MMR vaccine

1. Presented by : Beenish Sarfraz Roll No: 1360 Presented by:Ms Mahwish Aftab Department of Biotehnology Lahore College For Women University

2. The MMR Vaccine

3. MULTIVALENT VACCINE Multivalent or Polyvalent vaccines contain more than one antigen .It contain a mixture of different antigens and are more convenient to administer because fewer injections are needed.

4. 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).

5. Measles member of the family Paramyxoviridae transmitted from person to person by direct contact with respiratory droplets or airborne spread. causes a rash, cough, runny nose, eye irritation, and fever in most people.

6. Mumps Mumps virus is a member of the Paramyxoviridae family. causes fever, headache and inflammation of the glands under the jaw

7. Rubella Rubella (German measles) is in the Togaviridae family.. Rubella is an illness transmitted through direct or droplet contact from nasopharyngeal secretions characterized by rash, low-grade fever, lymphadenopathy, and Swollen glands Coryza (cold like symptoms) Aching joints (especially in young women )

8. HISTORY Mumps and rubella vaccine (German measles) first available in 1967 and 1969. Measles-mumps-rubella (MMR) vaccine combined in 1971 Developed by Maurice Hillman while at Merck in the late 1960s. In the United States, the vaccine was licensed in 1971 Second dose was introduced in 1989

9. DEVELOPMENT, FORMULATION & ADMINISTRATION Disease Immunized Component Vaccine Virus Strain Propagation Medium Growth Medium Measles attenuvax Enders attenuated Edmonston strain chick embryo cell culture Medium 199((a buffered salt solution containing vitamins and amino acids and supplemented with fetal bovine serum) containing SPGA (sucrose, phosphate, glutamate, and recombinant human albumin) as stabilizer and neomycin. Mumps Mumpsvax Jeryl Lynn (B Level) strain rubella Meruvax II Wistar RA 27/3 strain of live attenuated rubella virus WI-38 human diploid lung fibroblasts MEM Minimum Essential Medium (solution containing buffered salts, fetal bovine serum human serum albumin and neomycin, etc.)

10. MMR Vaccine MMR contains 1,000 TCID 50 (tissue culture infectious doses) of measles virus; 12,500 TCID 50 of mumps virus; and 1,000 TCID 50 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 neomycin.

11. MANUFACTURES OF MMR Merk as M-M-R II GlaxoKlienSmith as Priorix Serum Institute of India as Tresivac Sanofi Pasture as Trimovax

12. MMR DOSE The first MMR immunization will protect most from contracting measles, mumps, or rubella throughout their lives. FIRST DOSE MMR is offered to a child at between 12 and 13 months of age after the immunity a baby gets from their mother fades. The vaccine is injected into the muscle of the thigh or upper arm. 

13. SECOND DOSE OF MMR The second MMR dose is a booster dose which re-exposes the patient to the immunizing antigen. May be given at an time after 28 days pass the first dose . Also recommended to cover those individuals who may not have received adequate protection from their first MMR .

14. NEED FOR 2 nd DOSE: case study

15. SEPARATE AND COMBINED MMR: MMR 2 injections of combined MMR Very low risk of reactions Effective protection against disease Separate vaccines 6 injections of separate measles, mumps and rubella • Increased risk of disease • Increased risk of missing a dose completely • Increased risk of local reactions at injection site • Increased trauma to child

16. The level of effectiveness of MMR vaccine • 90-95% of people will be immune to measles after the first dose • 90-95% of people will be immune to mumps after the first dose • 97-99% of people will be immune to rubella after the first dose.

17. SAFETY The MMR vaccine has been used for 30 years with an excellent safety record.   Worldwide over 500 million doses of the MMR vaccine have been given since the mid-1970s .   - The US has used over 200 million doses of the MMR vaccine routinely, since the mid-1970s. - The UK has given around 13 million doses since its introduction in 1988 .

18. Condition Children A f fected After The Natural Disease Children A f fected After The First Dose Of MMR   Febrile convulsions (temperatu r e fits)   1 in 200 (measles)   1 in 1000   Meningitis/encephalitis 1 in 1000 (measles, mumps encephalitis) 1 in 20 (mumps meningitis) 1 in 6000 (rubella encephalitis)   less than 1 in 1 000 000   Conditions a f fecting blood clotting (ITP)   1 in 3000 (rubella) 1 in 6000 (measles)   1 in 22 000   Seve r e allergic r esponse (anaphylaxis)   -   1 in 100 000 SSPE (a delayed complication of measles that causes brain damage and death) 1 in 8000 (child r en who get measles under 2)     Death 1 in 2500 to 1 in 5000 (measles - higher in child r en under 1) 1 – 2 in 1000 for notified cases of measles in r ecent years  

19. Absolute reasons not to have MMR: children with untreated cancer or diseases of the immune system ; those receiving immunosuppressive therapy or high dose steroids • children with allergies to neomycin or gelatin (very rare) severe reaction to previous MMR . Reasons to postpone MMR: • the child is generally unwell with a fever • the child has had another live vaccine (including BCG) in the last three weeks • the child has been given an injection of immunoglobulin in the last three months.

20. MMR Vaccine Side Effects 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 Severe Problems (Very Rare) Serious allergic reaction Deafness Long-term seizures, coma, Permanent brain damage

21. Treatment of CDC Side Effects You can treat the fever 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.

22. 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 1930’s. Institute for Vaccine Safety reports that both the MMRII & the MMRV no longer contain Thimerosal .

23. Fewer visits to the medical centre will be required. (This is a major benefit in those countries where most people find transportation difficult; it could be a dis benefit to those health care personnel who rely on the fees paid for vaccinating children to augment their incomes.) There would be an improvement in the degree of vaccine coverage obtained which will have epidemiological benefits lowering of the unit cost of the vaccine may be expected as there would be decreases in the costs of separate vials, labels, packages, cold chain storage, needles and syringes, the time of medical personnel and the size of inventories. ADVANTAGES OF MULTIVALENT VACCINE