MMR II vaccine: A live attenuated MMR vaccine

MMR II is a brand of MMR Vaccine by Merck. This vaccine protects against measles, mumps, and rubella these 3 diseases. This is a live attenuated vaccine. It contains live attenuated measles virus derived from Enders’ attenuated Edmonston strain and propagated in chick embryo cell culture, live attenuated mumps virus the Jeryl Lynn, live attenuated rubella virus Wistar RA27/3 strain propagated in WI-38 human diploid lung fibroblasts.

Each dose is calculated to contain sorbitol (14.5 mg), sucrose (1.9 mg), hydrolyzed gelatin (14.5 mg), recombinant human albumin (≤0.3 mg), fetal bovine serum (<1 ppm), approximately 25 mcg of neomycin and other buffer and media ingredients. The product contains no preservatives.

Live attenuated measles virus Edmonston strain
Live attenuated mumps virus the Jeryl Lynn
Live attenuated rubella Wistar RA27/3 strain
Water for injection 0.5 ml
Each dose is calculated to contain sorbitol (14.5 mg), sucrose (1.9 mg), hydrolyzed gelatin (14.5 mg), recombinant human albumin (≤0.3 mg), fetal bovine serum (<1 ppm), approximately 25 mcg of neomycin and other buffer and media ingredients. The product contains no preservative.

Contents of MMR II Vaccine

Table of Contents

How is MMR II vaccine available?

MMR II vaccine is available as a pack of two vials. The lyophilized powder is available in a separate vial. Another vial contains diluent to be mixed with lyophilized powder. The vaccine is in an opaque paper packet. It should be stored in the packaging it comes with.

How is MMR II vaccine prepared?

MMR II vaccine, sterile water for injection is mixed with lyophilized powder. The needle should be attached to the syringe of sterile water. The water is pushed into the vial of lyophilized powder. The mixture is agitated gently to mix the content. The care should be taken while doing the procedure that sterilizers and disinfectants should not touch the vial. Care should be taken to avoid needle prick while mixing the contents. The mixture is sucked back into the syringe.

How the MMR II vaccine can be given?

MMR II vaccine can be given either by subcutaneous route. All the safety injection precautions need to be taken while giving the injection. The disinfectant applied to the skin should be evaporated completely before giving the injection. The injection should not be given intra-vascular as safety and efficacy by this route is not known. The disposables after the use of injection should be discarded as per biomedical waste management protocols. The vaccine if expired should be discarded and not used. The expired vaccines need to be discarded as per biomedical waste management protocols.

At what age MMR II vaccine is given?

MMR II vaccine is given at age 6-9 months and the next dose is given at 15 months followed by at 5 years of age in the routine immunization schedule.

What if someone has missed MMR II dose?

If an unvaccinated person above 9 months comes to OPD, the MMR II vaccine is the priority vaccine to be given. The missed dose should be given as early as possible. The opinion of a pediatrician is to be taken before vaccination.

Safety with other vaccines:

MMR II vaccine is safe with other vaccines like DPT, pneumococcal vaccines, Japanese encephalitis vaccine.
Other vaccines can be given together but should not be mixed in the same syringe.
The live vaccines can be given either one month before or with a gap of 28 days in between.
Varivax live vaccine can be given together with this vaccine.
Caution is needed if the patient is on daily prednisolone or other immunosuppression therapy.
Caution is needed if the patient has received blood or blood products or immunoglobulins in a few months prior.

How does MMR II vaccine works?

MMR II vaccine contains live attenuated viruses of measles, mumps, and rubella. Live attenuated means these are live viruses but they lack the capacity to cause disease though they have the capacity to infect. When these viruses are injected by the vaccine they infect the person who got the injection. They multiply in the body of the host. The immunity of the host recognizes this virus. Immunity develops a mechanism to fight this virus. In this process, the body also develops memory immunity. When the real infection of these diseases occurs the body rapidly increases the immune response and the disease is prevented. This is an active form of immunization.

What are the side effects of the MMR II vaccine?

Side effects of MMR II vaccine are usually milder when compared to the diseases it cause. Common side effects are:

Fever may come and usually lasts for 1-3 days and it can be easily controlled by oral medications like paracetamol at home.
Skin rash which looks like measles disease can appear in a few days after vaccination. This rash is usually milder and short-lasting than measles disease.
Pain, swelling, and redness at the injection site. This may come after injection and may last for 1-3 days. It usually subsides on its own or by simple measures like local cold fomentation.
Symptoms of upper respiratory tract infection like a cold and running nose.
Nervousness and crying.
Lymphadenopathy: Uncommon.
Conjunctivitis, bronchitis, parotid gland swelling, diarrhea, and vomiting are uncommon side effects. These are usually milder and are generally manageable on an OPD basis at home.
Thrombocytopenia is a rare side effect and if occurs it usually resolves on its own.
Like all other vaccines for anaphylaxis, the reaction may come after this vaccination though it is very rare. The facility at which vaccination is given should be ready to manage anaphylaxis with the necessary equipment and skilled personnel.

What cautions are needed with MMR II vaccine?

The facility to manage anaphylaxis should be ready while giving this injection.
Caution should be taken in those who are allergic egg proteins and gelatine proteins.
The vaccine should not be given to those who are allergic to any of its components.
This is a live vaccine so cannot be used in pregnancy.
The pregnancy should be avoided till after 3 months of giving this vaccine, though this vaccine is not a valid indication for abortion.
Caution should be taken in immunocompromised patients. The vaccine is used in them if the benefit outweighs the risks.
In infants of HIV mothers, this vaccine should be given as early as after 6 months of age.
The vaccine is avoided in those with active TB disease or those in the intensive phase of the TB-treatment.
The vaccine should be given after one month to those who got measles as the natural disease does not give immunity.
Biomedical waste management guidelines are to be followed like all other vaccinations.
The vaccine is stored as mentioned on a packet by the manufacturer.
If the patient has received a dose of plasma or blood products

To whom MMR II vaccine is contraindicated?

MMR II is contraindicated in those with stage 3 or stage 4 HIV AIDS disease.
MMR II is contraindicated for those who are severely immunocompromised.
Those who are pregnant.
Those who are allergic to any of its components.
Those who got anaphylaxis at the time of MMR II vaccine in past.
Those who are allergic to egg protein and gelatin protein.

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