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					Living Environment I
MMR Vaccine Information
Measles, Mumps, and Rubella (from A.D.A.M.)
Measles. Measles, one of the most contagious of all human infections, used to be a very common childhood
disease. Most cases resolve without serious complications. In severe cases, however, measles can cause
pneumonia, and in about 1 out of 1,000 cases it can lead to encephalitis (inflammation in the brain) or death.
The risk for these severe complications is highest in the very young and very old. In pregnant women, measles
increases the rates for miscarriage, low birth weight, and birth defects.
Aggressive vaccination programs have reduced the incidence of measles in the U.S., to a low of 43 cases in 2007,
most imported from other countries.
Mumps. Mumps is at record lows in the US, with 800 cases reported in 2007. In about 15% of cases, mumps
affects the lining of the brain and spinal cord, although this is usually not ultimately harmful. Swelling of the
testicles occurs in between 20 - 30% of males who have reached puberty, although sterility is rare. Deafness in
one ear occurs in one patient out of 20,000 with mumps.
Rubella (German Measles). When rubella, commonly known as German measles, infects children or adults, it
causes a mild illness that includes a rash, enlarged lymph nodes, and sometimes a fever. If a pregnant woman is
infected during her first trimester, however, her baby has a 80% chance for developing birth defects, including
heart abnormalities, cataracts, mental retardation, and deafness.
Before the vaccine became available, about 56,000 cases of rubella occurred annually in the U.S. Vaccination
programs have dramatically reduced the number of cases to a low of 12 in 2007, but between 6 - 11% of adults
are still susceptible, particularly unvaccinated Hispanic Americans who were born outside of the U.S.
Safe and effective live-virus vaccines for measles, mumps, and rubella have been developed over recent decades.
They are usually combined in children as the measles, mumps, and rubella (MMR) vaccine. Individual live-virus
vaccines or the combined MMR may be given to adults, depending on their risk factors.
Measles-Mumps-Rubella (MMR) Vaccine in Early Childhood. The combined MMR vaccine should be given in
two doses:
              Between ages 12 and 15 months for the first dose
              Between ages 4 and 6 years for the second dose. (Children who receive only one dose at 15
       months or older have five times the risk of measles compared to those who had two doses.)
Measles-Mumps-Rubella (MMR) Vaccine in Adolescents and Adults. The general recommendations for adult
MMR vaccinations are as follows:
                 Most people born before 1957 have experienced these once-common childhood diseases and do
        not require vaccination.
                 All unvaccinated people born after 1956 who did not already have measles and mumps should
        be given two doses, administered at least 1 month apart, (adolescents) or 1 dose (adults) of the live MMR
                 Many people received an inactivated measles-virus vaccine in the early 1960s or an inactivated
        mumps-virus vaccine between 1950 and 1978; such people need revaccination with two doses of the live
        MMR vaccine. (This will cause no harm even if someone had a previous live-virus-mumps vaccination.)
                 The American Academy of Pediatrics now recommends the live-virus MMR vaccine for HIV-
        infected children, teenagers, and young adults, except for those who are severely immunocompromised.
        The vaccine appears to be safe in HIV-infected children, and it should be stressed that measles is very
        dangerous in this population.
Rubella Vaccinations During Pregnancy. It is particularly important for any unvaccinated nonpregnant woman
who wants children to be vaccinated against rubella. It is recommended that women wait at least 28 days after
vaccination to start trying to conceive. Except under very special circumstances, no live-virus vaccine, especially
MMR, is given to an already pregnant woman, since there is a theoretical risk for birth defects from these
vaccines. Fortunately, the risk is low. In fact, studies have reported no increase in birth defects in women who
were inadvertently vaccinated for rubella early in their pregnancy.
Common side effects from the MMR vaccination include fever, rash, and joint pain. Most of these side effects are
less frequent after the second dose; however, teens and adults who receive this vaccine are more likely to suffer
from joint pain and stiffness.

Living Environment I
MMR Vaccine Information
Fever. About 5 - 15% of people who are vaccinated with any live measles virus vaccine develop a fever of 103 °F
or greater, usually between 5 and 15 days after the vaccination. It usually lasts 1 or 2 days but can persist up to 5
days. In very young children, seizures can occur from high fever 8 - 14 days after vaccination, but they are rare
and almost never have any long-term effects.
Swollen Glands. The live-mumps vaccine can cause mild swelling in the glands that are situated near the ears.
Joint Pain. Up to 25% of women have joint pain 1 - 3 weeks after a vaccination with a live-rubella virus; it lasts
for 1 day to 3 weeks. Such pain does not usually interrupt daily activities. Rarely, it recurs or becomes persistent.
Allergic Reaction. People who have known anaphylactic allergies (very severe reactions) to eggs or neomycin are
at high risk for a severe allergic response to the MMR vaccine. People with allergies that do not cause
anaphylactic shock to these substances are not at higher risk for a serious allergic reaction to the vaccine. Mild
allergic reactions, including rash and itching, may occur in some people. A rash occurs in about 5% of people
who are vaccinated with a live-measles vaccine. A live-mumps vaccination has caused rash and itching, but these
symptoms are usually mild.
Interaction with Tuberculosis Test. The live-measles vaccine may interfere with a tuberculosis test, so the two
should be administered at least 4 - 6 weeks apart. No evidence exists that the vaccine has an adverse effect on
tuberculosis itself.
Mild Infection. A mild form of measles that has no symptoms may develop in previously immunized people who
are exposed to the virus, although this mild infection may not be significant.
Idiopathic Thrombocytopenic Purpura (ITP). In about 1 in 22,300 doses, MMR can cause a rare bleeding
disorder called idiopathic thrombocytopenic purpura (ITP). This can cause a purple, bruise-like discoloration
that can spread across the body, nose bleeds, or tiny red spots. It is nearly always mild and temporary. (Of note,
the risk for ITP is much higher with the actual infections, particularly rubella.)
Note: Much controversy has arisen over unsubstantiated reports of neurologic side effects attributable to MMR.
This is of great concern since such reports have resulted in a decline in immunizations in certain areas, notably
affluent areas in England where the vaccination rate has dropped from 92% in 1996 to 84% currently. Here,
measles outbreaks are now climbing, and doctors fear that unless immunization rates increase rapidly, case
numbers will significantly increase. In these and other regions, some parents mistakenly believe that the dangers
of immunization outweigh a dangerous childhood illness that only older people remember. It should be strongly
noted that measles still cause about 745,000 deaths in unvaccinated children who live in underdeveloped
countries, primarily in Africa.
Most publicity has centered on a possible link between the MMR vaccine, which was introduced in 1988, and a
variant of autism that includes inflammatory bowel disease (IBD) and impaired behavioral development. Such
findings have been rigorously reviewed and refuted in a number of well-conducted studies.
Despite considerable publicity, there is no evidence linking MMR vaccination with the development of autism.
The Centers for Disease Control & Prevention's web site provides extensive information on this matter. The
popular media has incorrectly reported the possible link between autism and MMR as causing a split in the
scientific community, but virtually all experts refute any association between the two. In fact, reports of
symptoms related to autism increased only after widespread publicity of this supposed side effect.
The potential benefits from receiving the MMR vaccine far outweigh the potential adverse effects. Measles,
mumps, and rubella are all very serious illnesses and each may have complications resulting in lifetime
disabilities or even death. The incidence of such complications, related to having the actual diseases, is far
greater than the potential of developing serious, or even moderate, adverse effects due to the MMR vaccine.

Journal Retracts 1998 Paper Linking Autism to Vaccines
Published: February 2, 2010

A prominent British medical journal on Tuesday retracted a 1998 research paper that set off a sharp decline in
vaccinations in Britain after the paper’s lead author suggested that vaccines could cause autism.
The retraction by The Lancet is part of a reassessment that has lasted for years of the scientific methods and
financial conflicts of Dr. Andrew Wakefield, who contended that his research showed that the combined

Living Environment I
MMR Vaccine Information
measles, mumps and rubella vaccine may be unsafe.
But the retraction may do little to tarnish Dr. Wakefield’s reputation among parents’ groups in the United States.
Despite a wealth of scientific studies that have failed to find any link between vaccines and autism, the parents
fervently believe that their children’s mental problems resulted from vaccinations.
Tom Skinner, a spokesman for the Centers for Disease Control and Prevention, called the retraction of Dr.
Wakefield’s study “significant.”
“It builds on the overwhelming body of research by the world’s leading scientists that concludes there is no link
between M.M.R. vaccine and autism,” Mr. Skinner wrote in an e-mail message.
A British medical panel concluded last week that Dr. Wakefield had been dishonest, violated basic research
ethics rules and showed a “callous disregard” for the suffering of children involved in his research. Dr. Richard
Horton, editor in chief of The Lancet, said that until that decision, he had no proof that Dr. Wakefield’s 1998
paper was deceptive.
“That was a damning indictment of Andrew Wakefield and his research,” Dr. Horton said.
With that decision, Dr. Horton said he could retract the 1998 paper. Dr. Wakefield could not be reached for
Jim Moody, a director of SafeMinds, a parents’ group that advances the notion the vaccines cause autism, said
the retraction would strengthen Dr. Wakefield’s credibility with many parents.
“Attacking scientists and attacking doctors is dangerous,” he said. “This is about suppressing research, and it will
fuel the controversy by bringing it all up again.”
Dr. Wakefield is part of a small but fervent group of doctors who discourage vaccinations because of a seeming
link with autism.
Dr. Wakefield’s paper reported on his examinations of 12 children with chronic intestinal disorders who had a
history of normal development followed by severe mental regressions. He speculated that the combined measles,
mumps and rubella vaccine may have caused some sort of chronic intestinal measles infection that in turn
damaged the children’s brains. He suggested that the combined vaccine should be split into three separate shots
and given over a longer period of time.
But an investigation by a British journalist found financial and scientific conflicts that Dr. Wakefield did not
reveal in his paper. For instance, part of the costs of Dr. Wakefield’s research were paid by lawyers for parents
seeking to sue vaccine makers for damages. Dr. Wakefield was also found to have patented in 1997 a measles
vaccine that would succeed if the combined vaccine were withdrawn or discredited.
After years of investigation, the General Medical Council in Britain concluded that Dr. Wakefield had subjected
11 children to invasive tests like lumbar punctures and colonoscopies that they did not need and for which he did
not receive ethical approval.
After Dr. Wakefield’s study, vaccination rates plunged in Britain and the number of measles cases soared.
In the United States, anti-vaccine groups have advanced other theories since then to explain why they think
vaccines cause autism. For years, they blamed thimerosal, a vaccine preservative containing mercury. Because of
concerns over the preservative, vaccine makers in 2001 largely eliminated thimerosal from routinely
administered childhood vaccines.
But this change has had no apparent impact on childhood autism rates. Anti-vaccine groups now suggest that a
significant number of children have a cellular disorder whose effects are set off by vaccinations.
With each new theory, parents’ groups have called for research to explore possible links between vaccination and
autism. Study after study has failed to show any link, and prominent scientific agencies have concluded that
scarce research dollars should be spent investigating other possible causes of autism.


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