Measles, mumps, rubella, varicella (chickenpox) – immunization

Immunization is the best protection against measles, mumps, rubella and varicella (commonly known as chickenpox). Vaccines against these four diseases are usually given either as a combined MMRV vaccine, or as a combined MMR vaccine together with a separate chickenpox vaccine, depending on age.

In most immunization programs, full protection against measles, mumps and rubella requires two doses of vaccine. Chickenpox vaccine helps protect against the serious complications that the infection can cause, and also lowers the risk of developing shingles later in life.

How the vaccines protect#

Research shows that two doses of chickenpox vaccine give children stronger protection and reduce the risk of “breakthrough” chickenpox. Breakthrough chickenpox is when someone who has been vaccinated still catches the disease. When this happens in vaccinated children, the illness is usually much milder: fewer skin lesions, a lower fever and a quicker recovery.

Anyone with a history of past chickenpox infection is considered immune and does not need the vaccine.

Because young children, especially those under one year, are at risk of serious complications from measles, the first MMR dose is often given as a plain MMR vaccine rather than as MMRV. This is because giving MMRV as the very first dose to children under about four years of age carries a slightly higher risk of fever and febrile convulsions. A later dose that includes the varicella component then gives early protection against all four diseases.

It is safe for children with egg allergies to receive the MMR and MMRV vaccines.

Catch-up and special situations#

If you have not had the recommended doses, ask your doctor or immunization provider about catch-up vaccination. Catch-up doses are commonly offered to:

• Older children, teenagers and adults who were never fully immunized.
• Adults without documented evidence of two valid MMR doses, or without a blood test showing immunity to measles, mumps and rubella.
• Women planning a pregnancy, or after the birth of a child, who have low or no immunity to rubella.
• Infants travelling to areas where measles is circulating, who may be offered an early measles-containing dose. They will still need the routine doses later in childhood.

If two MMR doses are needed, they are generally given at least 28 days apart.

The MMRV combined vaccine is generally not recommended from about 14 years of age. From this age, people are usually given a separate MMR vaccine and a separate chickenpox vaccine.

MMR and MMRV are not recommended for everyone#

People with an impaired immune system should generally not receive these live vaccines. Possible causes of impaired immunity include:

• Very low antibody levels (such as hypogammaglobulinaemia).
• Some cancers, such as Hodgkin’s disease, leukaemia or multiple myeloma.
• HIV infection or AIDS.
• Treatment that suppresses immunity, including chemotherapy, radiotherapy or high-dose corticosteroids.

If you have an impaired immune system, speak with your doctor about what options might be available.

You should not be given the MMR or MMRV vaccine if you are already pregnant, and pregnancy should be avoided for 28 days after vaccination.

Before immunization#

Tell your immunization provider before vaccination if you (or your child):

• Are pregnant or intend to become pregnant.
• Are unwell, for example with a temperature over 38.5°C (101.3°F).
• Have had a serious reaction to any vaccine or to any vaccine component.
• Have had a severe allergic reaction to anything.
• Have had a “live” vaccine in the past month.
• Have recently had immunoglobulin or a blood transfusion.
• Have a condition, or are having treatment, that lowers immunity.

The MMR and MMRV vaccines are effective and safe, but like all medicines they can have unwanted side effects.

Common side effects#

Most side effects are mild and temporary, often appearing in the first few days, or sometimes 7 to 10 days after vaccination. They may include:

• Soreness, redness, itching, swelling or burning at the injection site for one to two days.
• Fever, which can occasionally rise above 39.4°C (102.9°F) and last two to three days.
• A faint red rash that is not infectious.
• A head cold, runny nose, cough or puffy eyes.
• Drowsiness or tiredness.
• Swelling of the salivary glands.
• The MMRV vaccine can cause a mild chickenpox-like rash 5 to 26 days after vaccination.

Specific treatment is not usually required. Do not overdress a child who has a fever. Routine use of paracetamol after vaccination is not recommended, but if fever is causing discomfort, paracetamol can be given — check the label for the correct dose, or ask your pharmacist, especially when giving it to children.

Sometimes a small, hard lump may persist at the injection site for some weeks or months. This is not a cause for concern and needs no treatment.

Uncommon and rare side effects#

• Temporary pain or stiffness in the joints. This is rare in young children but more common in teenagers and adult women.
• A temporary low platelet count (thrombocytopenia), which can cause bleeding or bruising. This may occur after the first MMR dose in roughly one in 20,000 to 30,000 vaccinations.
• Fever that triggers a seizure (febrile convulsion), occurring in about one in 3,000 young children vaccinated.
• Serious allergic reaction (anaphylaxis), which is very rare, occurring in fewer than one in a million vaccinations.

Because severe allergic reactions can happen, you are advised to stay at the clinic for at least 15 minutes after vaccination, in case treatment is needed.

If a side effect is unexpected, persistent or severe, or if you are worried about yourself or your child after a vaccination, see your doctor or immunization nurse as soon as possible, or go directly to a hospital. It is also important to seek advice if you or your child are unwell, as this may be due to another illness rather than the vaccine. Serious reactions can be reported to your local vaccine safety reporting service.

Deciding which immunizations you need#

The immunizations you may need depend on your health, age, lifestyle and occupation — together referred to as HALO. Talk to your doctor or immunization provider if you think you, or someone in your care, has health, age, lifestyle or occupation factors that could make immunization necessary.

Key points#

• Giving MMRV as the first dose to children under four years carries a higher risk of fever and febrile convulsions, so the first dose is often given as plain MMR.
• It is safe for children with egg allergies to receive the MMR and MMRV vaccines.
• Specific treatment is not usually required for side effects.
• The MMRV vaccine can cause a mild chickenpox-like rash 5 to 26 days after vaccination.
• Vaccines may cause soreness, redness, itching, swelling or burning at the injection site for one to two days.

Where to get help#