Measles – Mumps and Rubella (MMR) Vaccine

What are the MMR vaccination?

• MMR vaccine is administered against measles, mumps and rubella.
Some countries use combination vaccinations for measles and rubella
(MR) or for measles, mumps and rubella (MMR).
• Vaccines are provided in a powder form with diluents and must be
reconstituted before they can be used, it is essential that only the
diluents supplied with the vaccine be used.
• MR and MMR vaccines should be kept at 2°– 8°C.
• After reconstitution vaccine must be discarded after six hours or at the
end of immunization session, whichever comes first.
Some people should not get MMR vaccine or should wait:

1. People should not get MMR vaccine who have ever had a life-
threatening allergic reaction to gelatin, the antibiotic neomycin, or to
a previous dose of MMR vaccine.
2. People who are moderately or severely ill at the time the shot is
scheduled should usually wait until they recover before getting MMR
vaccine.
3. Pregnant women should wait to get MMR vaccine until after they
have given birth. Women should avoid getting pregnant for 4 weeks
after getting MMR vaccine.
4. Some people should check with their health care provider about
whether they should get MMR vaccine, including anyone who:
 Has HIV/AIDS, or another disease that affects the immune system.
 Is being treated with drugs that affect the immune system, such as
steroids, for 2 weeks or longer.
 Has any kind of cancer.
 Is taking cancer treatment with radiation or drugs.

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  Has ever had a low platelet count (a blood disorder).
5. People who recently had a transfusion or were given other blood
products should ask their doctor when they may get MMR vaccine.
Note:
- The first dose of MMR vaccine has been associated with rash and fever;
rash has been reported in about 1 person in 20, and fever in about 1
person in 5.
- Seizures caused by a fever are also reported more often after MMR.
- These usually occur 5-12 days after the first dose.

How safe the MMR vaccine and what are its potential side-effects?
Mild reactions to the vaccines include:
 Fever: as with the single – antigen measles vaccine, about 5% to 10%
of children develop a mild fever within 5 to 12 days of receiving the
vaccine.
 Rash: again as with the measles vaccine, about one in 20 children
develop a mild rash about 5 to 12 days of receiving the vaccine.
Severe reactions:
Are rare and similar to that experienced after receipt of the measles
vaccine.
 Although an association between MMR and autism has been
suggested, there was absolutely no evidence of a link between the
MMR vaccine and autism according to a study in 2004, UK.
 In addition rubella – containing vaccines may result in temporary
arthritis from one to three weeks after vaccination in about one in four
post pubertal females, these reactions are very rare in young children.
 Mumps – containing vaccines may result in rare cases of parotitis and
some cases of septic meningitis, children recover without sequels,
although some may need to be hospitalized.

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 Administration Summary: MMR Vaccine

Type of vaccine Live attenuated viral

Number of doses Two doses
Schedule In Palestine; 12-18 month
Booster Rubella vaccine alone given for females at 12 years,
measles immunization is recommended (routine or
campaign)
Contraindication Sever reaction to pervious dose, congenital or
acquired immune disorders.
Pregnancy; "although not recommended to administer
the vaccine during pregnancy, there has never been
any evidence of damage to the fetus from vaccination
the mother during pregnancy".
Adverse reactions Same as measles vaccine, plus cases of arthritis in
adolescent females for rubella – containing vaccine,
and rarely parotitis and aseptic meningitis with
mumps – containing vaccine may occur.
Special precaution None
Dosage 0.5ml
Injection site Outer mid-thigh in infant / outer upper arm if older

Injection type Subcutaneous (S.C.)

Storage Store between 2°– 8°C (vaccine may be frozen for

long – term storage but not the diluents)

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 Rotavirus Vaccine
What are the RV vaccination?
• Rotavirus is a virus that causes diarrhea, mostly in babies and young
children. The diarrhea can be severe, and lead to dehydration,
vomiting and fever are also common in babies with rotavirus, it is
transmitted by direct fecal- oral mode.
• Every year before the vaccine was available; more than 400,000
young children had to see a doctor for illness caused by rotavirus, 20
to 60 young children died.
• RV vaccine first dose should be administered starting at 6 weeks of
age and before 15 weeks of age. To optimize protection, RV vaccine
should be initiated as soon after 6 weeks of age as feasible.
• Orally vaccine, rotavirus vaccines can be given with other routine
vaccines at 2 and 4 months of age, or 2, 4 and 6 months of age.

Some babies should not get this vaccine:

1. A baby who has had a life-threatening allergic reaction to a dose of

rotavirus vaccine should not get another dose.
2. Babies with "severe combined immunodeficiency" (SCID) should not
get rotavirus vaccine.
3. Babies who have had a type of bowel blockage called
"intussusception" should not get rotavirus vaccine.
4. Babies who are moderate to severe ill should wait until they recover,
this includes babies with moderate or severe diarrhea or vomiting.
How safe is the RV vaccine and what are its potential side-effects?
Mild problems following rotavirus vaccine:
 Babies might become irritable, or have mild, temporary diarrhea or
vomiting after getting a dose of rotavirus vaccine.

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Serious problems following rotavirus vaccine:
 Intussusception is a type of bowel blockage that is treated in
a hospital, and could require surgery.
Administration Summary: Vaccine

Type of vaccine Live attenuated viral

Number of doses Two doses
Schedule In Palestine; 2,4 month
Booster None
Contraindication Babies with "severe combined immunodeficiency".
Babies who have had "intussusception".
Adverse reaction Babies might become irritable, or have mild,
temporary diarrhea or vomiting.
Intussusception is a type of bowel blockage.
Special precaution None
Dosage 1.5ml
Vaccine route Orally
Storage Store between 2°– 8°C

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 Contraindications to Immunization

There are not many contraindications to immunization, all infants should

be immunized except in these four rare situations:
Permanent Contraindication to Vaccination
1. Severe allergic reaction (e.g. anaphylaxis) after a previous dose or to
a vaccine component.
2. Encephalopathy (e.g. coma, decreased level of consciousness,
prolonged seizures) not attributable to another identifiable cause
within 7 days of administration of previous dose of DTP.
3. Known severe immunodeficiency (e.g. from hematologic and solid
tumors, patients recipient to chemotherapy, congenital
immunodeficiency, long-term immunosuppressive therapy; or patients
with HIV infection (exhibits the sign and symptoms of AIDS) who are
severely immunocompromised.
4. If a parent strongly objects to an immunization for a sick infant, do not
give it, ask the mother to come back when infant is well.
Invalid Contraindication to Vaccination
All these conditions are not contraindication, infant with these conditions
should be immunized:
1. Mild Illness: such as (low-grade fever, upper respiratory infection
(URI), colds, Asthma, otitis media, and mild diarrhea) should be
vaccinated on schedule.
2. Chronic illnesses: e.g. heart, lung, kidney, or liver.
3. Antimicrobial Therapy: Antibiotics do not have an effect on the
immune response to most vaccines.
4. Disease Exposure or Convalescence: if a person is not moderately or
severely ill, he or she should be vaccinated.

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5. Pregnant or Immunosuppressed Person in the Household:
• Most vaccines, including live vaccines MMR, OPV, varicella,
zoster, rotavirus, LAIV, and yellow fever) can be administered to
infants or children who are household contacts of pregnant or
immunosuppressed persons, as well as to breastfeeding infants.
• Vaccinia (smallpox) vaccine should not be administered to
household contacts of a pregnant or immunosuppressed person.
6. Breastfeeding:
• Breastfeeding does not decrease the response to routine childhood
vaccines and is not a contraindication for any vaccine except
smallpox.
• Yellow fever vaccine should be avoided in breastfeeding women.
7. Preterm Birth and Premature or low-birth weight:
• Vaccines should be started on schedule on the basis of the child’s
chronological age.
• Preterm infants have been shown to respond adequately to vaccines
used in infancy.
8. Allergy to Products Not Present in Vaccine:
Infants and children with nonspecific allergies, duck or feather allergy,
or allergy to penicillin, children who have relatives with allergies, and
children taking allergy shots can and should be immunized.
9. Allergy That is Not Anaphylactic:
• Anaphylactic allergy to a vaccine component (such as egg or
neomycin) is a true contraindication to vaccination.
• If an allergy to a vaccine component is not anaphylactic or is not
severe, it is not a contraindication to that vaccine.
10.Family History of Adverse Events:
• Family or personal history of seizures is a precaution for the use of
MMRV vaccine.

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 • Varicella-containing vaccine should not be administered to persons
who have a family history of congenital or hereditary
immunodeficiency in first-degree relatives (e.g., parents and
siblings) unless the immunocompetence of the potential vaccine
recipient has been clinically substantiated or verified by
a laboratory.
• Family history of sudden infant death syndrome (SIDS) is not
a contraindication to vaccination.
11.Tuberculin Skin Test:
• Infants and children who need a tuberculin skin test (TST) can and
should be immunized; all vaccines, including MMR, can be given
on the same day as a TST, or any time after a TST is applied.
• For most vaccines, there are no TST timing restrictions.
12.Multiple Vaccines:
Administration at the same visit of all vaccines for which a person is
eligible is critical to reaching and maintaining high vaccination
coverage.
13.Allergies or asthma: (except if there a known allergy to a specific
component of the vaccine).
14.Known or suspected HIV infection:
With no signs and symptom of AIDS or long-term
immunosuppressive therapy can give inactive vaccine without live
vaccine.
15.Recent or imminent surgery
16.Malnutrition
17.History of jaundice at birth
18.Stable neurological condition:
Such as Cerebral Palsy (CP) or Down's Syndrome.

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REMEMBER:
The “Rights of Medication Administration” should be applied to
each encounter when vaccines are administered.
These rights include:
1. The right patient
2. The right vaccine or diluents
3. The right time
4. The right dosage
5. The right route, needle length, and technique
6. The right site
7. The right documentation
Documentation:
All vaccines administered should be fully documented in the patient’s
permanent medical record. Healthcare providers who administer
vaccines covered by the National Childhood Vaccine Injury Act are
required to ensure that the permanent medical record of the recipient
indicates:
1) Date of administration.
2) Vaccine manufacturer.
3) Vaccine lot number.
4) Name and title of the person who administered the vaccine and the
address of the clinic or facility where the permanent record will reside
5) Vaccine information statement (VIS)
• date printed on the VIS
• date VIS given to patient or parent/guardian

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What Damage Vaccines:
1. Heat and sunlight can damage vaccines especially the live attenuated
ones (BCG, Polio and Measles).
2. Freezing damages the killed and toxoid (DTaP, DPT, DT, TT and
hepatitis B).
3. Freezing does not damage live attenuated vaccines (BCG, oral polio
and measles vaccines).
4. Disinfectant or antiseptics can damage vaccine (such as detergents)
and antibiotics such as streptomycin on BCG.
5. All vaccines lose their potency after a certain time you know that time
from the expiry date printed on the vaccine.

The Cold Chain

o Vaccines must be stored properly from the time they are manufactured
until the time they are administered. The system used to keep and
distribute vaccines in good condition is called the cold chain.
o The cold chain has three main components:
• Transport and storage equipment
• Trained personnel
• Efficient management procedures
o All three elements must combine to ensure a safe vaccine transport
and storage.
o The cold chain begins with the cold storage unit at the vaccine
manufacturing plant, extends through the transfer of vaccine to the
distributor and then to the provider’s office, and ends with the
administration of the vaccine to the patient.

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 Vaccination program

Age Vaccine Dose Route

BCG 0.05 ML ID
3-7 Day
HEP B 0.5 ML IM
1 Month IPV1 0. 5 ML SC
IPV2 0.5 ML SC
PENTA 1 0.5 ML IM
2 Month OPV1 2 Drops Orally
PCV1 0.5 ML IM
ROTA 1 1.5 ML Orally
PENTA 2 0.5 ML IM
OPV2 2 Drops Orally
4 Month
PCV2 0.5 ML IM
ROTA 2 1.5 ML Orally
PENTA3 0.5 ML IM
6 Month
OPV3 2 Drops Orally
9 Month Vitamin A 1 Capsule Orally
MMR1 0.5 ML SC
12 Month
PCV3 0.5 ML IM
15 Month Vitamin A 1 Capsule Orally
MMR2 0.5 ML SC
18 Month DPT Booster 0.5 ML IM
OPV Booster 2 Drops Orally
DT 0.5 ML IM
6 Years
OPV 2 Drops Orally
Rubella 0.5 ML SC
12 Years for female
15 Years Td 0.5 ML IM
Pentavalent vaccine is a combined vaccine with five individual vaccines conjugated
into one, intended to actively protect people from 5 potentially deadly diseases.
PENTA = Hib+ HepB+ DPT

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