MMR – Measles, Mumps, Rubella

MMR vaccine

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 droplets  in 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.

The vaccine

  • 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

  1. 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
  2. World Health Organization.  Regional office of the Mediterranean. Measles: Disease Burden.  Web 20 June 2017.
  3. Jochems CE1van der Valk JBStafleu FRBaumans V. The use of fetal bovine serum: ethical or scientific problem? Altern Lab Anim. 2002 Mar-Apr;30(2):219-27.
  4. Sørup S1Benn CS2Poulsen A3Krause TG4Aaby P5Ravn H5.Live vaccine against measles, mumps, and rubella and the risk of hospital admissions for nontargeted infections. JAMA. 2014 Feb 26;311(8):826-35.
  5. Marin M1Broder KRTemte JLSnider DESeward JFCenters for Disease Control and Prevention (CDC). Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010 May 7;59(RR-3):1-12.
  6. Orlíková H1Malý M2Lexová P3Šebestová H2Limberková R4Jurzykowská L3Kynčl J3,5. Protective effect of vaccination against mumps complications, Czech Republic, 2007-2012. BMC Public Health. 2016 Apr 1;16:293. 
  7. Mäkelä A1Nuorti JPPeltola H. Neurologic disorders after measles-mumps-rubella vaccination. Pediatrics. 2002 Nov;110(5):957-63.
    1. We did not identify any association between MMR vaccination and encephalitis, aseptic meningitis, or autism.
  8. Seither RCalhoun KMellerson JKnighton CLStreet EDietz VUnderwood JM. Vaccination Coverage Among Children in Kindergarten – United States, 2015-16 School Year. MMWR Morb Mortal Wkly Rep. 2016 Oct 7;65(39):1057-1064.
  9. Gastañaduy PA1Budd J1Fisher N1Redd SB1Fletcher J1Miller J1McFadden DJ 3rd1Rota J1Rota PA1Hickman C1Fowler B1Tatham L1Wallace GS1de Fijter S1Parker Fiebelkorn A1DiOrio M1. A Measles Outbreak in an Underimmunized Amish Community in Ohio. N Engl J Med. 2016 Oct 6;375(14):1343-1354.
  10. Weiss C1,2Schröpfer D3Merten S4,5. Parental attitudes towards measles vaccination in the canton of Aargau, Switzerland: a latent class analysis. BMC Infect Dis. 2016 Aug 11;16(1):400.
  11. Kuter BJ1Brown MWiedmann RTHartzel JMusey L. Safety and Immunogenicity of M-M-RII (Combination Measles-Mumps-Rubella Vaccine) in Clinical Trials of Healthy Children Conducted Between 1988 and 2009. Pediatr Infect Dis J. 2016 Sep;35(9):1011-20. 
  12. Singh VK1. Phenotypic expression of autoimmune autistic disorder (AAD): a major subset of autism. Ann Clin Psychiatry. 2009 Jul-Sep;21(3):148-61.
  13. Singh VK1Jensen RL. Elevated levels of measles antibodies in children with autism. Pediatr Neurol. 2003 Apr;28(4):292-4.
  14. Li Q1Han Y1Dy ABC2Hagerman RJ3,4. The Gut Microbiota and Autism Spectrum Disorders. Front Cell Neurosci. 2017 Apr 28;11:120. 
  15. Libbey JE1Sweeten TLMcMahon WMFujinami RS. Autistic disorder and viral infections. J Neurovirol. 2005 Feb;11(1):1-10.
  16. Mandomando IM1Naniche DPasetti MFVallès XCuberos LNhacolo AKotloff KLMartins HLevine MMAlonso P. Measles-specific neutralizing antibodies in rural Mozambique: seroprevalence and presence in breast milk. Am J Trop Med Hyg. 2008 Nov;79(5):787-92.
  17. Boulianne N1De Serres GDuval BJoly JRMeyer FDéry PAlary MLe Hénaff DThériault N. [Major measles epidemic in the region of Quebec despite a 99% vaccine coverage]. Can J Public Health. 1991 May-Jun;82(3):189-90.
  18. Sugerman DE1Barskey AEDelea MGOrtega-Sanchez IRBi DRalston KJRota PAWaters-Montijo KLebaron CW. Measles outbreak in a highly vaccinated population, San Diego, 2008: role of the intentionally undervaccinated. Pediatrics. 2010 Apr;125(4):747-55. 
  19. Agergaard J1Nante EPoulstrup GNielsen JFlanagan KLØstergaard LBenn CSAaby P. Diphtheria-tetanus-pertussis vaccine administered simultaneously with measles vaccine is associated with increased morbidity and poor growth in girls. A randomised trial from Guinea-Bissau. Vaccine. 2011 Jan 10;29(3):487-500.
    1. – Do not give DTP with Measles vaccine.  Associated with increased morbidity.
  20. Aaby P1Jensen HSimondon FWhittle H. High-titer measles vaccination before 9 months of age and increased female mortality: do we have an explanation?Semin Pediatr Infect Dis. 2003 Jul;14(3):220-32.
    1. Do not give before 9 months of age.
  21. Tae BS1Ham BKKim JHPark JYBae 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.
  22. da Costa Mdo D1Gonçalves LRBarbosa ERBacheschi LA. [Neuroimaging abnormalities in parkinsonism: study of five cases]. Arq Neuropsiquiatr. 2003 Jun;61(2B):381-6. Epub 2003 Jul 28.
  23. Mäkelä A1Nuorti JPPeltola H. Neurologic disorders after measles-mumps-rubella vaccination. Pediatrics. 2002 Nov;110(5):957-63.
    1. No association with MMR vaccine and encephalitis, autism or aseptic meningitis.  Studied over 500,000 children.
  24. D’Souza Y1Fombonne EWard BJ. No evidence of persisting measles virus in peripheral blood mononuclear cells from children with autism spectrum disorder. Pediatrics. 2006 Oct;118(4):1664-75.
  25. Singh VK1. Phenotypic expression of autoimmune autistic disorder (AAD): a major subset of autism. Ann Clin Psychiatry. 2009 Jul-Sep;21(3):148-61.
  26. Binamer Y1. Acute hemorrhagic edema of infancy after MMR vaccine. Ann Saudi Med. 2015 May-Jun;35(3):254-6. 
  27. Leung JH1Hirai HWTsoi 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
  28. Ma SJ1Xiong YQ1Jiang LN1Chen 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
  29. Vcev A1Pezerovic DJovanovic ZNakic DVcev IMajnarić L. A retrospective, case-control study on traditional environmental risk factors in inflammatory bowel disease in Vukovar-Srijem County, north-eastern Croatia, 2010. Wien Klin Wochenschr. 2015 May;127(9-10):345-54
  30. Morris DL1Montgomery SMThompson NPEbrahim SPounder REWakefield AJ. Measles vaccination and inflammatory bowel disease: a national British Cohort Study. Am J Gastroenterol. 2000 Dec;95(12):3507-12.
    1. “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.”
  31. Cheng DR1Perrett KP2Choo S3Danchin M4Buttery JP5Crawford NW6. Pediatric anaphylactic adverse events following immunization in Victoria, Australia from 2007 to 2013. Vaccine. 2015 Mar 24;33(13):1602-7
  32. Klein NP1Lewis E2Fireman B2Hambidge SJ3Naleway A4Nelson JC5Belongia EA6Yih WK7Nordin JD8Hechter RC9Weintraub E10Baxter R2. Safety of measles-containing vaccines in 1-year-old children. Pediatrics. 2015 Feb;135(2):e321-9.
  33. Hawken S1Potter BK1Benchimol EI2Little J3Ducharme R4Wilson K5. Seasonal variation in rates of emergency room visits and acute admissions following recommended infant vaccinations in Ontario, Canada: a self-controlled case series analysis. Vaccine. 2014 Dec 12;32(52):7148-53
  34. Macartney KK1Gidding HF2Trinh L3Wang H3McRae J3Crawford N4Gold M5Kynaston A6Blyth C7Yvonne Z8Elliott E8Booy R9Buttery J10Marshall H5Nissen M6Richmond P7McInytre PB9Wood N9PAEDS (Paediatric Active Enhanced Disease Surveillance) Network. Febrile seizures following measles and varicella vaccines in young children in Australia. Vaccine. 2015 Mar 10;33(11):1412-7.
    1. Australia gives Varicella at age 18 months??
  35. Owatanapanich SWanlapakorn NTangsiri RPoovorawan Y. Measles-mumps-rubella vaccination induced thrombocytopenia: a case report and review of the literature. Southeast Asian J Trop Med Public Health. 2014 Sep;45(5):1053-7.
  36. Valenzise M1Cascio A2Wasniewska M1Zirilli G1Catena MA1Arasi S1. Post vaccine acute disseminated encephalomyelitis as the first manifestation of chromosome 22q11.2 deletion syndrome in a 15-month old baby: a case report. Vaccine. 2014 Sep 29;32(43):5552-4.
  37. Malaiyan JMenon T1. Low vaccine efficacy of mumps component among MMR vaccine recipients in Chennai, India. Indian J Med Res. 2014 May;139(5):773-5.
  38. Hambidge SJNewcomer SRNarwaney KJ, et al.  Timely versus delayed early childhood vaccination and seizures. Pediatrics. 2014 Jun;133(6):e1492-9
    1. MMR vaccine timing – giving MMR before 15 months is associated with less febrile seizures.
  39. Wilson K1Ducharme R2Ward B3Hawken 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. 
    1. 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.”
  40. Ferrini W1Aubert VBalmer AMunier FLAbouzeid H. Anterior uveitis and cataract after rubella vaccination: a case report of a 12-month-old girl. Pediatrics. 2013 Oct;132(4):e1035-8. 
  41. Heijstek MW1Kamphuis SArmbrust WSwart JGorter Sde Vries LDSmits GPvan Gageldonk PGBerbers GAWulffraat NM. Effects of the live attenuated measles-mumps-rubella booster vaccination on disease activity in patients with juvenile idiopathic arthritis: a randomized trial. JAMA. 2013 Jun 19;309(23):2449-56.
    1. No increase in disease activity after MMR vaccine in patients with JIA.
  42. Cecinati V1Principi NBrescia LGiordano PEsposito S. Vaccine administration and the development of immune thrombocytopenic purpura in children. Hum Vaccin Immunother. 2013 May;9(5):1158-62.
    1. “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.” 
  43. Mantadakis E1Farmaki EBuchanan GR. Thrombocytopenic purpura after measles-mumps-rubella vaccination: a systematic review of the literature and guidance for management. J Pediatr. 2010 Apr;156(4):623-8.
  44. Davis RL1Kramarz PBohlke KBenson PThompson RSMullooly JBlack SShinefield HLewis EWard JMarcy SMEriksen EDestefano FChen RVaccine Safety Datalink Team. Measles-mumps-rubella and other measles-containing vaccines do not increase the risk for inflammatory bowel disease: a case-control study from the Vaccine Safety Datalink project. Arch Pediatr Adolesc Med. 2001 Mar;155(3):354-9.
  45. Hao L1Ma C1Wannemuehler KA1Su Q1An Z1Cairns L1Quick L1Rodewald L1Liu Y1He H1Xu Q1Ma Y1Yu W1Zhang N1Li L1Wang N1Luo H1Wang H2Gregory CJ1. Risk factors for measles in children aged 8 months-14 years in China after nationwide measlescampaign: A multi-site case-control study, 2012-2013. Vaccine. 2016 Dec 12;34(51):6545-6552.
    1. Lack of vaccination was the leading risk factor for measles infection, especially in children born since the 2010 supplementary immunization activity. 
  46. Sunil GomberShilpa Khanna AroraShukla Das,* and V. G. Ramachandran* Immune response to second dose of MMR vaccine in Indian children Indian J Med Res. 2011 Sep; 134(3): 302–306.
  47. Yadav S1Thukral RChakarvarti A. Comparative evaluation of measles, mumps & rubella vaccine at 9 & 15 months of age. Indian J Med Res. 2003 Nov;118:183-6.
    1. “ 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.”
  48. Ceyhan M1Kanra GErdem GKanra 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.
  49. Pebody RG1Gay NJHesketh LMVyse AMorgan-Capner PBrown DWLitton PMiller E. Immunogenicity of second dose measles-mumps-rubella (MMR) vaccine and implications for serosurveillance. Vaccine. 2002 Jan 15;20(7-8):1134-40.
  50. Rafiei Tabatabaei S1Esteghamati ARShiva FFallah FRadmanesh RAbdinia BShamshiri ARKhairkhah MShekari Ebrahimabad HKarimi A. Detection of serum antibodies against measles, mumps and rubella after primary measles, mumps and rubella (MMR) vaccination in children. Arch Iran Med. 2013 Jan;16(1):38-41. 
  51. Saffar MJ1Fathpour GRParsaei MRAjami AKhalilian ARShojaei JSaffar H. Measles-mumps-rubella revaccination; 18 months vs. 4-6 years of age: potential impacts of schedule changes. J Trop Pediatr. 2011 Oct;57(5):347-51
  52. LeBaron CW1Forghani BMatter LReef SEBeck CBi DCossen CSullivan BJ. Persistence of rubella antibodies after 2 doses of measles-mumps-rubella vaccine. J Infect Dis. 2009 Sep 15;200(6):888-99.
  53. Levine H1Zarka SAnkol OERozhavski VDavidovitch NAboudy YBalicer RD. Seroprevalence of measles, mumps and rubella among young adults, after 20 years of universal 2-dose MMR vaccination in Israel. Hum Vaccin Immunother. 2015;11(6):1400-5.
    1. 85.7% of 18-19 year olds were seropositive for measles.  (Rubella 90.4%, Mumps 87.0%)
  54. Mahamud A1Masunu-Faleafaga YWalls LWilliams NGarcia PTeshale EWilliams RDulski TBellini WJKutty PK. Seroprevalence of measles, mumps and rubella among children in American Samoa, 2011, and progress towards West Pacific Region goals of elimination.
    1. American Samoa. Protective antibodies found in 92%, 90% and 93% of first grade students for measles, mumps, rubella respectively.  93% of students had 1 dose of MMR, 84% had 2 doses of MMR. 
  55. Lebo EJ1Kruszon-Moran DM2Marin M1Bellini WJ1Schmid S1Bialek SR1Wallace GS1McLean HQ3. Seroprevalence of measles, mumps, rubella and varicella antibodies in the United States population, 2009-2010. Open Forum Infect Dis. 2015 Feb 20;2(1):ofv006.
  56. Gohil DJ1Kothari ST1Chaudhari AB2Gunale BK2Kulkarni PS2Deshmukh RA1Chowdhary AS1. Seroprevalence of Measles, Mumps, and Rubella Antibodies in College Students in Mumbai, India. Viral Immunol. 2016 Apr;29(3):159-63
  57. You Jin KimHae Ji KangSu Jin KimJeong-GuNam Sung Soon Kim Seroprevalence of measles-specific IgG antibodies in Korean children
  58. LeBaron CW1Beeler JSullivan BJForghani BBi DBeck CAudet SGargiullo P. Persistence of measles antibodies after 2 doses of measles vaccine in a postelimination environment. Arch Pediatr Adolesc Med. 2007 Mar;161(3):294-301.
  59. Jefferson T1Price DDemicheli VBianco EEuropean Research Program for Improved Vaccine Safety Surveillance (EUSAFEVAC) Project. Unintended events following immunization with MMR: a systematic review. Vaccine. 2003 Sep 8;21(25-26):3954-60.

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  • Avatar
    Sark M
    March 22, 2023 at 10:20 pm

    I have a kiddo that is 15.5 years old that will need catch up vaccines to enter school: MMR, Hep B, Varicella, Polio. Are there “safer” brands of these with less adjuvants or harmful ingredients you would recommend please?

  • Avatar
    Jennifer Hubbard
    July 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!!

  • Avatar
    Jennifer Hubbard
    June 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!

      • Avatar
        June 22, 2021 at 12:42 pm

        Thank you so much! This is really helpful and I would love to see the article 🙂

  • Avatar
    May 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!!

  • Avatar
    March 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?

  • Avatar
    March 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!

  • Avatar
    March 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?

  • Avatar
    March 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.

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