MMR vaccine

MMR vaccine

MMR vaccine
Combination of
Measles vaccine	Vaccine
Mumps vaccine	Vaccine
Rubella vaccine	Vaccine
Clinical data
Trade names	M-M-R II, Priorix, Tresivac, others
Other names	MPR vaccine[1]
AHFS/Drugs.com	Monograph
MedlinePlus	a601176
License data	US DailyMed: Measles
Pregnancy category	AU: B2[2]
ATC code	J07BD52 (WHO)
Legal status
Legal status	AU: S4 (Prescription only) UK: POM (Prescription only) US: ℞-only[3][4] EU: Rx-only[5] In general: ℞ (Prescription only)
Identifiers
CAS Number	1704518-68-2
ChemSpider	None
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The MMR vaccine is a

The MMR vaccine is widely used around the world. Worldwide over 500 million doses were administered between 1999 and 2004,[13] and 575 million doses have been administered since the vaccine's introduction worldwide.^[14] Measles resulted in 2.6 million deaths per year before immunization became common.^[14] This has decreased to 122,000 deaths per year as of 2012,^[update] mostly in low-income countries.^[14] Through vaccination, as of 2018^[update], rates of measles in North and South America are very low.^[14] Rates of disease have been seen to increase in populations that go unvaccinated.^[14] Between 2000 and 2018, vaccination decreased measles deaths by 73%.^[15]

Side effects of immunization are generally mild and resolve without any specific treatment.

Cochrane concluded that the "Existing evidence on the safety and effectiveness of MMR and MMRV vaccine supports current policies of mass immunisation aimed at global measles eradication in order to reduce morbidity and mortality associated with measles mumps rubella and varicella."^[17]

The combined MMR vaccine induces immunity less painfully than three separate injections at the same time, and sooner and more efficiently than three injections given on different dates. Public Health England reports that providing a single combined vaccine as of 1988, rather than giving the option to have them also done separately, increased uptake of the vaccine.^[23]

Measles

Before the widespread use of a vaccine against measles, rates of disease were so high that infection was felt to be "as inevitable as death and taxes."^[24] Reported cases of measles in the United States fell from hundreds of thousands to tens of thousands per year following introduction of the vaccine in 1963. Increasing uptake of the vaccine following outbreaks in 1971, and 1977, brought this down to thousands of cases per year in the 1980s. An outbreak of almost 30,000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule. Fewer than 200 cases have been reported in the US each year between 1997 and 2013, and the disease is no longer considered endemic there.^[25][26][27]

The benefit of measles vaccination in preventing illness, disability, and death has been well documented. The first 20 years of licensed measles vaccination in the US prevented an estimated 52 million cases of the disease, 17,400 cases of intellectual disability, and 5,200 deaths.^[28] During 1999–2004, a strategy led by the World Health Organization and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles deaths worldwide.^[13] Between 2000 and 2018, measles vaccination resulted in a 73% decrease in deaths from the disease.^[15]

Measles is common in many areas of the world. Although it was declared eliminated from the US in 2000, high rates of vaccination and good communication with people who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles in the US.^[29] Of the 66 cases of measles reported in the US in 2005, slightly over half were attributable to one unvaccinated individual who acquired measles during a visit to Romania.^[30] This individual returned to a community with many unvaccinated children. The resulting outbreak infected 34 people, mostly children and virtually all unvaccinated; 9% were hospitalized, and the cost of containing the outbreak was estimated at $167,685. A major epidemic was averted due to high rates of vaccination in the surrounding communities.^[29]

In 2017, an outbreak of measles occurred among the Somali-American community in Minnesota, where MMR vaccination rates had declined due to the misconception that the vaccine could cause autism. The US Centers for Disease Control and Prevention recorded 65 affected children in the outbreak by April 2017.^[31]

Rubella

Mumps is another viral disease that was once very common, especially during childhood. If mumps is acquired by a male who is past puberty, a possible complication is bilateral orchitis, which can in some cases lead to sterility.^[33]

Administration

The MMR vaccine is administered by a

The number of reports on neurological disorders is very small, other than evidence for an association between a form of the MMR vaccine containing the Urabe mumps strain and rare adverse events of aseptic meningitis, a form of viral meningitis.^[38][43] The UK National Health Service stopped using the Urabe mumps strain in the early 1990s due to cases of transient mild viral meningitis, and switched to a form using the Jeryl Lynn mumps strain instead.^[44] The Urabe strain remains in use in a number of countries; MMR with the Urabe strain is much cheaper to manufacture than with the Jeryl Lynn strain,^[45] and a strain with higher efficacy along with a somewhat higher rate of mild side effects may still have the advantage of reduced incidence of overall adverse events.^[44]

A Cochrane review found that, compared with placebo, MMR vaccine was associated with fewer upper respiratory tract infections, more irritability, and a similar number of other adverse effects.^[17]

Naturally acquired measles often occurs with

In 1998

Administering the vaccines in three separate doses does not reduce the chance of adverse effects, and it increases the opportunity for infection by the two diseases not immunized against first.[55]^[60] Health experts have criticized media reporting of the MMR-autism controversy for triggering a decline in vaccination rates.^[61] Before publication of Wakefield's article, the inoculation rate for MMR in the UK was 92%; after publication, the rate dropped to below 80%. In 1998, there were 56 measles cases in the UK; by 2008, there were 1348 cases, with two confirmed deaths.^[62]

In Japan, the MMR triplet is not used. Immunity is achieved by a combination vaccine for measles and rubella, followed up later with a mumps only vaccine. This has had no effect on autism rates in the country, further disproving the MMR autism hypothesis.^[63]

History

The component viral strains of MMR vaccine were developed by propagation in animal and human cells as all viruses require a living host cell to replicate.^{[citation needed]}

For example, in the case of mumps and measles viruses, the virus strains were grown in embryonated chicken eggs. This produced strains of virus which were adapted for chicken cells and less well-suited for human cells. These strains are therefore called attenuated strains. They are sometimes referred to as neuroattenuated because these strains are less virulent to human neurons than the wild strains.

The Rubella component, Meruvax, was developed in 1967, through propagation using the human embryonic lung cell line WI-38 (named for the Wistar Institute) that was derived six years earlier in 1961.^[64][65]

The term "MPR vaccine" is also used to refer to this vaccine, whereas "P" refer to parotitis which is caused by mumps.^[1]

Merck MMR II is supplied freeze-dried (

Pluserix was introduced in Hungary in 1999.[71] Enders' Edmonston strain has been used since 1999 in Hungary in Merck MMR II product.^[71] GSK Priorix vaccine, which uses attenuated Schwarz Measles, was introduced in Hungary in 2003.^[71]

MMRV vaccine

The

recommendations (pediatricians, 77%; family physicians, 73%).

MR vaccine

This section needs to be updated. Please help update this article to reflect recent events or newly available information. (November 2022)

This is a vaccine that covers measles and rubella but not mumps.[22] As of 2014, it was used in a "few (unidentified) countries".^[22]

Society and culture

Religious concerns

Some brands of the vaccine use gelatin, derived from pigs, as a stabilizer.^[74] This has caused reduced take-up among some communities,^[74][75] despite the fact that alternative vaccines without pig derivatives are approved and available.^[74]

References