MMR Vaccination Recommendations in the NHS
The NHS recommends MMR vaccination with two doses: the first dose at 12-15 months of age and the second dose at 4-6 years of age, which is essential for complete protection against measles, mumps, and rubella. 1
Vaccination Schedule
First Dose
- Administered at 12-15 months of age
- For the first dose in children aged 12-47 months, either separate MMR and varicella vaccines or the combined MMRV vaccine may be used
- Unless parents specifically request MMRV, separate MMR and varicella vaccines are recommended for the first dose due to a slightly increased risk of febrile seizures with MMRV 2
Second Dose
- Administered at 4-6 years of age (before entering kindergarten or first grade)
- The second dose can be administered earlier than 4 years if at least 28 days have elapsed since the first dose 2
- For the second dose, MMRV vaccine is generally preferred over separate injections 2
Special Populations
School-Aged Children
- All children entering school should have received two doses of MMR vaccine or have other evidence of immunity 2
- Children who do not have documentation of adequate vaccination should be admitted to school only after administration of the first dose 2
Adults
- Adults born in 1957 or later should receive at least one dose of MMR vaccine unless they have:
- Documentation of vaccination with at least one dose of measles-, rubella-, and mumps-containing vaccine
- Other acceptable evidence of immunity 2
- Persons born before 1957 are generally considered immune to measles and mumps 2
Women of Childbearing Age
- All women of childbearing age should be considered susceptible to rubella unless they have:
- Received at least one dose of MMR or other live rubella virus vaccine on or after the first birthday
- Serologic evidence of immunity 2
- MMR vaccine should be offered to all women of childbearing age who lack evidence of rubella immunity 2
Contraindications and Precautions
Contraindications
- History of anaphylactic reaction to neomycin
- Allergic reaction to gelatin or other vaccine components
- Altered immunity (blood dyscrasias, leukemia, lymphomas, malignant neoplasms)
- Primary or acquired immunodeficiency including HIV/AIDS
- Family history of congenital or hereditary immunodeficiencies
- Systemic immunosuppressive therapy
- Pregnancy 2
Precautions
- Personal or family history of seizures of any etiology (children with such history should receive separate MMR and varicella vaccines) 2
- Recent receipt of antibody-containing products 2
Clinical Considerations
Vaccine Effectiveness
- Approximately 5% of children who receive only one dose of MMR vaccine fail to develop immunity to measles, highlighting the importance of the two-dose schedule 2
- Studies show that 2-4 years after receiving the first MMR dose, a significant proportion of children have measles (19.5%) and mumps (23.4%) antibody levels below the protective threshold 3
- After the second dose of MMR, the proportion of children negative to one or more antigens drops to less than 4% 3
Administration with Other Vaccines
- MMR vaccine may be administered simultaneously with other vaccines
- If not given simultaneously, live vaccines should be separated by at least 28 days 2
Common Pitfalls to Avoid
Delaying the second dose: Ensure the second dose is administered at the recommended age to provide optimal protection against outbreaks in school settings 4
Overlooking adult vaccination: Adults born after 1957 without evidence of immunity should receive at least one dose of MMR vaccine 2
Ignoring contraindications: Always screen for contraindications and precautions before administering MMR vaccine 2
Missing opportunities for vaccination: Healthcare professionals should review vaccination status at every encounter to determine which vaccines are indicated 2
Failing to verify immunity in women of childbearing age: All women of childbearing age should have documented immunity to rubella 2