The MMR (Measles, Mumps and Rubella) Vaccine

August 3, 2010

MMR is a vaccination given to provide immunity against measles, mumps and rubella. It has bounced around the British media since it was introduced in 1988 – sometimes positive, sometimes negative. To get a decent handle on why MMR became part of the national Immunisation schedule, it’s worthwhile knowing a bit about the diseases it provides immunity against. If you are like me, a thirty-something, then you probably aren’t aware of too many people whose lives have been affected negatively due to the complications associated with these diseases. Ask someone a generation or more back though, and you’ll no doubt find considerable heartache in stories which are now thankfully rare due to the introduction of MMR.

Globally from 1999 to 2007, there were in total 5.5 million cases of measles, 4.7 million cases of mumps and 4.4 million cases of rubella reported to World Health Organisation. All three infections are highly contagious and spread by contact with an infected person’s respiratory fluids. “Coughs and sneezes spread diseases” is a colloquial phrase based in sound science.

Complications of measles include pneumonia, ear and eye infections, and croup (an infection of the lungs and throat). More serious complications, such as inflammation of the brain (encephalitis), are more rare, but can be fatal – there are still one million deaths worldwide from measles every year. Further measles information can be found on the Measles section of this website. Mumps symptoms include fever, headache, and painful swollen glands, and in more severe cases complications such as swelling of the testes or ovaries, deafness, or meningitis may occur. Mumps in later life is a much more painful affair with similar complications. Anyone can contract rubella, but young children are most commonly affected. Rubella during pregnancy can be serious because it can cause birth defects to develop in the unborn baby.

The MMR vaccine is a live attenuated vaccine for immunisation against measles, mumps and rubella (‘Live Attenuated’ means that the vaccine contains a live, but weakened, form of the viruses). Prior to 1988, there was no mumps vaccination in the UK and although a measles vaccine had been introduced in 1968, it had limited effect due to poor coverage. Rubella had been routinely vaccinated against since 1970, although initially only in girls, to reduce the problems rubella can cause during pregnancy. In 1988, when the MMR vaccine was introduced, with 90% coverage it effectively halted the 2 yearly cycles of measles epidemics and measles notifications fell to their lowest levels since records began in 1940. Mumps wasn’t a notifiable disease before 1988, so reliable statistics are not readily available. Rubella-associated pregnancy terminations dropped from a yearly average of 750 in the early 1970s to 50 a year in the late 1980s.

There are now currently over 110 countries worldwide who use the MMR vaccine. As with any vaccine schedule, follow up work continues to monitor safety, side effects, associated risks and the like. With 110 countries and countless millions recipients, there is an enormous amount of reliable information to ensure the battle against these diseases continues as safely and as efficiently as possible.

In the UK, MMR is given in the national immunisation programme at 12-15 months and at 3-5 years of age. There is no upper age limit and where required, two doses can be given separated by a three monthly interval. After the first dose, between 5% and 10% of children are not protected against the diseases (in addition, about 10% of children miss getting the first injection for various reasons). The second MMR dose is not given as a booster, but to increase protection. After two doses of MMR, less than 1% are left unprotected. This is important for maintaining herd immunity (link). There has never been a childhood immunity regime of single vaccines for measles, mumps and rubella in UK. To introduce one would require 6 separate vaccinations, which is much more difficult to implement and leave children unvaccinated for much longer periods of time, and so increasing the risk of getting infected.

As with any medical intervention, there are risks associated with the MMR virus, although as the table below shows, these are much less than similar risks associated with actually contracting the disease.

Condition Conditions Children affected after having the natural disease Children affected after the first dose of MMR
Febrile Convulsions (temperature fits) 1 in 200 1 in 1000
  • 1 in 1000 (measles, mumps encephalitis)
  • 1 in 20 (mumps meningitis)
  • 1 in 6000 (rubella encephalitis)
less than 1 in 1,000,000
Conditions affecting blood clotting (ITP)
  • 1 in 3000 (rubella)
  • 1 in 6000 (measles)
1 in 22,000
Severe allergic response (anaphylaxis) 1 in 100,000
SSPE (a delayed complication of measles
that causes brain damage and death)
1 in 8000 (children under 2) 0
  • 1 in 2500 to 1 in 5000 (measles; higher in children under 1)
  • 1-2 in 1000 for measles in recent years.

10 years after the implementation of MMR into the national vaccination schedule, a scientific paper was published in medical journal The Lancet by Dr Andrew Wakefield, which drew connections between MMR and autism in 12 children. Autism begins to become apparent in children usually between 12 and 24 months, at a similar time to the MMR immunisation schedule.

The paper, now retracted by 10 of the 12 co-authors and The Lancet itself, caused a media storm which lasted just over a decade. The ‘MMR Hoax’, as Guardian columnist Ben Goldacre has described it, has been demonstrated to have been a massive failure in the UK media’s ability to accurately report science. Here’s the crux of the matter – there have been over 20 in-depth studies which have all repeatedly negated any connections made in Wakefield’s 1998 paper between MMR and autism-related diseases. (It’s worth reading that sentence again). These include a Danish study on over half a million children , which provided “strong evidence against the hypothesis that MMR vaccination causes autism”; a Japanese study which measured the effect of MMR withdrawal on 30,000 children and found “that MMR vaccination is most unlikely to be a main cause of autism spectrum disorders”; and a Canadian study on 27,000 children which “ruled out an association between pervasive developmental disorder and … 1- or 2-dose MMR vaccinations”. Overwhelming evidence from around the world, published in peer-reviewed journals that there is no evidence at all for a link between MMR and autism.

Wakefield’s paper has been discredited not only by large scale worldwide research but also by investigations into financial impropriety and conflicts of interests, notably by Sunday Times investigative journalist, Brian Deer.

As a result of the media’s largely anti-MMR stance, MMR uptake levels started to fall as concerned parents felt pressurised to reject the MMR vaccination egged on by fear-mongers and anti-vaccination groups, such as JABS (link). In the face of rising measles cases in the UK (and the first measles death in the UK for 14 years in 2006) a media U-turn to become seemingly more pro-MMR and a redoubling of the governments’ efforts to raise vaccination rates, the MMR uptake levels are once again starting to rise. This will be welcome news to the unfortunate people who are unable to be vaccinated due to other medical complications, and rely on the herd immunity (link) of the population for protection.


9 Responses to “The MMR (Measles, Mumps and Rubella) Vaccine”

  1. Ros Says:

    Typo alert: ‘fear-mongerer’ should be ‘fear-monger’!

  2. Al Capone Junior Says:

    The main thing I see on this page is that the table needs formatting as it’s unclear which lines each stat belong to, and basically unreadable.

  3. Al Capone Junior Says:

    Yes, much better. I can tell which stats go where now. I would suggest to center columns 2 and 3, and leave column 1 left aligned. See if that looks better, it probably will. If that looks like dog doo then try putting a single space on the left hand side of each entry in columns 2 and 3, so as to get those babies off the left hand edge of the table boxes. I’m just a smidge nitty about tables and columns. 🙂

  4. Nic Says:

    The HPA links are coming up as page not found and a few of the other links are too!

  5. Hello he blog doesnt load properly when i try to load the pages using the web browser SEWERLUST 93 I suspect its a problem coming from either your theme or maybe your plugins

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