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Measles, mumps and rubella (MMR) vaccine

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Produced by Stephanie Hughes, Bupa Health Information Team, December 2011.

This factsheet is for people who would like information about the measles, mumps and rubella (MMR) vaccine. It's relevant for children and adults. However, for simplicity we will refer to your child throughout.

The MMR vaccine is a combined vaccine against measles, mumps and rubella. Children will usually receive a first dose at around the age of 13 months and another at three to five years, before they start school.

Availability and use of the MMR vaccine may vary from country to country.

 
What is the MMR vaccine?
How does the MMR vaccine work?
When is the MMR vaccine given?
Is the MMR vaccine effective?
Special care
Side-effects and safety
Single vaccines
 

What is the MMR vaccine?

 
The MMR vaccine is an injection that prevents your child from catching measles, mumps and rubella. Although most people usually recover from these illnesses, each one can be unpleasant and have serious consequences.
 

  • Measles is highly infectious and may cause complications such as diarrhoea, ear infections, pneumonia and encephalitis (inflammation of the brain).
     
  • Mumps is also infectious and can cause complications such as meningitis and deafness. It may also cause inflammation of your pancreas. In boys, it can damage the testicles and cause infertility. In girls, it can cause swelling of the ovaries.
     
  • Rubella (German measles) is usually a mild illness but it can be harmful to a developing baby during early pregnancy. If you're pregnant and get rubella in the first 16 weeks of pregnancy, it's very likely to harm your unborn baby. It can cause blindness, deafness, brain damage and heart damage in your baby. Rubella can also cause a miscarriage. If you get rubella within 16 and 20 weeks of pregnancy, there is a risk that your baby will be deaf. After 20 weeks, there is no increased risk.

The MMR vaccine can prevent each of these illnesses.

A combined vaccine against measles, mumps, rubella and varicella (chickenpox) is available in some countries. It is used in place of MMR vaccine and is recommended at 12 and 18 months.
 

How does the MMR vaccine work?

 
The MMR vaccine is made from weakened forms of each of the measles, mumps and rubella viruses. This vaccine stimulates your child's immune system to respond and remember the viruses. This means that if your child gets infected with one of the three viruses, his or her immune system will recognise the virus and act to prevent infection.
 

When is the MMR vaccine given?

 
The MMR vaccine can be given at any age. It is usually given to children in two doses. The first injection is recommended when your child is between 12 and 13 months old. A second dose is recommended when your child is between the ages of three and six years old to boost their immunity before starting school.

If a child needs to be protected against measles quickly, for example, during a measles outbreak, they can have the second dose of the MMR vaccine one month after the first dose. However, if they have the second dose before they reach the age of 18 months, they should still receive the routine dose when they reach three to five years old, before they start school.

The MMR vaccine can be offered to young people when they leave school or before they enter further education if they haven't already had both doses.

If you have never been vaccinated against rubella before, you should consider having the MMR vaccine if:

  • you're a woman of childbearing age
  • you're a healthcare worker who may come into contact with pregnant women
  • you have just had a baby

The MMR vaccine can be given at any age. It's not dangerous to receive the MMR vaccine more than once. If you can't remember whether or not you have had it, ask your doctor.

Is the MMR vaccine effective?

 
After the first dose of the MMR vaccine, 64 out of 100 people will be protected against mumps, 90 out of 100 people will be protected against measles and 95 out of 100 people will be protected against rubella. After the second dose, 99 out of 100 people will be protected against all three illnesses.

 

Special care

 
Most people can have the MMR vaccine, but there are some who shouldn't. These include:

  • people who take medicines that lower their immune system's response or who have a weakened immune system because of an illness such as HIV/AIDS or cancer
  • anyone who has had an anaphylactic reaction to gelatine or the antibiotics kanamycin and neomycin
  • anyone who has had a confirmed anaphylactic reaction to a previous dose of a MMR vaccine
  • pregnant women

Some people may get minor allergic reactions to the vaccine. However, this shouldn't stop people from having the MMR vaccine in the future. Anaphylaxis is a severe allergic reaction in which the tongue or the back of the throat may swell and is extremely rare with this vaccine.

Your doctor may advise to postpone you or your child's MMR vaccine until a later date, if:

  • you or your child have had another live vaccine within the previous four weeks
  • you or your child have a fever

Talk to your doctor or nurse if you're not sure whether you or your child should have the MMR vaccine.

 

Side-effects and safety

Side-effects are the unwanted but mostly mild and temporary effects of a successful immunisation. They're usually rare after the first dose and even less likely after the second. The side-effects you may get after the MMR vaccine often outweigh the side-effects and possible complications you may get from having measles, mumps or rubella.

The three viruses in the vaccine act at different times and may produce different side-effects as they start to work.
The measles part of the vaccine starts to work six to 11 days after immunisation. Your child may have a fever or develop a measles-like rash that usually lasts two to three days. You can give your child a dose of junior paracetamol (acetaminophen) if he or she develops a fever, but if the fever persists, contact your child's doctor. Children who get vaccine-related symptoms aren't infectious to others.

About one in every 1,000 immunised children may have a fit caused by the fever. This is called a febrile convulsion. However, the number of febrile convulsions caused by measles is much higher than the number the MMR vaccine may cause.
It's rare, but your child may get mild symptoms similar to mumps (fever and swollen glands) about two to three weeks after the MMR vaccine, when the mumps part of the vaccine starts to work.

Children may get a rash of small bruise-like spots in the first six weeks after the vaccination, but this is also very rare.

It can be caused by the measles or rubella parts of the vaccine. Take your child to his or her doctor if you see spots like these.

Fewer than one child in a million develops encephalitis (inflammation of the brain) after the MMR vaccine. If a child who hasn't been vaccinated catches measles, the chance is higher – between one in 200 and one in 5,000.

Side-effects of the vaccine are usually mild and, most importantly, they are milder than the potentially serious consequences of having measles, mumps or rubella. If you're concerned about any of your child's symptoms, see your doctor.
 

Egg allergy and the MMR vaccine

The MMR vaccine is made using a protein related to egg. However, evidence shows that it's safe to give the vaccine to nearly all children, even those who have a very severe reaction to eggs.

If your child has a severe egg allergy, let your doctor or nurse know. He or she can make special arrangements to give your child the MMR vaccine safely, in hospital if necessary.

Autism and bowel disease

You may have heard of a suggested link between the MMR vaccine and autism and bowel disease. However, there is a great deal of scientific evidence available, based on records of millions of MMR vaccinations that shows no connection between them.

A link between the MMR vaccination and autism was suggested in 1998 when a group of doctors published a paper about 12 autistic children who also had bowel problems. The doctors put forward a theory about bowel inflammation, caused by the MMR vaccine, which could lead to problems with brain development. The researchers didn't prove their theory and they actually stated in their paper that they had not proved a link between autism and the MMR vaccine. However, the resulting media attention gave the impression that there was one. This led to some parents whose children were born after 1999 to decide not to give them the vaccine.

If your child has autism, you will usually start to notice signs when he or she is around one to two years old. As the MMR injection is given at around this age, it's easy to understand why some parents thought there might be a link.

Single vaccines

 
Where the MMR vaccine is available, no country recommends single rather than combined vaccines.

There are a number of reasons why the vaccines in the combined MMR aren't routinely given separately.

  • Children would need to have six injections in total, which is more unpleasant because of the pain from each jab and six episodes of possible side-effects.
     
  • It could mean that fewer children have all the necessary vaccinations, increasing the level of measles, mumps and rubella outbreaks.
     
  • There may be more delay before being completely vaccinated, leaving children at risk of infection from the diseases for longer.
     
  • Single vaccines may not be licensed in your country.

If you or your child has had a single vaccine in the past for measles, mumps or rubella, having the full MMR vaccine at a later date will cause no harm. It's recommended to wait at least four weeks from when you have a single vaccine until you have the MMR vaccine.

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This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email. See our answers to common questions about measles, mumps and rubella (MMR) vaccine, including:
 
Do I need to have an MMR vaccination to travel abroad?
Why doesn’t the NHS offer single vaccines of measles, mumps and rubella?
Who are two doses of MMR needed?

 Do I need to have an MMR vaccination to travel abroad?

Measles, mumps and rubella are infectious diseases that occur throughout the world. In many countries, children aren't usually vaccinated with MMR and outbreaks of these diseases are more common than in the UK. So, if you haven't been immunised with the MMR vaccine, you should have it before you travel abroad. This will protect you from these infections and also prevent you bringing them back to the UK and spreading them further.
 

Explanation

Almost 200 countries offer immunisation against measles and many, but not all, also offer immunisation against mumps and rubella. All three diseases, in particular measles, need a large number of people to be immunised for the whole population to be protected. This is known as herd immunity. However, in many countries this doesn't happen and outbreaks of the diseases are common. This means that although you may be unlikely to catch measles, mumps or rubella in the UK, you may be at risk if you travel abroad and haven’t been immunised against these diseases.
 
More than 20 million people across the world catch measles every year and hundreds of thousands of people, mostly children, die from it. Africa and South-East Asia are the most badly affected areas - few people are immunised against the diseases in these areas.
 
Just over half of all countries immunise children against mumps. Mumps is common in Africa and South-East Asia, where people aren't usually immunised. There are epidemics in these areas around every two to five years.
 
Epidemics of rubella happen every five to nine years in some areas of the world and as many as 700,000 unborn children die every year when their mothers catch the disease.
 
Every year, people from the UK who haven't been immunised catch measles, mumps or rubella while they are abroad. These diseases may then be brought back to the UK where they may spread further. The Health Protection Agency (HPA) recommends that you should find out whether you have had the MMR immunisation before you travel. If you haven't, you can make an appointment with your GP or nurse to have it. This is particularly important if you're travelling to areas of the world where few people are immunised and outbreaks of these diseases occur. If you're pregnant, or there is a chance that you may become pregnant while you're travelling, it's very important to have the vaccination before you go away if you're not already immune to rubella.
 

Why doesn't the NHS offer single vaccines of measles, mumps and rubella?

The NHS doesn't offer single vaccines because they haven't been properly researched or tested to see how safe they are and how well they work, whereas the MMR vaccine has. Single vaccines aren't recommended because they could put babies and children at an increased risk of getting measles, mumps and rubella.
 

Explanation

Stories in the media have raised concerns about a possible link between the MMR vaccine, autism and bowel disease. Although there is a great deal of scientific evidence from around the world that shows no connection between these conditions and the MMR vaccine, many parents are still concerned and have looked for alternatives. One of these is to give single vaccines of measles, mumps and rubella.
 
Although there are 100 countries in the world that offer the MMR immunisation, only one, Japan, offers single vaccines instead. This is because in the 1990s the vaccine used there for the mumps part of the MMR vaccine caused some people to get meningitis and the decision was made to use single vaccines instead. The mumps vaccine that was used in Japan is different to the one used in the MMR vaccine in the UK.
 
Single vaccines for mumps and measles aren't licensed in the UK. This means that the vaccines don't undergo any testing in the UK to see how safe they are or how well they work. There is no research to show how they should be given or how much of a gap is needed between injections. However, there is a lot of research to prove the safety and effectiveness of the MMR vaccine.
 
There are also concerns about the quality and side-effects of single vaccines. For example, one mumps vaccine was found to give immunity to only a small number of children and another caused meningitis as a side-effect. Your child may also be more at risk of a severe allergic reaction, called anaphylaxis, after having a single vaccine of measles or rubella, compared with the MMR vaccine.
 
Single vaccines could put babies and children at greater risk of measles, mumps and rubella. If you decide that your child should have single vaccines, he or she will need to have a total of six injections. Not only does this mean more injections, which many children find upsetting, but also a much bigger gap between injections during which your child could catch any of the diseases. If your child catches measles, mumps or rubella, he or she could give it to brothers and sisters who are too young to have received the vaccines, to pregnant women or to children who have a weakened immune system.
 
Around one parent in 20 now chooses to give their child single vaccines against measles, mumps and rubella. However, only half of these children have two doses of all three vaccines. This means that children may not be protected against these diseases as they grow up. You can also catch measles, mumps and rubella as an adult, when the effects may be very serious. For example, if you're pregnant and catch rubella, it can affect the development of your unborn baby, and if you're a man, it can reduce your fertility.
 

Why are two doses of MMR needed?

After the first dose of the MMR vaccine, most, but not all, children develop immunity to measles mumps and rubella. Because there are still some children who don't have immunity after the first dose, a second dose is given. After this, almost all of the children who didn't have immunity after the first dose will develop it.
 

Explanation

When your child is immunised against measles, mumps and rubella, he or she will have two vaccinations. The first is given to your baby at about 13 months and the second 'booster' is given when your child is between three and five years old, before he or she starts school. Having two doses of MMR will ensure that your child is fully protected against measles. One dose provides over 90 percent protection against measles, but two doses provide almost 100 percent protection.
 
The immunisations are given at these times for a reason. Up until your baby reaches a year old he or she will still have some protection against infection from antibodies passed on in the womb. If the MMR vaccine is given when your baby is just a few months old, there is a chance that immunity from his or her mother will prevent the vaccine from working properly. The booster is given just before your child starts school or nursery, where he or she will be mixing with lots of new children and there is a greater risk of catching these diseases.
 
There are also some children who miss the first immunisation when they are babies. The second booster gives you a chance to have your child immunised before he or she starts school and will boost the immunity of children who have already been immunised.

 Further information

 
 

Sources

  • Joint Formulary Committee. British National Formulary. 63rd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2011
  • Measles, mumps, and rubella: prevention. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published 21 December 2009
  • MMR vaccine. Immunisation Scotland. www.immunisationscotland.org.uk, published 7 October 2011
  • Immunisation against infectious disease. Department of Health. www.dh.gov.uk, published 28 September 2011
  • Diseases and conditions. Centers for Disease Control and Prevention. www.cdc.gov, published 21 September 2011
  • Rubella. PubMed Health. www.ncbi.nlm.nih.gov, published 24 January 2011
  • Background information on the safety of rubella-containing vaccine given in pregnancy. Health Protection Agency. www.hpa.org.uk, published 4 May 2010
  • Frequently asked questions about mumps. Health Protection Agency. www.hpa.org.uk, published 28 May 2008
  • Vaccine information for the public and health professionals. Immunization Saves Lives. www.vaccineinformation.org, published December 2010
  • MMR the facts. Department for Health. www.dh.gov.uk, published 1 March 2003
  • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 610–15
  • Why is MMR preferable to single vaccines? Health Protection Agency. www.hpa.org.uk, accessed 11 October 2011
  • Measles. World Health Organization. www.who.int, accessed 3 October 2011
  • Measles risk during travel – update. National Travel Health Network and Centre. www.nathnac.org, published 18 May 2011
  • Exemptions from immunization laws. National Network for Immunization Information. www.immunizationinfo.org, published 5 April 2011
  • Measles mumps rubella varicella (MMRV) vaccine. Centers for Disease Control and Prevention. www.cdc.gov, published July 2010
     

Related topics

 
 
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
 

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