MMR vaccine

The measles, Mumps and Rubella (MMR) vaccine is a prescription medication in the vaccine class.

The MMR vaccine is approved to prevent measles, mumps, and rubella infections. It is a safe and effective vaccination that helps fight against these infectious diseases and related complications.

It is administered to children as part of routine national immunisation programs.

The MMR vaccination does not go through normal drug-like processes, including absorption, distribution, metabolism, or excretion. Instead, it stimulates the immune system to produce defence immunity.

The common side effects of the MMR vaccine may include pain, redness, lump at the injection site, back/joint pain, headache, nausea, and dizziness.

MMR vaccines are available as a powder for injection.

MMR vaccines are available in many countries globally like India, Germany, the United States, the United Kingdom, South Africa, China, Russia, Philippines, France, Canada and Australia.

The MMR vaccine class stimulates immunity by producing antibodies against Measles, Mumps, and Rubella virus.

The Measles, Mumps, and Rubella vaccine, sometimes known as the MMR vaccine, is a vital vaccination that contributes to the immune system to fight off these infectious illnesses. It uses live attenuated viruses, weaker, less aggressive versions of the actual pathogens. This ensures safety while eliciting an effective immune response. The MMR vaccination is highly effective since it is live, but several doses are required to develop long-lasting protection. This multi-dose regimen promotes immune system development and disease prevention by giving them reliable immunity against measles, mumps, and rubella.

MMR vaccines are available as a powder for injection.

Powder for injection: The MMR vaccine is supplied in two vials containing freeze-dried powder and a sterile diluent. It is generally given after thoroughly combining the powder and diluent and then drawing it into the syringe.

It is to be administered parenterally, as applicable.

Immunizing with the MMR vaccine can prevent measles, mumps, and rubella infections. Risks of disease, complications, and transmission among the population are reduced since it protects against these highly infectious diseases.

MMR vaccine can help support the following health benefits:

• Prevention: The primary advantage of the MMR vaccination is that it protects against measles, mumps, and rubella, three highly infectious diseases that can cause serious complications, even death in the case of measles. As a result of vaccination, individuals develop immunity, which lowers their risk of developing these medical conditions and any potential health effects, such as birth problems from viral during pregnancy.
• Community Health: MMR vaccination is crucial for developing herd immunity. It prevents disease transmission and protects vulnerable populations, including newborns, the elderly, and those with weakened immune systems, when a significant percentage of the community is immune. The general well-being of a population is improved by having high immunisation rates, which are essential for preventing epidemics and ensuring community safety.
• Reduced hospitalization: MMR vaccination programmes, among others, result in long-term financial benefits by reducing the need for treatment, hospitalisation, and prolonged care. They also show immunisations as beneficial public health investment by improving the well-being of employees, decreasing lost workdays, and raising total society productivity.

MMR vaccines are approved for use in the following clinical indications:

• Prophylaxis against measles
• Prophylaxis against mumps
• Prophylaxis against rubella

Parenterally: MMR vaccine is available in powder for injection. For infants and young children, the vaccine is injected into the vastus lateralis part of the thigh, whereas for adults, it is injected into the deltoid muscle. It should be administered intramuscularly and subcutaneously and not intravenously or intradermally.

It can be only given by a healthcare professional in a hospital setting or during routine immunization programs.

After administration, the healthcare provider will document the vaccination, including the date, time, dose, and injection site.

The dosage and duration of treatment should be as per the treating physician's clinical judgment.

MMR vaccine is available as a powder for injection.

Injection, lyophilized powder for reconstitution

≥1000 Tissue culture infectious doses (TCID)50/≥12,500 TCID50/≥1000 TCID50 (M-M-R II)

≥3.4 log10 Cell culture infectious doses (CCID)50/≥4.2 log10 CCID50/≥3.3 log10 CCID50 (Priorix)

Dosage Adjustment for Adult Patients

Immunization Against Measles, Mumps & Rubella

19 to 49 years old: 0.5 mL SC/IM (primary dose) and second dose is administered to high-risk individuals after 28 days

More than 50 years old: 0.5 mL SC/IM but administer only 1 dose.

Post-exposure prophylaxis

Administer 0.5 mL/SC/IM x 1 dose within 72 hr after exposure

2nd dose recommendations

Student in post-secondary education

Recent exposure

Occupational risk

Previously vaccinated with killed measles vaccine

Vaccinated with an unknown type of measles vaccine during 1963-67

International travellers

Healthcare personnel should consider getting the MMR vaccination in two doses for measles and mumps and one dose for rubella at appropriate times.

MMR vaccine is available as a powder for injection.

MMR vaccine should be used to prevent measles, mumps and rubella infections, along with no appropriate dietary restrictions. Consuming regular foods and drinks before and after receiving the vaccine is safe.

However, staying fully hydrated and maintaining a healthy, balanced diet rich in fruits, vegetables, whole grains, and lean proteins that can help support overall immune system function is always recommended, which can boost the effectiveness of vaccines.

The dietary restriction should be individualized as per patient requirements.

MMR vaccine may be contraindicated in the following conditions: -

• Anaphylaxis reactions (Hypersensitivity to any component of the MMR vaccine like neomycin or gelatin)
• Pregnancy
• Immunodeficiency disorders like HIV/AIDS infection
• Severe previous response to the MMR vaccination

• Hematopoietic proliferative diseases
• Solid tumours/chemotherapy
• Blood Transfusions or Immune Globulins
• Long-term immunosuppressive therapy
• Individuals with lymphomas, leukaemia, blood dyscrasias, or any other malignant tumours affecting the lymphatic or bone marrow

• Family history of congenital or hereditary immunodeficiency

The treating physician must closely monitor the patient and keep pharmacovigilance as follows.

• Children with weak immune systems, such as those with HIV/AIDS infection or cancer or who are taking certain drugs, may not respond as well to the MMR vaccine and may consult a healthcare professional who might suggest modifying the vaccine schedule or giving additional doses to these people to improve protection.
• It may be advisable to postpone the vaccination if the child is currently experiencing a fever or a moderate to severe sickness.
• Healthcare professionals should assess the risks and benefits of the vaccination in case of any severe allergic reactions or a severe reaction to a previous dose of the MMR vaccine.
• MMR vaccines are not typically recommended during pregnancy, and advised to avoid getting pregnant atleast 3 months after vaccination.
• Individuals with a history of low platelet count or bleeding disorders should be cautious while taking the MMR vaccine.
• When administering the MMR vaccine simultaneously with MMR immunoglobulin or other vaccines, it is recommended to use separate syringes and distinct injection sites.

Caution is advised when consuming alcohol with the MMR vaccine

There is no sufficient scientific evidence traceable regarding the use and safety of the MMR vaccine in the breastfeeding population.

There is no sufficient scientific evidence traceable regarding the use and safety of the MMR vaccine in concurrent use with any particular food.

The adverse reactions related to MMR vaccine can be categorized as

• Common: Pain, erythema, swelling or itching at the injection site, headache, temporal joint pain and low-grade fever
• Less Common: Mild fever, swollen glands (lymphadenopathy)
• Rare: Severe allergic reactions, febrile seizures, high-grade fever and thrombocytopenia.

The clinically relevant drug interactions of the MMR vaccine are briefly summarized here:

• Immunosuppressants- Drugs like prednisone or cyclosporine suppress the immune system and may reduce the effectiveness of the MMR vaccine when used.
• Immunoglobulins: Administering immunological globulins, such as immune globulins for hepatitis B or rabies, around the same time as the MMR vaccine may interfere with the vaccine's effectiveness when used concurrently. It is generally recommended to wait and administer after a certain period between receiving immune globulins and the MMR vaccine.
• Other Vaccines: Children are administered different vaccines to reduce any risk; it is generally recommended to administer them at separate sites and times from the MMR vaccine to minimize the risk of interference. Other live vaccines should be administered at least four weeks apart to avoid the risk of one immune response interfering with another.

The common side of the MMR vaccine includes the following-

• Redness, pain, swelling or lump where the shot was given
• Headache
• Joint pain
• Nausea
• Dizziness
• Headache
• Vomiting
• Diarrhea
• Fever
• Rash

The MMR vaccine should be prudent in the following group of special populations.

• Pregnancy:

MMR vaccine is usually considered contraindicated during pregnancy; avoid pregnancy for 3 months following vaccination.

A 10-year research indicated that babies who received the rubella vaccine during pregnancy did not develop congenital rubella syndrome. Mumps infection during the first trimester may increase the chance of spontaneous abortion, and there is no proof that the mumps vaccination causes human congenital disabilities. Data on the effects of the vaccination strain are few, although wild-type measles during pregnancy is linked to foetal hazards. Cautious is recommended while using.

• Paediatrics: Paediatricians recommend the MMR vaccination to protect children against measles, mumps, and rubella to protect them against serious infections, complications, hospitalisation, and outbreaks.

Dosage Adjustment for Paediatric Patients

Immunization Against Measles, Mumps & Rubella

Routine vaccination: The first dose must be administered by 12 months.

The primary dose is 0.5 mL SC/IM between ages 1 to 15 months, and the secondary dose is between 4 to 6 years.

International travel:

6 to 12 months. Administer 1 MMR dose before leaving the country for foreign travel; follow up with two doses of the vaccine, the first at 12 to 15 months of age (12 months if the child lives in a region with a high illness risk) and the second at least four weeks later

More than 12 months: Before departing the country for a foreign trip, give the MMR vaccine in two doses. The first dosage should be given at or after 12 months, and the second dose at least four weeks later.

Catch-up vaccination:

A single injection of 2 doses (0.5 mL SC/IM each) should be administered to all school-aged children and adolescents.

A minimum of 4 weeks must be apart between the first and second dosage.

HIV infection during pregnancy:

After successful antiretroviral therapy has been established, administer two doses of the MMR vaccination at scheduled times to people who had received the vaccine before that time.

More than 12 years or older with HIV infection:

Give the vaccine to all HIV-positive people with no signs of severe immunosuppression currently.

• Geriatrics: MMR vaccine can be given to geriatrics (elderly individuals) if they have not previously been vaccinated or lack evidence of immunity to measles, mumps, and rubella. They are mainly advised when there is a significant risk of exposure. Unless the risk of exposure is very high, routine vaccinations are not typically recommended for geriatrics.
• Lactating mothers:

There is no sufficient scientific evidence traceable regarding the use and safety of the MMR vaccine for lactating mother populations.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Overdosage of MMR vaccine rarely occurs as healthcare professionals administer it according to specific or precise dosing guidelines. If multiple doses were accidentally administered, it could be prevented by implementing measures such as proper record-keeping and verification of previous vaccinations.

There is no specific antidote or treatment for excessive intake of MMR vaccine. Medical attention should be sought immediately when an overdose is suspected, followed by monitoring any adverse effects or allergic reactions. Supportive therapy should also be given, addressing any symptoms that persist or worsen. Physical treatment might be added if necessary.

Pharmacodynamics of MMR vaccine:

The MMR vaccines have a physiological mechanism that plays a role in their pharmacodynamics.

Measles, mumps, and rubella (MMR) vaccine pharmacodynamics include interactions with the immune system to trigger protective responses against these viral diseases. The vaccine's antigens trigger an immune response once administered to a patient. The measles, mumps, and rubella antigens stimulate B and T cells by acting like viruses without actually causing the illnesses. T cells contribute to the eradication of certain infections, while B cells create antibodies that are specific to infections. The production of memory cells ensures long-lasting immunity. This dynamic process sets up the immune system to provide a rapid and effective defence upon contact with actual viruses, preventing or lessening the severity of illnesses and promoting herd immunity.

Pharmacokinetics of MMR vaccine:

Regarding pharmacokinetics, the MMR vaccination differs from drugs since it does not involve processes like absorption, distribution, metabolism, or excretion. Instead, it establishes defence immunity through the complex operations of the immune system. Antigens from the vaccine are absorbed after injection, triggering an immunological response that produces antibodies and, eventually, immunity. The exact kinetics of this process differ from person to person, and research remains in progress to better understand and optimise the efficacy of vaccines.

Duration: more than 15 years after 2 doses

Onset: Active immunity detected after 1 dose

• Zimakoff A C, Jensen A, Vittrup D M, Herlufsen E H, Sørensen J K, Malon M et al. Measles, mumps, and rubella vaccine at age 6 months and hospitalisation for infection before age 12 months: randomised controlled trial BMJ 2023; 381 :e072724
• Elliman, D, and H Bedford. “MMR vaccine: the continuing saga.” BMJ (Clinical research ed.) vol. 322,7280 (2001): 183-4. doi:10.1136/bmj.322.7280.183
• Vesikari, T. et al. “Clinical trial of a new trivalent measles-mumps-rubella vaccine in young children.” American journal of diseases of Children (1960) vol. 138,9 (1984): 843-7. doi:10.1001/archpedi.1984.02140470043013

• Inform the caregivers of the schedule for administering the MMR vaccine also explain how the medication should be taken, e.g., with food, water, or any special instructions like shaking the bottle
• Assure caregivers that MMR vaccine immunizations are generally safe, with only minor, short side effects. Encouraging them to immediately report any unexpected or severe responses to the healthcare physician and, whenever applicable, to use reporting systems like the Vaccine Adverse Event Reporting System (VAERS)
• Inform caregivers of the recommended immunization schedule, which usually consists of two or three doses, depending on the vaccine brand. Also, mention the ages at which the doses should be administered and give the Vaccine Information Statements, which must be disclosed before immunization by the National Childhood Vaccine Injury Act of 1986 about the Centres for Disease Control and Prevention (CDC) website (www.cdc.gov/vaccines), these resources are freely accessible.

• https://www.cdc.gov/vaccines/hcp/vis/vis-statements/MMR.html
• https://medicalguidelines.msf.org/
• https://www.cdc.gov/vaccines/vpd/mmr/public/index.html
• https://www.ncbi.nlm.nih.gov/books/NBK554450/
• https://www.indianpediatrics.net/oct2014/785 figure1.pdf