Measles mumps and rubella (edmonston measles strain) vaccine
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Vaccine containing live attenuated measles (Edmonston strain), mumps and rubella antigens.
Drugs List
Therapeutic Indications
Uses
Measles - prophylaxis
Mumps - prophylaxis
Rubella - prophylaxis
For the simultaneous immunisation against measles, mumps and rubella in the following groups:
Individuals over 12 months of age - in line with the national immunisation schedule.
For use in measles outbreaks, or for post-exposure vaccination, or, for use in previously unvaccinated children older than 9 months who are in contact with susceptible pregnant women, and persons likely to be susceptible to mumps and rubella.
Dosage
For comprehensive information or advice on this product or the immunisation programme in the UK, the following website should be accessed.
https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
Adults
A single 0.5 ml dose at an elected date. A second dose may be administered at least 4 weeks after the first dose in accordance with official recommendations. The second dose is intended for individuals who did not respond to the first dose for any reason.
Children
First dose children 12 to 13 months of age
Administer 0.5ml of the reconstituted vaccine as a single dose at an elected date.
Booster dose (3 to 5 years)
A second dose of measles, mumps and rubella vaccine is recommended in the national immunisation schedule. A second dose should be given before school or nursery entry. When protection against measles is required urgently (e.g. during a measles outbreak), the second dose of MMR vaccine can be given 1 month after the first dose; if the second dose is given before 18 months of age, then children should still receive the routine dose before starting school at 3 to 5 years of age.
Children who suffered ITP (idiopathic thrombocytopenic purpura) within 6 weeks of the first dose of MMR, or its component vaccines, should have their serological status evaluated at the time the second dose is due. If this shows the child is not fully immune then a second dose of MMR is recommended.
Infants aged 6 to 12 months
Children below 12 months of age should not normally receive the vaccine as they may not respond sufficiently to the measles component of the vaccine. This is due to the possible persistence of maternal measles antibodies. The MMR vaccine can be administered to this age group in accordance with official recommendations or when an early protection is considered necessary. These infants should be re-vaccinated at 12 to 13 months. An additional dose with a measles containing vaccine should be considered according to official recommendations.
Although the vaccine is not licensed for use in children under 9 months of age it may be given to infants more than 6 months of age in the control of outbreaks of measles or to those travelling to endemic areas. It should be offered to susceptible children within 3 days of exposure to measles infection. These children should still receive routine MMR vaccinations at the recommended ages. It is NOT suitable for post-exposure prophylaxis of mumps or rubella since the antibody response is too slow for effective prophylaxis.
Adolescents
School leavers/those entering further education
All children should have received two doses of MMR vaccine before they leave school. The school-leaving booster session or appointment is an opportunity to ensure that unimmunised or partially immunised children are given MMR. Two doses of the vaccine should be offered to those who have not previously received two doses during childhood. If two doses of the vaccine are required, the second dose should be given one month after the initial dose.
In a young adult who has received only a single dose of the vaccine in childhood, a second dose is recommended to achieve full protection.
Administration
The vaccine is to be injected intramuscularly or subcutaneously.
The preferred injection sites are the anterolateral area of the thigh in younger children and the deltoid area in older children, adolescents and adults. The vaccine should be administered subcutaneously in patients with thrombocytopenia or any coagulation disorder.
Contraindications
Children under 6 months
Immunosuppression
Severe febrile conditions
Within 3 months of immunoglobulin
Within 4 weeks of other live vaccines
Hereditary fructose intolerance
Pregnancy
Primary or secondary immunodeficiencies
Precautions and Warnings
Children aged 6 to 12 months
Family history of convulsions
History of allergies including anaphylaxis
Breastfeeding
Central nervous system disorder
Glucose-galactose malabsorption syndrome
History of seizures
HIV infection without clinical manifestation
Thrombocytopenia
Live vaccine must not be given during/within 6 months of chemotherapy
Live vaccine must not be given during/within 6 months of radiotherapy
Postpone immunisation if there is active or suspected infection
Should be administered irrespective of previous component disease exposure
Vaccine may not be effective in 100% of patients
May contain trace amounts of neomycin
Preparation contains sucrose
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Allow disinfecting agents to evaporate before administering vaccine
Do not mix with other vaccines in the same syringe
Do not use if any signs of precipitate or particulate matter apparent
Inject other vaccines at different sites
Record name and batch number of administered product
Resuscitation facilities must be immediately available
Children under 1 year may show reduced response
If ITP occurs within 6 wks of 1st dose, check immune status before 2nd dose
Infants below 12 months: reduced response, revaccinate at 12 - 13 months
Theoretical risk of transmission of live virus to susceptible contacts
Follow national immunisation guidelines
Give within 72 hrs after exposure to natural measles for limited protection
Female: Contraception required during and for 1 month after treatment
There is increasing evidence that the MMR vaccine can be given safely even when the child has had an anaphylactic reaction to food containing egg. All children with egg allergy should receive the MMR vaccination as a routine procedure in primary care. Recent data suggest that anaphylactic reactions to MMR vaccine are not associated with hypersensitivity to egg antigens but to other components of the vaccine (such as gelatin). Studies have shown no severe cardiorespiratory reactions were reported after MMR vaccination. For children with a confirmed anaphylactic reaction to egg-containing food, MMR vaccine should be administered with extreme caution, with adequate treatment for anaphylaxis readily available. Children who have had documented anaphylaxis to the vaccine itself should be assessed by an allergist.
History or family history of convulsions or a history of cerebral injury. The physician should be alert to the temperature elevation which may follow vaccination.
Excretion of live rubella virus from the nose and throat of susceptible vaccinees has been reported 7 to 28 days after vaccination. Although transmission has not been recorded, it should be regarded as a possibility and appropriate measures taken.
Individuals known to infected with HIV and are not immunocompromised may be vaccinated. However, these vaccinees should be monitored closely for measles, mumps and rubella because vaccination may be less effective in these patients.
Reviews undertaken on behalf of the CSM, the Medical Research Council, and the Cochrane Collaboration, have not found any evidence of a link between MMR vaccination and bowel disease or autism. The Chief Medical Officers have advised that the MMR vaccine is the safest and best way to protect children against measles, mumps and rubella. Information (including fact sheets and a list of references) may be obtained from www.dh.gov.uk/immunisation.
Pregnancy and Lactation
Pregnancy
Measles mumps and rubella vaccine is contraindicated during pregnancy.
The manufacturer does not recommend using this vaccine during pregnancy. At the time of writing there is limited published information regarding the use of the measles, mumps and rubella vaccine during pregnancy. Potential risks are unknown.
Lactation
Use measles, mumps and rubella vaccine with caution during breastfeeding.
The manufacturer advises caution if this vaccine is used when breastfeeding. The presence of measles, mumps and rubella vaccine in human breast milk and the effects on exposed infants are unknown.
Side Effects
Anaphylactoid reaction
Anaphylaxis
Angioneurotic oedema
Arthralgia
Arthritis
Aseptic meningitis
Ataxia
Atypical measles
Bronchospasm
Bruising at injection site
Burning (injection site)
Conjunctivitis
Cough
Crying
Diarrhoea
Dizziness
Encephalitis
Encephalopathy
Epididymo-orchitis
Erythema at injection site
Facial oedema
Febrile convulsions
Fever
Guillain-Barre syndrome
Headache
Induration (injection site)
Irritability
Local pain (injection site)
Lymphadenopathy
Malaise
Measles inclusion body encephalitis (MIBE)
Myalgia
Nasopharyngitis
Nausea
Nerve deafness
Ocular palsies
Optic neuritis
Otitis media
Panniculitis
Papillitis
Paraesthesia
Parotitis
Peripheral oedema
Pneumonia
Pneumonitis
Polyneuritis
Polyneuropathy
Pruritus
Purpura
Rash
Rash at injection site
Retinitis
Retrobulbar optic neuritis
Rhinitis
Rhinorrhoea
Seizures
Sore throat
Stevens-Johnson syndrome
Stinging (injection site)
Subacute panencephalitis (SSPE)
Swelling (injection site)
Syncope
Tenderness (injection site)
Thrombocytopenia
Upper respiratory tract infection
Urticaria
Vasculitis
Vesiculation (injection site)
Viral infection
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: January 2020
Reference Sources
Summary of Product Characteristics: MMRVAXPRO. Sanofi Pasteur Ltd. Revised April 2019.
Immunisation against infectious disease - The Green Book.
Available at: https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
Last accessed 15 January 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 15 January 2020.
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