Contraindications and precautions associated with the MMR vaccine

Always check the general contraindications and precautions associated with vaccines containing live attenuated pathogens.

An MMR vaccine may not be administered to a person

  • who has had an immediate severe allergic reaction, or anaphylaxis, following a previous vaccine dose
  • who has had a verified anaphylactic reaction to neomycin or other excipient
  • whose immune defence is significantly weakened due to an illness or its treatment
  • who is pregnant.

The contraindications and precautions related to MMR vaccinations may also be temporary.

The decision to administer a vaccination should always be evaluated on an individual basis. The benefits of the vaccination should be weighed against its potential risks.

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Fever as a contraindication to an MMR vaccination

Do not administer an MMR vaccination to a recipient who has a fever or a febrile illness; in this case the vaccination should be postponed. 

While the vaccination will not make an infectious disease more severe, the infection may reduce the effectiveness of live vaccines, at least theoretically.

Previous convulsions or febrile convulsions are not a contraindication to vaccination. If the vaccine recipient tends to experience febrile convulsions, provide instructions for taking fever medications.

Suspected allergic reaction

Suspected or confirmed hypersensitivity to an ingredient of the MMR vaccine is not necessarily a contraindication to vaccination. 

The decision to administer the vaccination is made on a case-by-case basis. In most cases, the vaccine can be given under a physician’s supervision. 

If necessary, extend the monitoring time following the vaccination. Examples of MMR vaccinations to persons with allergies:

1. The patient has been diagnosed with immediate hypersensitivity to neomycin or had anaphylaxis symptoms following a previous MMR vaccination

  • Request an assessment by an allergy specialist
  • The MMR vaccine is administered at an outpatient clinic, and the recipient should be monitored for two hours.

2. The recipient has delayed hypersensitivity (type IV) to one of the vaccine ingredients

  • Contact dermatitis caused by neomycin does not increase the risk of anaphylaxis.
  • Administer the MMR vaccine normally.

3. The recipient has been diagnosed with an egg allergy

  • The MMR vaccine is produced in cultures of fibroblast from chick embryos. The quantity of chicken or egg proteins contained in it is so low that people who are allergic to eggs rarely get symptoms.
  • There is no need to expose the recipient to, or test them with egg.
  • The MMR vaccine can be administered normally.

Pregnancy and breastfeeding

The MMR vaccine may not be administered during pregnancy.

  • It is recommended that the recipient use contraception for three months following the administration of the vaccination.
  • An MMR vaccine accidentally administered during pregnancy is not grounds for termination.
  • The family members of and persons close to a pregnant woman can be vaccinated normally. Vaccine recipients cannot transmit the vaccine viruses to other people.

Breastfeeding is not a contraindication to vaccinating the mother or the child. The weakened rubella virus in the vaccine administered to a breastfeeding mother may be transmitted to the infant in breast milk. However, no symptoms of rubella have been found in these children.

Illness or medication that weakens the immune system

An MMR vaccination may not be administered to a person with severe immune deficiency as the vaccine contains live, attenuated pathogens. 

Mild or moderate immune deficiency is not always a contraindication to vaccination. The administration of an MMR vaccination should be considered individually. The expected benefits of the vaccination should be weighed against

  • the risk of contracting the disease, the risk of spreading the infection, infection pressure and the epidemic situation
  • hazardousness of the disease: secondary diseases and complications
  • vaccine effectiveness, which may be lower than in healthy recipients.

In addition to weighing the benefits, you should assess the risk of contracting the disease and secondary diseases caused by the attenuated vaccine virus compared to the risk posed by the naturally occurring virus.

The decision about the vaccination is also influenced by the type and degree of the recipient’s immune deficiency. In particular, the number of CD4 cells is decisive. 

The decision to vaccinate is made and the optimal time of administration is determined by the treating physician. For example, the administration of an MMR vaccination to an HIV positive person who is asymptomatic or has mild symptoms can be considered. The recipient’s immune defence may not be severely compromised.

Family members of a person with immune deficiency

  • If a person with severe immune deficiency cannot be vaccinated, ensure that any persons susceptible to the MMR diseases close to them are vaccinated.
  • The attenuated measles, mumps or rubella viruses in the vaccine have not been found to infect a family member with immune deficiency.

Immunoglobulin treatment or transfusion

An MMR vaccine may be administered to a person exposed to measles, mumps or rubella even if they have recently received gamma globulin or a blood transfusion. 

In other situations, the vaccination should be postponed

  • at least for 3 months after a blood transfusion
  • for 8 to 11 months after high-dose gamma globulin therapy (0.4-2 g/kg iv.)
  • for 7 months after receiving plasma and thrombocyte products.

While administering the vaccination during these periods will not be detrimental, immunoglobulins and blood products may reduce the effectiveness of live attenuated viral vaccines.

If necessary, administer a new vaccine dose to ensure adequate protection against the diseases.

Thrombocytopenia, or low platelet count

Reduced platelet count occurs in various viral diseases and as a secondary disease of measles and rubella. It is also a very rare adverse effect of the MMR vaccine.

  • If the recipient has previously had thrombocytopenia, the physician will assess whether the MMR vaccination should be administered.
  • In particular, the administration of a second dose of the MMR vaccine should be considered carefully if the recipient had thrombocytopenia within six weeks of the first vaccination.

However, this is not an absolute contraindication to further vaccinations. In most cases, the benefits of the protection afforded by the vaccination against measles and rubella are greater than the risk of thrombocytopenia reoccurrence. 

The risk of developing thrombocytopenia caused by naturally occurring rubella or measles pathogens is at least ten times as high as the risk of developing thrombocytopenia resulting from the MMR vaccine.