Editing MMR vaccine

{{Short description|Combined vaccine against measles, mumps, and rubella}}
{{pp-pc|small=yes}}
{{Use dmy dates|date=June 2024}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox drug
| Verifiedfields = changed
| Watchedfields = changed
| verifiedrevid = 476995634
| type = combo
| image = MMR vaccine.jpg
| alt =
| caption = MMR vaccine

<!-- Combo data -->
| component1 = Measles vaccine
| class1 = [[Vaccine]]
| component2 = Mumps vaccine
| class2 = Vaccine
| component3 = Rubella vaccine
| class3 = Vaccine

<!-- Clinical data -->
| tradename = M-M-R II, Priorix, Tresivac, others
| Drugs.com = {{drugs.com|monograph|measles-mumps-and-rubella-virus-vaccine}}
| MedlinePlus = a601176
| DailyMedID = Measles
| pregnancy_AU = B2
| pregnancy_AU_comment = <ref name="Drugs.com pregnancy">{{cite web | title=Measles virus vaccine / mumps virus vaccine / rubella virus vaccine (M-M-R II) Use During Pregnancy | website=Drugs.com | date=16 October 2019 | url=https://www.drugs.com/pregnancy/measles-virus-vaccine-mumps-virus-vaccine-rubella-virus-vaccine.html | access-date=5 September 2020 | archive-date=12 November 2020 | archive-url=https://web.archive.org/web/20201112003104/https://www.drugs.com/pregnancy/measles-virus-vaccine-mumps-virus-vaccine-rubella-virus-vaccine.html | url-status=live }}</ref>
| ATC_prefix = J07
| ATC_suffix = BD52

| legal_AU = S4
| legal_CA = <!-- Schedule I, II, III, IV, V, VI, VII, VIII -->
| legal_UK = POM
| legal_US = Rx-only
| legal_US_comment = <ref>{{cite web | title=M-M-R II- measles, mumps, and rubella virus vaccine live injection, powder, lyophilized, for suspension | website=DailyMed | date=23 May 2022 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a9e384f-e717-436b-b9a0-15e53cef0862 | access-date=19 June 2022 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406003823/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a9e384f-e717-436b-b9a0-15e53cef0862 | url-status=live }}</ref><ref>{{cite web | title=Priorix- measles, mumps, and rubella vaccine, live kit | website=DailyMed | date=3 June 2022 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=95c6fdb6-b587-4413-92f9-d592b9f7a23e | access-date=19 June 2022 | archive-date=20 June 2022 | archive-url=https://web.archive.org/web/20220620005258/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=95c6fdb6-b587-4413-92f9-d592b9f7a23e | url-status=live }}</ref>
| legal_EU = Rx-only
| legal_EU_comment = <ref name="M-M-RVaxPro EPAR">{{cite web | title=M-M-RVaxPro EPAR | website=[[European Medicines Agency]] | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/m-m-rvaxpro | access-date=4 December 2020 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406174101/https://www.ema.europa.eu/en/medicines/human/EPAR/m-m-rvaxpro | url-status=live }}</ref>
| legal_status = Rx-only

<!-- Identifiers -->
| CAS_number = 1704518-68-2
| ChemSpiderID = None
| synonyms = MPR vaccine<ref name="mpr">{{cite book |vauthors=Grignolio A |title=Vaccines: Are they Worth a Shot? |date=2018 |publisher=Springer |isbn=9783319681061 |page=2 |url=https://books.google.com/books?id=hgFkDwAAQBAJ&pg=PA2 |access-date=22 May 2020 |archive-date=17 April 2021 |archive-url=https://web.archive.org/web/20210417185159/https://books.google.com/books?id=hgFkDwAAQBAJ&pg=PA2 |url-status=live }}</ref>
}}

<!-- Definition and medical use -->
The '''MMR vaccine''' is a [[vaccine]] against [[measles]], [[mumps]], and [[rubella]] (German measles), abbreviated as ''MMR''.<ref name=Mau2005/> The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses.<ref name="CDC2021">{{cite web |title=Measles, Mumps, and Rubella (MMR) Vaccination: What Everyone Should Know |url=https://www.cdc.gov/vaccines/vpd/mmr/public/index.html |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC)|date=26 January 2021 |archive-date=26 April 2020 |archive-url=https://web.archive.org/web/20200426105545/https://www.cdc.gov/vaccines/vpd/mmr/public/index.html |url-status=live }}</ref><ref name=WHO2017Pos>{{cite journal | vauthors =  | title = Measles vaccines: WHO position paper – April 2017 | journal = Relevé Épidémiologique Hebdomadaire | volume = 92 | issue = 17 | pages = 205–227 | date = April 2017 | pmid = 28459148 | hdl = 10665/255149 }}</ref><ref>{{cite journal | title = Measles vaccines: WHO position paper, April 2017 - Recommendations | journal = Vaccine | volume = 37 | issue = 2 | pages = 219–222 | date = January 2019 | pmid = 28760612 | doi = 10.1016/j.vaccine.2017.07.066 | s2cid = 205605355 | last1 = World Health Organization }}</ref> After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella.<ref name="CDC2021"/> The vaccine is also recommended for those who do not have evidence of [[immunity (medical)|immunity]],<ref name="CDC2021"/> those with well-controlled [[HIV/AIDS]],<ref>{{cite web |vauthors=Kinney R |title=Core Concepts – Immunizations in Adults – Basic HIV Primary Care – National HIV CurriculumImmunizations in Adults |url=https://www.hiv.uw.edu/go/basic-primary-care/immunizations/core-concept/all |website=www.hiv.uw.edu |date=2 May 2017 |access-date=10 September 2018 |archive-date=2 September 2018 |archive-url=https://web.archive.org/web/20180902191739/https://www.hiv.uw.edu/go/basic-primary-care/immunizations/core-concept/all |url-status=live }}</ref><ref name=ACIP1998>{{cite journal | vauthors = Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L | title = Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR. Recommendations and Reports | volume = 47 | issue = RR-8 | pages = 1–57 | date = May 1998 | pmid = 9639369 | url = <!-- Official URL --> https://www.cdc.gov/mmwr/PDF/rr/rr4708.pdf | access-date = 26 January 2020 | url-status = live | archive-url = https://web.archive.org/web/20191030190011/https://www.cdc.gov/mmwr/PDF/rr/rr4708.pdf | archive-date = 30 October 2019 }}</ref> and within 72 hours of exposure to measles among those who are incompletely immunized.<ref name=WHO2017Pos/> It is given by [[Injection (medicine)|injection]].<ref name="CDCAdmin">{{cite web |title=Administering MMR Vaccine |url=https://www.cdc.gov/vaccines/vpd/mmr/hcp/administering-mmr.html |website=Centers for Disease Control and Prevention |access-date=28 December 2021 |date=26 January 2021 |archive-date=28 December 2021 |archive-url=https://web.archive.org/web/20211228081247/https://www.cdc.gov/vaccines/vpd/mmr/hcp/administering-mmr.html |url-status=live }}</ref>

<!-- Frequency of use and effects -->
The MMR vaccine is widely used around the world. As of 2012, 575 million doses had been administered since the vaccine's introduction worldwide.<ref name=EU2018>{{cite web |title=Addressing misconceptions on measles vaccination |url=https://ecdc.europa.eu/en/measles/prevention-and-control/addressing-misconceptions-measles |website=European Centre for Disease Prevention and Control |date=15 April 2014 |access-date=10 September 2018 |archive-date=11 September 2018 |archive-url=https://web.archive.org/web/20180911002527/https://ecdc.europa.eu/en/measles/prevention-and-control/addressing-misconceptions-measles |url-status=live }}</ref> Measles resulted in 2.6 million deaths per year before immunization became common.<ref name=EU2018/> This has decreased to 122,000 deaths per year {{as of|2012|lc=y|post=,}} mostly in low-income countries.<ref name=EU2018/> Through vaccination, {{as of|2018|lc=y}}, rates of measles in North and South America are very low.<ref name=EU2018/> Rates of disease have been seen to increase in populations that go unvaccinated.<ref name=EU2018/> Between 2000 and 2018, vaccination decreased measles deaths by 73%.<ref name="WHO Measles Fact Sheet">{{cite web | url=https://www.who.int/en/news-room/fact-sheets/detail/measles | title=Measles Fact Sheet | website=[[World Health Organization]] (WHO) | date=5 December 2019 | access-date=28 November 2022 | archive-date=28 November 2022 | archive-url=https://web.archive.org/web/20221128010546/https://www.who.int/en/news-room/fact-sheets/detail/measles | url-status=live }}</ref>

<!-- Side effects and mechanisms -->
Side effects of immunization are generally mild and resolve without any specific treatment.<ref name="CDC2021Vis">{{cite web |title=MMR (Measles, Mumps, and Rubella) Vaccine Information Statement |url=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=16 August 2021 |date=August 2021 |archive-date=3 September 2018 |archive-url=https://web.archive.org/web/20180903141726/https://www.cdc.gov/vaccines/hcp/vis/vis-statements/mmr.html |url-status=live }}</ref> These may include [[fever]], as well as pain or redness at the injection site.<ref name="CDC2021Vis"/> [[Severe allergic reaction]]s occur in about one in a million people.<ref name="CDC2021Vis"/> Because it contains live viruses, the MMR vaccine is not recommended during [[pregnancy]] but may be given during [[breastfeeding]].<ref name="CDC2021"/> The vaccine is safe to give at the same time as other vaccines.<ref name="CDC2021Vis"/> Being recently immunized does not increase the risk of passing measles, mumps, or rubella on to others: That is, even though the vaccine contains live viruses, they are not transmitted.<ref name="CDC2021"/> There is no evidence of an association between MMR immunisation and [[Autism spectrum|autistic spectrum disorders]].<ref name="pmid 34806766">{{cite journal | vauthors = Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V | title = Vaccines for measles, mumps, rubella, and varicella in children | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 11 | pages = CD004407 | date = November 2021 | pmid = 34806766 | pmc = 8607336 | doi = 10.1002/14651858.CD004407.pub5 }}</ref><ref>{{cite journal | vauthors = Hussain A, Ali S, Ahmed M, Hussain S | title = The Anti-vaccination Movement: A Regression in Modern Medicine | journal = Cureus | volume = 10 | issue = 7 | pages = e2919 | date = July 2018 | pmid = 30186724 | pmc = 6122668 | doi = 10.7759/cureus.2919 | doi-access = free }}</ref><ref name=AFP2017>{{cite journal | vauthors = Spencer JP, Trondsen Pawlowski RH, Thomas S | title = Vaccine Adverse Events: Separating Myth from Reality | journal = American Family Physician | volume = 95 | issue = 12 | pages = 786–794 | date = June 2017 | pmid = 28671426 }}</ref> The MMR vaccine is a mixture of live [[attenuated virus|weakened virus]]es of the three diseases.<ref name="CDC2021"/>

<!-- History and culture -->
The MMR vaccine was developed by [[Maurice Hilleman]].<ref name=Mau2005>{{cite journal | vauthors =  | title = Maurice R. Hilleman, PhD, DSc | journal = Seminars in Pediatric Infectious Diseases | volume = 16 | issue = 3 | pages = 225–226 | date = July 2005 | pmid = 16044396 | doi = 10.1053/j.spid.2005.05.002 }}</ref> It was licensed for use in the US by [[Merck & Co.|Merck]] in 1971.<ref name=Good2015/> Stand-alone [[measles vaccine|measles]], [[mumps vaccine|mumps]], and [[rubella vaccine]]s had been previously licensed in 1963, 1967, and 1969, respectively.<ref name=Good2015>{{cite journal | vauthors = Goodson JL, Seward JF | title = Measles 50 Years After Use of Measles Vaccine | journal = Infectious Disease Clinics of North America | volume = 29 | issue = 4 | pages = 725–743 | date = December 2015 | pmid = 26610423 | doi = 10.1016/j.idc.2015.08.001 }}</ref><ref>{{cite web |title=Measles: information about the disease and vaccines Questions and Answers |url=https://www.immunize.org/catg.d/p4209.pdf |website=Immunization Action Coalition | date=November 2018 |access-date=28 November 2022 |archive-date=28 November 2022 |archive-url=https://web.archive.org/web/20221128011445/https://www.immunize.org/catg.d/p4209.pdf |url-status=live }}</ref> Recommendations for a second dose were introduced in 1989.<ref name=Good2015/> The [[MMRV vaccine]], which also covers [[chickenpox]], may be used instead.<ref name="CDC2021"/> An [[MR vaccine]], without coverage for mumps, is also occasionally used.<ref name=WHO2014Sheet>{{cite web |title=Information Sheet Observed Rate of Vaccine Reactions, Measles, Mumps, and Rubella Vaccines |url=http://fdaghana.gov.gh/img/vacine/MMR%20vaccine%20information.pdf |website=fdaghana.gov.gh |access-date=30 April 2022 |date=May 2014 |archive-date=27 December 2021 |archive-url=https://web.archive.org/web/20211227095245/https://fdaghana.gov.gh/img/vacine/MMR%20vaccine%20information.pdf |url-status=live }}</ref>

==Medical use==
[[File:Priorix.jpg|thumb|Priorix]]
[[Cochrane (organisation)|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."<ref name="pmid 34806766" />

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

===Measles===
[[File:Measles US 1938-2019.png|upright=1.3|alt=Measles cases 1944-1963 followed a highly variable epidemic pattern, with 150,000-850,000 cases reported per year. A sharp decline followed the introduction of the first measles vaccine in 1963, with fewer than 25,000 cases reported in 1968. Outbreaks around 1971 and 1977 gave 75,000 and 57,000 cases, respectively. Cases were stable at a few thousand per year until an outbreak of 28,000 in 1990. Cases declined from a few hundred per year in the early 1990s to a few dozen in the 2000s. | thumb | Measles cases reported in the [[United States]] 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."<ref>{{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 }}</ref> 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.<ref>{{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 = <!-- Official 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) }}</ref><ref>{{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=<!-- Official 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 }}</ref><ref>{{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 }}</ref>

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.<ref>{{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 }}</ref> 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.<ref name="pmid 16528234">{{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 = <!-- Official 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) }}</ref> Between 2000 and 2018, measles vaccination resulted in a 73% decrease in deaths from the disease.<ref name="WHO Measles Fact Sheet" />

Measles is [[Endemic (epidemiology)|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.<ref name=Parker/> 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]].<ref>{{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 = <!-- Official 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) }}</ref> 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.<ref name=Parker>{{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 }}</ref>

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.<ref>{{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 = <!-- Official 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 }}</ref>

===Rubella===
[[File:Rubella in the US 1966-2017.png|thumb|upright=1.3|Rubella rates fell sharply in the United States when immunization was introduced.]]
[[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 syndrome|congenital rubella]], which can cause significant [[congenital]] defects.<ref>{{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 }}</ref>

===Mumps===
[[Mumps]] is another [[virus|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 [[infertility|sterility]].<ref>{{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}}</ref>

===Administration===
The MMR vaccine is administered by a [[subcutaneous injection]], the first dose typically at twelve months of age.<ref name="CDCAdmin"/> The second dose may be given as early as one month after the first dose.<ref name=Vesikari/> 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.<ref name=CDC-MMR-FAQ>{{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 }}</ref> Areas where measles is common typically recommend the first dose at nine months of age and the second dose at fifteen months of age.<ref name=WHO2017Pos/>

==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>

==History==
[[File:Hilleman-Walter-Reed.jpeg|thumb|[[Maurice Hilleman]], who developed the MMR vaccine]]
[[File:Preparation of measles vaccines.jpg|thumb|Two workers make openings in chicken eggs in preparation for a measles vaccine]]
The component viral strains of MMR vaccine were developed by propagation in animal and human cells.<ref name="pmid12962524">{{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=}}</ref>

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 ''[[Vaccination#Types of vaccinations|attenuated]] strains''. They are sometimes referred to as ''neuroattenuated'' because these strains are less [[virulence|virulent]] to human [[neuron]]s 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.<ref>{{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 }}</ref><ref>{{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 }}</ref>

{| class="wikitable"
!Disease immunized
!Component vaccine
!Virus strain
!Propagation medium
![[Growth medium]]
|-
|[[Measles]]
|[[Attenuvax]]
| Enders' attenuated Edmonston strain<ref>{{cite web
| url =http://www.merck.com/product/usa/pi_circulars/a/attenuvax/attenuvax_pi.pdf
| title =Attenuvax Product Sheet
| access-date =4 February 2009
| year = 2006
| publisher =Merck & Co
| page =1
| archive-url= https://web.archive.org/web/20091231032205/http://merck.com/product/usa/pi_circulars/a/attenuvax/attenuvax_pi.pdf
| archive-date= 31 December 2009
}}</ref>
| rowspan="2"|chick embryo cell culture
| rowspan="2" |Medium 199
|-
|[[Mumps]]
|[[Mumpsvax]]<ref name="Merck_Mumpsvax_1999_pdf">{{cite web
| url=http://www.merck.com/product/usa/pi_circulars/m/mumpsvax/mumpsvax_pi.pdf
| archive-url=https://web.archive.org/web/20060813175920/http://www.merck.com/product/usa/pi_circulars/m/mumpsvax/mumpsvax_pi.pdf
| archive-date=13 August 2006
| url-status=dead
|title=MUMPSVAX (Mumps Virus Vaccine Live) Jeryl Lynn Strain
| year=2002
| author=Merck Co.
| publisher=Merck Co.
| author-link=Merck & Co.
| access-date=26 January 2015
}}</ref>
|[[Jeryl Lynn]] (B level) strain<ref name="Jeryl_Lynn_1967_pdf">{{cite journal | vauthors = Young ML, Dickstein B, Weibel RE, Stokes J, Buynak EB, Hilleman MR | title = Experiences with Jeryl Lynn strain live attenuated mumps virus vaccine in a pediatric outpatient clinic | journal = Pediatrics | volume = 40 | issue = 5 | pages = 798–803 | date = November 1967 | pmid = 6075651 | doi = 10.1542/peds.40.5.798 | s2cid = 35878536 }}</ref>
|-
|[[Rubella]]
|[[Meruvax II]]
| Wistar RA 27/3 strain of live attenuated rubella virus
| [[WI-38]] human embryonic [[cell line]]
| MEM (solution containing buffered salts, [[fetal bovine serum]], [[human serum albumin]] and [[neomycin]], etc.)
|}
The term "MPR vaccine" is also used to refer to this vaccine, whereas "P" refers to [[parotitis]] which is caused by mumps.<ref name="mpr"/>

Merck MMR II is supplied freeze-dried ([[lyophilization|lyophilized]]) and contains live viruses. Before injection, it is reconstituted with the solvent provided.<ref>{{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}}</ref>

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".<ref name="plotkin18">{{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}}</ref>

Pluserix was introduced in Hungary in 1999.<ref name=borocz20/> Enders' Edmonston strain has been used since 1999 in Hungary in [[Merck & Co.|Merck]] MMR II product.<ref name="borocz20">{{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 }}</ref> GSK Priorix vaccine, which uses attenuated Schwarz Measles, was introduced in Hungary in 2003.<ref name=borocz20/>

==MMRV vaccine==
{{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.<ref name=Vesikari>{{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 }}</ref> 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.<ref name=klein08>{{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 = <!-- Official 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) }}</ref>

In a 2012 study<ref>{{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 }}</ref> 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 [[Advisory Committee on Immunization Practices|ACIP]]/[[AAFP]]/[[American Academy of Pediatrics|AAP]] recommendations (pediatricians, 77%; family physicians, 73%).

==MR vaccine==
{{Update section|date=November 2022}}

This is a vaccine that covers measles and rubella but not mumps.<ref name=WHO2014Sheet/> As of 2014, it was used in a "few (unidentified) countries".<ref name=WHO2014Sheet/>

== Society and culture ==
=== Religious concerns ===
Some brands of the vaccine use [[gelatin]], derived from [[pig]]s, as a [[Stabilizer (chemistry)|stabilizer]].<ref name="PHE" /> This has caused reduced take-up among some communities,<ref name="PHE" /><ref>{{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 }}</ref> despite the fact that alternative vaccines without pig derivatives are approved and available.<ref name="PHE">{{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 }}</ref>

== References ==
{{reflist}}

== Further reading ==
{{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}}

== External links ==
* {{MeSH name|Measles-Mumps-Rubella Vaccine}}

{{Vaccines}}
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{{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]]