What is MMR?
MMR is the combined vaccine against measles, mumps and rubella. It is the safest way to protect our children against these diseases
Why should my child have the MMR vaccine?
If children do not have protection against measles, mumps and rubella, we run the risk of new epidemics.
This means not just measles outbreaks, but also the return of babies born with terrible defects as a result of congenital rubella syndrome, or of children becoming deaf or hospitalised following mumps.
Who should have the immunisation?
All babies over 12 months of age (usually at 13 months) should receive a dose of MMR vaccine by injection. All children between 3 and 5 years of age should receive a second dose, before starting school.
How long does it protect for?
MMR vaccine gives long-term protection.
MMR has been used in the United States for nearly 30 years and has reduced the level of disease to very low levels. After almost 20 years in Finland the protection offered by MMR has eliminated measles, mumps and rubella.
MMR vaccine can be used to protect people who have come into contact with measles during an outbreak of the disease, but it must be given within three days of exposure.
Are there any side effects?
The three separate vaccines in the MMR vaccination may have different side effects at different times.
Six to 10 days after their MMR vaccine, some children may become feverish, develop a measles-like rash and go off their food as the measles part of the vaccine starts to work.
In the 6 weeks after the vaccine, your child may (very rarely) get a rash of small bruise-like spots. If you see spots like these, show them to your doctor.
Very rarely, children may get a mild form of mumps about 3 weeks after their immunisation. They will not be infectious and they can mix with other people as normal.
About 1 child in every 1000 who has the immunisation may have a fit which is usually caused by a fever and is called a 'febrile convulsion'. But if a child has not been immunised and they get measles, they are 10 times more likely to have a fit.
Although encephalitis (inflammation of the brain) has been reported (one case in a million doses), the risk of children getting encephalitis after MMR vaccine is no higher than the risk of encephalitis if they had not had the vaccine.
However, the risk of a child developing encephalitis as a result of having measles is more common - about one in every 5000 cases. It is even less common to have side effects after the second (pre-school) dose, and when side effects do happen, they are usually much milder.
These risks are much smaller than those associated with measles itself.
Reasons for not giving MMR:
People should not be given the MMR vaccine if they:
have untreated malignant disease or altered immunity; this includes people receiving immunosuppressive treatment or X-ray therapy (radiotherapy) or high dose steroids
have had a severe allergic reaction to MMR vaccine previously
react severely to neomycin or kanamycin
are pregnant (women should avoid becoming pregnant for one month after MMR)
have had a blood, plasma or immunoglobulin transfusion in the previous three months
have received another live vaccine in the preceding 3 weeks.
How effective is MMR?
A single dose of the MMR vaccine gives 90% protection against measles and mumps and 95% against rubella. This means that out of 100 people given the vaccine, 90 will then be immune to measles and mumps, and 95 to rubella.
Adding a second dose increases the protection to over 99%. In most years since its introduction MMR has been given to more than 90% of children. The combination of high uptake and two doses makes it much more likely that we will be able to eliminate measles in this country.
Since the introduction of MMR in 1988, the incidence of mumps has fallen to its lowest ever levels. Recently there has been an increase in cases of mumps in young people too old to have had MMR.
My child gets a rash when she eats eggs. Is the MMR vaccine safe for her?
Because the measles part of the MMR vaccine is grown in chick cells, there was a worry that it might cause a reaction in children who are allergic to eggs. In fact, evidence shows that it is safe to give MMR vaccine even to children who have a very severe reaction to eggs. If you are worried about how your child will react to the vaccine, talk to your doctor, who may consider immunising her in a hospital so she can be watched carefully.
Why are two doses of MMR vaccine given?
To give better protection.
After the first dose of vaccine, up to 5-10% of people remain unprotected against measles, and a similar proportion remain susceptible to mumps; less than 5% remain unprotected against rubella.
After two doses of MMR, less than 1% of people remain susceptible.
For this reason, all countries in the EU, plus the US, Canada, Australia and New Zealand, recommend two doses of MMR in childhood.
Why isn't the MMR vaccine given in separate, single doses?
Measles, mumps and rubella vaccines have never been given separately in infancy in the UK.
Before the introduction of MMR in 1988, measles vaccine used to be given to infants from age one and (up to 1996) rubella vaccine was given to girls at age 10 to 13 years.
Separate mumps vaccine has never been routinely given in the UK.
There is no advantage in giving these vaccines separately. In fact, it makes it more likely that your child will catch one of the diseases.
Why? Because delaying giving any element of the vaccine simply puts a child at greater risk of contracting that disease.
Some people argue that making single vaccines available (that is, one for measles, one for mumps and one for rubella) would be better because parents who don't want their children to have the MMR would take the single vaccines. In fact, the evidence from the UK and elsewhere is that the opposite is true.
With six injections, it is very likely that many children would not complete the course. Therefore, to suggest that giving six injections rather than two will improve uptake is unlikely.
Uptake would be poorer with single vaccines than with the MMR, children would be unprotected while waiting between vaccines and so more children would be at risk from the diseases.
Single unlicensed vaccines imported into this country have not been independently tested for potency and toxicity in the same way as MMR vaccine.
Following the scare about whooping cough vaccine in the 1970s, parents were offered the option of splitting out the whooping cough vaccine from DTP. As a result many parents opted not to have the whooping cough part. The catastrophic result of this was that coverage dropped from 80% to around 30% with whooping cough epidemics in 1977/79 and 1981/83. There were over 100,000 notified cases in England and Wales and over 100 totally preventable deaths.
Can my baby's immune system cope with so many vaccines?
There is no evidence to suggest that having a number of vaccines, even one at a time, overloads the immune system. Our immune systems are being challenged by many different antigens around us all the time so there is no reason to think that those in a vaccine will overload the system.
In the US, where more vaccines are given in a single GP visit than in the UK, a study found no difference in hospital admission in children who had had multiple immunisations compared with children who had only received polio vaccine.
Is there a link between MMR and autism?
There has recently been much publicity about a suggested link between autism and the MMR vaccine. All recent research in this area shows there is no link.
As the effects of autism are typically first noticed when a child is between one and two years of age, they often coincide with a child receiving MMR vaccine. This suggested to some people that MMR could be causing the autism.
Autism is a condition where people fail to interact socially, have poor language skills and obsessional tendencies. There is a wide range of autistic disorders.
Autism is said to be on the rise, but this may be because doctors are now diagnosing it more.
The most recent studies in the UK, California, Finland and Sweden on the adverse effects of MMR have found no evidence of such a link. A review of all the scientific evidence carried out by the US Institute of Medicine also concluded that the evidence does not support a link between MMR and autism. The changes in the reported levels of autism in the UK (and the USA and Sweden) show no link to the introduction of MMR or changes in MMR uptake.
Does MMR vaccine cause bowel disease?
In the early 1990s a group of researchers suggested there might be a link between measles infection and inflammatory bowel disease (IBD) in young adults. They subsequently published a paper which some people interpreted as suggesting a link between measles-containing vaccines such as MMR, and IBD. Subsequent research has shown no link between measles, measles vaccines or MMR vaccine and IBD.
What's the overall risk?
The risks associated with the effects of the three diseases are much greater than the potential risks of the vaccine. MMR has been given for nearly 30 years in the US and is considered very safe. Around the world more than 90 countries have given more than 500 million doses of the MMR vaccine with, in the words of the World Health Organisation, "an outstanding safety record".
This position is supported by the following organisations:
Royal College of General Practitioners
British Medical Association
Royal College of Nursing
Faculty of Public Health Medicine
UK Public Health Association
Royal College of Midwives
Community Practitioners and Health Visitors Association
Royal Pharmaceutical Society
Public Health Laboratory Service
Medicines Control Agency
The information above has been sourced from Health Promotion England.
As many of you are aware, there is a lot of controversy surrounding MMR and its links to inflammatory bowel disease and autism. Dr Sarah Brewer was recently asked in our 'Ask the Doctor' section about her views on the safety of MMR. Click here to see her response.
Below are several sites that discuss MMR in more detail. As always though, if you have any further questions or concerns you should contact your health visitor and/or doctor.
The Department of Health discusses the MMR vaccination.
The National Autistic Society provides plenty of information on the MMR vaccination along with their views on its links to autism.
If you would like more information on Single Vaccinations, the Medicines Control Agency's regulations, how to secure single vaccinations for your child, and where to go for help with this visit JABS, where you can request full details and listings of sympathetic practioners, via e-mail.
JABS is a parent-led organisation, campaigning for the parental right to informed choice on vaccines. It describes itself as not anti-vaccines but anti-damage.