Overview
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All cases of measles seen in New Zealand are the result of non-immune people bringing the virus into the country from overseas. Very high coverage of this vaccine is necessary to prevent the spread of measles, in particular, and no vaccination opportunity should be missed.
After a single dose of MMR vaccine 90–95 out of 100 people will be protected from measles, 69–81 protected from mumps and 90–97 from rubella. After a second dose of MMR vaccine the number of people protected from these diseases increases, almost everyone will be protected from measles and rubella, and around 85% protected from mumps.
The MMR vaccine is given as part of the National Immunisation Schedule at ages 12 months and 15 months. Two doses are recommended and funded for non-immune children and adults.
Immunity to measles, mumps and rubella is assumed after two documented doses of MMR, unless revaccination is required post-immunosuppression or in occupational high-risk situations where serology has been undertaken.
Immunity to measles is also assumed in people who lived in New Zealand prior to 1969. Other people who lived in countries with limited circulating measles* prior to 1969 may not be immune to measles if not previously immunised with a measles-containing vaccine. Therefore, they can be considered for funded MMR vaccination, particularly in the case of a community outbreak. Those born prior to 1969 do not need to be recalled for MMR vaccination but may benefit from a clinical discussion about their risk.
MMR vaccine information has recently been updated in the Immunisation Handbook to not preclude people born before 1969.
*Countries with limited circulating measles prior to 1969 include remote island nations. .
Responses to vaccine
- Measles component: Fever and/or mild rash 6–12 days after immunisation
- Mumps component: Fever and/or mild swelling under the jaw 10—14 days after immunisation
- Rubella component: Fever, mild rash and/or swollen glands 2—4 weeks after immunisation
- Temporary joint pain 2—4 weeks after immunisation is more common in adult women than children
- Temporary low platelet count
- Convulsion associated with fever
Other formulations and brands
Other brands: M-M-R II
Schedule and administration
Priorix and M-M-R II vaccines are fully interchangeable, a person who receives one M-M-R II can complete their course of vaccines with Priorix. MMR vaccine is funded as part of the National Immunisation Schedule at 12 months and 15 months of age.
MMR vaccine is also recommended for some occupations: staff in early childhood services, healthcare assistants and long-term facility carers, laboratory staff, medical, nursing and other health professionals, and students in training for these occupations.
Special groups
MMR vaccine is funded for (re)-immunisation following immunosuppression. MMR vaccine is contraindicated in immunosuppressed individuals.
MMR vaccine is recommended for all HIV-positive children, whether symptomatic or asymptomatic, if the CD4+ lymphocyte percentage is 15 percent or greater. Asymptomatic children who are not severely immunocompromised are recommended to receive MMR vaccine from age 12 months to provide early protection against the three diseases.
Susceptible HIV-positive children and adults aged 14 years and older may receive MMR vaccine if the CD4+ lymphocyte count is 200 cells/mm3 or greater. Administration of MMR with CD4+ counts below these recommended levels has been associated with related pneumonitis (from the measles component).
Catch-up doses
This vaccine is funded for children aged under 18 years and adults born 1 January 1969 or later who do not have not two documented doses of MMR vaccine given from 12 months of age and a minimum of 4 weeks apart.
Storage and preparation
Store vaccine and diluent as per cold chain between 2°C to 8°C.
Administration
The Ministry of Health recommends that MMR vaccine is administered via the IM route. However, administration of MMR vaccine by either the IM or SC injection route delivers a valid dose of vaccine. In the original clinical trials, MMR vaccine was given by SC injection and this became the recommended route of injection. Since then, data have shown that administration of MMR vaccine by IM injection generates an immune response equal to the response when the vaccine is given via the SC route, and the vaccine is also well-tolerated.
- The first MMR vaccine dose is due at 12 months of age.
- The second MMR vaccine dose due at 15 months of age is not recommended to be given early, unless there is a high risk of exposure to these diseases, such as during an outbreak.
- When there is a high risk of exposure to measles, mumps or rubella, 15-months MMR2 dose can be administered as early as 4 weeks after the MMR1 dose
- From 15 months of age, the second MMR vaccine dose can routinely be given as soon as four weeks after the first dose.
The second MMR dose is a revaccination intended for those who may not be fully protected following the first dose. It is not a booster dose.
Due to limits of detection levels of assays two documented doses of MMR are adequate presumptive evidence of immunity, even when serology is negative or equivocal for one or more of the diseases covered by the vaccine.
Priorix can be administered concurrently with other vaccines, including varicella and all the National Immunisation Schedule vaccines. Separate syringes and different injection sites should be used. If not given at the same visit as varicella vaccine, a 4 week interval between the two live virus vaccines should be observed.
In the case of a measles outbreak, the Ministry of Health may provide advice that the vaccine may be prescribed for an infant aged 6–11 months who has been in direct contact with a measles case. This dose is called ‘dose zero’ or MMR0. Two further doses are required from 12 months of age as per the Schedule.
Vaccine Safety
MMR vaccine can be given to:
- The close contacts of a newborn baby
- The close contacts of a pregnant woman
- The close contacts of a person who is immune suppressed
- To a person with egg allergy or anaphylaxis
- To a breastfeeding woman.
Immunisation should be postponed in individuals suffering from a fever over 38°C. However, the presence of a minor infection is not a reason to delay immunisation.
MMR vaccine should not be given to:
- Anyone who has a severe weakness of the immune system.
- Anyone who had a severe allergic response (anaphylaxis) to a previous dose of this vaccine or a component of this vaccine.
- Women who are currently pregnant. Women are advised to delay pregnancy for 4 weeks after receipt of an MMR vaccine dose.
- People who have received another live injected vaccine within the previous four weeks.
Advice should be sought for the following groups:
- People receiving high-dose steroid medicine, e.g. prednisone, for more than 14 days. They should wait for at least four weeks after their treatment has finished before receiving the vaccine.
- People who are HIV-positive.
- Children with idiopathic thrombocytopenic purpura (ITP) at the time of vaccination.
- People who have received a blood product in the 11 months before immunisation.
- People expecting to receive a blood product in the two months after immunisation. These should not be given for two months after immunisation unless their use outweighs the benefits of the immunisation.
- Administration of MMR vaccine should be postponed in individuals suffering from a fever over 38°C. The presence of a minor infection is not a reason to delay immunisation.
Tuberculin skin testing (Mantoux test) should be avoided for 4–6 weeks following vaccination with Priorix. The measles vaccine component may temporarily suppress tuberculin skin sensitivity.
Vaccine Effectiveness
Infants under 12 months of age may fail to respond to the measles component of MMR vaccine due to persisting transplacental maternal measles antibodies. The younger the infant the less likely it is they will develop protection against measles.
In children aged 12 months and over and adults 90-95% of vaccinees are protected from measles, 69-81% from mumps and 90-97% from rubella after a single MMR vaccination. After a second dose of MMR vaccine the number of people protected from these diseases increases, almost everyone will be protected from measles and rubella, and up to 88% protected from mumps.
Secondary vaccine failure, waned immunity without an anamnestic (memory) response to the presence of wild or vaccine virus, occurs rarely for rubella and in only about 5% recipients for measles, but about 26% of MMR vaccine recipients will become susceptible to mumps around 10–20 years after vaccination.
A single MMR vaccination, administered to a measles non-immune individual within 72 hours of contact with a confirmed measles case, may prevent the development of measles disease in the vacicne recipient. Receipt of an MMR vaccine will not make incubating disease worse.
References
- Gillet Y, Steri GC, Behre U, Arsene JP, Lanse X, Helm K, et al. Immunogenicity and safety of measles-mumps-rubella-varicella (MMRV) vaccine followed by one dose of varicella vaccine in children aged 15 months-2 years or 2-6 years primed with measles-mumps-rubella (MMR) vaccine. Vaccine. 2009;27(3):446-53.
- McGraw TT. Reimmunization following early immunization with measles vaccine: A prospective study. Pediatrics. 1986;77(1):45-8.
- McLean, HQ, Fiebelkorn AP, Temte JL and Wallace GS. Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMRW 2013 62(RR04); 1-34 June 14. [accessed October 2016] Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
- Health New Zealand | Te Whatu Ora, Immunisation handbook [Internet]. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/immunisation-handbook
- Reef SE, Plotkin SA. Rubella vaccines. In: Plotkin S, Orenstein W, Offit P, editors. Plotkin’s vaccines. 7th ed. Philadelphia: Elsevier; 2018. p. 970-1000.
- Rubin SA. Mumps vaccines. In: Plotkin S, Orenstein W, Offit P, editors. Plotkin's vaccines. 7th ed. Philadelphia: Elsevier; 2018. p. 663-88.
- Strebel PM, Papania MJ, Gastanaduy PA, Goodson JL. Measles vaccines. In: Plotkin S, Orenstein W, Offit P, editors. Plotkin’s vaccines. 7th ed. Philadelphia: Elsevier; 2018. p. 579-618.
- World Health Organization. Meeting of the Strategic Advisory Group of Experts on Immunization, October 2015 – conclusions and recommendations. Weekly Epidemiology Record.2015, 90:50; 691 [cited October 2016] Available from: https://www.who.int/groups/strategic-advisory-group-of-experts-on-immunization/
