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MMR vaccine

January 01, 1970

The MMR vaccine is a vaccine against measles, mumps, and rubella (German measles), abbreviated as MMR.[6] The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses.[7][8][9] After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella.[7] The vaccine is also recommended for those who do not have evidence of immunity,[7] those with well-controlled HIV/AIDS,[10][11] and within 72 hours of exposure to measles among those who are incompletely immunized.[8] It is given by injection.[12]

MMR vaccine
MMR vaccine
Combination of
Measles vaccineVaccine
Mumps vaccineVaccine
Rubella vaccineVaccine
Clinical data
Trade namesM-M-R II, Priorix, Tresivac, others
Other namesMPR vaccine[1]
AHFS/Drugs.comMonograph
MedlinePlusa601176
License data
Pregnancy
category
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • UK: POM (Prescription only)
  • US: ℞-only[3][4]
  • EU: Rx-only[5]
  • In general: ℞ (Prescription only)
Identifiers
CAS Number
  • 1704518-68-2
ChemSpider
  • None
 NY (what is this?)  (verify)

The MMR vaccine is widely used around the world. Worldwide over 500 million doses were administered between 1999 and 2004,[13] and 575 million doses have been administered since the vaccine's introduction worldwide.[14] Measles resulted in 2.6 million deaths per year before immunization became common.[14] This has decreased to 122,000 deaths per year as of 2012, mostly in low-income countries.[14] Through vaccination, as of 2018, rates of measles in North and South America are very low.[14] Rates of disease have been seen to increase in populations that go unvaccinated.[14] Between 2000 and 2018, vaccination decreased measles deaths by 73%.[15]

Side effects of immunization are generally mild and resolve without any specific treatment.[16] These may include fever, as well as pain or redness at the injection site.[16] Severe allergic reactions occur in about one in a million people.[16] Because it contains live viruses, the MMR vaccine is not recommended during pregnancy but may be given while breastfeeding.[7] The vaccine is safe to give at the same time as other vaccines.[16] Being recently immunized does not increase the risk of passing measles, mumps, or rubella on to others.[7] There is no evidence of an association between MMR immunisation and autistic spectrum disorders.[17][18][19] The MMR vaccine is a mixture of live weakened viruses of the three diseases.[7]

The MMR vaccine was developed by Maurice Hilleman.[6] It was licensed for use in USA by Merck in 1971.[20] Stand-alone measles, mumps, and rubella vaccines had been previously licensed in 1963, 1967, and 1969, respectively.[20][21] Recommendations for a second dose were introduced in 1989.[20] The MMRV vaccine, which also covers chickenpox, may be used instead.[7] An MR vaccine, without coverage for mumps, is also occasionally used.[22]

Medical use edit

 
Priorix

Cochrane concluded that the "Existing evidence on the safety and effectiveness of MMR and MMRV vaccine supports current policies of mass immunisation aimed at global measles eradication in order to reduce morbidity and mortality associated with measles mumps rubella and varicella."[17]

The combined MMR vaccine induces immunity less painfully than three separate injections at the same time, and sooner and more efficiently than three injections given on different dates. Public Health England reports that providing a single combined vaccine as of 1988, rather than giving the option to have them also done separately, increased uptake of the vaccine.[23]

Measles edit

 
Measles cases reported in the United States fell drastically after introduction of the measles vaccine.

Before the widespread use of a vaccine against measles, rates of disease were so high that infection was felt to be "as inevitable as death and taxes."[24] Reported cases of measles in the United States fell from hundreds of thousands to tens of thousands per year following introduction of the vaccine in 1963. Increasing uptake of the vaccine following outbreaks in 1971, and 1977, brought this down to thousands of cases per year in the 1980s. An outbreak of almost 30,000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule. Fewer than 200 cases have been reported in the US each year between 1997 and 2013, and the disease is no longer considered endemic there.[25][26][27]

The benefit of measles vaccination in preventing illness, disability, and death has been well documented. The first 20 years of licensed measles vaccination in the US prevented an estimated 52 million cases of the disease, 17,400 cases of intellectual disability, and 5,200 deaths.[28] During 1999–2004, a strategy led by the World Health Organization and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles deaths worldwide.[13] Between 2000 and 2018, measles vaccination resulted in a 73% decrease in deaths from the disease.[15]

Measles is common in many areas of the world. Although it was declared eliminated from the US in 2000, high rates of vaccination and good communication with people who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles in the US.[29] Of the 66 cases of measles reported in the US in 2005, slightly over half were attributable to one unvaccinated individual who acquired measles during a visit to Romania.[30] This individual returned to a community with many unvaccinated children. The resulting outbreak infected 34 people, mostly children and virtually all unvaccinated; 9% were hospitalized, and the cost of containing the outbreak was estimated at $167,685. A major epidemic was averted due to high rates of vaccination in the surrounding communities.[29]

In 2017, an outbreak of measles occurred among the Somali-American community in Minnesota, where MMR vaccination rates had declined due to the misconception that the vaccine could cause autism. The US Centers for Disease Control and Prevention recorded 65 affected children in the outbreak by April 2017.[31]

Rubella edit

 
Rubella rates fell sharply in the United States when immunization was introduced.

Rubella, also known as German measles, was also very common before widespread vaccination. The major risk of rubella is during pregnancy when the baby may contract congenital rubella, which can cause significant congenital defects.[32]

Mumps edit

Mumps is another viral disease that was once very common, especially during childhood. If mumps is acquired by a male who is past puberty, a possible complication is bilateral orchitis, which can in some cases lead to sterility.[33]

Administration edit

The MMR vaccine is administered by a subcutaneous injection, the first dose typically at twelve months of age.[12] The second dose may be given as early as one month after the first dose.[34] The second dose is a dose to produce immunity in the small number of persons (2–5%) who fail to develop measles immunity after the first dose. In the US it is done before entry to kindergarten because that is a convenient time.[35] Areas where measles is common typically recommend the first dose at nine months of age and the second dose at fifteen months of age.[8]

Safety edit

Adverse reactions, rarely serious, may occur from each component of the MMR vaccine. Ten percent of children develop fever, malaise, and a rash 5–21 days after the first vaccination;[36] and 3% develop joint pain lasting 18 days on average.[37] Older women appear to be more at risk of joint pain, acute arthritis, and even (rarely) chronic arthritis.[38] Anaphylaxis is an extremely rare but serious allergic reaction to the vaccine.[39] One cause can be egg allergy.[40] In 2014, the FDA approved two additional possible adverse events on the vaccination label: acute disseminated encephalomyelitis (ADEM), and transverse myelitis, with permission to also add "difficulty walking" to the package inserts.[41] A 2012 IOM report found that the measles component of the MMR vaccine can cause measles inclusion body encephalitis in immunocompromised individuals. This report also rejected any connection between the MMR vaccine and autism.[42] Some versions of the vaccine contain the antibiotic neomycin and therefore should not be used in people allergic to this antibiotic.[19]

The number of reports on neurological disorders is very small, other than evidence for an association between a form of the MMR vaccine containing the Urabe mumps strain and rare adverse events of aseptic meningitis, a form of viral meningitis.[38][43] The UK National Health Service stopped using the Urabe mumps strain in the early 1990s due to cases of transient mild viral meningitis, and switched to a form using the Jeryl Lynn mumps strain instead.[44] The Urabe strain remains in use in a number of countries; MMR with the Urabe strain is much cheaper to manufacture than with the Jeryl Lynn strain,[45] and a strain with higher efficacy along with a somewhat higher rate of mild side effects may still have the advantage of reduced incidence of overall adverse events.[44]

A Cochrane review found that, compared with placebo, MMR vaccine was associated with fewer upper respiratory tract infections, more irritability, and a similar number of other adverse effects.[17]

Naturally acquired measles often occurs with immune thrombocytopenic purpura (ITP, a purpuric rash and an increased tendency to bleed that resolves within two months in children), occurring in 1 to 20,000 cases.[17] Approximately 1 in 40,000 children are thought to acquire ITP in the six weeks following an MMR vaccination.[17] ITP below the age of six years is generally a mild disease, rarely having long-term consequences.[46][47]

False claims about autism edit

Main article: MMR vaccine and autism

In 1998 Andrew Wakefield et al. published a fraudulent paper about twelve children, reportedly with bowel symptoms and autism or other disorders acquired soon after administration of MMR vaccine,[48] while supporting a competing vaccine. In 2010, Wakefield's research was found by the General Medical Council to have been "dishonest",[49] and The Lancet fully retracted the paper.[50][51] Three months following The Lancet's retraction, Wakefield was struck off the UK medical register, with a statement identifying deliberate falsification in the research published in The Lancet,[52] and was barred from practising medicine in the UK.[53] The research was declared fraudulent in 2011 by the British Medical Journal.[54]

Since Wakefield's publication, multiple peer-reviewed studies have failed to show any association between the vaccine and autism.[17][55] The US Centers for Disease Control and Prevention,[56][57] the Institute of Medicine of the US National Academy of Sciences,[58] the UK National Health Service[59] and the Cochrane Library review[17] have all concluded that there is no evidence of a link.

Administering the vaccines in three separate doses does not reduce the chance of adverse effects, and it increases the opportunity for infection by the two diseases not immunized against first.[55][60] Health experts have criticized media reporting of the MMR-autism controversy for triggering a decline in vaccination rates.[61] Before publication of Wakefield's article, the inoculation rate for MMR in the UK was 92%; after publication, the rate dropped to below 80%. In 1998, there were 56 measles cases in the UK; by 2008, there were 1348 cases, with two confirmed deaths.[62]

In Japan, the MMR triplet is not used. Immunity is achieved by a combination vaccine for measles and rubella, followed up later with a mumps only vaccine. This has had no effect on autism rates in the country, further disproving the MMR autism hypothesis.[63]

History edit

 
Maurice Hilleman, who developed the MMR vaccine
 
Two workers make openings in chicken eggs in preparation for a measles vaccine

The component viral strains of MMR vaccine were developed by propagation in animal and human cells.[64]

For example, in the case of mumps and measles viruses, the virus strains were grown in embryonated chicken eggs. This produced strains of virus which were adapted for chicken cells and less well-suited for human cells. These strains are therefore called attenuated strains. They are sometimes referred to as neuroattenuated because these strains are less virulent to human neurons than the wild strains.

The Rubella component, Meruvax, was developed in 1967, through propagation using the human embryonic lung cell line WI-38 (named for the Wistar Institute) that was derived six years earlier in 1961.[65][66]

Disease immunized Component vaccine Virus strain Propagation medium Growth medium
Measles Attenuvax Enders' attenuated Edmonston strain[67] chick embryo cell culture Medium 199
Mumps Mumpsvax[68] Jeryl Lynn (B level) strain[69]
Rubella Meruvax II Wistar RA 27/3 strain of live attenuated rubella virus WI-38 human embryonic cell line MEM (solution containing buffered salts, fetal bovine serum, human serum albumin and neomycin, etc.)

The term "MPR vaccine" is also used to refer to this vaccine, whereas "P" refer to parotitis which is caused by mumps.[1]

Merck MMR II is supplied freeze-dried (lyophilized) and contains live viruses. Before injection it is reconstituted with the solvent provided.[70]

According to a review published in 2018, the GlaxoSmithKline (GSK) MMR vaccine known as Pluserix "contains the Schwarz measles virus, the Jeryl Lynn–like mumps strain, and RA27/3 rubella virus".[71]

Pluserix was introduced in Hungary in 1999.[72] Enders' Edmonston strain has been used since 1999 in Hungary in Merck MMR II product.[72] GSK Priorix vaccine, which uses attenuated Schwarz Measles, was introduced in Hungary in 2003.[72]

MMRV vaccine edit

Main article: MMRV vaccine

The MMRV vaccine, a combined measles, mumps, rubella and varicella (chickenpox) vaccine, has been proposed as a replacement for the MMR vaccine to simplify administration of the vaccines.[34] Preliminary data indicate a rate of febrile seizures of 9 per 10,000 vaccinations with MMRV, as opposed to 4 per 10,000 for separate MMR and varicella shots; US health officials therefore do not express a preference for use of MMRV vaccine over separate injections.[73]

In a 2012 study[74] pediatricians and family doctors were sent a survey to gauge their awareness of the increased risk of febrile seizures (fever fits) in the MMRV. 74% of family doctors and 29% of pediatricians were unaware of the increased risk of febrile seizures. After reading an informational statement only 7% of family doctors and 20% of pediatricians would recommend the MMRV for a healthy 12- to 15-month-old child. The factor that was reported as the "most important" deciding factor in recommending the MMRV over the MMR+V was ACIP/AAFP/AAP recommendations (pediatricians, 77%; family physicians, 73%).

MR vaccine edit

This is a vaccine that covers measles and rubella but not mumps.[22] As of 2014, it was used in a "few (unidentified) countries".[22]

Society and culture edit

Religious concerns edit

Some brands of the vaccine use gelatin, derived from pigs, as a stabilizer.[75] This has caused reduced take-up among some communities,[75][76] despite the fact that alternative vaccines without pig derivatives are approved and available.[75]

References edit

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Further reading edit

External links edit

  • "Measles Mumps Rubella Vaccines". Drug Information Portal. U.S. National Library of Medicine.
  • Measles-Mumps-Rubella Vaccine at the U.S. National Library of Medicine Medical Subject Headings (MeSH)

January 01, 1970
vaccine, vaccine, against, measles, mumps, rubella, german, measles, abbreviated, first, dose, generally, given, children, around, months, months, with, second, dose, months, years, with, least, four, weeks, between, doses, after, doses, people, protected, aga. The MMR vaccine is a vaccine against measles mumps and rubella German measles abbreviated as MMR 6 The first dose is generally given to children around 9 months to 15 months of age with a second dose at 15 months to 6 years of age with at least four weeks between the doses 7 8 9 After two doses 97 of people are protected against measles 88 against mumps and at least 97 against rubella 7 The vaccine is also recommended for those who do not have evidence of immunity 7 those with well controlled HIV AIDS 10 11 and within 72 hours of exposure to measles among those who are incompletely immunized 8 It is given by injection 12 MMR vaccineMMR vaccineCombination ofMeasles vaccineVaccineMumps vaccineVaccineRubella vaccineVaccineClinical dataTrade namesM M R II Priorix Tresivac othersOther namesMPR vaccine 1 AHFS Drugs comMonographMedlinePlusa601176License dataUS DailyMed MeaslesPregnancycategoryAU B2 2 ATC codeJ07BD52 WHO Legal statusLegal statusAU S4 Prescription only UK POM Prescription only US only 3 4 EU Rx only 5 In general Prescription only IdentifiersCAS Number1704518 68 2ChemSpiderNone N Y what is this verify The MMR vaccine is widely used around the world Worldwide over 500 million doses were administered between 1999 and 2004 13 and 575 million doses have been administered since the vaccine s introduction worldwide 14 Measles resulted in 2 6 million deaths per year before immunization became common 14 This has decreased to 122 000 deaths per year as of 2012 update mostly in low income countries 14 Through vaccination as of 2018 update rates of measles in North and South America are very low 14 Rates of disease have been seen to increase in populations that go unvaccinated 14 Between 2000 and 2018 vaccination decreased measles deaths by 73 15 Side effects of immunization are generally mild and resolve without any specific treatment 16 These may include fever as well as pain or redness at the injection site 16 Severe allergic reactions occur in about one in a million people 16 Because it contains live viruses the MMR vaccine is not recommended during pregnancy but may be given while breastfeeding 7 The vaccine is safe to give at the same time as other vaccines 16 Being recently immunized does not increase the risk of passing measles mumps or rubella on to others 7 There is no evidence of an association between MMR immunisation and autistic spectrum disorders 17 18 19 The MMR vaccine is a mixture of live weakened viruses of the three diseases 7 The MMR vaccine was developed by Maurice Hilleman 6 It was licensed for use in USA by Merck in 1971 20 Stand alone measles mumps and rubella vaccines had been previously licensed in 1963 1967 and 1969 respectively 20 21 Recommendations for a second dose were introduced in 1989 20 The MMRV vaccine which also covers chickenpox may be used instead 7 An MR vaccine without coverage for mumps is also occasionally used 22 Contents 1 Medical use 1 1 Measles 1 2 Rubella 1 3 Mumps 1 4 Administration 2 Safety 2 1 False claims about autism 3 History 4 MMRV vaccine 5 MR vaccine 6 Society and culture 6 1 Religious concerns 7 References 8 Further reading 9 External linksMedical use edit nbsp Priorix Cochrane concluded that the Existing evidence on the safety and effectiveness of MMR and MMRV vaccine supports current policies of mass immunisation aimed at global measles eradication in order to reduce morbidity and mortality associated with measles mumps rubella and varicella 17 The combined MMR vaccine induces immunity less painfully than three separate injections at the same time and sooner and more efficiently than three injections given on different dates Public Health England reports that providing a single combined vaccine as of 1988 rather than giving the option to have them also done separately increased uptake of the vaccine 23 Measles edit nbsp Measles cases reported in the United States fell drastically after introduction of the measles vaccine Before the widespread use of a vaccine against measles rates of disease were so high that infection was felt to be as inevitable as death and taxes 24 Reported cases of measles in the United States fell from hundreds of thousands to tens of thousands per year following introduction of the vaccine in 1963 Increasing uptake of the vaccine following outbreaks in 1971 and 1977 brought this down to thousands of cases per year in the 1980s An outbreak of almost 30 000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule Fewer than 200 cases have been reported in the US each year between 1997 and 2013 and the disease is no longer considered endemic there 25 26 27 The benefit of measles vaccination in preventing illness disability and death has been well documented The first 20 years of licensed measles vaccination in the US prevented an estimated 52 million cases of the disease 17 400 cases of intellectual disability and 5 200 deaths 28 During 1999 2004 a strategy led by the World Health Organization and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1 4 million measles deaths worldwide 13 Between 2000 and 2018 measles vaccination resulted in a 73 decrease in deaths from the disease 15 Measles is common in many areas of the world Although it was declared eliminated from the US in 2000 high rates of vaccination and good communication with people who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles in the US 29 Of the 66 cases of measles reported in the US in 2005 slightly over half were attributable to one unvaccinated individual who acquired measles during a visit to Romania 30 This individual returned to a community with many unvaccinated children The resulting outbreak infected 34 people mostly children and virtually all unvaccinated 9 were hospitalized and the cost of containing the outbreak was estimated at 167 685 A major epidemic was averted due to high rates of vaccination in the surrounding communities 29 In 2017 an outbreak of measles occurred among the Somali American community in Minnesota where MMR vaccination rates had declined due to the misconception that the vaccine could cause autism The US Centers for Disease Control and Prevention recorded 65 affected children in the outbreak by April 2017 31 Rubella edit nbsp Rubella rates fell sharply in the United States when immunization was introduced Rubella also known as German measles was also very common before widespread vaccination The major risk of rubella is during pregnancy when the baby may contract congenital rubella which can cause significant congenital defects 32 Mumps edit Mumps is another viral disease that was once very common especially during childhood If mumps is acquired by a male who is past puberty a possible complication is bilateral orchitis which can in some cases lead to sterility 33 Administration edit The MMR vaccine is administered by a subcutaneous injection the first dose typically at twelve months of age 12 The second dose may be given as early as one month after the first dose 34 The second dose is a dose to produce immunity in the small number of persons 2 5 who fail to develop measles immunity after the first dose In the US it is done before entry to kindergarten because that is a convenient time 35 Areas where measles is common typically recommend the first dose at nine months of age and the second dose at fifteen months of age 8 Safety editAdverse reactions rarely serious may occur from each component of the MMR vaccine Ten percent of children develop fever malaise and a rash 5 21 days after the first vaccination 36 and 3 develop joint pain lasting 18 days on average 37 Older women appear to be more at risk of joint pain acute arthritis and even rarely chronic arthritis 38 Anaphylaxis is an extremely rare but serious allergic reaction to the vaccine 39 One cause can be egg allergy 40 In 2014 the FDA approved two additional possible adverse events on the vaccination label acute disseminated encephalomyelitis ADEM and transverse myelitis with permission to also add difficulty walking to the package inserts 41 A 2012 IOM report found that the measles component of the MMR vaccine can cause measles inclusion body encephalitis in immunocompromised individuals This report also rejected any connection between the MMR vaccine and autism 42 Some versions of the vaccine contain the antibiotic neomycin and therefore should not be used in people allergic to this antibiotic 19 The number of reports on neurological disorders is very small other than evidence for an association between a form of the MMR vaccine containing the Urabe mumps strain and rare adverse events of aseptic meningitis a form of viral meningitis 38 43 The UK National Health Service stopped using the Urabe mumps strain in the early 1990s due to cases of transient mild viral meningitis and switched to a form using the Jeryl Lynn mumps strain instead 44 The Urabe strain remains in use in a number of countries MMR with the Urabe strain is much cheaper to manufacture than with the Jeryl Lynn strain 45 and a strain with higher efficacy along with a somewhat higher rate of mild side effects may still have the advantage of reduced incidence of overall adverse events 44 A Cochrane review found that compared with placebo MMR vaccine was associated with fewer upper respiratory tract infections more irritability and a similar number of other adverse effects 17 Naturally acquired measles often occurs with immune thrombocytopenic purpura ITP a purpuric rash and an increased tendency to bleed that resolves within two months in children occurring in 1 to 20 000 cases 17 Approximately 1 in 40 000 children are thought to acquire ITP in the six weeks following an MMR vaccination 17 ITP below the age of six years is generally a mild disease rarely having long term consequences 46 47 False claims about autism edit Main article MMR vaccine and autism In 1998 Andrew Wakefield et al published a fraudulent paper about twelve children reportedly with bowel symptoms and autism or other disorders acquired soon after administration of MMR vaccine 48 while supporting a competing vaccine In 2010 Wakefield s research was found by the General Medical Council to have been dishonest 49 and The Lancet fully retracted the paper 50 51 Three months following The Lancet s retraction Wakefield was struck off the UK medical register with a statement identifying deliberate falsification in the research published in The Lancet 52 and was barred from practising medicine in the UK 53 The research was declared fraudulent in 2011 by the British Medical Journal 54 Since Wakefield s publication multiple peer reviewed studies have failed to show any association between the vaccine and autism 17 55 The US Centers for Disease Control and Prevention 56 57 the Institute of Medicine of the US National Academy of Sciences 58 the UK National Health Service 59 and the Cochrane Library review 17 have all concluded that there is no evidence of a link Administering the vaccines in three separate doses does not reduce the chance of adverse effects and it increases the opportunity for infection by the two diseases not immunized against first 55 60 Health experts have criticized media reporting of the MMR autism controversy for triggering a decline in vaccination rates 61 Before publication of Wakefield s article the inoculation rate for MMR in the UK was 92 after publication the rate dropped to below 80 In 1998 there were 56 measles cases in the UK by 2008 there were 1348 cases with two confirmed deaths 62 In Japan the MMR triplet is not used Immunity is achieved by a combination vaccine for measles and rubella followed up later with a mumps only vaccine This has had no effect on autism rates in the country further disproving the MMR autism hypothesis 63 History edit nbsp Maurice Hilleman who developed the MMR vaccine nbsp Two workers make openings in chicken eggs in preparation for a measles vaccine The component viral strains of MMR vaccine were developed by propagation in animal and human cells 64 For example in the case of mumps and measles viruses the virus strains were grown in embryonated chicken eggs This produced strains of virus which were adapted for chicken cells and less well suited for human cells These strains are therefore called attenuated strains They are sometimes referred to as neuroattenuated because these strains are less virulent to human neurons than the wild strains The Rubella component Meruvax was developed in 1967 through propagation using the human embryonic lung cell line WI 38 named for the Wistar Institute that was derived six years earlier in 1961 65 66 Disease immunized Component vaccine Virus strain Propagation medium Growth medium Measles Attenuvax Enders attenuated Edmonston strain 67 chick embryo cell culture Medium 199 Mumps Mumpsvax 68 Jeryl Lynn B level strain 69 Rubella Meruvax II Wistar RA 27 3 strain of live attenuated rubella virus WI 38 human embryonic cell line MEM solution containing buffered salts fetal bovine serum human serum albumin and neomycin etc The term MPR vaccine is also used to refer to this vaccine whereas P refer to parotitis which is caused by mumps 1 Merck MMR II is supplied freeze dried lyophilized and contains live viruses Before injection it is reconstituted with the solvent provided 70 According to a review published in 2018 the GlaxoSmithKline GSK MMR vaccine known as Pluserix contains the Schwarz measles virus the Jeryl Lynn like mumps strain and RA27 3 rubella virus 71 Pluserix was introduced in Hungary in 1999 72 Enders Edmonston strain has been used since 1999 in Hungary in Merck MMR II product 72 GSK Priorix vaccine which uses attenuated Schwarz Measles was introduced in Hungary in 2003 72 MMRV vaccine editMain article MMRV vaccine The MMRV vaccine a combined measles mumps rubella and varicella chickenpox vaccine has been proposed as a replacement for the MMR vaccine to simplify administration of the vaccines 34 Preliminary data indicate a rate of febrile seizures of 9 per 10 000 vaccinations with MMRV as opposed to 4 per 10 000 for separate MMR and varicella shots US health officials therefore do not express a preference for use of MMRV vaccine over separate injections 73 In a 2012 study 74 pediatricians and family doctors were sent a survey to gauge their awareness of the increased risk of febrile seizures fever fits in the MMRV 74 of family doctors and 29 of pediatricians were unaware of the increased risk of febrile seizures After reading an informational statement only 7 of family doctors and 20 of pediatricians would recommend the MMRV for a healthy 12 to 15 month old child The factor that was reported as the most important deciding factor in recommending the MMRV over the MMR V was ACIP AAFP AAP recommendations pediatricians 77 family physicians 73 MR vaccine editThis section needs to be updated Please help update this article to reflect recent events or newly available information November 2022 This is a vaccine that covers measles and rubella but not mumps 22 As of 2014 it was used in a few unidentified countries 22 Society and culture editReligious concerns edit Some brands of the vaccine use gelatin derived from pigs as a stabilizer 75 This has caused reduced take up among some communities 75 76 despite the fact that alternative vaccines without pig derivatives are approved and available 75 References edit a b Grignolio A 2018 Vaccines Are they Worth a Shot Springer p 2 ISBN 9783319681061 Archived from the original on 17 April 2021 Retrieved 22 May 2020 Measles virus vaccine mumps virus vaccine rubella virus vaccine M M R II Use During Pregnancy Drugs com 16 October 2019 Archived from the original on 12 November 2020 Retrieved 5 September 2020 M M R II measles mumps and rubella virus vaccine live injection powder lyophilized for suspension DailyMed 23 May 2022 Archived from the 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PMID 6075651 S2CID 35878536 About the Vaccine MMR and MMRV Vaccine Composition and Dosage U S Centers for Disease Control and Prevention CDC 26 January 2021 Archived from the original on 6 October 2021 Retrieved 7 October 2021 Reef SE Plotkin SA 2018 Rubella Vaccines Plotkin s Vaccines pp 970 1000 e18 doi 10 1016 B978 0 323 35761 6 00052 3 ISBN 9780323357616 a b c Borocz K Csizmadia Z Markovics A Farkas N Najbauer J Berki T et al February 2020 Application of a fast and cost effective three in one MMR ELISA as a tool for surveying anti MMR humoral immunity the Hungarian experience Epidemiology and Infection 148 e17 doi 10 1017 S0950268819002280 PMC 7019553 PMID 32014073 Centers for Disease Control and Prevention CDC Advisory Committee on Immunization Practices ACIP March 2008 Update recommendations from the Advisory Committee on Immunization Practices ACIP regarding administration of combination MMRV vaccine PDF MMWR Morbidity and Mortality Weekly Report 57 10 258 260 PMID 18340332 Archived PDF from the original on 19 October 2020 Retrieved 26 January 2020 O Leary ST Suh CA Marin M November 2012 Febrile seizures and measles mumps rubella varicella MMRV vaccine what do primary care physicians think Vaccine 30 48 6731 6733 doi 10 1016 j vaccine 2012 08 075 PMID 22975026 a b c Vaccines and porcine gelatine PDF Public Health England August 2015 Archived PDF from the original on 14 April 2019 Retrieved 14 April 2019 Pager T 9 April 2019 Monkey Rat and Pig DNA How Misinformation Is Driving the Measles Outbreak Among Ultra Orthodox Jews The New York Times Archived from the original on 14 April 2019 Retrieved 14 April 2019 Further reading editWorld Health Organization January 2009 The immunological basis for immunization series module 7 measles update 2009 World Health Organization WHO hdl 10665 44038 ISBN 9789241597555 World Health Organization November 2010 The immunological basis for immunization series module 16 mumps World Health Organization WHO hdl 10665 97885 ISBN 9789241500661 World Health Organization December 2008 The immunological basis for immunization series module 11 rubella World Health Organization WHO hdl 10665 43922 ISBN 9789241596848 Ramsay M ed December 2019 Chapter 21 Measles Immunisation against infectious disease Public Health England Ramsay M ed April 2013 Chapter 23 Mumps Immunisation against infectious disease Public Health England Ramsay M ed April 2013 Chapter 28 Rubella Immunisation against infectious disease Public Health England Hamborsky J Kroger A Wolfe S eds 2015 Chapter 13 Measles Epidemiology and Prevention of Vaccine Preventable Diseases 13th ed Washington D C U S Centers for Disease Control and Prevention CDC ISBN 978 0990449119 Hamborsky J Kroger A Wolfe S eds 2015 Chapter 15 Mumps Epidemiology and Prevention of Vaccine Preventable Diseases 13th ed Washington D C U S Centers for Disease Control and Prevention CDC ISBN 978 0990449119 Hamborsky J Kroger A Wolfe S eds 2015 Chapter 20 Rubella Epidemiology and Prevention of Vaccine Preventable Diseases 13th ed Washington D C U S Centers for Disease Control and Prevention CDC ISBN 978 0990449119 Roush SW Baldy LM Hall MA eds March 2019 Chapter 7 Measles Manual for the surveillance of vaccine preventable diseases Atlanta GA U S Centers for Disease Control and Prevention CDC Roush SW Baldy LM Hall MA eds March 2019 Chapter 9 Mumps Manual for the surveillance of vaccine preventable diseases Atlanta GA U S Centers for Disease Control and Prevention CDC Roush SW Baldy LM Hall MA eds March 2019 Chapter 14 Rubella Manual for the surveillance of vaccine preventable diseases Atlanta GA U S Centers for Disease Control and Prevention CDC External links edit Measles Mumps Rubella Vaccines Drug Information Portal U S National Library of Medicine Measles Mumps Rubella Vaccine at the U S National Library of Medicine Medical Subject Headings MeSH Portals nbsp Medicine nbsp Viruses Retrieved from https en wikipedia org w index php title MMR vaccine amp oldid 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