| Content updated on 8th March 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 already this year in Europe there have been more cases of measles reported than in the whole of 2022. In August 2023 the HPSC reported a small number of cases of measles in Ireland, the first outbreak since 2019.
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.
We have had a case(s) of measles in Ireland and there are outbreaks in Europe. 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.
Should a 3rd dose of MMR vaccine be offered?
No, 3 doses of MMR vaccine are not recommended. The advice is people should be age appropriately vaccinated. Dose 1 is recommended at 12 months of age. Dose 2 is recommended when children are in Junior Infants.
What is the dosing schedule?
Full immunisation requires two doses of MMR vaccine, with an interval of at least 28 days between doses.
Which MMR vaccines are available and are they interchangeable?
Two MMR vaccines are available in Ireland. They are MMRvaxpro (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.
| Case Scenarios |
| A child who has never been immunised with MMR |
Unimmunised children, should receive two doses of MMR vaccine, with an interval of at least 28 days between doses. |
| A child who missed one dose of either MMR1 or MMR 2 |
Children who have received one dose of MMR vaccine, can receive a second dose at any interval after at least 28 days. |
| Parents who are unsure if their child has received the MMR vaccine |
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 |
Serology is not recommended after the MMR vaccine as serology may not be accurate after vaccination. |
| A child who is not yet in Junior Infants |
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 |
MMR vaccine may be given before the age of one year, for example before travelling to an area where there is an active measles outbreak. However, doses of MMR given before the age of 1 year old should be discounted and so MMR should be offered again after the age of one year.
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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.
Breastfeeding is not a contraindication to MMR vaccination.
Immunodeficiency in a family member or household contact is not a contraindication to MMR vaccination.
Precautions
- Acute severe febrile illness, defer until recovery.
- Injection with another live vaccine within the previous 4 weeks.
- Recent administration of blood or blood products.
Where possible, MMR should be deferred for 6 months after packed red‐cell transfusion, whole blood transfusion and Human Normal Immunoglobulin (HNIG), and deferred for 11 months after high‐dose immunoglobulin (as for Kawasaki Disease). Please see NIAC Immunisation Guidelines for Ireland Chapter 2 Tables 2.5 and 2.6 here).
If the MMR vaccine is administered within these timeframes, a further 1 or 2 doses as required should be given.
- Patients who developed thrombocytopoenia within 6 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 3 component viruses.
For more information on contraindications and precautions to MMR vaccination, please see NIAC Chapter 12 Measles.
Is egg allergy a contraindication to MMR vaccine?
Egg allergy is not a contraindication to MMR vaccine. Currently‐used measles and mumps vaccines do not contain significant amounts of egg cross‐reacting proteins and recent data suggest that anaphylaxis following MMR vaccine is associated with other vaccine components (e.g. gelatin or neomycin).
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.
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 don’t 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.
Studies to see if children who have been immunised are more likely to have these conditions have shown that there is no link between the conditions and vaccines. Extensive research into the MMR vaccine, involving thousands of children, was carried out in the UK, the USA, Denmark and Finland. This research showed that there is no link between MMR and autism. A study looked at the vaccination records of every child born in Denmark from 1991 to 1998 (over half a million children). During that time, 82% of children born in Denmark received the MMR vaccine. The researchers found that the risk of autism was the same in immunised children and in children who had not been immunised.
Dr Andrew Wakefield, a British gastroenterologist and 12 colleagues, published a case series in the Lancet in 1998, claiming the MMR vaccine may predispose to autism in children. The study was an uncontrolled design, had a small sample size (n=12) and its conclusions were of a speculative nature. Despite these shortcomings, the paper received wide publicity, and MMR vaccination rates began to drop because parents were concerned about the risk of autism after vaccination.
The General Medical Council in the UK in May 2010 decided that Dr Andrew Wakefield should be removed from the medical register after finding him guilty of serious professional misconduct and unethical behaviour in relation to research he carried out on children. Dr Wakefield used the results of this research to falsely represent a link between the MMR vaccine and autism. Subsequent studies have found no link between the MMR vaccine and autism.
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 8 March 2024
