Measles-Mumps-Rubella-Varicella (MMRV) Vaccine
Immunization is one of the most effective ways to protect yourself and your family against vaccine preventable diseases.
What is measles?
Measles is a highly contagious viral infection that is spread through the air from person to person.
Measles lives in the nose and throat mucus of an infected person. It can spread to others through coughing and sneezing. Also, measles virus can remain for up to two hours on a surface or in an airspace where the infected person coughed or sneezed. If other people breathe the contaminated air or touch the infected surface, then touch their eyes, noses, or mouths, they can become infected.
Symptoms of measles begin seven to 21 days, usually 10 to 14 days, after exposure to a case of measles and include fever, runny nose, cough, drowsiness, irritability and red eyes. Small white spots (known as "Koplik's spots") can appear on the inside of the mouth and throat, but are not always present. Then, three to seven days after the start of the symptoms, a red blotchy rash appears on the face and then progresses down the body. Measles is contagious one day before fever develops and usually 4 days before the rash appears. Measles remains contagious until four days after the appearance of the rash.
Most people fully recover from measles within two to three weeks. But measles can cause complications in up to 25 per cent of people, such as pneumonia, ear infections, diarrhea, hearing loss, encephalitis (brain swelling), seizures, or, rarely, even death. Measles can be especially dangerous for infants, those with weakened immune systems and pregnant women.
What is mumps?
Mumps is a contagious disease that is caused by the mumps virus. Mumps is spread by droplets of saliva or mucus from the mouth, nose, or throat of an infected person, usually when the person coughs or sneezes. Items used by an infected person, such as cups or utensils can also be contaminated with the virus, which may spread to others if those items are shared. In addition, the virus may spread when someone with mumps touches items or surfaces without washing their hands and someone else then touches the same surface and rubs their mouth or nose.
Symptoms typically appear 16 to 18 days after infection, but this period can range from 12 to 25 days after infection. Mumps is best known for the swelling of the cheeks and jaw that it causes, which is a result of parotitis (inflammation of the salivary glands). Mumps also causes fever and headache. Mumps can be contagious from seven days before and up to five days after the salivary glands begin to swell. Up to half of people who get mumps have very mild or no symptoms, and therefore do not know they were infected with mumps.
People who show symptoms usually recover after a week or two, but mumps can occasionally cause serious complications. The most common complication is orchitis (swelling of the testicles) in males who have reached puberty; rarely does this lead to fertility problems. Other rare complications include encephalitis (swelling of the brain) and/or meningitis (swelling of the tissue covering the brain and spinal cord) and oophoritis (swelling of the ovaries) in females who have reached puberty and deafness. Mumps infection during the first trimester of pregnancy may increase the risk of a miscarriage.
What is rubella?
Rubella is a contagious disease caused by a virus. Rubella is spread by contact with an infected person, through coughing and sneezing.
Symptoms typically appear about 14 to 21 days after being exposed to someone who was contagious.
The infection is usually mild with fever, rash, headache, malaise, mild runny nose (coryza) and red eyes (conjunctivitis). The rash usually starts on the face and spreads to the rest of the body. These symptoms last approximately three days. Rubella is contagious one week before and at least four days after the appearance of the rash. About half of the people who get rubella do not have symptoms.
Complications are not common, but they occur more often in adults. Aching joints occur in many cases, especially among young women. In rare cases, rubella can cause serious problems, including encephalitis (swelling of the brain). Rubella is most dangerous for a pregnant woman's unborn baby. Infection during pregnancy can cause miscarriage, or birth defects like deafness, blindness, intellectual disability, and heart defects.
What is varicella (chickenpox)?
Chickenpox is a contagious disease caused by a virus. Chickenpox spreads very easily from person to person. It is passed from an infected person to others through coughing or sneezing. A person can also get chickenpox after touching a blister or the liquid from a blister.
Symptoms typically appear 10 to 21 days after infection, usually 14 to 16 days after infection. The classic symptom of chickenpox is a rash that turns into itchy, fluid-filled blisters that eventually turn into scabs. The rash may first show up on the face, chest, and back then spread to the rest of the body. In children, the first sign of disease is often rash, while in adults, mild fever and malaise may occur one to two days before the rash. Some people who have been immunized against chickenpox can still get the disease. However, the symptoms are usually milder with fewer blisters and mild or no fever. Chickenpox is contagious as long as five days but usually one to two days before the rash and until all blisters have formed scabs, usually about five days after the rash.
Complications of chickenpox can include dehydration, pneumonia, encephalitis and blood stream infections (sepsis). The risk of these complications increases with age. Chickenpox infection during pregnancy can cause miscarriage, congenital varicella syndrome (CVS) and other complications.
Why is the MMRV vaccine important?
The MMRV vaccine offers parents an option to have their child immunized against four diseases in one vaccine. This vaccine reduces the number of injections for children.
In Ontario, measles, mumps, rubella, and varicella vaccination is required for school attendance under the Immunization of School Pupils Act (ISPA). Parents are required to provide a record of immunization or a valid exemption before their child attends school.
How well does the MMRV protect against measles, mumps, rubella and/or chickenpox?
Almost all children who receive two doses of vaccine against these four diseases are protected against all of them. Protection from measles, mumps and rubella after getting the vaccine is life-long.
Who is eligible to receive the publicly funded vaccine?
In Ontario, children are eligible to receive the publicly funded MMRV vaccine from four to 12 years of age to protect against measles, mumps, rubella and chickenpox.
At what age should the MMRV vaccine be given?
The MMRV vaccine is offered to children between four to six years of age as part of their routine immunization schedule. The vaccine is currently approved for children up to 12 years of age.
Who should not get the MMRV vaccine?
Children should not receive the vaccine if they have:
- allergies to the vaccine or any component of the vaccine;
- known allergies to neomycin; or
- previously experienced an allergic reaction to any measles, mumps, rubella and/or varicella vaccines.
Please consult with your health care provider if you have:
- a weakened immune system or take medications that suppress the immune system;
- a personal or family history of febrile seizures;
- previously had a severe allergic reaction to eggs, or anything that contained eggs;
- received blood or blood products; or
- a severe infection with a high fever greater than 38.5°C.
You should always discuss the benefits and risks of any vaccine with your health care provider or local public health unit prior to receiving the vaccine.
Is the MMRV vaccine safe?
The MMRV vaccine is safe and effective; most children will have no reaction. Some common side effects from the MMRV include redness, swelling and tenderness in the area where the needle is given. Fever, and/or a rash can occur four to 12 days after getting the vaccine. The rash can be a blotchy red rash (measles-like) and/or spots that look like blisters (chickenpox). Severe reactions are rare.
There have been studies that showed a possible increased risk of febrile seizures in children who received the MMRV vaccine as a first dose when younger than two years of age. These studies were conducted in the United States for the MMRV vaccine ProQuad™. The rate of febrile seizures in Priorix-Tetra™ has not been reported to be higher than if MMR and varicella vaccines are given separately. As children get older their risk for febrile seizures lessens. Children who are four to six years of age do not experience febrile seizures as often as children less than four years of age.
Please report any side effects or severe vaccine reaction to your health care provider or local public health unit.
When should I call my health care provider?
Call your health care provider or go to the nearest hospital emergency department if your child has any of the following reactions within three days of receiving the vaccine:
- swelling of the face or mouth;
- trouble breathing, hoarseness or wheezing;
- high fever (over 40°C);
- convulsions or seizures; or
- other serious symptoms (e.g., paraesthesia).
Who should I talk to if I have any questions?
Talk to your health care provider or call your local public health unit.
How should my child's immunization be recorded?
After you or your child receives any immunization, make sure the health care provider updates the personal immunization record (the "Yellow Card"). This will be your record to keep so that you know what immunizations you have received.