What is the MMR vaccination?
The MMR vaccination is a triple vaccination that simultaneously protects against infection with measles, mumps and rubella viruses. It is a live vaccination: the MMR vaccine contains measles, mumps and rubella viruses that are still capable of reproducing but have been weakened. These can no longer trigger the respective disease. Nevertheless, the immune system reacts to them by producing specific antibodies for defense.
The MMR vaccination can also be administered if someone already has sufficient protection against one or two of the three diseases. So, for example, someone who has already had mumps and is therefore immune to the pathogens can still receive the MMR vaccination – there is no increased risk of side effects.
In a sense, an extension of the measles-mumps-rubella vaccine (MMR vaccine) is the MMRV vaccine. This quadruple vaccine additionally protects against disease caused by varicella – the chickenpox pathogens.
Advantages of the combination vaccination
A combination vaccine such as the MMR vaccine has several advantages over single vaccines (single vaccines):
- Fewer side effects: Reducing the number of shots needed also has the advantage that the vaccinated person is less likely to have to “endure” a potential vaccine reaction from the MMR vaccination.
- Just as tolerable, just as effective: the MMR vaccination is considered to be just as tolerable and effective as the single vaccinations.
Single vaccines against measles, mumps and rubella are currently not available at all in Germany.
MMR vaccination in case of compulsory measles vaccination
In principle, vaccinations against measles, mumps and rubella (usually administered in combination as MMR vaccination) are only recommended in Germany by the Standing Commission on Vaccination (STIKO) at the Robert Koch Institute (RKI).
In addition to the recommended measles vaccination, however, measles vaccination has been mandatory for certain cases since March 2020. Because no single vaccine against measles is available in this country, doctors also administer the MMR vaccination here.
According to the Measles Protection Act, measles vaccination is mandatory in the following cases:
- For children and adolescents who were already being cared for in a community setting when the Measles Protection Act came into effect (March 1, 2020), proof of measles vaccination received or measles disease experienced must be received no later than July 31, 2021.
- The measles vaccination requirement also applies to adolescents and adults who work or wish to work in medical or community settings (including as part of a regular volunteer or internship) if they have not had the measles and were born after 1970.
- Similarly, anyone who has been housed in a children’s home or in a community shelter for asylum seekers, refugees, or ethnic German immigrants for at least four weeks on March 1, 2020, must provide proof of full measles vaccination protection.
MMR vaccination for infants
The Standing Committee on Vaccination recommends that all infants be vaccinated against measles, mumps and rubella before their second birthday. Doctors use a combination vaccine for this purpose.
MMR vaccination: How often and when are babies vaccinated?
The first MMR vaccination should be given between the 11th and 14th month of life. In doing so, pediatricians usually inject the MMR vaccine at one site and the varicella vaccine at another site at the same time – usually in the lateral thigh muscles on the left and right. Indeed, the MMRV quadruple vaccine showed a slightly increased risk of febrile seizures when used as part of the initial vaccination.
The second MMR vaccination is usually given by the end of the second year of life, before the second birthday (i.e., at 23 months of age at the latest). It is important that there be at least four weeks between the two vaccination dates – otherwise a weakened immune response can be expected. Instead of the triple vaccine, the MMRV quadruple vaccine can also be injected at the second vaccination without any problems.
Early MMR vaccination before the eleventh month of life
In principle, MMR vaccination can also be given before the eleventh month of life, starting at the ninth month of life. This is necessary, for example, if the parents want to give their child to a community facility at this age – complete vaccination protection against measles is then mandatory.
Lifelong (although not 100%) protection against measles, mumps and rubella is provided by complete basic immunization by means of two MMR vaccinations. A booster at a later date is therefore not necessary.
MMR vaccination for older children and adolescents
For older children and adolescents who were not (sufficiently) vaccinated against measles, mumps and/or rubella as infants, physicians recommend that immunization be made up as soon as possible:
- Anyone who did not receive MMR vaccination as a baby needs complete basic immunization with two doses of MMR vaccine at least four weeks apart.
- If someone has received at least one MMR vaccination as a child, doctors still give the missing second dose to complete the basic immunization (MMR catch-up vaccination).
The same applies to adolescents who must be vaccinated against measles on a mandatory basis – because they have never had the measles and, for example, want to attend a school or training institution or do an internship in a kindergarten.
MMR vaccination for adults
Sometimes the MMR vaccination for adults is purely a recommendation – for example, for sufficient protection against rubella before pregnancy. However, it may also be mandatory to fulfill the measles vaccination requirement (because there is no single vaccine against measles).
Keyword rubella
Experts recommend MMR vaccination to all women of childbearing age if they were not vaccinated against rubella as a child or were vaccinated only once, or if their rubella vaccination status is unclear. The same applies to employees in pediatric, obstetrics, prenatal care, or community settings.
Keyword Mumps.
For anyone born after 1970 who was not vaccinated against mumps as a child or was vaccinated only once, or whose mumps vaccination status is unclear, the STIKO recommends a single MMR vaccination for occupational reasons in the following cases:
- Occupation in health care services in direct patient care (e.g., nursing).
- @ activity in a community facility or educational institution
Keyword measles
The situation is different if there is a measles vaccination requirement – for example, because an adult born after 1970 wants to work in a doctor’s office or kindergarten. Then the following applies:
- A single MMR vaccination is sufficient only if the person concerned received at least one vaccination against measles as a child.
- If the individual was never vaccinated against measles as a child or if the vaccination status is unclear, two measles vaccinations (i.e., two doses of the MMR vaccine) are required.
MMR vaccination: side effects
Most people tolerate the MMR vaccination well. However, a vaccine reaction is less common after the second MMR vaccination than after the first.
Reactions at the injection site, such as redness, swelling, and pain, often develop temporarily in the first few days after vaccination. These signal that the immune system is responding to the vaccination.
Occasionally, nearby lymph nodes swell. In addition, mild general symptoms such as fatigue, headache, gastrointestinal complaints or increased body temperature may occur for a short time. The latter may also be accompanied by a febrile convulsion in infants and young children. However, this usually remains without consequences.
Sometimes mild swelling of the parotid gland occurs after MMR vaccination. Occasionally, adolescents and adults (but very rarely children) also report joint discomfort. Mild testicular swelling after MMR vaccination is also possible but rare.
Very rarely, vaccinated individuals react allergically to the MMR vaccine or with prolonged joint inflammation. Occasionally, the number of blood platelets decreases, but only temporarily (blood platelets = thrombocytes are important for blood clotting).
In a few isolated cases worldwide, brain inflammation has been reported after MMR vaccination. So far, however, no connection between the inflammation and the MMR vaccination has been proven.
MMR vaccination and autism
In addition, subsequent large-scale, high-quality studies (e.g., a Danish study of more than 530,000 children) have demonstrated that there is no association between MMR vaccination and autistic disorders.
MMR vaccination: who should not receive it?
Medical professionals advise against MMR vaccination in the following cases:
- If there is an acute fever (> 38.5 degrees Celsius) or an acute severe illness
- In case of a known allergy to one of the components of the MMR vaccine
- During pregnancy (see below)
In cases of severe immune system impairment (e.g., certain congenital immunodeficiencies, HIV infection), affected individuals should discuss with their treating physician whether MMR vaccination is appropriate. Vaccination failure could occur primarily because the immune system is too weak to build up vaccine protection.
MMR vaccination: pregnancy and lactation
MMR vaccination consists of live vaccines. It is therefore contraindicated in pregnancy. Pregnant women are generally not allowed to receive live vaccines. The attenuated pathogens may be dangerous for the unborn child, even if they do not harm the mother.
After an MMR vaccination, pregnancy should be avoided for at least four weeks!
However, if a vaccination has been given by mistake, it is usually not necessary to terminate the pregnancy. There are numerous described vaccinations during or shortly before pregnancy that did not result in an increased risk of malformations of the child.
