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 primary (first dose) and booster (second and subsequent doses) 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.

Administration

The vaccine is intended for subcutaneous injection although it may be given by the intramuscular route, in the deltoid region or in the anterolateral area of the thigh.

Contraindications

Children under 6 months
Immunosuppression
Severe febrile conditions
Within 3 months of immunoglobulin
Within 4 weeks of other live vaccines
Pregnancy
Primary or secondary immunodeficiencies

Precautions and Warnings

Children aged 6 to 12 months
Family history of convulsions
Breastfeeding
Central nervous system disorder
Hereditary fructose intolerance
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
Contains sorbitol
May contain trace amounts of neomycin
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 7-28 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.nhs.uk

Pregnancy and Lactation

Pregnancy

Measles mumps and rubella vaccine is contraindicated in pregnancy.Women intending to become pregnant should be advised to delay for one month following vaccination.

Extensive studies have failed to link rubella vaccination in early pregnancy with foetal damage. If the vaccine is given inadvertently during pregnancy, then termination is not recommended.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Breastfeeding is not a contraindication to measles mumps and rubella immunisation, and the vaccine may be given to breastfeeding mothers. Studies have shown that vaccines containing live attenuated rubella given to breastfeeding mothers may secrete the virus in the breast milk and transmit it to the breastfed infant without evidence of any symptomatic disease. If the child is confirmed or suspected to be immunodeficient, the risks and benefits of vaccinating the mother should be evaluated.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Allergic reaction
Anaphylactic reaction
Anorexia
Arthralgia
Arthritis
Bronchitis
Conjunctivitis
Cough
Crying
Diarrhoea
Encephalitis
Epididymo-orchitis
Erythema at injection site
Erythema multiforme
Febrile convulsions
Fever
Guillain-Barre syndrome
Insomnia
Kawasaki disease
Local pain (injection site)
Lymphadenopathy
Meningitis
Nervousness
Optic neuritis
Otitis media
Parotid swelling
Peripheral neuritis
Rash
Swelling (injection site)
Thrombocytopenia
Thrombocytopenic purpura
Transverse myelitis
Upper respiratory tract infection
Vomiting

Presentation

Solution for injection.

Each 0.5ml dose when reconstituted contains not less than equivalent of:
1000 CCID50 of measles virus live (the attenuated Schwarz strain)
1000 CCID50 of Mumps virus live (RIT 4385 strain derived from Jeryl Lynn strain)
1000 CCID50 of Rubella virus live (Wistar, RA 27/3 Strain)

(CCID50 - Cell Culture Infective Dose 50)

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 primary (first dose) and booster (second and subsequent doses) 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.
www.immunisation.dh-gov.uk/green-book-chapters/

Adults

Elderly

Children

Adolescents

Administration

The vaccine is intended for subcutaneous injection although it may be given by the intramuscular route, in the deltoid region or in the anterolateral area of the thigh.

Contraindications

Children under 6 months
Immunosuppression
Severe febrile conditions
Within 3 months of immunoglobulin
Within 4 weeks of other live vaccines
Pregnancy
Primary or secondary immunodeficiencies

Precautions and Warnings

Children aged 6 to 12 months
Family history of convulsions
Breastfeeding
Central nervous system disorder
Hereditary fructose intolerance
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
Contains sorbitol
May contain trace amounts of neomycin
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 7-28 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.nhs.uk

Pregnancy and Lactation

Pregnancy

Measles mumps and rubella vaccine is contraindicated in pregnancy.Women intending to become pregnant should be advised to delay for one month following vaccination.

Extensive studies have failed to link rubella vaccination in early pregnancy with foetal damage. If the vaccine is given inadvertently during pregnancy, then termination is not recommended.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Breastfeeding is not a contraindication to measles mumps and rubella immunisation, and the vaccine may be given to breastfeeding mothers. Studies have shown that vaccines containing live attenuated rubella given to breastfeeding mothers may secrete the virus in the breast milk and transmit it to the breastfed infant without evidence of any symptomatic disease. If the child is confirmed or suspected to be immunodeficient, the risks and benefits of vaccinating the mother should be evaluated.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Counselling

Advise post-pubertal females of the need to avoid pregnancy for one month after vaccination.

Patients with a history or family history of convulsions may experience a febrile response. Parents or carers should be made aware of this effect and given advice on controlling fever.

Advise patients that there is a risk of excretion of live rubella virus from the nose and throat of susceptible vaccinees 7-28 days after vaccination and appropriate measures should be taken.

Side Effects

Allergic reaction
Anaphylactic reaction
Anorexia
Arthralgia
Arthritis
Bronchitis
Conjunctivitis
Cough
Crying
Diarrhoea
Encephalitis
Epididymo-orchitis
Erythema at injection site
Erythema multiforme
Febrile convulsions
Fever
Guillain-Barre syndrome
Insomnia
Kawasaki disease
Local pain (injection site)
Lymphadenopathy
Meningitis
Nervousness
Optic neuritis
Otitis media
Parotid swelling
Peripheral neuritis
Rash
Swelling (injection site)
Thrombocytopenia
Thrombocytopenic purpura
Transverse myelitis
Upper respiratory tract 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: April 2013

Reference Sources

Immunisation against infectious disease - The Green Book.
Available at: www.immunisation.dh-gov.uk/green-book-chapters/

Summary of Product Characteristics: Priorix. GlaxoSmithKline UK. Revised October 2017.