MMR (MEASLES, MUMPS, RUBELLA) VACCINE

This vaccine prevents measles, mumps and rubella. The MMR vaccine is given twice, at 1 year and 4 years of age. The three infectious diseases which make up the MMR vaccine are different viral infections which cause fever, rashes and infections of different organs of the body. Measles is the most severe disease of the three.

The mortality rate of measles in children in the United States has seen significant changes over the decades, primarily due to the introduction and widespread use of the measles vaccine.

Pre-vaccine Era: Before the measles vaccine was introduced in 1963, measles was a common childhood illness. During this period, there were about 3 to 4 million measles cases annually in the US, leading to an estimated 400 to 500 deaths each year, mostly among children. The mortality rate was roughly 1 to 2 deaths per 1,000 reported measles cases. In countries where poor health and malnutrition were rampant, death rates from measles were much higher.

Post-vaccine Introduction: After the introduction of the measles vaccine in 1963, there was a dramatic decline in measles cases and related deaths. By the late 1960s and early 1970s, the number of measles cases had decreased significantly. With continued vaccination efforts throughout the 1970s and 1980s, measles mortality dropped even further.

Measles Elimination: In 2000, measles was declared eliminated in the United States, meaning there was no continuous disease transmission for at least 12 months. During this time, the incidence and mortality of measles were exceptionally low. Occasionally, small outbreaks occurred, primarily linked to importations from countries where measles was still endemic, but deaths were rare due to high vaccination coverage and robust healthcare responses.

In recent years, measles cases in the US have primarily resulted from importations by foreign travelers, with some outbreaks increasingly linked to vaccine hesitancy among parents. Despite these outbreaks, deaths have remained rare due to timely public health responses and treatment. How- ever, maintaining high vaccination rates are crucial to prevent any increase in mortality. Overall, robust vaccination programs have kept measles mortality exceptionally low, but continued vigilance in vaccinations is necessary to avoid a resurgence.

Some recent notable outbreaks of measles in the US include:

1. Disneyland Measles Outbreak (2014): This outbreak originated at Disneyland in California and eventually spread to multiple states. It was linked to international travelers who brought the virus into the park.
2. Minnesota Measles Outbreak (2017): This outbreak occurred primarily within the Somali-American community in Minnesota. Low vaccination rates and close-knit religious and cultural gatherings contributed to the spread of measles.
3. Washington State Measles Outbreak (2019): This outbreak mainly affected Washington state, particularly in the Clark County area. Low vaccination rates and close contacts within the community led to a rapid spread of the virus, prompting a public health emergency declaration.
4. Texas Measles outbreak: January through July, 2025: 762 cases.

Each outbreak had its specific contributing factors, but they all high- light the importance of vaccination for preventing the spread of measles.

Here in Arkansas, a mumps outbreak began on August 8, 2016, when a confirmed case was reported in Springdale, Arkansas. 2,951 cases were eventually reported in Arkansas. The outbreak spread from the Springdale community to the rest of Northwest Arkansas and over 30 counties in the state. The outbreak primarily affected the Marshallese community, but it also involved people of all races, ethnicities, and ages. This outbreak affected school aged children and young adults. A similar outbreak happened in Alaska the next year. Thus, there is an important need for MMR vaccination.

Since children do not get their MMR until their first birthday, virtually all babies are susceptible to measles, mumps and rubella during the first year of their lives. The MMR vaccine can sometimes be given earlier than the standard schedule in certain situations, such as during outbreaks or prior to international travel. In these cases, the vaccine may be administered to infants as young as 6 months. However, doses given before 12 months typically do not count toward the routine immunization schedule in the United States.

If the MMR vaccine is given to a child before their first birthday, the child will still need the standard two doses: one at 12–15 months and another at 4–6 years. The early dose serves primarily as an additional precaution under special circumstances.

Side effects: Side effects of MMR are generally minor. Usually, there is no reaction for the first day or two. Within a week or two, a few children will develop a low-grade fever, runny nose and minor rash. This can be treated with acetaminophen (Tylenol -see Dosage Guide on page 234). These symptoms will generally resolve spontaneously and are not serious.

Rarely, children who receive the MMR may develop joint swelling and or redness and limp. Other rare reactions are a transient low platelet count and extremely rarely, a seizure. We should be contacted with any reactions such as these.

Your child should not receive the MMR vaccine if your child:

1. had a previous severe allergic reaction (anaphylaxis) to a previous dose of MMR.
2. is pregnant or thinks she is pregnant. It is safe to give the MMR to a child whose mother is pregnant.
3. has a known immunodeficiency, such as HIV or is taking cancer treatments or is taking other drugs, such as prednisone or steroids, that make it hard for the body to fight infection.
4. is born with or develops any disease that makes it hard for the body to fight infection, such as cancer, leukemia, or lymphoma (cancer of the lymph glands).
5. has received gamma globulin during the past 11 months.
6. has a family member in the same household who is on chemotherapy or some other treatment that reduces the effectiveness of the immune system.
7. currently has a moderate or severe acute illness.
8. has thrombocytopenia (low platelets) or thrombocytopenic purpura (bruising caused by low platelets).
9. has a need for tuberculin skin testing (TB exposure)

The MMR-Autism myth: The MMR vaccine has unfortunately acquired an unfounded reputation for causing autism in young children. This misconception originated from a single paper authored by Dr. Andrew Wakefield, and published in The Lancet in 1998, entitled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” The study suggested a possible link between the MMR (measles, mumps, and rubella) vaccine and autism. However, this study was thoroughly discredited and eventually retracted by The Lancet in 2010 due to serious ethical concerns and methodological flaws. The publication had a significant negative impact on public perception of vaccines, leading to decreased vaccination rates and subsequent outbreaks of vaccine preventable diseases like measles.

The erroneous claims in the article were quickly picked up by U.S. pop culture and even endorsed by some U.S. politicians, intensifying the problem of vaccine misinformation. The General Medical Council (GMC) of the U.K. found that the research and conclusions in Dr. Wakefield’s pa- per were profoundly flawed by professional misconduct, false statements, flawed research, and an undisclosed conflict of interest. As a result, Dr. Wakefield’s medical license was revoked by the General Medical Council due to the severity of the findings. The Lancet retracted the paper, and its editor was fired.

The General Medical Council stated the following in its proceedings against Dr. Wakefield: "Accordingly, the Panel has determined that Dr. Wakefield’s name should be erased from the medical register. The Panel concluded that it is the only sanction appropriate to protect patients and is in the wider public interest, including maintaining public trust and confidence in the profession and is proportionate to the serious and wide-ranging findings made against him."



Currently, no credible medical study supports a link between the MMR vaccine, or any other vaccine, and the development of autism. In fact, numerous studies have conclusively proven that the MMR vaccine does not cause autism. Despite clear evidence, the myth persists.

The Centers for Disease Control and Prevention (CDC) states: "Current scientific evidence does not support the hypothesis that the measles-mumps-rubella (MMR) vaccine, or any combination of vaccines, causes the development of autism, including regressive forms of autism. The question about a possible link between the MMR vaccine and autism has been extensively reviewed by independent expert groups in the U.S., including the National Academy of Sciences, Institute of Medicine. These reviews have concluded that the available evidence does not support a causal link between the MMR vaccine and autism."

Bottom line: There is no evidence that vaccines cause autism. Specifically, there is no evidence that the MMR vaccine causes autism.

For more information on the MMR-autism myth, the Vaccine Education Center at CHOP.EDU is an excellent resource. They also offer a useful app for iPhone and Android called “Vaccines on the Go,” which provides accurate vaccine information, authored by Dr. Paul Offit, the Chief of Infectious Diseases at the Children’s Hospital of Philadelphia.