mMR vaccine

File:Priorix.jpg

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 to reduce morbidity and mortality associated with measles mumps rubella and varicella."

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.{{cite web |title=Measles, mumps, rubella (MMR): use of combined vaccine instead of single vaccines |url=https://www.gov.uk/government/publications/mmr-vaccine-dispelling-myths/measles-mumps-rubella-mmr-maintaining-uptake-of-vaccine |website=GOV.UK |access-date=12 July 2018 |archive-date=12 July 2018 |archive-url=https://web.archive.org/web/20180712221642/https://www.gov.uk/government/publications/mmr-vaccine-dispelling-myths/measles-mumps-rubella-mmr-maintaining-uptake-of-vaccine |url-status=live }}

File:Measles US 1938-2019.png fell drastically after the introduction of the measles vaccine.]]

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."{{cite journal | vauthors = Babbott FL, Gordon JE | title = Modern measles | journal = The American Journal of the Medical Sciences | volume = 228 | issue = 3 | pages = 334–361 | date = September 1954 | pmid = 13197385 | doi = 10.1097/00000441-195409000-00013 }} 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.{{cite journal | title = Summary of notifiable diseases, United States, 1993 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 42 | issue = 53 | pages = i-xvii; 1–73 | date = October 1994 | pmid = 9247368 | url = https://www.cdc.gov/mmwr/PDF/wk/mm4253.pdf | access-date = 26 January 2020 | url-status = live | archive-url = https://web.archive.org/web/20201024200449/https://www.cdc.gov/mmwr/PDF/wk/mm4253.pdf | archive-date = 24 October 2020 | author1 = Centers for Disease Control and Prevention (CDC) }}{{cite journal | vauthors=((Centers for Disease Control and Prevention (CDC))) | title=Summary of Notifiable Diseases --- United States, 2007 | journal=MMWR Morb. Mortal. Wkly. Rep. | volume=56 | issue=53 | date=July 2009 | url= https://www.cdc.gov/mmwr/pdf/wk/mm5653.pdf | access-date=26 January 2020 | archive-date=24 October 2020 | archive-url=https://web.archive.org/web/20201024200418/https://www.cdc.gov/mmwr/PDF/wk/mm5653.pdf | url-status=live }}{{cite book | publisher = U.S. Centers for Disease Control and Prevention (CDC) | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | veditors = Hamborsky J, Kroger A, Wolfe S | edition = 13th | location = Washington D.C. | year = 2015 | isbn = 978-0990449119 | url = https://www.cdc.gov/pinkbook | access-date = 9 September 2017 | archive-date = 30 December 2016 | archive-url = https://web.archive.org/web/20161230001534/https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | url-status = live }}

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.{{cite journal | vauthors = Bloch AB, Orenstein WA, Stetler HC, Wassilak SG, Amler RW, Bart KJ, Kirby CD, Hinman AR | title = Health impact of measles vaccination in the United States | journal = Pediatrics | volume = 76 | issue = 4 | pages = 524–532 | date = October 1985 | pmid = 3931045 | doi = 10.1542/peds.76.4.524 | s2cid = 6512947 }} 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.{{cite journal | title = Progress in reducing global measles deaths, 1999-2004 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 55 | issue = 9 | pages = 247–249 | date = March 2006 | pmid = 16528234 | url = https://www.cdc.gov/mmwr/pdf/wk/mm5509.pdf | access-date = 26 January 2020 | url-status = live | archive-url = https://web.archive.org/web/20210305135803/https://www.cdc.gov/mmwr/pdf/wk/mm5509.pdf | archive-date = 5 March 2021 | author1 = Centers for Disease Control and Prevention (CDC) }} Between 2000 and 2018, measles vaccination resulted in a 73% decrease in deaths from the disease.

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. 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.{{cite journal | title = Measles--United States, 2005 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 55 | issue = 50 | pages = 1348–1351 | date = December 2006 | pmid = 17183226 | url = https://www.cdc.gov/mmwr/pdf/wk/mm5550.pdf | access-date = 26 January 2020 | url-status = live | archive-url = https://web.archive.org/web/20210126050729/https://www.cdc.gov/mmwr/PDF/wk/mm5550.pdf | archive-date = 26 January 2021 | author1 = Centers for Disease Control and Prevention (CDC) }} 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.{{cite journal | vauthors = Parker AA, Staggs W, Dayan GH, Ortega-Sánchez IR, Rota PA, Lowe L, Boardman P, Teclaw R, Graves C, LeBaron CW | title = Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States | journal = The New England Journal of Medicine | volume = 355 | issue = 5 | pages = 447–455 | date = August 2006 | pmid = 16885548 | doi = 10.1056/NEJMoa060775 | s2cid = 34529542 | doi-access = free }}

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.{{cite journal | vauthors = Hall V, Banerjee E, Kenyon C, Strain A, Griffith J, Como-Sabetti K, Heath J, Bahta L, Martin K, McMahon M, Johnson D, Roddy M, Dunn D, Ehresmann K | title = Measles Outbreak - Minnesota April-May 2017 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 66 | issue = 27 | pages = 713–717 | date = July 2017 | pmid = 28704350 | pmc = 5687591 | doi = 10.15585/mmwr.mm6627a1 | url = https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6627.pdf | access-date = 26 January 2020 | url-status = live | archive-url = https://web.archive.org/web/20200802231920/https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6627.pdf | archive-date = 2 August 2020 }}

File:Rubella in the US 1966-2017.png

Rubella, also known as German measles, was also very common before widespread vaccination. The major risk of rubella is during pregnancy when the baby may contract congenital rubella, which can cause significant congenital defects.{{cite web | title=Measles, Mumps, Rubella (MMR) Vaccine and Immunization Information | website=National Network for Immunization Information (NNii) | date=22 April 2010 | url=https://www.immunizationinfo.org/vaccines/rubella/ | access-date=28 November 2022 | archive-url=https://web.archive.org/web/20221128012158/https://www.immunizationinfo.org/vaccines/rubella/ |archive-date=28 November 2022 |url-status=live }}

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.{{cite book| title=Male infertility: a guide for the clinician| vauthors=Jequier AM| isbn=978-0-632-05129-8| location=Malden, MA| publisher=Blackwell Publishing| year=2000| page=118| url=https://books.google.com/books?id=ULWh1Wc1nKMC| access-date=24 September 2016| archive-date=17 April 2021| archive-url=https://web.archive.org/web/20210417193726/https://books.google.com/books?id=ULWh1Wc1nKMC| url-status=live}}

The MMR vaccine is administered by a subcutaneous injection, the first dose typically at twelve months of age. The second dose may be given as early as one month after the first dose. The second dose is a dose to produce immunity in the small number of persons (2–5%) who fail to develop measles immunity after the first dose. In the US it is done before entry to kindergarten because that is a convenient time.{{cite web|url=https://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmr/faqs-mmr-hcp.htm |title=MMR vaccine questions and answers |year=2004 |access-date=28 May 2008 |publisher=U.S. Centers for Disease Control and Prevention (CDC) |url-status=dead |archive-url=https://web.archive.org/web/20080725232358/http://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmr/faqs-mmr-hcp.htm |archive-date=25 July 2008 }} Areas where measles is common typically recommend the first dose at nine months of age and the second dose at fifteen months of age.

Adverse reactions, rarely serious, may occur from each component of the MMR vaccine. Ten percent of children develop fever, malaise, and a rash 5–21 days after the first vaccination;{{cite journal | vauthors = Harnden A, Shakespeare J | title = 10-minute consultation: MMR immunisation | journal = BMJ | volume = 323 | issue = 7303 | pages = 32 | date = July 2001 | pmid = 11440943 | pmc = 1120664 | doi = 10.1136/bmj.323.7303.32 }} and 3% develop joint pain lasting 18 days on average.{{cite journal | vauthors = Thompson GR, Ferreyra A, Brackett RG | title = Acute arthritis complicating rubella vaccination | journal = Arthritis and Rheumatism | volume = 14 | issue = 1 | pages = 19–26 | year = 1971 | pmid = 5100638 | doi = 10.1002/art.1780140104 | url = https://deepblue.lib.umich.edu/bitstream/2027.42/37715/1/1780140104_ftp.pdf | access-date = 1 September 2019 | url-status = live | hdl-access = free | archive-date = 25 November 2011 | archive-url = https://web.archive.org/web/20111125081635/http://deepblue.lib.umich.edu/bitstream/2027.42/37715/1/1780140104_ftp.pdf | hdl = 2027.42/37715 }} Older women appear to be more at risk of joint pain, acute arthritis, and even (rarely) chronic arthritis.{{cite journal | vauthors = Schattner A | title = Consequence or coincidence? The occurrence, pathogenesis and significance of autoimmune manifestations after viral vaccines | journal = Vaccine | volume = 23 | issue = 30 | pages = 3876–3886 | date = June 2005 | pmid = 15917108 | doi = 10.1016/j.vaccine.2005.03.005 }} Anaphylaxis is an extremely rare but serious allergic reaction to the vaccine.{{cite journal | vauthors = Carapetis JR, Curtis N, Royle J | title = MMR immunisation. True anaphylaxis to MMR vaccine is extremely rare | journal = BMJ | volume = 323 | issue = 7317 | pages = 869 | date = October 2001 | pmid = 11683165 | pmc = 1121404 | doi = 10.1136/bmj.323.7317.869a }} One cause can be egg allergy.{{cite journal | vauthors = Fox A, Lack G | title = Egg allergy and MMR vaccination | journal = The British Journal of General Practice | volume = 53 | issue = 495 | pages = 801–802 | date = October 2003 | pmid = 14601358 | pmc = 1314715 | url = http://openurl.ingenta.com/content/nlm?genre=article&issn=0960-1643&volume=53&issue=495&spage=801&aulast=Fox | url-status = dead | archive-url = https://archive.today/20130126182439/http://openurl.ingenta.com/content/nlm?genre=article&issn=0960-1643&volume=53&issue=495&spage=801&aulast=Fox | archive-date = 26 January 2013 }} In 2014, the FDA approved two additional possible adverse events on the vaccination label: acute disseminated encephalomyelitis (ADEM), and transverse myelitis, with permission to also add "difficulty walking" to the package inserts.{{cite web|title=Approval for label change|website=Food and Drug Administration|url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm394905.htm | archive-url = https://web.archive.org/web/20150203162448/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm394905.htm | archive-date = 3 February 2015 }} A 2012 IOM report found that the measles component of the MMR vaccine can cause measles inclusion body encephalitis in immunocompromised individuals. This report also rejected any connection between the MMR vaccine and autism.{{cite book | veditors = Stratton K, Ford A, Rusch E, Clayton EW | vauthors = ((Institute of Medicine)) | title = Adverse Effects of Vaccines | year = 2012 | pmid = 24624471 | doi = 10.17226/13164 | isbn = 978-0-309-21435-3 | publisher = National Academies Press | id=Bookshelf ID: NBK190024 | publication-place=Washington, D.C. }} Some versions of the vaccine contain the antibiotic neomycin and therefore should not be used in people allergic to this antibiotic.

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.{{cite book |veditors=Stratton KR, Howe CJ, Johnston RB |title=Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality |year=1994 |isbn=978-0-309-07496-4 |chapter=Measles and mumps vaccines |chapter-url=http://books.nap.edu/openbook.php?record_id=2138&page=131 |publisher=National Academies Press |vauthors=((Institute of Medicine)) |doi=10.17226/2138 |pmid=25144097 |id=Bookshelf ID: NBK236291 |access-date=29 August 2007 |archive-date=24 August 2015 |archive-url=https://web.archive.org/web/20150824183227/http://books.nap.edu/openbook.php?record_id=2138&page=131 |url-status=live }} 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.{{cite journal | vauthors = Colville A, Pugh S, Miller E | title = Withdrawal of a mumps vaccine | journal = European Journal of Pediatrics | volume = 153 | issue = 6 | pages = 467–468 | date = June 1994 | pmid = 8088305 | doi = 10.1007/BF01983415 | s2cid = 43300463 }} 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,{{cite journal | vauthors = Fullerton KE, Reef SE | title = Commentary: Ongoing debate over the safety of the different mumps vaccine strains impacts mumps disease control | journal = International Journal of Epidemiology | volume = 31 | issue = 5 | pages = 983–984 | date = October 2002 | pmid = 12435772 | doi = 10.1093/ije/31.5.983 | doi-access = free }} 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.

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.

Naturally acquired measles often occurs with immune thrombocytopenic purpura (ITP, a purpuric rash and an increased tendency to bleed that resolves within two months in children), occurring in 1 to 20,000 cases. Approximately 1 in 40,000 children are thought to acquire ITP in the six weeks following an MMR vaccination. ITP below the age of six years is generally a mild disease, rarely having long-term consequences.{{cite journal | vauthors = Sauvé LJ, Scheifele D | title = Do childhood vaccines cause thrombocytopenia? | journal = Paediatrics & Child Health | volume = 14 | issue = 1 | pages = 31–32 | date = January 2009 | pmid = 19436461 | pmc = 2661332 | doi = 10.1093/pch/14.1.31 }}{{cite journal | vauthors = Black C, Kaye JA, Jick H | title = MMR vaccine and idiopathic thrombocytopaenic purpura | journal = British Journal of Clinical Pharmacology | volume = 55 | issue = 1 | pages = 107–111 | date = January 2003 | pmid = 12534647 | pmc = 1884189 | doi = 10.1046/j.1365-2125.2003.01790.x }}

{{main|MMR vaccine and autism}}

In 1998 Andrew Wakefield et al. published a fraudulent paper about twelve children, reportedly with bowel symptoms and autism or other disorders acquired soon after administration of MMR vaccine,{{cite journal | vauthors = Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA | title = Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children | journal = Lancet | volume = 351 | issue = 9103 | pages = 637–641 | date = February 1998 | pmid = 9500320 | doi = 10.1016/S0140-6736(97)11096-0 | url = http://briandeer.com/mmr/lancet-paper.htm | access-date = 5 September 2007 | url-status = live | s2cid = 439791 | archive-url = https://web.archive.org/web/20070927010149/http://briandeer.com/mmr/lancet-paper.htm | archive-date = 27 September 2007 | url-access = subscription }}{{Retracted|doi=10.1016/S0140-6736(10)60175-4|pmid=20137807|http://retractionwatch.com/the-retraction-watch-leaderboard/top-10-most-highly-cited-retracted-papers/ Retraction Watch|http://retractionwatch.com/2015/02/03/frauds-long-tail-measles-outbreak-shows-important-look-downstream-retractions/ Retraction Watch|intentional=yes}} while supporting a competing vaccine. In 2010, Wakefield's research was found by the General Medical Council to have been "dishonest",{{cite news| vauthors = Jardine C |title=GMC brands Dr Andrew Wakefield 'dishonest, irresponsible and callous'|url=https://www.telegraph.co.uk/news/health/7095145/GMC-brands-Dr-Andrew-Wakefield-dishonest-irresponsible-and-callous.html |archive-url=https://ghostarchive.org/archive/20220112/https://www.telegraph.co.uk/news/health/7095145/GMC-brands-Dr-Andrew-Wakefield-dishonest-irresponsible-and-callous.html |archive-date=12 January 2022 |url-access=subscription |url-status=live|access-date=31 January 2015|work=The Telegraph|date=29 January 2010|location=London}}{{cbignore}} and The Lancet fully retracted the paper.{{cite journal | title = Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children | journal = Lancet | volume = 375 | issue = 9713 | pages = 445 | date = February 2010 | pmid = 20137807 | doi = 10.1016/S0140-6736(10)60175-4 | s2cid = 26364726 | author=((The Editors of The Lancet)) }}{{cite news | vauthors = Triggle N | title=Lancet accepts MMR study 'false' | website=BBC News | date=2 February 2010 | url=http://news.bbc.co.uk/2/hi/health/8493753.stm | access-date=11 June 2022 | archive-date=3 November 2021 | archive-url=https://web.archive.org/web/20211103171340/http://news.bbc.co.uk/2/hi/health/8493753.stm | url-status=live }} Three months following The Lancet's retraction, Wakefield was struck off the UK medical register, with a statement identifying deliberate falsification in the research published in The Lancet,{{cite web|url=http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf |title=General Medical Council, Fitness to Practise Panel Hearing, 24 May 2010, Andrew Wakefield, Determination of Serious Professional Misconduct |access-date=18 September 2011 |publisher=General Medical Council |url-status=dead |archive-url=https://web.archive.org/web/20110809092833/http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf |archive-date=9 August 2011 }} and was barred from practising medicine in the UK.{{cite news|url=https://www.theguardian.com/society/2010/may/24/mmr-doctor-andrew-wakefield-struck-off |title=MMR row doctor Andrew Wakefield struck off register |newspaper=The Guardian|date= 24 May 2010|access-date=24 May 2010 | location=London | vauthors = Meikle J, Sarah B | archive-url= https://web.archive.org/web/20100527003931/http://www.guardian.co.uk/society/2010/may/24/mmr-doctor-andrew-wakefield-struck-off| archive-date= 27 May 2010 | url-status= live }} The research was declared fraudulent in 2011 by the British Medical Journal.{{cite journal | vauthors = Godlee F, Smith J, Marcovitch H | title = Wakefield's article linking MMR vaccine and autism was fraudulent | journal = BMJ | volume = 342 | issue = jan05 1; c7452 | pages = c7452 | date = January 2011 | pmid = 21209060 | doi = 10.1136/bmj.c7452 | s2cid = 43640126 }}

Since Wakefield's publication, multiple peer-reviewed studies have failed to show any association between the vaccine and autism. The US Centers for Disease Control and Prevention,{{cite web | title = Measles, Mumps, Rubella (MMR) Vaccine | publisher = U.S. Centers for Disease Control and Prevention (CDC) | date = 24 August 2018 | url = https://www.cdc.gov/vaccinesafety/vaccines/mmr-vaccine.html | access-date = 28 November 2022 |archive-url = https://web.archive.org/web/20221128012741/https://www.cdc.gov/vaccinesafety/vaccines/mmr-vaccine.html |archive-date = 28 November 2022}}{{cite web | title = Autism and Vaccines - Vaccine Safety | publisher = U.S. Centers for Disease Control and Prevention (CDC) | date = 24 August 2018 | url = https://www.cdc.gov/vaccinesafety/concerns/autism.html | access-date = 28 November 2022 | archive-url = https://web.archive.org/web/20221128012758/https://www.cdc.gov/vaccinesafety/concerns/autism.html | archive-date = 28 November 2022 | url-status = live }} the Institute of Medicine of the US National Academy of Sciences,{{cite book | vauthors=((Institute of Medicine)) | title=Immunization Safety Review | publisher=National Academies Press | publication-place=Washington, D.C. | year=2004 | isbn=978-0-309-09237-1 | doi=10.17226/10997 | id=Bookshelf ID: NBK25344 | pmid= 20669467 | doi-access = free | title-link = doi }} the UK National Health Service{{cite web | title=MMR (measles, mumps and rubella) vaccine | website=UK National Health Service | date=4 July 2022 | url=https://www.nhs.uk/conditions/vaccinations/mmr-vaccine/ | access-date=28 November 2022 | archive-url=https://web.archive.org/web/20221128013700/https://www.nhs.uk/conditions/vaccinations/mmr-vaccine/ | archive-date=28 November 2022 | url-status=live }} and the Cochrane Library review have all concluded that there is no evidence of a link.

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.{{cite web|title=MMR: myths and truths |url=http://www.mmrthefacts.nhs.uk/basics/truths.php |access-date=3 September 2007 |year=2004 |author=National Health Service |url-status=dead |archive-url=https://web.archive.org/web/20080913173824/http://www.mmrthefacts.nhs.uk/basics/truths.php |archive-date=13 September 2008 }}MMR vs three separate vaccines:

• {{cite journal | vauthors = Halsey NA, Hyman SL | title = Measles-mumps-rubella vaccine and autistic spectrum disorder: report from the New Challenges in Childhood Immunizations Conference convened in Oak Brook, Illinois, June 12-13, 2000 | journal = Pediatrics | volume = 107 | issue = 5 | pages = E84 | date = May 2001 | pmid = 11331734 | doi = 10.1542/peds.107.5.e84 | collaboration = Conference Writing Panel | doi-access = free | title-link = doi }}
• {{cite journal | vauthors = Leitch R, Halsey N, Hyman SL | title = MMR--Separate administration-has it been done? | journal = Pediatrics | volume = 109 | issue = 1 | pages = 172 | date = January 2002 | pmid = 11773568 | doi = 10.1542/peds.109.1.172 | department = Letter to the editor }}
• {{cite journal | vauthors = Miller E | title = MMR vaccine: review of benefits and risks | journal = The Journal of Infection | volume = 44 | issue = 1 | pages = 1–6 | date = January 2002 | pmid = 11972410 | doi = 10.1053/jinf.2001.0930 }} Health experts have criticized media reporting of the MMR-autism controversy for triggering a decline in vaccination rates.{{cite news | url=http://news.bbc.co.uk/2/hi/health/5118166.stm | title=Doctors issue plea over MMR jab | work=BBC News | access-date=4 February 2009 | date=26 June 2006 | archive-date=7 July 2018 | archive-url=https://web.archive.org/web/20180707192022/http://news.bbc.co.uk/2/hi/health/5118166.stm | url-status=live }} 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.{{cite journal | vauthors = Thomas J | year = 2010 | title = Paranoia strikes deep: MMR vaccine and autism | url = https://www.psychiatrictimes.com/view/paranoia-strikes-deep-mmr-vaccine-and-autism | archive-url = https://archive.today/20150409124829/http://www.searchmedica.com/resource.html?rurl=http://www.psychiatrictimes.com/display/article/10168/1531916 | url-status = live | archive-date = 9 April 2015 | journal = Psychiatric Times | volume = 27 | issue = 3 | pages = 1–6 }}

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.{{cite journal | vauthors = Honda H, Shimizu Y, Rutter M | title = No effect of MMR withdrawal on the incidence of autism: a total population study | journal = Journal of Child Psychology and Psychiatry, and Allied Disciplines | volume = 46 | issue = 6 | pages = 572–579 | date = June 2005 | pmid = 15877763 | doi = 10.1111/j.1469-7610.2005.01425.x | s2cid = 10253998 | citeseerx = 10.1.1.579.1619 }}

File:Hilleman-Walter-Reed.jpeg, who developed the MMR vaccine]]

File:Preparation of measles vaccines.jpg

The component viral strains of MMR vaccine were developed by propagation in animal and human cells.{{cite journal |vauthors=Wellington K, Goa KL |title=Measles, mumps, rubella vaccine (Priorix; GSK-MMR): a review of its use in the prevention of measles, mumps and rubella |journal=Drugs |volume=63 |issue=19 |pages=2107–26 |date=2003 |pmid=12962524 |doi=10.2165/00003495-200363190-00012 |url=}}

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.{{cite journal | vauthors = Plotkin SA, Vaheri A | title = Human fibroblasts infected with rubella virus produce a growth inhibitor | journal = Science | volume = 156 | issue = 3775 | pages = 659–661 | date = May 1967 | pmid = 6023662 | doi = 10.1126/science.156.3775.659 | s2cid = 32622296 | bibcode = 1967Sci...156..659P }}{{cite journal | vauthors = Hayflick L, Moorhead PS | title = The serial cultivation of human diploid cell strains | journal = Experimental Cell Research | volume = 25 | issue = 3 | pages = 585–621 | date = December 1961 | pmid = 13905658 | doi = 10.1016/0014-4827(61)90192-6 }}

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

Merck MMR II is supplied freeze-dried (lyophilized) and contains live viruses. Before injection, it is reconstituted with the solvent provided.{{cite web|url=https://www.cdc.gov/vaccines/vpd/mmr/hcp/about.html|title=About the Vaccine – MMR and MMRV Vaccine Composition and Dosage|access-date=7 October 2021|date=26 January 2021|publisher=U.S. Centers for Disease Control and Prevention (CDC) |archive-date=6 October 2021|archive-url=https://web.archive.org/web/20211006025435/https://www.cdc.gov/vaccines/vpd/mmr/hcp/about.html|url-status=live}}

According to a review published in 2018, the GlaxoSmithKline (GSK) MMR vaccine known as Pluserix "contains the Schwarz measles virus, the Jeryl Lynn–like mumps strain, and RA27/3 rubella virus".{{cite book |doi=10.1016/B978-0-323-35761-6.00052-3|chapter=Rubella Vaccines|title=Plotkin's Vaccines|year=2018| vauthors = Reef SE, Plotkin SA |pages=970–1000.e18|isbn=9780323357616}}

Pluserix was introduced in Hungary in 1999. Enders' Edmonston strain has been used since 1999 in Hungary in Merck MMR II product.{{cite journal | vauthors = Böröcz K, Csizmadia Z, Markovics Á, Farkas N, Najbauer J, Berki T, Németh P | title = Application of a fast and cost-effective 'three-in-one' MMR ELISA as a tool for surveying anti-MMR humoral immunity: the Hungarian experience | journal = Epidemiology and Infection | volume = 148 | pages = e17 | date = February 2020 | pmid = 32014073 | pmc = 7019553 | doi = 10.1017/S0950268819002280 }} GSK Priorix vaccine, which uses attenuated Schwarz Measles, was introduced in Hungary in 2003.

{{main|MMRV vaccine}}

The MMRV vaccine, a combined measles, mumps, rubella, and varicella (chickenpox) vaccine, has been proposed as a replacement for the MMR vaccine to simplify the administration of the vaccines.{{cite journal | vauthors = Vesikari T, Sadzot-Delvaux C, Rentier B, Gershon A | title = Increasing coverage and efficiency of measles, mumps, and rubella vaccine and introducing universal varicella vaccination in Europe: a role for the combined vaccine | journal = The Pediatric Infectious Disease Journal | volume = 26 | issue = 7 | pages = 632–638 | date = July 2007 | pmid = 17596807 | doi = 10.1097/INF.0b013e3180616c8f | s2cid = 41981427 }} Preliminary data indicate a rate of febrile seizures of 9 per 10,000 vaccinations with MMRV, as opposed to 4 per 10,000 for separate MMR and varicella shots; US health officials therefore, do not express a preference for use of MMRV vaccine over separate injections.{{cite journal | title = Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 57 | issue = 10 | pages = 258–260 | date = March 2008 | pmid = 18340332 | url = https://www.cdc.gov/mmwr/PDF/wk/mm5710.pdf | access-date = 26 January 2020 | url-status = live | archive-url = https://web.archive.org/web/20201019154628/https://www.cdc.gov/mmwr/PDF/wk/mm5710.pdf | archive-date = 19 October 2020 | author1 = Centers for Disease Control and Prevention (CDC) | author2 = Advisory Committee on Immunization Practices (ACIP) }}

In a 2012 study{{cite journal | vauthors = O'Leary ST, Suh CA, Marin M | title = Febrile seizures and measles-mumps-rubella-varicella (MMRV) vaccine: what do primary care physicians think? | journal = Vaccine | volume = 30 | issue = 48 | pages = 6731–6733 | date = November 2012 | pmid = 22975026 | doi = 10.1016/j.vaccine.2012.08.075 }} pediatricians and family doctors were sent a survey to gauge their awareness of the increased risk of febrile seizures (fever fits) in the MMRV. 74% of family doctors and 29% of pediatricians were unaware of the increased risk of febrile seizures. After reading an informational statement only 7% of family doctors and 20% of pediatricians would recommend the MMRV for a healthy 12- to 15-month-old child. The factor that was reported as the "most important" deciding factor in recommending the MMRV over the MMR+V was ACIP/AAFP/AAP recommendations (pediatricians, 77%; family physicians, 73%).

{{Update section|date=November 2022}}

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

Some brands of the vaccine use gelatin, derived from pigs, as a stabilizer. This has caused reduced take-up among some communities,{{cite news |vauthors=Pager T |title='Monkey, Rat and Pig DNA': How Misinformation Is Driving the Measles Outbreak Among Ultra-Orthodox Jews |url=https://www.nytimes.com/2019/04/09/nyregion/jews-measles-vaccination.html |access-date=14 April 2019 |work=The New York Times |date=9 April 2019 |archive-date=14 April 2019 |archive-url=https://web.archive.org/web/20190414053524/https://www.nytimes.com/2019/04/09/nyregion/jews-measles-vaccination.html |url-status=live }} despite the fact that alternative vaccines without pig derivatives are approved and available.{{cite web |title=Vaccines and porcine gelatine |url=https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/751199/Vaccines_porcine_gelatine.pdf |publisher=Public Health England |access-date=14 April 2019 |date=August 2015 |archive-date=14 April 2019 |archive-url=https://web.archive.org/web/20190414103713/https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/751199/Vaccines_porcine_gelatine.pdf |url-status=live }}

{{reflist}}

{{refbegin|2}}

• {{cite book | vauthors=((World Health Organization)) | title=The immunological basis for immunization series: module 7: measles (update 2009) | publisher=World Health Organization (WHO) | date=January 2009 | hdl=10665/44038 | isbn=9789241597555 | hdl-access=free }}
• {{cite book | vauthors=((World Health Organization)) | title=The immunological basis for immunization series: module 16: mumps | publisher=World Health Organization (WHO) | date=November 2010 | hdl=10665/97885 | isbn=9789241500661 | hdl-access=free }}
• {{cite book | vauthors=((World Health Organization)) | title=The immunological basis for immunization series: module 11: rubella | publisher=World Health Organization (WHO) | date=December 2008 | hdl=10665/43922 | isbn=9789241596848 | hdl-access=free }}
• {{cite book | title=Immunisation against infectious disease | publisher=Public Health England | veditors = Ramsay M | url=https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book | date=April 2013 }}
• {{cite web | title= Measles: the green book, chapter 21 | date=31 December 2019 | url=https://www.gov.uk/government/publications/measles-the-green-book-chapter-21 }}
• {{cite web | title= Mumps: the green book, chapter 23 | date=4 April 2013 | url=https://www.gov.uk/government/publications/mumps-the-green-book-chapter-23 }}
• {{cite web | title= Rubella: the green book, chapter 28 | date=4 April 2013 | url=https://www.gov.uk/government/publications/rubella-the-green-book-chapter-28 }}
• {{cite book | publisher = U.S. Centers for Disease Control and Prevention (CDC) | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | veditors = Hamborsky J, Kroger A, Wolfe S | edition = 13th | location = Washington D.C. | year = 2015 | isbn = 978-0990449119 | url=https://www.cdc.gov/pinkbook/hcp/table-of-contents/index.html }}
• {{cite web | title = Chapter 13: Measles | date =10 July 2024 | url =https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-13-measles.html }}
• {{cite web | title = Chapter 15: Mumps | date = 29 July 2024 | url = https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-15-mumps.html }}
• {{cite web | title = Chapter 20: Rubella | date = 29 July 2024 | url = https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-20-rubella.html }}
• {{cite book | veditors = Roush SW, Baldy LM, Hall MA | title = Manual for the surveillance of vaccine-preventable diseases | publisher = U.S. Centers for Disease Control and Prevention (CDC) | location = Atlanta GA | url = https://www.cdc.gov/vaccines/pubs/surv-manual/ | date=March 2019 }}
• {{cite web | title = Chapter 7: Measles | date = May 2024 | url = https://www.cdc.gov/vaccines/pubs/surv-manual/chpt07-measles.html }}
• {{cite web | title = Chapter 9: Mumps | date = 19 December 2023 | url = https://www.cdc.gov/vaccines/pubs/surv-manual/chpt09-mumps.html }}
• {{cite web | title = Chapter 14: Rubella | date = 22 August 2023 | url = https://www.cdc.gov/vaccines/pubs/surv-manual/chpt14-rubella.html }}

{{refend}}

• {{MeSH name|Measles-Mumps-Rubella Vaccine}}

{{Vaccines}}

{{GlaxoSmithKline}}

{{Portalbar|Medicine|Viruses}}

{{Authority control}}

{{DEFAULTSORT:Mmr Vaccine}}

Category:Combination vaccines

Category:Drugs developed by GSK plc

Category:Live vaccines

Category:Measles

Category:Drugs developed by Merck & Co.

Category:Mumps

Category:Rubella

Category:Wikipedia medicine articles ready to translate