Measles/ Mumps/ Rubella vaccine (MMR)

Registered South African indications:

• Prevention of measles, mumps and rubella

Contraindications

• Hypersensitivity to the active ingredient or to any of the excipients in this combination product
• Hypersensitivity to neomycin (except history of contact dermatitis)
• Pregnancy
• Severe humoral or cellular (primary or acquired) immunodeficiency (e.g. severe combined immunodeficiency, agammaglobulinemia, AIDS)
• Symptomatic HIV infection
• Age-specific CD4+ T-lymphocyte percentage:
  - Children < 12mths: CD4+ <25%
  - Children 12-35mths: CD4+ <20%
  - Children 36-59mths: CD4+ <15%
• Acute severe febrile illness

Cautions

• Breastfeeding
• Renal impairment
• Hepatic impairment
• Elderly
• Hypersensitivity to egg protein
• Infants (9-12 months)
• Central nervous system disorders
• Susceptibility to febrile convulsions
• Personal or family history of convulsions
•  ≤ 72 hours after exposure to natural measles
• Immunocompromised patients
• Pre-existing thrombocytopaenia
• History of thrombocytopenia after measles, mumps or rubella vaccination
• Patients with history of psychogenic response to needle injections (syncope)
• Asymptomatic HIV patients
• IgG subclass deficiencies
• Congenital neutropenia
• Chronic granulomatous disease
• Complement deficiency diseases
• History of allergies
• History of cerebral injury
• Fructose intolerance (certain formulations)

Forms avail. in SA and covered in this monograph: inj

Prevention of measles, mumps and rubella

• IM/SC: 0.5ml, as a single dose; Second dose to be given after at least 28 days

A second dose should be given according to official recommendations

To be administered in the deltoid region or in the anterolateral area of the thigh

Not to be administered intravascularly

Subcutaneous administration recommended in patients with thrombocytopaenia or any coagulation disorder

Forms avail. in SA and covered in this monograph: inj

Prevention of measles, mumps and rubella

Younger than 9 months

• Not established for use

Between 9-12 months

• IM/SC: 0.5ml, as a single dose

Infants in their first year of life may not respond sufficiently to the components of the vaccine

When epidemiological situations require vaccinating infants in their first year of life (e.g. outbreak or travel to endemic regions), second dose should be given in the second year of life; preferably within three months of the first dose. Under no circumstances should the interval between doses be less than 28 days

Older than 12 months

• See adult dosage

A second dose is recommended at 4-6 years old, prior to entering into school

To be administered in the deltoid region or in the anterolateral area of the thigh

Not to be administered intravascularly

Subcutaneous administration recommended in patients with thrombocytopaenia or any coagulation disorder

Pregnancy

• Contraindicated
• Pregnant women should not be vaccinated with measles/ mumps/ rubella vaccine. However, fetal damage has not been documented when measles, mumps or rubella vaccines have been given to pregnant women
• Even if a theoretical risk cannot be excluded yet, no cases of congenital rubella syndrome have been reported in more than 3500 susceptible women who were unknowingly in early stages of pregnancy when vaccinated with rubella containing vaccines. Therefore, inadvertent vaccination of unknowingly pregnant women with measles, mumps and rubella containing vaccines should not be a reason for termination of pregnancy
• Pregnancy should be avoided for 1 month following vaccination. Women who intend to become pregnant should be advised to delay

Breastfeeding

• Caution
• There is limited experience with measles/ mumps/ rubella vaccine during breastfeeding. Studies have shown that breastfeeding postpartum women vaccinated with live attenuated rubella vaccines may secrete the virus in breast milk and transmit it to breastfed infants without evidence of any symptomatic disease
• Only in the event the child is confirmed or suspected to be immunodeficient, risks and benefits of vaccinating the mother should be evaluated

Fertility

• Measles/ mumps/ rubella vaccine has not been evaluated in fertility studies

Renal Impairment

• Caution; no information available

Hepatic Impairment

• Caution; no information available

Elderly

• Caution; no information available 

Porphyria Information

• Probably not porphyrinogenic (PNP)
  Some vaccines can cause a side effect of persistent high fever that may trigger an acute porphyric attack

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Nervousness
• Abnormal crying
• Insomnia
• Febrile convulsions
• Encephalitis
• Cerebellitis
• Cerebellitis-like symptoms
• Transient gait disturbance
• Transient ataxia
• Guillain-Barré syndrome
• Transverse myelitis
• Peripheral neuritis

Cardiovascular Disorders

• Vasculitis

Respiratory Disorders

• Bronchitis
• Cough
• Upper respiratory tract infection

Gastrointestinal Disorders

• Parotid gland enlargement
• Diarrhoea
• Vomiting

Genitourinary Disorders

• Orchitis
• Epididymitis

Endocrine and Metabolic Disorders

• Anorexia

Musculoskeletal Disorders

• Arthralgia
• Arthritis

Skin and Subcutaneous Tissue Disorders:

• Erythema multiforme
• Rash
• Injection site redness
• Injection site pain and swelling

Immune, Blood and Lymphatic System Disorders

• Meningitis
• Measles-like syndrome
• Mumps-like syndrome
• Fever
• Thrombocytopenia
• Thrombocytopenic purpura
• Anaphylactic reactions
• Lymphadenopathy
• Allergic reactions

Sensory Disorders

• Conjunctivitis
• Otitis media

• Blood transfusions
• Human gammaglobulins
• Neisseria meningitidis B vaccine

None routine

Precautions for administration

• Alcohol and other disinfecting agents must be allowed to evaporate from the skin before injection of the vaccine since they can inactivate the attenuated viruses in the vaccine

Immunocompromised patients

• Vaccination may be considered in patients with selected immune deficiencies where the benefits outweigh the risks (e.g. asymptomatic HIV subjects, IgG subclass deficiencies, congenital neutropenia, chronic granulomatous disease and complement deficiency diseases)
• Immunocompromised patients who have no contraindication for this vaccination may not respond as well as immunocompetent subjects, therefore some of these patients may acquire measles, mumps or rubella in case of contact, despite appropriate vaccine administration. These patients should be monitored carefully for signs of measles, parotitis and rubella

Coadministration with other vaccines

• Clinical studies have demonstrated that measles/ mumps/ rubella vaccine can be given simultaneously with any of the following  vaccines: diphtheria-tetanus-acellular pertussis vaccine (DTPa), reduced antigen diphtheria-tetanus-acellular pertussis vaccine (dTpa), Haemophilus influenzae type b vaccine (Hib), inactivated polio vaccine (IPV), hepatitis B vaccine (HBV), hepatitis A vaccine (HAV), meningococcal serogroup B vaccine (MenB), meningococcal serogroup C conjugate vaccine (MenC), meningococcal serogroups A, C, W-135 and Y conjugate vaccine (MenACWY), varicella zoster vaccine (VZV), oral polio vaccine (OPV) and pneumococcal conjugate vaccine in accordance with local recommendations
• If measles/ mumps/ rubella vaccine is to be given at the same time as another injectable vaccine, the vaccines should always be administered at different injection sites
• If not given at the same time, an interval of at least one month is recommended between administration of measles/ mumps/ rubella vaccine and other live attenuated vaccines
• Due to an increased risk of fever, tenderness at the injection site, change in eating habits and irritability when the Neisseria meningitidis serogroup B vaccine was coadministered with a combined measles-mumps-rubella-varicella (MMR-V) vaccinne, seperate vaccination with with measles/ mumps/ rubella vaccine can be considered when possible

Tuburculin skin test

• If tuberculin testing has to be done it should be carried out before or simultaneously with vaccination since it has been reported that combined measles, mumps and rubella vaccines may cause a temporary depression of tuberculin skin sensitivity. As this anergy may last up to a maximum of 6 weeks, tuberculin testing should not be performed within that period after vaccination to avoid false negative results

Measles/ mumps/ rubella vaccine (MMR) is a live, attenuated vaccine, measles, mumps and rubella vaccine offers active immunity to disease caused by the measles, mumps, and rubella viruses.

Injection 0.5ml

• Priorix (GSK) originator
• Trimovax (Sanofi) originator

Measles Virus 1000 CCID, Mumps Virus 12500 CCID, Rubella Virus 1000 CCID

• Omzyta (MSD)