MMR Vaccination

Measles, Mumps and Rubella Immunisation

I believe that MMR (triple dose: PRIORIX GSK) immunisation has a reasonable safety profile from the available evidence at the moment.  Two of my three children have been given the MMR immunisation.  The Department of Health recommends MMR immunisation.  Information can be obtained on their web site at http://www.doh.gov.uk/cmo/cmoh.htm

Some of the concerns about MMR immunisation stem from the research of a group at The Royal Free Hospital led by Dr Andrew Wakefield, who have suggested that both the measles infection and measles vaccination can be associated with an increased risk of Crohn’s disease (an inflammatory disease of the bowel), and that MMR vaccine may be associated with the development of autism (a disorder frequently diagnosed in the 2^nd year of life). 

MMR was introduced into the UK immunisation programme in 1988, since when around 10 million immunisations have been given to children at the age of 13-15 months as well as at 4 years of age and no obvious statistical relationship between MMR and autism or Crohn’s has been established.  This said, I understand as a parent your concerns given the present media attention to MMR and the fact that it may be considered unnatural to get infected with three live, albeit attenuated viruses, all at once.

I believe that giving the measles, mumps and rubella immunisation separately provides an acceptable way of immunising against these three conditions.  There is, however, little evidence in the literature that they are safer when given singly.  It has been suggested that they are marginally less effective when given singly because the immune response obtained is not so great.  However, it is just the sheer volume of the immune response when all are given at the same time which has given cause for concern.  The single measles, rubella and mumps immunisations do not have a UK product licence but do in France, France and USA respectively.   They are the same attenuated viruses as in the MMR. That is for measles the Schwartz strain, for rubella the Wistar RA27/3M and the mumps the Jeryl Lynn Strain. As with any vaccines there may be problems with availability. 

(Currently the Mumps Vaccine is unavailable. It has been off the market for about 2 years now.)

The other disadvantage of giving the immunisations separately is the time it takes for the full immunisation programme to be completed.  I recommend a period of six months between immunisations as by this time the acute antibodies to an infection have fallen back to normal levels.  (Dr Andrew Wakefield at The Royal Free Hospital recommends one year.  There is some evidence that having the wild measles and mumps within a year of each other in childhood predisposes to Crohn’s disease).  These are both empirical times.

My experience with giving the immunisations singly over the past 4 years is that they are at least as effective at inducing protective antibodies as the MMR. Also if I had given as many MMRs as I have given completed single immunisations I would have expected between 6 and 10 children to be admitted to hospital with fever induced fits .So far none have needed admission or had fits, neither have any children had measles, mumps or rubella after or whilst waiting immunisation.

                                                                                                                                                           

                                                                                                                                   

POSSIBLE REACTIONS TO MEASLES, MUMPS AND RUBELLA IMMUNISATIONS

Allergic reactions to the individual components of the measles, mumps and rubella immunisations

After any immunisation one can have an acute allergic reaction to it and so following immunisation I ask you to wait for about 10 minutes (or one hour if there is a suspicion that your child is egg allergic).  It is also possible to have an allergic type reaction 24 – 48 hours after the immunisation with swelling at the site, fever and irritability.  This should be treated with regular a Calpol

The infective elements of the reaction tend to occur later than this:

Measles 

With the measles vaccine there is a 1:10 chance of a modified measles like illness at 5–12 days after immunisation with fever, rash, irritability and diarrhoea.  You should treat this with regular Calpol and Nurofen as it is said that 1 in 1000 children will develop a febrile convulsion or fit following the measles (or MMR) immunisation.

With both the measles and rubella components the child may very rarely develop a rash of small bruise-like spots in the six weeks after immunisation.

Mumps

A modified mumps infection following the mumps immunisation is less common than with measles and occurs later, 2–3 weeks after the immunisation, with pain and swelling in the parotid glands (the glands just beneath the ear), fever and irritability.  There is generally no rash.  Again Calpol or Nurofen should be given regularly.

Rubella

Following the rubella immunisation there is not usually very much in the way of an infective reaction but more often there is a post viral “reactive arthritis” with pain and swelling in the joints which occurs 2–3 weeks after the immunisation.

The strains of the viruses given singly are exactly the same ones as in the MMR so your doctor will have come across the various components to the reactions if your child develops these.  However please let me know if you think your child has had any reaction to any of the given vaccines on 02072244668 in hours or on 07765162004 out of hours.

After the MMR there is a 1 in 1000 chance that your child will be admitted to hospital with a febrile convulsion .To date with 4 years experience we have had no serious reactions to the single vaccines we have given.