Right Parenting - Measles and MMR vaccines

Measles vaccine is ideally given in the 9th month and MMR vaccine is administered in the 15th month.

In UAE, the measles vaccine is not found to be necessary before the age of 1 year and that’s why it has been removed from the basic vaccination programme. Instead, the MMR vaccine is given at the age of 1 year.

Another dose of MMR is given at the school entry level at around 5 years of age.

MMR vaccine is to provide protection against 3 types of viral illnesses – Measles, Mumps and Rubella- which are common in childhood. All of them are transmitted through droplets relaesed in air by infected individual while coughing, sneezing or breathing.

What is Measles?

It is a serious viral illness causing 1 million deaths all over the world every year.

The incubation period (i.e. the period between exposure and development of symptoms) is around 2 weeks. Just prior to developing full fledged illnes, there is a phase with cough, cold and conjunctivitis. Koplik spots – greyish white sand grain-sized dots inside mouth are often seen and are considered specific for the disease.

The actual illness starts with high grade fever (40* C or more) and a characteristic rash. The rash of measles is made up of flat, red spots that merge with each other giving an appearance of a red sheet enveloping the body. It starts from top (above the nape of neck) and then spreads downwards to cover most of the body. Diarrhea, hacking cough and ear discharge are often present alongwith. It has serious complications involving heart, lungs and brain and can even cause death.

What is Mumps?

Mumps virus leads to an illness with fever, body ache, headache and a painful enlargement of parotid salivary glands. The swollen glands give a ‘puffed cheek’ appearance. Inflammation of brain, testes, pancreas, kidneys, thyroid and heart are known complications.

What is Rubella?

Rubella by itself is a mild illness. It leads to mild fever and lymph-glands enlargement on back of neck and behind ears. Its rash is similar to measles but much less conspicuous and short lived. Hence it is also called a ‘Three day measles’ or ‘German measles’.

The significace of rubella is when it occurs in pregnant women. That time it can lead to several severe abnormalities in the fetus causing ‘Congenital rubella syndrome’. Babies born with this syndrome have growth retardation, deafness, skin rashes, jaundice, enlarged liver and spleen and various defects in heart, eyes and blood.

Is there no treatment for these infections?

As with most viral infections, the treatment of these infections is supportive and symptomatic like controlling fever, pains, aches and cough with analgesics and cough syrups. Soothing lotions like calamine can be applied on skin rashes. In measles, Vitamin A in large doses helps in recovery and antiviral medicines are also sometimes useful. In mumps, warm salt-water gargles provide some relief.

Why do we need to give a separate measles vaccine earlier and another MMR at school entry in schedule?

In a country like India, Measles is known to occur in quite a significant number in infancy and then it is more troublesome. For first six months, antibodies passed on from the mother protect the baby against measles. At the same time, these antibodies interfere with proper up-take of vaccine. That’s why at around nine months of age, when the effect of these protective antibodies has waned the vaccine is administered. The second dose (as MMR) at 15th month ensures a complete protection against measles during childhood. To counter the fact that the protection levels for measles drop down after 15 years of vaccination, another dose (as MMR) is added at school entry (4-6 years) or at middle school level (10-12 years).

Is it necessary to feed egg to the baby before measles or MMR vaccine?

Many parents, especially those fully vegetarian, are worried when told by a doctor or a nurse that feeding egg to check for egg-allergy is a must before giving Measles or MMR vaccine. Let me say it loud and clear for parents and those ill-informed health professionals – Feeding an egg before Measles or MMR vaccine is not a must.

Then why is it such a widespread belief?

Since Measles virus strain commonly used in vaccines is grown of hen’s chick embryo cells, the vaccine can introduce antigens from egg. But reactions to measles vaccine are seen in only those individuals who have Type 1 or severe anaphylactic type of reaction (shock, collapse, breathlessness etc.) to eggs. This particular type of allergy to eggs is extremely rare (less than 1 per 100,000 population) and that is the only contra-indication as far as egg allergy is concerned. Mild rections like skin rashes or stomach upsets following eggs are in no way considered contra-indicaions.

Nowadays, an ‘Egg-less’ measles vaccine, made up of virus grown on human diploid cells is available and that can be given even to individuals with Type 1 egg allergy.

What are the other contra-indications for these vaccines?

As these vaccines are made from live but attenuated (modified not to cause disease) viruses, they are not advisable in immune deficiency states, malignacies and in patients on steroids or anti-cancer drugs. Any acute active illness and pregnacy are other contraindications.

What are side effects of these vaccines?

Mild fever and rash after 5-7 days (Measles component), parotid gland swelling after 10 days (Mumps) and Joint pains and lymph node swellings (Rubella) are possible side-effects of vaccination.

What is SSPE?

SSPE (Subacute sclerosing pan-encephalitis) is a serious slowly progressive brain infection that occurs years later as a complication of measles illness as well as measles vaccination. The risk is much less after vaccination than after natural illness.

Is MMR associated with autism?

No- it is not. Some earlier studies tried to link MMR and autism, especially since thiomersal-a mercury compound is used in the vaccine as a preservative. But subsequently five large epidemiological studies conducted in the United States, the United Kingdom, Denmark, and Sweden since 2001 consistently provided evidence that there is no association between thimerosal-containing vaccines and autism. Similarly, 14 large epidemiological studies consistently showed no association between the MMR vaccine and autism.

Is accidental MMR vaccination in pregancy dangerous?

Although exposure to rubella virus in the vaccine presents a theoretical risk of Congenital rubella syndrome in the fetus, no deformities have been observed in pregancies allowed to proceed after such an accidental MMR vaccination.

What are their interactions with other vaccines?

Killed vaccines like DPT can be safely administered alongwith Measles and MMR vaccines as can other live attenuated vaccines like OPV (Oral polio vaccine) and Chickenpox.

BCG is one live vaccine that should be avoided to be given on the same day as its efficacy might be hampered in such an event. It can be given after a gap of 4-6 weeks.

Is measles vaccine necessary after an attack of measles?

Measles infection provides a life long immunity but only clinical suspicion or diagnosis of measles is not enough to say ‘No’ to vaccination as there are many illnesses mimicking measles in appearance and symptoms. So only if a blood test confirming measles antibodies in the body is performed, one could avoid vaccination against measles.

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