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VACCINE INFORMATION
The MMR vaccine is a "3-in-1" vaccine that protects against measles, mumps, and rubella. Although single antigen (individual) vaccines have been developed for each component of the MMR, they are not readily available and usually used only for very specific situations. An example of such a situation would be if an outbreak of either measles, mumps, or rubella was occurring in a specific community and public health officials deemed it necessary to immunize infants 6 to 12 months old. Single antigen vaccines might be used because they pose less risk to children younger than the recommended age of 12 months for the MMR. For children 12 months or older and adults, the risks of giving the single antigen vaccine are presumed to be the same as giving the MMR.

IMMUNIZATION SCHEDULE
The MMR is one of the recommended childhood immunizations. In most states, proof of at least one MMR is required for school entry.

The first shot is recommended at 12-15 months. Because the first shot may not provide adequate lifetime immunity to some individuals, a second MMR is recommended prior to school entry at 4-6 years or prior to entry into junior high at 11-13 years. Some states require a second MMR at kindergarten entry.

Adults 18 years or older who were born after 1956 should also receive MMR if they are uncertain of their immunization status or if they have only had one MMR prior to school entry. Adults born during or prior to 1956 are presumed to be immune. Many people within that age group had the actual diseases during childhood.

BENEFITS
One MMR will protect 90 to 98% of individuals receiving the immunization from contracting measles, mumps, or rubella throughout their lives. The second MMR is recommended to cover the up to 10% of individuals that will not receive adequate protection from the first MMR.

Measles is a virus which causes a rash, cough, runny nose, eye irritation, and fever in most people, but can also lead to pneumonia, seizures, brain damage, and death.

Mumps virus causes fever, headache, and swollen glands, but can also lead to deafness, meningitis, swollen testicles or ovaries, and death.

Rubella, also known as the German Measles, is generally a mild disease, but can cause serious birth defects in woman who become infected while pregnant.

RISKS
Most people who receive the MMR will have no associated problems. Others may have minor problems, such as soreness and redness at the injection site or fevers. Serious problems associated with receiving the MMR are rare.

Potential mild to moderate adverse effects include:

Measles vaccine component
- A rash may occur 1 to 2 weeks after receiving the immunization. This occurs in about 5% of children receiving the MMR.
- A fever of 103 degrees F or higher, without other symptoms of illness, may occur in about 5 to 15% of children receiving the MMR. This fever usually occurs within 1 to 2 weeks after getting the immunization and typically lasts only 1 to 2 days. This potential adverse reaction occurs less commonly after the administration of the second MMR.
Mumps vaccine component
- Minor swelling of the glands in the cheeks and under the jaws, lasting several days, may occur within 1 to 2 weeks after receiving the MMR. This occurs only rarely.
Rubella vaccine component
- Swelling of lymph nodes and/or a rash lasting 1 to 3 days may develop within 1 to 2 weeks after the MMR injection. This occurs in about 14 to 15% of children receiving the MMR.
- Mild joint pain or stiffness for several days may occur within 1 to 3 weeks after MMR injection. This only occurs in about 1% of children but up to 25% of adults receiving the MMR. Women experience this side effect more commonly than men (up to 40% of women receiving MMR). In rare cases, this joint pain/stiffness may continue in a transient manner (coming and going) for months.
- Painful swelling of the joints (arthritis), lasting up to 1 week, may occur in less than 1% of children but up to 10% of adults receiving the MMR. Joint damage resulting from this is extremely rare.
- Rarely, pain or numbness in the hands or feet for several days may develop after MMR injection. This is a rare occurrence and is more common in adults than children.

In rare cases, children up to 6 years old receiving the MMR vaccine may exhibit seizure activity (convulsion, fit, spasm, twitching, jerking, or staring spells). This usually develops within 1 to 2 weeks after the injection and is typically associated with a high fever. Short-term brain inflammation, which resolves completely, may also occur rarely. The incidence of these types of adverse neurologic effects is about 1 in every one million MMRs given.

After taking any medication or receiving any vaccine, there is an extremely minimal chance of death. The potential of this happening after receiving the MMR is about the same as it is after taking any drug, even over-the-counter medications.

The potential benefits from receiving the MMR vaccine far outweigh the potential adverse effects. Measles, mumps, and rubella are all very serious illnesses and each may have complications resulting in lifetime disabilities or even death. The incidence of such complications, related to having the actual diseases, is far greater than the potential of developing serious, or even moderate, adverse effects due to the MMR vaccine.

DELAY OR DO NOT GIVE (CONTRAINDICATIONS)
If the child is ill, with something more serious than just a cold (for example, fever), immunization should be delayed. Most experts agree that children with a history of previous seizures should still receive the MMR. Although the chance of such children developing seizures after the MMR is still small, it is 5 times greater than that of children without a seizure history. Health care providers need to be informed of any problems that may have occurred with the first MMR injection prior to receiving the second MMR.

MMR should not be given to individuals with:

an allergy to eggs, gelatin, or the antibiotic neomycin serious enough to require medical treatment
a history of receiving gamma globulin within the past 3 months
an immune deficiency caused by cancer, leukemia, lymphoma, or taking prednisone, steroids, chemotherapy, radiation therapy or immunosuppressant drugs
a woman who is, or possibly may become pregnant within the next 3 months

POSTIMMUNIZATION SYMPTOMS AND CARE
Watch for and be familiar with how to care for a fever, arthralgia (joint pain/stiffness), minor gland enlargement/tenderness, or minor redness/soreness at the injection site. If a rash develops, without other symptoms, no treatment is necessary and it should resolve within several days.

CALL THE PRIMARY HEALTH CARE PROVIDER IF:

uncertain if the MMR should be given, withheld, or delayed for a specific individual.
moderate or serious adverse effects are noted after an MMR injection.
other symptoms, not commonly associated with potential adverse effects of the MMR, develop.
for any questions or concerns related to MMR immunizations.

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