| Content updated on 21st June 2024 |
Rationale and Current situation with MMR vaccine coverage in Ireland
Measles is a highly infectious disease that can cause serious complications, particularly in children under the age of 12 months, pregnant women, and the immunosuppressed.
Measles cases are rising internationally and in Europe. Measles outbreaks have been reported in some European countries including the UK and Romania. Since 1st January 2024 to 19th June 2024, 58 measles cases have been reported by the HPSC in Ireland.
According to HPSC 2023 data, uptake rate for MMR1 and MMR2 is <90%, which is below the 95% recommended by WHO. Prior to 2023, MMR uptake was previously below 90% in 2008. In addition, approximately, 10% of children from each birth cohort may be missing one or two doses of MMR, based on HPSC uptake statistics from 2016-2021.
The aim of the MMR catch-up campaign is to improve population coverage with MMR vaccine and to prevent measles outbreaks, given the reduction in MMR uptake and concerns regarding the rising number of measles cases internationally.
Which population cohorts are targeted to catch-up with MMR as part of this catch-up campaign?
The priority age groups for catch-up vaccination are children and young adults under 25 years. However, the MMR vaccine may be administered to all ages where patients present for vaccination, as per the recommended groups in NIAC chapter 12. (Please see further information below.) Children should be age-appropriately vaccinated.
Both children resident in Ireland and Refugees and Applicants Seeking Protection in Ireland are included in the catch-up programme
Adults born in Ireland before 1978 are likely to have had measles infection and so do not routinely require vaccination.
The National Immunisation Advisory Committee advise adults in the following groups who are partially vaccinated, unvaccinated or unsure about their vaccination status should receive one or two doses of MMR vaccine as indicated by their vaccination history:
- All adults aged under 25 years of age, a recent seroprevalence study showed those born 1998-2004 had the highest seronegativity for measles.
- Adults considered at high risk of exposure to measles (e.g., those living in congregate settings or members of underserved communities).
- Adults living with people who are vulnerable to severe consequences of measles infection. (e.g., non-immune pregnant women, severely immunocompromised people, and infants under one year of age).
- Migrants from low resource settings (migrants from low resource settings are less likely to have been vaccinated with MMR and should be offered two doses of MMR vaccine unless documented evidence of vaccination).
- Adults of all ages who are planning to travel to an area where measles is endemic or where outbreaks are occurring.
It is estimated that at least 90% of people born in Ireland before 1978 are likely to have had measles infection and are thus immune to measles.
Where there is uncertainty about measles status, the MMR vaccine should be offered on request to individuals born in Ireland before 1978 particularly if they are considered at high risk of exposure or disease as outlined in b) and c) above.
What is the routine childhood dosing schedule?
All children at 12 months of age should receive an MMR vaccine, with a second dose at 4-5 years of age. Over 99% of those who receive two doses of measles vaccine ≥12 months of age and ≥4 weeks apart will develop measles immunity which is lifelong in most people. Full immunisation requires two doses of MMR vaccine, over the age of 12 months, with an interval of at least 28 days between doses.
Should a child be vaccinated earlier then the routine dosing schedule?
There is no requirement to routinely vaccinate children earlier than the usual vaccination schedule of MMR1 at 12 months and MMR2 in Junior Infants, unless specifically advised by public health as part of an outbreak response.
Please see additional advice below regarding vaccinating infant’s age 6 months to less than 12 months old who are travelling to another country.
What is the recommendation for vaccinating infant’s age 6 months to less than 12 months old who are travelling to another country?
Infants aged six months to less than 12 months of age should receive one dose of MMR vaccine when travelling to areas where measles is endemic or where outbreaks are occurring. As measles is circulating widely globally, the HSE, on the advice of public health, has implemented this recommendation to apply for all travel abroad.
The MMR vaccine should ideally be given two or more weeks prior to travel.
A dose given at less than 12 months of age does not replace the dose recommended at 12 months of age.
If a dose of MMR vaccine is given before the first birthday, either because of travel to an endemic country or because of a local outbreak, two further doses should be given at 12 months of age or older (at least four weeks after the first dose) and at 4 to 5 years of age.
Infants aged less than 6 months cannot receive the MMR vaccine but they should have some protection from maternal antibodies.
Should the 2nd MMR vaccine dose be given earlier?
No, there is no recommendation to get a second MMR early. Children should get the 2nd MMR vaccine in junior infants in school. If they are living in Sligo, Leitrim or Donegal, they should get the vaccine at age 4-5 years from their GP. One dose of MMR vaccine gives 95% protection from measles. A second MMR vaccine is given to increase the protection from measles to 99%. It is also given to give long-lasting protection from mumps and rubella.
Is there an upper age limit for the MMR vaccine?
No, there is no upper age limit for MMR vaccine.
Which MMR vaccines are available and are they interchangeable?
Two MMR vaccines are available in Ireland. They are M-M-RVaxpro (Sanofi Pastuer) and Priorix (GlaxoSmithKline). These vaccines are interchangeable i.e. if an individual has been vaccinated with one product in the past they can be either vaccinated with that MMR vaccine again or with a different brand.
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Case Scenarios
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A child who has never been immunised with MMR
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Unimmunised children in a class above junior infants, should receive two doses of MMR vaccine, with an interval of at least 28 days between doses.
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A child who missed one dose of either MMR1 or MMR 2
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Children who have received one dose of MMR vaccine, can receive a second dose at any interval after at least 28 days.
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Parents who are unsure if their child has received the MMR vaccine
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If parents have their own record showing that their child got 2 doses of MMR vaccine then no additional doses of MMR vaccine are required.
If parents are unsure about whether their child got 2 doses of MMR or not then they should be advised to receive MMR catch-up vaccination.
The NIAC Immunisation Guidelines for Ireland advise, if someone does not have a documented or reliable verbal history of immunisation they should be assumed to be unimmunised. See NIAC Immunisation guidelines chapter 2 here. Adverse events are much less common after the 2nd dose of MMR vaccine than after the 1st dose.
A US study showed that the proportion of adverse events, after the administration of a third dose of MMR, were lower than or within the range of adverse events reported in prior studies of first and second dose MMR. Therefore, if an individual has already had two doses of MMR and a third dose is inadvertently administered, it will likely not cause any increase in side‐effects. Parents can be advised to check their child’s immunisation records at their local health office if they wish. Contact details for local health offices can be found here.
In areas where it is not possible to review electronic records students should be offered a catch‐up dose of MMR vaccine if the students (or parents) are unsure if they have received the recommended 2 doses of MMR vaccine.
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A parent who requests serology for their child
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Serology is not recommended after the MMR vaccine as serology may not be accurate after vaccination.
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A child who is not yet in Junior Infants
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MMR2 is offered to all children who are in Junior Infants. If a child is too young for junior infants, they should receive one MMR, if they have never received an MMR before over the age of 1 year. They will be offered their second MMR in Junior Infants.
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A child who received a dose of MMR under the age of one year old
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A dose of MMR given at less than 12 months of age does not replace the dose recommended at 12 months of age.
If a dose of MMR vaccine is given before the first birthday, either because of travel or because of a local outbreak, two further doses should be given at 12 months of age or older (at least four weeks after the first dose) and at 4 to 5 years of age.
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If there is an outbreak of measles what happens?
Advice on MMR vaccination in an outbreak setting will be provided by the regional Public Health Department– the below NIAC advice is included here for information purposes.
Outbreaks of measles may be controlled by immunising susceptible individuals within 72 hours of contact of a case of measles as vaccine - induced immunity develops more rapidly than that following infection. Susceptible persons aged ≥6 months should be given MMR vaccine within 72 hours of contact with a case.
However, maternal antibodies may compromise the response to the vaccine. Therefore, infants vaccinated before their first birthday should have a repeat vaccination at 12 months of age, at least four weeks after the first vaccine, with a further dose in junior infants or at 4-5 years of age.
When protection is urgently required for those aged 12 months and older, a second dose of MMR vaccine can be given as early as four weeks after the first dose. This is a valid dose and no further doses are required if both doses were given after 12 months of age.
For further information about MMR vaccination in an outbreak setting, please see chapter 12 NIAC Immunisation guidelines.
What is acceptable presumptive evidence of immunity against measles for healthcare workers (HCWs)?
At least one of the following is acceptable
- written documentation of vaccination with two doses of MMR vaccine at least four weeks apart
Or
- serological evidence of measles immunity (i.e., detectable measles specific IgG from an INAB accredited laboratory)
Or
- birth in Ireland before 1978. Most adults born in Ireland before 1978 are likely to have had measles infection. MMR vaccine should be offered to such individuals on request if they are considered at high risk of exposure.
HCWs born since 1978 without evidence of two doses of MMR vaccine or measles immunity should be offered one or two doses of MMR vaccine as required at least four weeks apart so that two doses are received.
Are there any reasons why MMR should not be given?
The National immunisation Advisory Committee (NIAC) has stated the following contraindications and precautions to MMR vaccination.
Contraindications
- Anaphylaxis following a previous dose of MMR or any of the vaccine constituents e.g. gelatin or neomycin.
- Significant immunocompromised. (see NIAC Immunisation Guidelines for Ireland Chapter 3 here).
- Infants of mothers who took infliximab or other TNFα blocking agents throughout the second or third trimester.
- Pregnancy. There is no evidence of congenital rubella syndrome or increase in other teratogenic effects in women inadvertently given rubella vaccine before or during early pregnancy, but pregnancy remains a contraindication.
- Pregnancy should be avoided for 1 month after MMR.
The following are NOT contraindications to MMR vaccine
- Breastfeeding.
- Immunodeficiency in a family member or household contact is not a contraindication to MMR vaccination.
- Allergy to egg including anaphylaxis following egg. MMR vaccines do not contain significant amounts of egg cross-reacting proteins and recent data suggest that anaphylaxis following MMR is not associated with hypersensitivity to egg antigens but to other vaccine components (gelatin or neomycin).
- People living with HIV who are not severely immunocompromised (see Chapter 3).
- Personal or family history of convulsions.
- Close contacts of immunosuppressed individuals should be fully immunised with MMR, as there is no evidence of harm from the transmission of measles, mumps and rubella viruses from recent vaccinees.
- Uncertainty as to whether a person has had two previous MMR vaccines.
- Use of topical tacrolimus does not affect the immunogenicity of the MMR vaccine
- Priorix contains 334 micrograms of phenylalanine per 0.5ml dose. Though phenylalanine may be harmful to individuals with phenylketonuria (PKU) the amount of phenylalanine contained in Priorix is negligible and vaccination with Priorix is advised in individuals with PKU
- Recent injection of anti-RhD immunoglobulin.
- Hereditary fructose intolerance.
Precautions
- Acute severe febrile illness, defer until recovery.
- Injection with another live vaccine within the previous four weeks. Two live vaccines can be administered on the same day without causing interference e.g., MMR and Varicella (exception is yellow fever vaccine).
- Family history of primary immunodeficiency (e.g., severe combined immunodeficiency syndrome (SCID)) defer vaccination until immune status is determined.
- Recent administration of blood, blood products, HNIG or specific immunoglobulin could prevent vaccine virus replication. MMR should be deferred for specific intervals depending on product received as outlined in Chapter 2 Table 2.6.5.
- Tuberculin skin testing should be deferred for at least four weeks after MMR vaccine as the vaccine can reduce the tuberculin response and could give a false negative result.
- Patients who developed thrombocytopaenia within six weeks of their first dose of MMR should undergo serological testing to decide whether a second dose is necessary. The second dose is recommended if the patient is not fully immune to the three component viruses
For more information on contraindications and precautions to MMR vaccination, please see NIAC Chapter 12 Measles.
Can MMR vaccine be given at the same time as other vaccines?
MMR is a live vaccine and can be given at the same time as other live vaccines or if not at the same time there should be a four week interval between the two live vaccines.
MMR, varicella and zoster vaccine can be given on the same day or ≥4 weeks apart. This does not apply to LAIV nasal spray vaccine, where no interval is required between this and the MMR vaccine.
MMR vaccine may be given at the same time or at any interval before or after any non-live vaccines. MMR can be given at the same time or at any interval as inactivated vaccines such as HPV (Human Papillomavirus) or Tdap (low dose tetanus, diphtheria and acellular) vaccines.
What are the adverse reactions to the MMR vaccine?
- Although adverse reactions following immunisation are most commonly reported at the time of vaccination, these are typically transient and of short duration. Local reactions, which are very common (i.e., occurring in >1/10), include erythema at the injection site. Local reactions which are common (i.e., occurring in >1/100 and <1/10), include rhinitis and rash.
- A febrile convulsion occurs rarely in <1 in 1,000 children.
- Mini-measles” may occur 6-10 days after immunisation and consists of mild pyrexia and an erythematous rash.
- ‘Mini-mumps’ with salivary gland swelling may rarely occur during the third week after immunisation.
- The rubella component may occasionally produce a rash, mild arthralgia, and lymph-node swelling 2-4 weeks post-vaccination, particularly in post- pubertal females (up to 25% of recipients). The incidence is lower than after natural disease.
- Very rarely, erythema multiforme, thrombocytopoenia and nerve deafness have been reported.
- There is no evidence of congenital rubella syndrome or increase in other teratogenic effects in women inadvertently given MMR vaccine. However, pregnancy remains a contraindication to its administration.
Of note, the MMR vaccine does not shed, therefore there is no risk of spreading measles infection after vaccination. There have been no reports of vaccinated people passing infection to contacts.
How is an adverse event reported?
Adverse events should be reported to HPRA. Reports should be as detailed as possible and include the batch number of the vaccine.
Is there any link with the MMR vaccine and autism?
Scientific evidence confirms that there is no causal relationship between the MMR vaccine and autism or inflammatory bowel disease.
Discussing the MMR vaccine with parents who are worried about a link to autism
We know that vaccines do not cause autism. However, when things happen around the time vaccines are given, we can think that there is a link between the two things. For example, the signs of autism usually become noticeable at about the age when children are given the MMR vaccine, but one does not cause the other.
Over the past 30 years, more than 500 million doses of MMR vaccine have been given in over 90 countries. Experts from around the world, including the World Health Organization, agree that there is no link between the MMR vaccine and autism or inflammatory bowel disease.
See studies below
- A 2019 study of over 650,000 children born in Denmark found no increased risk for autism after the MMR vaccine. (Hviid et al., 2019 )
- In 2014, a group of researchers in Australia reviewed studies involving over 1 million children. They found no evidence of a link between the MMR vaccine and autism in children. (Taylor et al., 2014).
- Scientists in the UK and in Denmark investigating the MMR and autism found that there were no differences in the number of children with autism between those who had received the MMR and those that were unvaccinated. (Farrington et al., 2001 ; Madsen and Vestergaard, 2004 ).
- Scientist and doctors in the UK in 1999 and Denmark in 2002 found that there was no link between MMR vaccine and autism. (Taylor et al., 1999 ; Mäkelä et al., 2002 ).
How do I contact the National Immunisation office if I have a clinical query?
Clinical queries can be sent to the National Immunisation Office at our email address.
How can vaccines be ordered?
Vaccines can be ordered now through the national cold chain service. Ordering queries can be sent to the national cold chain service email address.
Where can I get further information and resources?
This page was updated on 21 June 2024
