Measles, Mumps, Rubella (MMR)

Updated: April 22, 2010

Table of Contents

    Understanding the Disease

    Mumps is a viral infection spread from person to person by secretions sneezed or coughed from the nose or throat.

    Mumps usually begins with swelling and tenderness of one or more of the salivary glands. This lasts about a week. Complications can include inflamed testicles (20% to 50% of post-pubertal males infected), brain involvement including aseptic meningitis (15% of cases), and inflammation of the pancreas (2% to 5% of cases) and ovaries (5% of post-pubertal females). Permanent deafness occurs in 1 out of 2,000 cases.

    The mumps virus has not been associated with problems during pregnancy, although there are some reports of an increase in fetal loss associated with mumps during the first trimester.

    Before widespread vaccination, there were about 200,000 cases of mumps and 20 to 30 deaths reported each year in the United States. In 1998, there were just 600 cases of mumps and no fatalities reported from the disease.

    Available Vaccines

    The mumps vaccine is available as:

    • MMR (Measles-Mumps-Rubella)
    • MMRV (Measles-Mumps-Rubella-Varicella Virus Vaccine Live)

    Product: ProQuad (MMRV)
    Manufacturer: Merck
    Year licensed: 2005

    Product: M-M-R II (MMR)
    Manufacturer: Merck
    Year licensed: 1971

    Neither MMR or MMRV vaccines contain thimerosal.

    History of the Vaccine

    The current “Jeryl Lynn” strain of the mumps vaccine was developed by Dr. Maurice Hillman from the mumps virus that infected his 5-year-old daughter (whose name was Jeryl Lynn). This vaccine has been widely used worldwide (300 million doses given) since it was approved by the FDA in 1967.

    Today, mumps vaccine is generally given in combination with mumps and rubella vaccines (MMR) or MMR combined with varicella (MMRV).Originally, just one dose of the MMR vaccine was recommended. In 1989, the American Academy of Family Physicians, the American Academy of Pediatrics, and the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, changed the recommendation to two doses. This change and a higher vaccination rate have nearly eliminated these three diseases in the United States. Continued immunization of children is needed to prevent the spread of these infections imported from other countries.

    Because of intense misinformation about MMR in the United Kingdom, MMR vaccine coverage has declined across Europe, resulting in outbreaks of measles and mumps in multiple countries, including the United States and Canada, and congenital rubella in the Netherlands and Canada. Japan, which does not immunize with mumps vaccine has on-going outbreaks of mumps with permanent deafness being reported at a rate of 1/1000.

    Monovalent measles and rubella vaccines are no longer produced in the United States.

    Who Should and Should Not Receive the Vaccine

    Who should receive the MMR vaccine?

    • All infants 12 months of age or older
    • Susceptible adults who do not have documented evidence of measles immunity, such as a physician-diagnosed case of measles, a blood test showing the presence of measles antibody, or proof of receiving measles vaccine.

    Immunity against measles is particularly important for adults at high risk for measles exposure, including college students and health care workers. People born before 1957 who are not in one of these high-risk categories are generally considered immune to measles through environmental exposure.

    Frequently, it is believed that members of the following groups should not receive the vaccine. In fact, susceptible members may still receive the vaccine:

    • Women who are breast feeding
    • Individuals who have HIV infection but no symptoms of AIDS
    • Children whose mothers or other household members are pregnant, as immunizing these contacts poses no risk to the pregnant individual

    Administering the vaccine within 72 hours to people who have been exposed to measles may prevent them from developing the disease.

    Who should not receive the MMR vaccine?

    • People with serious allergies to gelatin or any of the other components of the vaccine
    • Women who are pregnant or trying to conceive. Moreover, women should not become pregnant within 28 days after immunization with MMR.
    • Immunocompromised persons (with the exception of HIV-infected persons who have no symptoms of AIDS, as noted above) and persons receiving cancer chemotherapy or high doses of steroids
    • People receiving blood products (except washed red blood cells) such as immune globulin should have the MMR vaccine deferred for 3 to 11 months depending on the blood product and dosage administered.
    • People who are moderately or severely ill should consult with their physician before receiving any vaccine.

    This vaccine is recommended by:

    • Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
    • American Academy of Pediatrics
    • American Academy of Family Physicians

    Summaries the childhood, adolescent and adult immunization recommendations can be found at the CDC site.

    Dose Schedule

    Two doses of MMR vaccine administered on or after the first birthday are recommended for all children. The first dose is generally given at 12 to 15 months of age, and the second dose is generally given at four to six years of age. There must be a minimum of four weeks between doses.

    Effectiveness of the Vaccine

    Under conditions of routine use in the United States 80-90 percent of those who receive MMR vaccine at one year of age or older are immune after the first dose. The two dos schedule should protect most children.

    Known Side Effects

    Nearly all children who get the MMR vaccine (more than 80%) will have no side effects. Most children who have a side effect will have only a mild reaction, such as soreness, redness or swelling where the shot was given, mild rash, mild to moderate fever, swelling of the lymph glands, and temporary pain, stiffness, or temporary swelling in the joints.

    In about 5% to 15% of children given MMR, a fever in excess of 103 degrees F may occur—usually beginning about 7 to 12 days after the vaccine has been administered.

    About 15% of women who receive MMR will develop acute arthritis or swelling of the joints. This condition is usually very short-lived.

    In rare cases (about 3 children out of 10,000 given MMR, or 0.03% of recipients) a moderate reaction such as seizure related to high fever may occur. The risk of a febrile seizure after the first dose of MMRV is increased by an additional child per 1000 (compared to children who got MMR and varicella vaccine at different sites on the same day).

    In very rare cases (far less than 1 child out of 10,000 given MMR), children have a serious reaction, such as lowered consciousness, coma, or hypersensitivity (anaphylaxis)—swelling inside the mouth, difficulty breathing, low blood pressure, and rarely, shock. Even more rarely, children may have low blood platelets that can lead to a temporary bleeding problem that is described in more detail in the “Related Issues” section below. Since 1990, there have been 11 case reports of anaphylaxis in those who received the vaccine. Thirty to 40 million children were vaccinated during this time period. No children who experienced such a reaction died as a result.

    In extremely rare cases (less than 1 child out of 1,000,000 given measles vaccine) children have developed encephalitis 6-15 days after vaccination.

    MMR side effects are largely due to the measles vaccine that it contains. Adverse reactions to the monovalent mumps vaccine are rare.

    Reimmunization with MMR vaccine is not associated with an increased incidence of reactions even when a person is already immune to one or more of the viruses.

    Related Issues

    In the event of a mumps outbreak, students may not be allowed to remain in school unless they have received two doses of a mumps-containing vaccine or have other proof of immunity. Those who remain susceptible should be excluded from school until at least 26 days after the onset of mumps in the last infected person at that school.

    There has been extensive misinformation about whether measles-containing vaccines might be associated with autism and/or inflammatory bowel disease. These theories have been fully discredited: MMR vaccine does not cause autism. Researchers estimate that about one in every 22,000 MMR vaccinations could result in a child developing a temporary bleeding disorder called idiopathic thrombocytopenic purpura (ITP). ITP is rarely dangerous— generally much less serious than measles, mumps, or rubella — and is easily treated. A recent study found that children who had ITP and later received the MMR vaccine had no vaccine-associated recurrences.

    Key References and Sources of Additional Information

    • AAP, Committee on Infectious Diseases. (2009). Mumps. In LK Pickering (Ed.), Red Book: Report of the Committee on Infectious Diseases (28th ed., pp 468-472). Elk Grove Village, IL: Author. 
    • Barlow WE, Davis RL, and Glasser JW. (2001). The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rubella vaccine. New England Journal of Medicine, 345(9), 656-661.  
    • Centers for Disease Control and Prevention (CDC). (1998). Measles, mumps, and rubella: Vaccine use and strategies for elimination of measles, rubella and congenital rubella syndrome, and control of mumps: Recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report, 47(RR-8), 1-57. Available online
    • CDC. (2006). Updated recommendations of the Advisory Committee on Immunization Practices for the control and elimination of mumps.MMWR 55(22): 629-30. Available online.
    • CDC. (2008). Update: Recommdations from the Advisory Committee on Immunization Practices (ACIP) regarding the administration of MMRV vaccine. MMWR 57(10): 258-50. Available online.
    • Myers MG, Pineda D. 2008. Do vaccines cause that?! A guide for evaluating vaccine safety concerns. I4PH Press, Galveston.

    CDC Information