The MMR Vaccine

by Lori Klongtruatroke Reisa Mohamed Andrew Reiter Marlylee Scudero Elaine Snyder

What is the MMR Vaccine?

The MMR, which is comprised of a 3 in 1 vaccine, is one of the recommended childhood immunizations. It protects children against three highly contagious viruses which are as follows: Measles, Mumps and Rubella (German Measles).

What is Measles?

Measles is a virus that causes a rash, cough, runny nose, eye irritation, and fever in most people. It may sometimes in rare cases lead to pneumonia, seizures, brain damage, and death.

What is Mumps?

Mumps, another viral childhood disease, causes fever, headache and inflammation of the glands under the jaw. It also cause deafness, meningitis, swollen testicles or ovaries, and death in some cases. If a male who is past puberty acquires mumps, he may have a rare case of bilateral orchitis (inflammation of one or both testes), which may lead to sterility if not treated.

What is Rubella?

Rubella or German measles consists of a pinkish red rash that starts on the face, with mild fever and swollen lymph nodes. Sometimes rubella may have no symptoms. It is a mild illness that runs its course in three days, but it is can be fatal for a fetus if a pregnant woman contracts it. The woman may have a miscarriage, or the baby she is carrying may have birth defects, including deafness, eye problems, heart defects and mental retardation. So as healthcare workers, we are to advise new mothers who get the rubella vaccine to take a contraceptive and avoid pregnancy for two to three months afterwards.

The war on infection

Thousand year war : Humans vs. Microbes (bacteria and Viruses)

People have used antibiotics to combat bacterial infections for almost a hundred years, Most bacteria is susceptible to this method of disease management. The successful use of antibiotics has saved lives. Though with the invention of ABX, people would still get sick before they could develop antibodies fast enough to defend themselves from pathogens, and not all pathogens (viruses) are effected by ABX.

Vaccines are now used for their benefits in prevention of some stubborn bacterial infections and for prevention against serious life threatening viral infection.

What is a Vaccine?
A Vaccine is an antigen introduced to a none infected host for the purpose of creating antibodies.

The First Vaccine (Smallpox) was created by Edward Jenner by method of taking a weaker form of a virus and injecting it into a none infected child, who then developed immunity to the stronger form of the same virus.

Today many viruses are used under the same theory as Jenner.

(vaccine, 2003)
Pict: http://www.1st-art-gallery.com/thumbnail/223903/1/Edward-Jenner-1749-1823-Performing-The-First-Vaccination-Against-Smallpox-In-1796-1879.jpg)

What is MMRV

MMR is a three part combine vaccination for measles, mumps and rubella.

Until 1971 the MMR was given as three separate vaccines. Before 1960 a vaccination for measles, mumps or rubella did not exist. Currently 2010 manufactures are Merk as M-M-R II GlaxoKlienSmith as Priorix Serum Institute of India as Tresivac Sanofi Pasture as Trimovax
MMR contains 1,000 TCID50 (tissue culture infectious doses) of measles virus; 12,500 TCID50 of mumps virus; and 1,000 TCID50 of rubella virus. sorbitol (14.5 mg), sodium phosphate, sucrose (1.9 mg), sodium chloride, hydrolyzed gelatin (14.5 mg), recombinant human albumin ( 0.3 mg), fetal bovine serum ( < 1 ppm) 25 mcg of neomyci (atenuvax,2010)
Image: http://a.abcnews.com/images/WN/apg_vaccine_080903_mn.jpg

Atenuvax for Measles

Measles vaccine is attenuated meaning it is weakened but still a living virus. This is done by Cell culture adaption Naturally the measles virus grows in the cells of tissue that lines the back off the throat, lungs, heart and skin. This allows for a strong virus that may be easily transmitted from host to host. (chop, 2010) Antigens grown by means of cell adaption Virulence is down graded from 1000x replication to 20x - 20 replications gives the body enough exposure to make antibodies for a life times worth of protection. (chop, 2010) In 1962 Four million people were diagnosed with measles resulting in three thousand deaths. Between 1953 and 1964 the measles averaged 450 mortalities a year. (CDC,2010)

Mumpsvax for mumps

AKA Jeryl Lynn Strain (B level)

Mumps is also an attenuated antigen by cell culture adaption. The Mumps Virus naturally replicates rapidly in the salivary glands, and the cells that line the upper respiratory system. this is why the pathogen produces the chipmunk like appearance in those infected. The mumps vaccine was developed by head Merk research Dr. Maurice Hilleman, whom took a culture sample from his infected daughter Jeryl Lynn and then replicated the virus, their by creating an attenuated antigen.(chop, 2010) 1964 - 212,000 mumps cases were reported causing deafness in 1:1000 infected. 1967 mumps vaccine was licensed (cdc, 2007)

Dr. Maurice Hilleman

Life magazine life.com

Meruvax II for Rubella

Meruvax II for Rubella is also attenuated by process of cell cultured Adaption The rubella virus replicates naturally at full strength in the human epithelial cells that line the back of the throat, and easily spread with a cough from one host to the next.

Rubella was 1st taken at full strength live viruses from and then replicated in a Medium that consists of human embryonic fibroblast cells. This process was first used in England circa 1960. (chop, 2010)
The rubella vaccine is week enough that an estimated 1000 first term pregnant woman were mistakenly injected with vaccine and there were no reported birth defects in full term babies vs. of 1000 woman who acquired the virus and were not vaccinated, 847 cases reported birth defects.

Rubella continued
1964 65 rubella epidemic resulted in 20,000 infants born with (CRS) on genital rubella syndrome.

In as a result there were - 2,100 neonatal deaths - 11,250 miscarriages - 3,580 blind - 1,800 mentally retarded
2000 only 6 reported cases of CRS (cdc, 2010)

When Can the MMR Vaccine Be Given?

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The first MMR immunization will protect most from contracting measles, mumps, or rubella throughout their lives. The second MMR dose is a booster dose which reexposes the patient to the immunizing antigen. Also recommended to cover those individuals who may not have received adequate protection from their first MMR.

When Can the MMR Vaccine Be Given?

MMR Vaccine administered to children around the age of one year. A second MMR is recommended before entering school at 4 6. May be given at an time after 28 days pass the first dose.

MMR Vaccine Side Effects Per the Center for Disease Control

Mild problems Fever Mild rash Swelling of glands in the cheeks or neck Moderate Problems Seizure (Jerking or Staring) caused by fever Temporary pain and stiffness in the joints Temporary low platelet count, which can cause a bleeding disorder Severe Problems (Very Rare) Serious allergic reaction Deafness Long-term seizures, coma, or lowered consciousness Permanent brain damage

Treatment of CDC Side Effects

You can treat the fever with the correct dose of infant acetaminophen or ibuprofen, by keeping the toddler cool and by offering lots to drink to keep hydrated.

Soak a washcloth in ice cold water and pat the parts of the body where the rash has covered. More than likely it will be on the face, arms and stomach area. Do not rub the washcloth on the rash, this will only irritate the condition more.

What if there is a moderate or severe reaction?

Call the doctor, or get the person to the doctor right away Tell your doctor what happened, the date the time it happened, and when the vaccine was given. Ask the provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form.

Contraindications

History of anaphylactic reaction to neomycin Hypersensitivity to gelatin or any other component of the vaccine Primary or acquired immunodeficiency states Family history of congenital or hereditary immunodeficiency Immunosuppressive therapy Active untreated tuberculosis or febrile illness Pregnancy Allergy to eggs

MMR & Autism

Thimerosal has often been connected with autism by some parents and scientists. Thimerosal contains ethyl mercury which is a preservative that prevents bacterial growth. It has been used since the 1930s. Article in NY Times on March 8, 2010 says that 1 in 4 parents links autism to vaccines. 9 out of 10 parents agreed that vaccines were important. And 1 in 8 has refused at least one vaccine. Institute for Vaccine Safety reports that both the MMRII & the MMRV no longer contain Thimerosal.

MMR Vaccine Options for Prevention of Side Effects Linked to Autism

Hold off on giving the vaccine until it can be enforced by school (age 4-6). Most states do not require a booster when the vaccine is given at age 4 or older. The vaccine works better when given to older children. (A titer should be run when the child is 10 to ensure full immunity). Give the MMR as 3 separate shots spread out over several months to several years. Parents may choose not to give the vaccine at all. States have different laws regarding immunizations. Minnesota allows for Medical Exemption & Conscientious Objection.

References

Immunization laws:: Minnesota department of health. (2007, April 20). Retrieved from http://www.health.state.mn.us/divs/idepc/immunize/laws/index.html Dr. B. Sears, Initials. (2009, October 30). Ask dr. sears:: the vaccine book. Retrieved from http://www.askdrsears.com/thevaccinebook/ Medlineplus health information. (n.d.). Retrieved from http://medlineplus.gov/ "Vaccine." World of Microbiology and Immunology. 2003. Retrieved March 08, 2010 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G23409800570.html

(Chop) childrens hospital of philidelphia A Look at Each Vaccine: MMR (Measles, Mumps and Rubella) Vaccine. Vaccine education center, Children's Hospital of Philadelphia. 2010. Retrieved March 7, 2010 from chop.edu: http://www.chop.edu/service/vaccine-education-center/a-look-at-eachvaccine/mmr-measles-mumps-and-rubella-vaccine.html
CDC What Would Happen If We Stopped Vaccinations? June 12, 2007. Retrieved March 7, 2010 from CDC.gov: http://www.cdc.gov/vaccines/vacgen/whatifstop.htm Atenuvax Proposed Prescribing Information injection-subcutaneous. 1990. Retrieved march 6, 2010 from PDF: https://www.merck.com/product/usa/pi.../a/attenuvax/attenuvax_pi.pdf
Rabin, R. (2010, March 8). Vital signs - one in four parents links autism to vaccines, study finds - nytimes.com. Retrieved from http://www.nytimes.com/2010/03/09/health/research/09child.html

References Continued

"Institute for Vaccine Safety - Thimerosal Table." Institute for Vaccine Safety. N.p., 23 Feb 2010. Web. 9 Mar 2010. <http://www.vaccinesafety.edu/thi-table.htm>.