Measles Vaccine:MMR,Side effects,anaphylaxis,Contraindications

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Measles Vaccine

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MEASLES - VACCINE - LATEST UPDATES

Dr Nitin Shah
Hon. Pediatrician, UHC, LTMG Hospital, Mumbai.
Treasurer, Indian Academy of Pediatrics, 1998-2001

Q. What are the side effects of measles / MMR vaccine?
A. Measles vaccine is a very safe vaccine. If at all, it leads to mild pain, swelling, induration or fever. It is seen in less than 10% of patients, is transient & mild, lasts for <24 hours & responds well to paracetamol. It can occur from the day of injection till 5-7 days. Sometimes a patient can develop measles like infection with cough, cold, red eyes & rash over skin. Again it lasts for 2-5 day & is self-limiting. There are 2 complications that could prove fatal and are discussed in next question. Contrary to belief, measles vaccine does not lead to SSPE. Again it is discussed later.

Q. What about anaphylaxis in patients with egg allergy?
A. Anaphylaxis is seen in patients with egg allergy as measles vaccine (like MMR) is grown in chick embryo culture. In patients, with mild egg allergy it leads to less severe reactions like angioedema, puffiness, urticaria, anaphylactoid reactions. In patients with severe allergies, it can lead to frank anaphylaxis. In cases of severe egg allergy, measles & MMR vaccines are contraindicated. In case with mild egg allergy, measles or MMR vaccines can be given but with strict medical supervision and all the measures of resuscitation & drugs kept ready should the patient develop reaction

Q. What is toxic shock syndrome following measles / MMR vaccine?
A. Toxic shock syndrome (TSS) is an unfortunate but avoidable reaction of measles vaccine. Measles vaccine does not have a preservative. Hence, once reconstituted it should not be kept beyond 2-3 hours & that too it should be kept on ice. If it is not stored properly or is used after 2-3 hours there are chances of growth of pathogens, most important being staphylococci. When infected, the staphylococcal toxin formed will lead to fever, diarrhea, vomiting, blood in stools, DIC, shock & ultimately death. This usually follows use of multidose bulbs where the balance doses are not kept properly or not used in time. Obviously, it is totally avoidable by using properly stored vaccine and using the vaccine immediately after reconstitution. Single dose vaccine vials are hence preferred over multidose vials.

Q. Can measles / MMR vaccine lead to SSPE?
A. SSPE or subacute sclerosing panencephalitis is a slow viral disease of brain caused by measles wild virus. Hence, logically measles vaccine should prevent SSPE as it will prevent measles. There were some patients who had never suffered from measles but were vaccinated with measles vaccine in past and developed SSPE later. That led to the belief that it was the vaccine virus, which led to SSPE in them. In fact it was quoted that the incidence of SSPE following measles vaccine was 10 times less than following actual measles. But this is not true. In USA, mass vaccination with MMR has eradicated measles infection & so also SSPE. If SSPE was to follow vaccination, SSPE cases should have continued to occur. One can explain that those who developed SSPE following vaccination without having history of measles in past probably had developed sub-clinical measles before vaccination & hence developed SSPE because of wild virus & the blame unnecessarily went to the vaccine virus. So it is now clear that measles vaccination does not lead to SSPE, but in fact prevents SSPE.

Q. What are the contraindications for measles/MMR vaccine?
A. True & severe egg allergy is the contraindication to use Measles or MMR vaccine. A sick patient should receive any vaccine after he recovers from his illness. If a patient has shown severe adverse effects following any vaccine he should not receive the same vaccine again & this is true for measles & MMR vaccine too.

Q. What if the patient comes late for measles vaccine?
A. Measles can occur till 5-15 years of age. If a patient comes before 12 months of age, he can still be given measles vaccine. It he comes after 12 months he is given MMR or Measles vaccine, whichever he can afford.

Q. Can measles vaccine be given along with other vaccines?
A. Measles vaccine can be given simultaneously with other vaccines. In fact it is given along with 5th dose of OPV & even 3rd dose of Hepatitis B vaccine as per IAP schedule. Measles is also given with mumps & rubella vaccines as MMR. As measles vaccine can interfere with immunity, especially T cell immunity for 4-6 weeks, BCG should not be given along with it. Similarly no other vaccine should be given within 4-6 weeks of measles or MMR vaccine.

Q. Can measles be eradicated?
A. Any infectious disease, which has no extra-human reserve & has a potent vaccine that induces life long immunity has a chance of being eradicated by immunization strategy. Measles is one such candidate for eradication. Effective & high coverage of routine measles immunization has almost eradicated measles from western countries like USA. After success of pulse polio campaign, a pilot mass measles vaccine programme has been started in some areas of India. After the results we will know the success or otherwise of such programme. Theoretically it is possible to eradicate measles from world.

Last created on 23-02-2001
Last updated on 01-12-2004

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Dr.Shah N.Measles Vaccine.Pediatric Oncall [serial online] 2004 [cited 2004 December 1];1. Available from: