MMR Vaccine Patient Information Print Page
Bottom Line
Live vaccines are contraindicated in patients who are taking any immunomodulating or immunosuppressant medication. Speak with your rheumatologist to make the best plan for you.
Why is there so much in the news about measles lately?
- Two doses of the MMR vaccine are almost 100% effective in preventing measles (in a person not on immune active medication).
- Because of how infective measles is more than 95% of the population needs to be vaccinated to produce ‘community immunity’ where the risk of infection is very small.
- However the number of people receiving the MMR vaccination has been decreasing in Canada over the past number of years. This means that individuals exposed to the measles vaccines are at risk of infection and with more virus circulating in the community more people will be infected.
- This is particularly important for people who have autoimmune conditions or are taking immune-active medications as they are already at higher risk for infections.
Is the MMR (measles, mumps, rubella) vaccine recommended for me?
| Born before 1970 | Whether or not recall prior infection (e.g. as a child) | No need for MMR vaccination unless:
|
| Born in or after 1970 | No prior MMR doses | 2 doses recommended |
| Received 1 MMR dose (at any time) | Recommend blood test to determine if immune
|
|
| Received 2 MMR doses (at any time) | No need for further doses |
*Blood test = measles IgG serology (reported qualitatively as non-reactive=not immune indeterminate or reactive=immune)
How is the vaccine administered?
The vaccine is administered as an intramuscular injection in the upper arm
How does the vaccine work?
The vaccine works to trigger your body to make antibodies that help you fight the real virus if you are ever infected.
- First dose(s): If you have never received an MMR vaccine before this will be the first time your body is exposed to these viruses.
- Booster dose: For most the MMR vaccine will be a ‘booster’ meaning you have previously been vaccinated or (likely) had a prior infection.
How effective is the vaccine?
- Two doses of the MMR vaccine are almost 100% effective in preventing measles (in a person not on immune active medication). In clinical studies a single MMR vaccine produced a response (antibodies to the measles virus) in 95% of unvaccinated people with 2 doses producing an antibody response in 99% of people.
- Even though the vaccine response may not be as strong or last as long in people on immunomodulating therapies there is still a benefit. Getting vaccinated is the best way to reduce the risk of measles infection.
What are the possible side effects of the vaccine?
- The most common side effect is pain at the site of injection.
- About 1 in 20 people will experience body chills/feeling feverish muscle or joint aches and/or feeling tired with or without a rash about 1-3 weeks after immunization. These symptoms may last for a few days and indicate that the immune system is responding. Side effects are less after the second dose of the vaccine.
- Acetaminophen (Tylenol®) or ibuprofen (Advil®) or naproxen (Aleve®) may be used to manage any side effects experienced.
- As with all vaccines there’s a chance of rare but serious side effects such as allergic reactions.
Is the MMR vaccine safe for patients with rheumatic diseases?
- The MMR vaccine is a live vaccine and thus administration is contraindicated in patients taking immunosuppressive medications (including methotrexate ≤25mg/week and leflunomide).
- Live vaccines are ideally administered ≥4 weeks before DMARD initiation.
- A period of ≥3 months would ideally elapse between therapy cessation and live vaccine administration[1], however the MMR vaccine may be considered safe[2]:
- ≥4 weeks after stopping csDMARD (SSZ/HCQ not considered to be immunosuppressive)
- ≥1 week after stopping tsDMARD
- ≥1 dosing interval for bDMARD and IV cyclophosphamide therapies
- To ensure minimal immunosuppression (reduce risk of infection) and optimal vaccine response: recommend waiting >3 half-lives after stopping biologics to give live vaccines.[2] To ensure safety, guidelines recommend waiting ≥6mo after the last dose of RTX and with confirmation of adequate immune reconstitution.
| Therapy | Mean Half-life (d) | 3 Half-lives (d) | 5 Half-lives (d) |
|---|---|---|---|
| Adalimumab | 14 | 42 | 70 |
| Certolizumab | 14 | 42 | 70 |
| Etanercept | 4.3 | 13 | 22 |
| Golimumab | 12 | 36 | 60 |
| Infliximab | 8-10 | 24-30 | 40-50 |
| Abatacept | 13 | 39 | 65 |
| Rituximab | 21 | 63 | 105 |
| Sarilumab | 8-10 | 24-30 | 40-50 |
| Tocilizumab | 13 | 39 | 65 |
[1] National Advisory Council on Immunization. Measles vaccine.
[2] American College of Rheumatology 2022 Guidelines for Vaccinations in Patients with Rheumatic and Musculoskeletal diseases
- Live vaccines can be given immediately following discontinuation of high-dose steroid therapy if the duration was <14 days and for low-to-moderate doses of steroid (prednisone equivalent of ≤20mg/day)[1].
- If high-dose steroid therapy is used >2 weeks: recommend waiting ≥1 month following discontinuation.
- DMARD/high-dose steroid therapy should not be restarted for at least 4 weeks post-completion of the vaccine series[1]