MMR vaccine is designed to protect against three things: measles, mumps and rubella.
Measles is a virus which causes high fever, lethargy, cough, nasal discharge, conjunctivitis and a characteristic rash.About 30% of infected patients will have complications, and 1 in 5 will be hospitalized.1 in 1,000 develop encephalitis, and between 1 in 500 and 1 in 1,000 will die.
Highly contagious, spread through respiratory dropletsin the air.
Worldwide measles infection is the 5th most common cause of death in children under 5.
Rare in the United States.Last estimates were 31-39 million illnesses worldwide in a single year.
Virus that usually causes swelling of the parotid glands, but can affect any organ system.Adolescent males can get swelling of the testes (called orchitis) which can reduce fertility or even cause sterility in rare cases.Can also cause miscarriage.Rarely causes encephalitis or deafness.
Contagious, but less so than measles or chickenpox.Spread via respiratory droplets (airborne) or by direct contact.
Before the vaccine: 200,000+ cases.Now: rare, with periodic outbreaks of up to a few thousand patients.
Virus that causes a fever and characteristic rash. Rarely causes encephalitis.
Is a teratogen if Mom contracts rubella in pregnancy.Leads to severe birth defects or miscarriage. Lasting effects of congenital rubella are severe, with no known treatment available.
Spread through respiratory droplets in the air, or through the placenta. Moderately contagious.
Before: 20,000 cases of congenital rubella per year.Now: rare.
Is a live, attenuated virus.
CDC recommended schedule: 12-15 months, 4-6 years.
Who should not get the vaccine?
Ingredients: sorbitol, sodium phosphate, sucrose, sodium chloride, gelatin, human albumin, fetal bovine serum, 25 mcg neomycin.
Research citations for MMR
Hamborsky J, Kroger A, Wolfe S. Epidemiology and Prevention of Vaccine-Preventable Diseases: Measles.Centers for Disease Control and Prevention. 13th ed. Washington D.C
Tae BS1, Ham BK, Kim JH, Park JY, Bae JH. Clinical features of mumps orchitis in vaccinated postpubertal males: a single-center series of 62 patients. Korean J Urol. 2012 Dec;53(12):865-9. doi: 10.4111/kju.2012.53.12.865. Epub 2012 Dec 20.
Leung JH1, Hirai HW, Tsoi KK. Immunogenicity and reactogenicity of tetravalent vaccine for measles, mumps, rubella and varicella (MMRV) in healthy children: a meta-analysis of randomized controlled trials. Expert Rev Vaccines. 2015;14(8):1149-57
Ma SJ1, Xiong YQ1, Jiang LN1, Chen Q2. Risk of febrile seizure after measles-mumps-rubella-varicella vaccine: A systematic review and meta-analysis. Vaccine. 2015 Jul 17;33(31):3636-49
“In this cohort, monovalent measles vaccination status is not associated with inflammatory bowel disease by age 26 yr. Older age at measles vaccination needs to be examined in other studies to confirm whether it is a genuine risk for Crohn’s disease.”
MMR vaccine timing – giving MMR before 15 months is associated with less febrile seizures.
Wilson K1, Ducharme R2, Ward B3, Hawken S4. Increased emergency room visits or hospital admissions in females after 12-month MMR vaccination, but no difference after vaccinations given at a younger age. Vaccine. 2014 Feb 26;32(10):1153-9.
Increased number of emergency visits in females only after MMR vaccination. “…translates to 192 excess events per 100,000 females vaccinated compared to the number of events that would have occurred in 100,000 males vaccinated.”
“The available data clearly indicate that ITP is very rare and the only vaccine for which there is a demonstrated cause-effect relationship is the measles, mumps and rubella (MMR) vaccine that can occur in 1 to 3 children every 100,000 vaccine doses.”
“ Following MMR vaccination, 102 infants came for post vaccination sampling of which 92 per cent were seropositive for measles, 100 per cent for mumps and 98 per cent for rubella. In the age group of 15-18 months, of the 120 children, 67 (56%) were seronegative for measles, 84 (70%) for mumps and 86 (71.6%) for rubella. In 50 per cent of the children, there was a history of measles immunization at 9 months of age. After MMR vaccination, 100 children came for post vaccination sampling and seropositivity of 92, 96 and 94 per cent was observed for measles, mumps and rubella, respectively. The rise in the pre- and post-immunization geometrical mean titre was significant (P < 0.05) for each component of the vaccine in both the age groups.”
Ceyhan M1, Kanra G, Erdem G, Kanra B. Immunogenicity and efficacy of one dose measles-mumps-rubella (MMR) vaccine at twelve months of age as compared to monovalent measles vaccination at nine months followed by MMR revaccination at fifteen months of age. Vaccine. 2001 Aug 14;19(31):4473-8.
Jennifer HubbardJuly 8, 2021 at 10:04 am
Hi Dr. Krumbeck! My 5 year old shows very high immunity on her titers to measles, mumps and rubella. I would like to use her titers for school instead of a 2nd dose of MMR. Do you know or is there any research on whether giving that 2nd dose, even though she already has immunity, would provide her with LONGER lasting immunity than just 1 dose? From what I am reading it seems like the 2nd dose is not a “booster” but to cover the 5% of children who do not respond to dose 1. BUT, I am wondering if two doses would protect her longer than just 1 dose. I hope this makes sense! I’m more concerned about maintaining rubella antibodies into childbearing years. Thanks!!
Jennifer HubbardJune 3, 2021 at 11:47 am
Hi Dr Krumbeck, Thank you so much for this course! What do you think about waiting until 2 years old (or even 3) for the MMR vaccine. I have read articles that say this is when the blood brain barrier is more developed and makes a case for less severe reactions being seen. I would love your thoughts on this! Thank you!
Erika Krumbeck, NDJune 22, 2021 at 9:15 am
That’s a great question. I do have some parents who prefer to wait until 2 or 3 to get the MMR vaccine. I pushed it back to 15 months for most kids based on some research that shows it is better tolerated at that age (fewer side effects, etc). I’ll look for that research paper and get back to you.
As for the BBB – I don’t see any compelling research that it is “more developed” at this age. Here’s an interesting PDF I found: https://cfpub.epa.gov/si/si_public_file_download.cfm?p_download_id=536430&Lab=NCCT
It shows that the BBB is fully formed in gestational weeks 6-14.
Of course, if kids are showing signs of neurobehavioral issues it would be perfectly appropriate to wait as long as there are no measles outbreaks in the community.
Hope this helps!
jennyhubbard19June 22, 2021 at 12:42 pm
Thank you so much! This is really helpful and I would love to see the article 🙂
dr.bMay 20, 2019 at 10:26 pm
Hi Dr. K! On the physician’s for informed consent website, they suggest that the pre-vaccination era death rate of measles was more likely at 1 in 10,000.
Here’s their statement about it: “Some sources estimate the measles case-fatality rate as 1 in 1,000, but PIC states that the actual measles case-fatality rate is 1 in 10,000. Why is that?
A pre-vaccination rate of about 1 in 1,000 reported cases has been publicized by public health departments. However, the key word is “reported.” Only 10% of cases are reported to public health departments, such as the Centers for Disease Control and Prevention (CDC).
Since nearly 90% of measles cases are not reported to the CDC, the result is a case-fatality rate of 1 in 10,000 for all measles cases. It is important to measure disease risks based on total measles cases, not just the 10% of cases that are reported.” They continue to expoud here:
I don’t think this is an entirely unbiased website, but nonetheless curious about your thoughts.
Thanks for the great course!!
Erika Krumbeck, NDMay 24, 2019 at 12:17 pm
You know this is a good point – in the past measles cases would only be reported if they ended up in a doctor’s office, or ER.
Now, however, most cases *are* reported. The best we can do is look at the rest of the data and try to figure out what the current case-fatality rate is.
This: https://www.ncbi.nlm.nih.gov/pubmed/30923799 shows a case fatality rate that changed (0.15%, up to 2.33%) in Mongolia. Is that applicable to a developed country? I’m not sure.
This one: https://www.ncbi.nlm.nih.gov/pubmed/30797735 discusses case fatality rates in developing nations, where CFR is declining from 2.2 – 1.5%. That is also probably less relevant for our country.
The problem is that we haven’t had an outbreak large enough to see what the case fatality rate would be in a developed nation, so I’m not sure we could extrapolate there.
kirrilyellisonMarch 16, 2019 at 3:27 am
Hi there, I read that MMR vaccine has high levels of glyphosate from the gelatin component, do you have information on this?
Erika Krumbeck, NDMarch 16, 2019 at 8:52 am
I’ve heard of that rumor several places, but I can’t find any actual scientific research that supports that. I can’t find ANY published studies on glyphosate in vaccines at all.
Just for context, I HATE glyphosate, and I do think it is causing all sorts of problems. (It is probably why many of my patients tolerate wheat products in Europe, but not the US.) There is now some pretty solid evidence that glyphosate causes reproductive issues, and I suspect it is causing endothelial barrier dysfunction too (“leaky gut.”) There is animal research that even at low doses glyphosate affects intestinal transit too.
So all that said, I still don’t think glyphosate is a big issue in vaccines. Glyphosate doesn’t tend to bioaccumulate, at least from the research I have seen. (There’s not a lot though!!) So the chance that glyphosate would be absorbed into bone or hide is pretty small. And then the total amount of gelatin in the vaccine itself is really small too – so we’re looking at parts per billion.
Chances are a baby (or toddler, at the time of MMR administration) would be exposed to MUCH more glyphosate by consuming ONE meal of non-organic grains, or even by wind-drift from a nearby organic farm than from the MMR vaccine.
If anyone finds any published research to contradict this please let me know!!
Remember again that really really HUGE studies show no link between the MMR vaccine and autism, but there *are* studies that show a link between autism and pesticides, autism and flame retardant exposure, autism and phthalates, autism and acetaminophen, and more.
ncatgirlMarch 6, 2019 at 10:38 am
Dr Erika – Thanks for the insights around Tylenol and the risks associated with giving it to treat fevers after vaccines. Got the message to avoid it “around the time of vaccine” but can you specify timing? Our son is getting the MMR vaccine on Friday. At what point would you consider it then safe to start giving Tylenol thereafter should he develop a fever that isnt associated with the vaccine? more than 2 weeks? more than that? Thanks!
Erika Krumbeck, NDMarch 12, 2019 at 9:16 pm
2 weeks should be fine! (Of course you know I hate Tylenol in general, so I always prefer families to avoid it whenever possible!!!)
ncatgirlMarch 6, 2019 at 10:20 am
Hi Dr Erika – In the Varicella session,you mentioned that kids can transmit Chickenpox if they display a rash after the vaccine and should avoid immune compromised people for 6 weeks under these circumstances. Is it also the case that a child can transmit any of the MMR diseases if they break out in fever or rash after the vaccine?
Erika Krumbeck, NDMarch 12, 2019 at 9:20 pm
This is a great question. The safety guidelines say it is fine to give MMR to a patient in the same household as an immune compromised patient. Measles rashes aren’t contagious like the varicella rash is. (Measles is spread via an airborne infection, but varicella can be spread directly by the vesicles – the spots, or pox as they are often called.) Does that make sense?
maggie.prestonMarch 13, 2018 at 9:05 pm
Hi Dr. Erika! I have a question, will post it here and under varicella.
You recommend not getting live virus vaccines when the immune system is compromised but I wanted to know a little more about what that means. In my baby’s case- at his 12 month visit he just came back with elevated lead levels. Not crazy high (6.5mcg) but over the safe limit for infants. I’m wondering if elevated lead makes someone immune compromised and if it’s best to wait until his levels go down to get those vaccines. thank you for your thoughts on this. I’ve really enjoyed this program.
Erika KrumbeckMarch 14, 2018 at 8:04 pm
Wow Maggie this is an excellent question, and honestly one that I do not have the answer to. I was more referring to babies who have a cold, flu or immune suppression, which would affect the immune system when a live virus vaccine is brought into play. I doubt that with that level of lead it would significantly depress their immune system function, but boy there are a lot of other factors to think about. I would have a really good discussion with your child’s primary care provider about it. You may need to answer some of the other questions too, to see if delaying is an option: are there any cases of measles or chickenpox in your community? Is there anyone immune compromised around your child?
Unfortunately live virus vaccines have really never been studied in this group of kids, despite the fact that lead toxicity is so common.
Let me know how it goes and what you end up deciding!