinely given in the UK. They're not available on the NHS due to the risk that fewer children would receive all the necessary injections, increasing the levels of measles, mumps and rubella in the UK.

The delay in having six separate injections would also put more children at risk of developing the conditions as well as increasing the amount of work and inconvenience for parents and those administering the vaccines. 

Side effects

As there are three separate vaccines, different side effects can occur at different times. Side effects are usually mild. It's important to remember that they're milder than the potential complications of measles, mumps and rubella.

Side effects include:

  • developing a mild form of measles that lasts for two to three days
  • developing a mild form of mumps that lasts for a day or two

In rare cases, a small rash of bruise-like spots may appear a number of weeks after the injection. See your GP if you notice this kind of rash or if you have any concerns about your child's symptoms following the MMR.

Read more about how MMR is performed and the potential side effects of MMR.

You can find the answers to many other common questions about MMR on the frequently asked questions page.

Measles on the rise

The success of the MMR vaccine means that in the UK, cases of measles are rare.

However, in recent years the number of cases has risen. For example, the Health Protection Agency reported a surge in measles cases in England and Wales for the first half of 2011. A total of 496 laboratory-confirmed cases were reported from January to May 2011 in children and young adults, compared with just 374 cases for the whole of 2010. Read more about the rising trend in measles.

It's thought that the rise in measles cases is due to parents not getting their child vaccinated with the MMR vaccine, probably because of speculation linking MMR to autism.

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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: 

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:

Rubella can cause:

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.

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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 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 an MMR vaccination 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 the MMR 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 MMR vaccination after giving birth, to protect against rubella in the future.

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.

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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.

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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. 

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Frequently asked Questions

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

My child is allergic to eggs. Can she have the MMR vaccination?

Can the MMR vaccination be given as three separate injections?

I don't know if my teenage daughter has had her second MMR jab. What should I do?

Does the MMR jab contain thiomersal (mercury)?

My child is due for his MMR jab but I am concerned about the connection between autism and MMR. Could it put him at risk?

Our son was born six weeks prematurely. Should we delay getting him vaccinated?

A month after I got vaccinated for MMR, I found out I was pregnant. Will my baby be ok?

Can I have single vaccines on the NHS? If not, where can I buy them?

My son is 18 and has been asked to have a second MMR jab before university. Is this sensible?

If my child develops a mild case of measles after receiving their first MMR vaccine, are they contagious to non-vaccinated children?

My baby had measles at the age of six weeks. Can I get the vaccine without the measles component?

We are due to go travelling and my 14-month-old son is due to have his MMR jab three weeks before we go. Will he have developed immunity before we go? And can he have travel vaccines at the same time as the MMR?

My child is receiving their MMR jab tomorrow. How long should I leave it before taking them swimming?

Does MMR give a lifetime of immunity?

I have heard that mumps is going around. I thought that MMR prevented mumps, so why is this happening?

Our 14-month-old son had his MMR jab last week. I am 12 weeks pregnant - is there any risk of my son affecting my unborn child?

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

Yes, these vaccines can be given together.

The recommended childhood vaccination schedule indicates that MMR is given at around 12-13 months of age at the same time as Hib/MenC and the pneumococcal conjugate vaccine (PCV). 

My child is allergic to eggs. Can she have the MMR vaccination?

Yes, the MMR vaccine can be safely given to children who have a severe allergy to egg. This is because MMR vaccine is grown on chick cells, not the egg white or yolk. If you have any concerns, talk to your health visitor, practice nurse or doctor.

Can the MMR vaccination be given as three separate injections?

Measles, mumps and rubella vaccines are not available separately on the NHS.

I don't know if my teenage daughter has had her second MMR jab. What should I do?

It is important that she has the MMR jab now. If you are not sure whether she has ever had the MMR jab, she should have one dose now and make an appointment to have a second dose in three months' time. An extra MMR dose will not cause any harm.

Does the MMR jab contain thiomersal (mercury)?

No, the MMR vaccine has never contained thiomersal (a preservative containing mercury that is used in some vaccines).

My child is due for his MMR jab but I am concerned about the connection between autism and MMR. Could it put him at risk?

There is currently no scientific evidence of a link between MMR and autism, so you should not worry. Your child should have his MMR jab to protect him against measles, mumps and rubella.

Our son was born six weeks prematurely. Should we delay getting him vaccinated?

No. Babies should receive their vaccinations according to the recommended schedule, at around 12-13 months of age, irrespective of whether they're are born prematurley.

A month after I got vaccinated for MMR, I found out I was pregnant. Will my baby be ok?

Evidence from clinical trials suggests that there will be no harm to your baby. However, you should discuss this with your midwife or GP at the earliest possible opportunity to be further reassured.

Can I have single vaccines on the NHS? If not, where can I buy them?

Measles, mumps and rubella vaccines are not available separately on the NHS.

The NHS does not recommend single measles, mumps or rubella vaccines because there is no evidence to support the use of single vaccines or to suggest that they are 'safer' than MMR. Having single vaccines puts your child at risk of catching measles, mumps or rubella in the gaps between the vaccines.

The NHS does not keep a list of private clinics that provide single vaccines. Any clinic that does offer these privately are unlicensed, which means they're not checked for safety and effectiveness.

No country in the world recommends MMR and then offers parents a choice of having single vaccines instead. Every independent expert group around the world (including the World Health Organization) supports the use of MMR.  None support the use of single vaccines.  

My son is 18 and has been asked to have a second MMR jab before university. Is this sensible?

Many universities are recommending their students have MMR, because there have been outbreaks of mumps.

To ensure he is fully protected against mumps, he needs to have had two doses of MMR. Even if he has already had two doses of a measles vaccine, having a third to make sure he is protected against mumps will not cause any harm.    

If my child develops a mild case of measles after receiving their first MMR vaccine, are they contagious to non-vaccinated children?

No. Post-vaccination symptoms are not infectious, so your child will not pass anything on to non-vaccinated children.  

My baby had measles at the age of six weeks. Can I get the vaccine without the measles component?

Although your baby had measles at six weeks, it is still advised that they have the MMR. This will help protect your baby against mumps and rubella and will also boost the antibodies your baby has already developed against measles.  

We are due to go travelling and my 14-month-old son is due to have his MMR jab three weeks before we go. Will he have developed immunity before we go? And can he have travel vaccines at the same time as the MMR?

Immunity to measles, mumps and rubella starts to develop after two weeks, so having his MMR three weeks before travelling is fine. It is also fine to have other travel vaccines on the same day as the MMR.   

My child is receiving their MMR jab tomorrow. How long should I leave it before taking them swimming?

There is no reason why your child cannot resume normal activities, including swimming, straight after receiving their MMR jab.   

Does MMR give a lifetime of immunity?

The immunity that MMR gives is probably lifelong. It is known that individuals will remain immune for at least 30 years against measles, 23 years against rubella and 19 years against mumps - in other words, for the amount of time that the vaccines have been available. 

If in the future evidence shows that immunity is fading, decisions would be made about offering a further dose in, for example, the adult years.   

I have heard that mumps is going around. I thought that MMR prevented mumps, so why is this happening?

You need two doses of MMR to be protected against mumps. MMR was introduced in 1988, with a second dose introduced in 1996, so some teenagers and young people have not had two doses of MMR. This has led to several recent outbreaks of mumps among this age group.

If you think this applies to you, you should book an appointment for the second dose now. If you have never had the MMR vaccine, you should have one dose now and another three months later.

Our 14-month-old son had his MMR jab last week. I am 12 weeks pregnant - is there any risk of my son affecting my unborn child?

There is no risk to your unborn baby as it is impossible for anyone to catch any of the diseases from a child recently vaccinated with MMR.  

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Selected links

NHS Direct Wales links

Childhood immunisations

Measles

Mumps

Rubella

External links

Yellow Card Scheme

 

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 03/03/2015 14:19:18

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