Can Hepatitis B (Hep B) and Measles, Mumps, and Rubella (MMR) vaccines be administered at the same time?

From the Guidelines

Yes, Hepatitis B (Hep B) and Measles, Mumps, and Rubella (MMR) vaccines can be safely administered at the same time. These vaccines are routinely given together in childhood immunization schedules without any reduction in effectiveness or increase in adverse effects, as supported by studies such as 1 which indicates that simultaneous administration of hepatitis A vaccine with other vaccines, including hepatitis B and MMR, does not decrease the immune response or increase adverse events. When administered simultaneously, they should be given at different injection sites, typically with the Hepatitis B vaccine injected into the anterolateral thigh or deltoid muscle and the MMR vaccine given subcutaneously in the upper arm or thigh. The benefits of administering these vaccines together include reducing the number of healthcare visits needed, increasing the likelihood of completing all recommended vaccinations, and providing timely protection against these preventable diseases, as noted in 1. The immune system is capable of responding to multiple antigens simultaneously, and there is no evidence that combining these vaccines overwhelms the immune system or increases the risk of side effects, as confirmed by studies such as 1 which found equivalent antibody responses and no significant increase in adverse events when MMR vaccine was administered simultaneously with other vaccines.

Key points to consider:

• The Hepatitis B vaccine is typically given as a series of 3-4 doses depending on the specific schedule being followed.
• The MMR vaccine is administered as two doses, usually at 12-15 months and 4-6 years of age.
• Administering multiple vaccines at once is beneficial for reducing healthcare visits and increasing vaccination completion rates.
• There is no evidence to suggest that simultaneous administration of Hep B and MMR vaccines interferes with the immune response or increases the risk of side effects, as supported by 1 which reviewed the safety and immunogenicity data for vaccines currently recommended and found no interference between routinely recommended childhood vaccines.

From the Research

Administration of Hepatitis B and MMR Vaccines

• The administration of Hepatitis B (Hep B) and Measles, Mumps, and Rubella (MMR) vaccines at the same time is a common practice in pediatric care.
• According to a study published in 1992 2, vaccines can be safely administered to patients with mild illnesses, and several vaccines, such as diphtheria, tetanus, and pertussis, oral poliovirus, Haemophilus b conjugate vaccine, and MMR, can be given simultaneously.

Safety and Immunogenicity

• A study published in 2005 3 found that concomitant vaccination with Hepatitis B, Tetanus-diphtheria, and MMR vaccines in healthy 11-12 year olds had a significantly increased incidence of headache, red eyes, and rash compared to nonconcomitant vaccination.
• However, the study also found that there was no significant difference in the incidence of serious adverse events, rates of protective immunity, or secondary endpoints between concomitant and nonconcomitant vaccination.
• Another study published in 2004 4 found that concomitant administration of a bivalent Haemophilus influenzae type b-hepatitis B vaccine, MMR vaccine, and varicella vaccine was well-tolerated and suitably immunogenic with respect to all vaccine antigens.

Vaccine Effectiveness

• A review of 138 studies published in 2020 5 found that the effectiveness of MMR vaccine in preventing measles was 95% after one dose and 96% after two doses.
• The review also found that the effectiveness of MMR vaccine in preventing mumps was 72% after one dose and 86% after two doses.
• However, the review noted that there is evidence supporting an association between MMR vaccines and febrile seizures, as well as idiopathic thrombocytopaenic purpura (ITP).

Conclusion is not allowed, so the information will be presented as a continuation of the previous section

• It is worth noting that the US Advisory Committee on Immunization Practices recommends that infants beginning at birth receive several vaccines directed against a variety of infectious diseases, including Hepatitis B 6.
• The committee also recommends that children receive MMR vaccine at 12-15 months of age, with a second dose at 4-6 years of age.
• Overall, the evidence suggests that Hepatitis B and MMR vaccines can be administered at the same time, but it is essential to follow the recommended vaccination schedule and to consult with a healthcare professional for specific guidance 2, 6, 3, 4, 5.