Editing MMR vaccine (section)

==Safety==

[[Adverse drug reaction|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;<ref>{{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 }}</ref> and 3% develop [[arthralgia|joint pain]] lasting 18 days on average.<ref>{{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 }}</ref> Older women appear to be more at risk of joint pain, acute [[arthritis]], and even (rarely) chronic arthritis.<ref name=Schattner>{{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 }}</ref> [[Anaphylaxis]] is an extremely rare but serious allergic reaction to the vaccine.<ref>{{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 }}</ref> One cause can be [[egg allergy]].<ref name="pmid14601358">{{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 }}</ref> 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.<ref>{{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 }}</ref> 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]].<ref>{{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. }}</ref> Some versions of the vaccine contain the antibiotic [[neomycin]] and therefore should not be used in people allergic to this antibiotic.<ref name=AFP2017/>

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.<ref name=Schattner/><ref>{{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 }}</ref> 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.<ref name=Colville>{{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 }}</ref> 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,<ref>{{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 }}</ref> 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.<ref name=Colville/>

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.<ref name="pmid 34806766" />

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.<ref name="pmid 34806766" /> Approximately 1 in 40,000 children are thought to acquire ITP in the six weeks following an MMR vaccination.<ref name="pmid 34806766" /> ITP below the age of six years is generally a mild disease, rarely having long-term consequences.<ref>{{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 }}</ref><ref>{{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 }}</ref>

===False claims about autism===
{{main|MMR vaccine and autism}}

In 1998 [[Andrew Wakefield]] ''et al.'' [[Lancet MMR autism fraud|published a <!-- Do not remove the word "fraudulent" without talk page consensus -->fraudulent paper]] about twelve children, reportedly with bowel symptoms and [[autism spectrum|autism]] or other disorders acquired soon after administration of MMR vaccine,<ref>{{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}}</ref> while supporting a competing vaccine. In 2010, Wakefield's research was found by the [[General Medical Council]] to have been "dishonest",<ref>{{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}}</ref> and ''[[The Lancet]]'' fully retracted the paper.<ref>{{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)) }}</ref><ref>{{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 }}</ref> Three months following ''The Lancet's'' retraction, Wakefield was struck off the [[General Medical Council#Registering doctors in the UK|UK medical register]], with a statement identifying deliberate falsification in the research published in ''The Lancet'',<ref name=gmc-uk_Wakefield_SPM>{{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 }}</ref> and was barred from practising medicine in the UK.<ref name=MeikleBoseley>{{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 }}</ref> The research was declared fraudulent in 2011 by the ''[[British Medical Journal]]''.<ref>{{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 }}</ref>

Since Wakefield's publication, multiple peer-reviewed studies have failed to show any association between the vaccine and autism.<ref name="pmid 34806766" /><ref name=NHS /> The US [[Centers for Disease Control and Prevention]],<ref>{{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}}</ref><ref>{{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 }}</ref> the [[Institute of Medicine]] of the US [[National Academy of Sciences]],<ref>{{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 }}</ref> the UK [[National Health Service]]<ref>{{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 }}</ref> and the Cochrane Library review<ref name="pmid 34806766" /> 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.<ref name=NHS>{{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 }}</ref><ref>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 }}</ref> Health experts have criticized media reporting of the MMR-autism controversy for triggering a decline in vaccination rates.<ref>{{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 }}</ref> 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.<ref>{{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 }}</ref>

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.<ref>{{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 }}</ref>