Measles, Mumps, Rubella and Varicella (MMRV) Vaccine
Measles
Measles is caused by the measles virus and spreads through the air by droplet or direct contact with nasal or throat secretions of infected persons, and less commonly, by articles soiled with nasal and throat secretions. Affected persons will present initially with tiredness, fever, cough, runny nose, red eyes and white spots inside the mouth. This is followed by a red blotchy skin rash 3-7 days later. The rash usually spreads from the face down to the rest of the body. In severe cases, lungs, guts and brain can get involved and lead to serious consequences or even death.
Mumps
Mumps is caused by the mumps virus which affects the salivary glands and sometimes the nerve tissue. It is spread by droplet and direct contact with the saliva of an infected person. The disease is characterised by painful swelling of the salivary glands, usually at the cheek(s). Sometimes, there may be complications like deafness, or infection of the brain, pancreas, testicles or ovaries.
Rubella
Rubella, also known as “German Measles”, is caused by rubella virus. It can be transmitted by contact with secretions from nose and throat of infected persons through droplet spread or direct contact with patients. Children usually present with fever, headache, malaise, diffuse rash, enlargement of lymph nodes, upper respiratory symptoms and conjunctivitis. Some patients may not have rash at all. Complications include arthritis, thrombocytopenia and encephalitis.
Rubella infection can cause anomalies in the developing foetus. Congenital rubella syndrome (CRS) is likely to occur in infants born to women who got infected during the first 3 months of pregnancy. CRS is characterised by deafness, cataract, heart malformations and mental retardation.
Varicella
Varicella (also known as chickenpox) is a viral illness caused by the varicella-zoster virus. It is highly contagious and is spread by airborne transmission of droplets from the respiratory tract or from the vesicle fluid of the skin lesions of chickenpox or herpes zoster infection. Affected persons present with fever and itchy rash. The rash usually develops over 5 days with formation of vesicles and appears first on the scalp and face, moves to the trunk and then to the limbs. The rash occurs mainly over the trunk. The vesicles are itchy, and then dry up and form a scab in around 3 days. Affected persons usually recover in 2 to 4 weeks.
Varicella is usually a mild disease of childhood. It is more severe in adults and in individuals of any age with impaired immunity. The disease may be complicated by skin infection, aseptic meningitis, encephalitis and pneumonia. Infection in early pregnancy may be associated with congenital malformation of the foetus.
Measles, Mumps, Rubella and Varicella (MMRV) Vaccine
MMRV vaccine can effectively prevent the above 4 infectious diseases. In Hong Kong, MMRV vaccine is included in the Hong Kong Childhood Immunisation Programme.
Children should receive two doses of measles-containing and varicella-containing vaccines. In the Department of Health, the second dose is given as MMRV vaccine.
A. The following individuals should NOT receive MMRV or should wait
- moderate or severe acute illness with fever ≥38.5°C
- serious allergic reaction to a previous dose of measles-containing or varicella-containing vaccine
- known history of severe allergy to gelatine or certain antibiotics
- individuals with severe immunosuppression from diseases or treatment, e.g.:
- immunodeficiency
- on current cancer treatment, such as chemotherapy and radiotherapy
- taking immunosuppressive medicines, such as high dose corticosteroid
- family history of congenital or hereditary immunodeficiency
- untreated active tuberculosis
- received immunoglobulin or other blood products (e.g. blood transfusion) within the past 11 months
- has received other live vaccines in the past four weeks, or has received varicella-containing vaccine in the past three months
- pregnancy
B. What are the side effects?
- In general, MMRV vaccine is safe and well tolerated.
- About 20% to 25% of children may have minor local reaction after vaccination, such as pain, redness or swelling at the injection site. These symptoms are usually self-limiting.
- Some children may develop fever 5-12 days after vaccination, but the fever will usually subside within 2-5 days. Parents can use anti-fever medication to relieve the symptoms. A small fraction of children may have febrile convulsion.
- Some children may become irritable or acquire upper respiratory infection after vaccination, but these symptoms are usually mild and self-limiting.
- A small number of children may develop a rash 1-2 weeks after vaccination, but it will usually disappear after a few days. Latent infections leading to herpes zoster have been reported but the majority of cases have been mild and have not been associated with complications.
- A minority of children may develop transient swelling of salivary glands behind the cheeks, swelling of lymph glands (in the head or neck) or transient arthritis.
Points to Note:
- Children should avoid taking salicylates (e.g. aspirin) within 6 weeks after receiving MMRV vaccine.
- Rarely, the varicella virus in the vaccine may transmit from vaccine recipients who develop a varicella-like rash to susceptible high-risk individuals (e.g. immunocompromised, pregnant women without immunity to chickenpox, newborn infants of mothers without immunity to chickenpox, all newborn infants born at less than 28 weeks gestation). However, it is not a contraindication for a child to receive varicella vaccine just because there is high risk individual in the same household. A pregnant mother or other household pregnant member is also not a contraindication for immunisation of a child in the household. No precautions are needed following immunisation of a child who does not develop a rash. However, if the child develops a rash post-vaccination, high risk individuals should avoid close contact with the child until the rash has resolved.