Medicine:MMR vaccine

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Short description: Combined vaccine against measles, mumps, and rubella

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MMR vaccine
MMR vaccine
Combination of
Measles vaccineVaccine
Mumps vaccineVaccine
Rubella vaccineVaccine
Clinical data
Trade namesM-M-R II, Priorix, Tresivac, others
Other namesMPR vaccine[1]
AHFS/Drugs.comMonograph
MedlinePlusa601176
License data
Pregnancy
category
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • UK: POM (Prescription only)
  • US: ℞-only [3][4]
  • EU: Rx-only [5]
  • In general: ℞ (Prescription only)
Identifiers
CAS Number
ChemSpider
  • None
 ☒NcheckY (what is this?)  (verify)

The MMR vaccine (abbreviated as MMR)[6] is a combination vaccine against measles, mumps, and rubella (German measles).[3] It contains the combined measles vaccine, mumps vaccine, and rubella vaccine into a single injection.[3][7][8][9] After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella.[7] The vaccine is also recommended for those who do not have evidence of immunity,[7] those with well-controlled HIV/AIDS,[10][11] and within 72 hours of exposure to measles among those who are incompletely immunized.[8] It is given by injection.[12]

The MMR vaccine is widely used around the world. As of 2012, 575 million doses had been administered since the vaccine's introduction worldwide.[13] Measles resulted in 2.6 million deaths per year before immunization became common.[13] This has decreased to 122,000 deaths per year as of 2012, mostly in low-income countries.[13] Through vaccination, as of 2018, rates of measles in North and South America are very low.[13] Rates of disease have been seen to increase in populations that go unvaccinated.[13] Between 2000 and 2018, vaccination decreased measles deaths by 73%.[14]

Side effects of immunization are generally mild and resolve without any specific treatment.[15] These may include fever, as well as pain or redness at the injection site.[15] Severe allergic reactions occur in about one in a million people.[15] Because it contains live viruses, the MMR vaccine is not recommended during pregnancy but may be given during breastfeeding.[7] The vaccine is safe to give at the same time as other vaccines.[15] Being recently immunized does not increase the risk of passing measles, mumps, or rubella on to others: That is, even though the vaccine contains live viruses, they are not transmitted.[7] There is no evidence of an association between MMR immunization and autistic spectrum disorders.[16][17][18] The MMR vaccine is a mixture of live weakened viruses of the three diseases.[7]

The MMR vaccine was developed by Maurice Hilleman.[6] It was licensed for use in the US by Merck in 1971.[19] Stand-alone measles, mumps, and rubella vaccines had been previously licensed in 1963, 1967, and 1969, respectively.[19][20] Recommendations for a second dose were introduced in 1989.[19] The MMRV vaccine, which also covers chickenpox, may be used instead.[7] An MR vaccine, without coverage for mumps, is also occasionally used.[21]

Medical use

Priorix

Cochrane concluded that the "Existing evidence on the safety and effectiveness of MMR and MMRV vaccine supports current policies of mass immunisation aimed at global measles eradication to reduce morbidity and mortality associated with measles mumps rubella and varicella."[16]

The combined MMR vaccine induces immunity less painfully than three separate injections at the same time, and sooner and more efficiently than three injections given on different dates. Public Health England reports that providing a single combined vaccine as of 1988, rather than giving the option to have them also done separately, increased uptake of the vaccine.[22]

Measles

Measles cases 1944-1963 followed a highly variable epidemic pattern, with 150,000-850,000 cases reported per year. A sharp decline followed the introduction of the first measles vaccine in 1963, with fewer than 25,000 cases reported in 1968. Outbreaks around 1971 and 1977 gave 75,000 and 57,000 cases, respectively. Cases were stable at a few thousand per year until an outbreak of 28,000 in 1990. Cases declined from a few hundred per year in the early 1990s to a few dozen in the 2000s.
Measles cases reported in the United States fell drastically after the introduction of the measles vaccine.

Before the widespread use of a vaccine against measles, rates of disease were so high that infection was felt to be "as inevitable as death and taxes."[23] Reported cases of measles in the United States fell from hundreds of thousands to tens of thousands per year following introduction of the vaccine in 1963. Increasing uptake of the vaccine following outbreaks in 1971, and 1977, brought this down to thousands of cases per year in the 1980s. An outbreak of almost 30,000 cases in 1990 led to a renewed push for vaccination and the addition of a second vaccine to the recommended schedule. Fewer than 200 cases have been reported in the US each year between 1997 and 2013, and the disease is no longer considered endemic there.[24][25][26]

The benefit of measles vaccination in preventing illness, disability, and death has been well documented. The first 20 years of licensed measles vaccination in the US prevented an estimated 52 million cases of the disease, 17,400 cases of intellectual disability, and 5,200 deaths.[27] During 1999–2004, a strategy led by the World Health Organization and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles deaths worldwide.[28] Between 2000 and 2018, measles vaccination resulted in a 73% decrease in deaths from the disease.[14]

Measles is common in many areas of the world. Although it was declared eliminated from the US in 2000, high rates of vaccination and good communication with people who refuse vaccination are needed to prevent outbreaks and sustain the elimination of measles in the US.[29] Of the 66 cases of measles reported in the US in 2005, slightly over half were attributable to one unvaccinated individual who acquired measles during a visit to Romania.[30] This individual returned to a community with many unvaccinated children. The resulting outbreak infected 34 people, mostly children and virtually all unvaccinated; 9% were hospitalized, and the cost of containing the outbreak was estimated at $167,685. A major epidemic was averted due to high rates of vaccination in the surrounding communities.[29]

In 2017, an outbreak of measles occurred among the Somali-American community in Minnesota, where MMR vaccination rates had declined due to the misconception that the vaccine could cause autism. The US Centers for Disease Control and Prevention recorded 65 affected children in the outbreak by April 2017.[31]

Rubella

Rubella rates fell sharply in the United States when immunization was introduced.

Rubella, also known as German measles, was also very common before widespread vaccination. The major risk of rubella is during pregnancy when the baby may contract congenital rubella, which can cause significant congenital defects.[32]

Mumps

Mumps is another viral disease that was once very common, especially during childhood. If mumps is acquired by a male who is past puberty, a possible complication is bilateral orchitis, which can in some cases lead to sterility.[33]

Administration

The MMR vaccine is administered by a subcutaneous injection, the first dose typically at twelve months of age.[12] The second dose may be given as early as one month after the first dose.[34] The second dose is a dose to produce immunity in the small number of persons (2–5%) who fail to develop measles immunity after the first dose. In the US it is done before entry to kindergarten because that is a convenient time.[35] Areas where measles is common typically recommend the first dose at nine months of age and the second dose at fifteen months of age.[8]

Safety

Adverse reactions, rarely serious, may occur from each component of the MMR vaccine. Ten percent of children develop fever, malaise, and a rash 5–21 days after the first vaccination;[36] and 3% develop joint pain lasting 18 days on average.[37] Older women appear to be more at risk of joint pain, acute arthritis, and even (rarely) chronic arthritis.[38] Anaphylaxis is an extremely rare but serious allergic reaction to the vaccine.[39] One cause can be egg allergy.[40] In 2014, the FDA approved two additional possible adverse events on the vaccination label: acute disseminated encephalomyelitis (ADEM), and transverse myelitis, with permission to also add "difficulty walking" to the package inserts.[41] A 2012 IOM report found that the measles component of the MMR vaccine can cause measles inclusion body encephalitis in immunocompromised individuals. This report also rejected any connection between the MMR vaccine and autism.[42] Some versions of the vaccine contain the antibiotic neomycin and therefore should not be used in people allergic to this antibiotic.[18]

The number of reports on neurological disorders is very small, other than evidence for an association between a form of the MMR vaccine containing the Urabe mumps strain and rare adverse events of aseptic meningitis, a form of viral meningitis.[38][43] The UK National Health Service stopped using the Urabe mumps strain in the early 1990s due to cases of transient mild viral meningitis, and switched to a form using the Jeryl Lynn mumps strain instead.[44] The Urabe strain remains in use in a number of countries; MMR with the Urabe strain is much cheaper to manufacture than with the Jeryl Lynn strain,[45] and a strain with higher efficacy along with a somewhat higher rate of mild side effects may still have the advantage of reduced incidence of overall adverse events.[44]

A Cochrane review found that, compared with placebo, MMR vaccine was associated with fewer upper respiratory tract infections, more irritability, and a similar number of other adverse effects.[16]

Naturally acquired measles often occurs with immune thrombocytopenic purpura (ITP, a purpuric rash and an increased tendency to bleed that resolves within two months in children), occurring in 1 to 20,000 cases.[16] Approximately 1 in 40,000 children are thought to acquire ITP in the six weeks following an MMR vaccination.[16] ITP below the age of six years is generally a mild disease, rarely having long-term consequences.[46][47]

False claims about autism

Main article: Social:MMR vaccine and autism

In 1998 Andrew Wakefield et al. published a fraudulent paper about twelve children, reportedly with bowel symptoms and autism or other disorders acquired soon after administration of MMR vaccine,[48] while supporting a competing vaccine. In 2010, Wakefield's research was found by the General Medical Council to have been "dishonest",[49] and The Lancet fully retracted the paper.[50][51] Three months following The Lancet's retraction, Wakefield was struck off the UK medical register, with a statement identifying deliberate falsification in the research published in The Lancet,[52] and was barred from practising medicine in the UK.[53] The research was declared fraudulent in 2011 by the British Medical Journal.[54]

Since Wakefield's publication, multiple peer-reviewed studies have failed to show any association between the vaccine and autism.[16][55] The US Centers for Disease Control and Prevention,[56][57] the Institute of Medicine of the US National Academy of Sciences,[58] the UK National Health Service[59] and the Cochrane Library review[16] have all concluded that there is no evidence of a link.

Administering the vaccines in three separate doses does not reduce the chance of adverse effects, and it increases the opportunity for infection by the two diseases not immunized against first.[55][60] Health experts have criticized media reporting of the MMR-autism controversy for triggering a decline in vaccination rates.[61] Before publication of Wakefield's article, the inoculation rate for MMR in the UK was 92%; after publication, the rate dropped to below 80%. In 1998, there were 56 measles cases in the UK; by 2008, there were 1348 cases, with two confirmed deaths.[62]

In Japan, the MMR triplet is not used. Immunity is achieved by a combination vaccine for measles and rubella, followed up later with a mumps only vaccine. This has had no effect on autism rates in the country, further disproving the MMR autism hypothesis.[63]

History

Maurice Hilleman, who developed the MMR vaccine
Two workers make openings in chicken eggs in preparation for a measles vaccine.

The component viral strains of MMR vaccine were developed by propagation in animal and human cells.[64]

For example, in the case of mumps and measles viruses, the virus strains were grown in embryonated chicken eggs. This produced strains of virus which were adapted for chicken cells and less well-suited for human cells. These strains are therefore called attenuated strains. They are sometimes referred to as neuroattenuated because these strains are less virulent to human neurons than the wild strains.

The rubella component, Meruvax, was developed in 1967, through propagation using the human embryonic lung cell line WI-38 (named for the Wistar Institute) that was derived six years earlier in 1961.[65][66]

Disease immunized Component vaccine Virus strain Propagation medium Growth medium
Measles Attenuvax Enders' attenuated Edmonston strain[67] chick embryo cell culture Medium 199
Mumps Mumpsvax[68] Jeryl Lynn (B level) strain[69]
Rubella Meruvax II Wistar RA 27/3 strain of live attenuated rubella virus WI-38 human embryonic cell line MEM (solution containing buffered salts, fetal bovine serum, human serum albumin and neomycin, etc.)

The term "MPR vaccine" is also used to refer to this vaccine, whereas "P" refers to parotitis which is caused by mumps.[1]

Merck MMR II is supplied freeze-dried (lyophilized) and contains live viruses. Before injection, it is reconstituted with the solvent provided.[70]

According to a review published in 2018, the GlaxoSmithKline (GSK) MMR vaccine known as Pluserix "contains the Schwarz measles virus, the Jeryl Lynn–like mumps strain, and RA27/3 rubella virus".[71]

Pluserix was introduced in Hungary in 1999.[72] Enders' Edmonston strain has been used since 1999 in Hungary in Merck MMR II product.[72] GSK Priorix vaccine, which uses attenuated Schwarz Measles, was introduced in Hungary in 2003.[72]

MMRV vaccine

Main article: Medicine:MMRV vaccine

The MMRV vaccine, a combined measles, mumps, rubella, and varicella (chickenpox) vaccine is used as a replacement for the MMR vaccine to simplify the administration of the vaccines.[34]

MR vaccine

The MR vaccine (abbreviated "MRV") is a vaccine for measles and rubella, not mumps.[21] In 2014, the World Health Organization reported it as used in a "few (unidentified) countries".[21] A MRV delivered by a micro-needle patch was the subject of a study reported in 2024.[73]

Society and culture

Religious concerns

Some brands of the vaccine use gelatin, derived from pigs, as a stabilizer.[74] This has caused reduced take-up among some communities,[74][75] despite the fact that alternative vaccines without pig derivatives are approved and available.[74]

References

  1. ↑ 1.0 1.1 Vaccines: Are they Worth a Shot?. Springer. 2018. p. 2. ISBN 978-3-319-68106-1. https://books.google.com/books?id=hgFkDwAAQBAJ&pg=PA2. Retrieved 22 May 2020. 
  2. ↑ "Measles virus vaccine / mumps virus vaccine / rubella virus vaccine (M-M-R II) Use During Pregnancy". 16 October 2019. https://www.drugs.com/pregnancy/measles-virus-vaccine-mumps-virus-vaccine-rubella-virus-vaccine.html. 
  3. ↑ 3.0 3.1 3.2 "M-M-R II- measles, mumps, and rubella virus vaccine live injection, powder, lyophilized, for suspension". 23 May 2022. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0a9e384f-e717-436b-b9a0-15e53cef0862. 
  4. ↑ "Priorix- measles, mumps, and rubella vaccine, live kit". 3 June 2022. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=95c6fdb6-b587-4413-92f9-d592b9f7a23e. 
  5. ↑ "M-M-RVaxPro EPAR". 17 September 2018. https://www.ema.europa.eu/en/medicines/human/EPAR/m-m-rvaxpro. 
  6. ↑ 6.0 6.1 "Maurice R. Hilleman, PhD, DSc". Seminars in Pediatric Infectious Diseases 16 (3): 225–226. July 2005. doi:10.1053/j.spid.2005.05.002. PMID 16044396. 
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 "Measles Vaccination". U.S. Centers for Disease Control and Prevention (CDC). 26 January 2021. https://www.cdc.gov/measles/vaccines/index.html. 
  8. ↑ 8.0 8.1 8.2 "Measles vaccines: WHO position paper – April 2017". Weekly Epidemiological Record 92 (17): 205–227. April 2017. PMID 28459148. 
  9. ↑ World Health Organization (January 2019). "Measles vaccines: WHO position paper, April 2017 - Recommendations". Vaccine 37 (2): 219–222. doi:10.1016/j.vaccine.2017.07.066. PMID 28760612. 
  10. ↑ "Core Concepts – Immunizations in Adults – Basic HIV Primary Care – National HIV CurriculumImmunizations in Adults". 2 May 2017. https://www.hiv.uw.edu/go/basic-primary-care/immunizations/core-concept/all. 
  11. ↑ "Measles, mumps, and rubella--vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR. Recommendations and Reports 47 (RR-8): 1–57. May 1998. PMID 9639369. https://www.cdc.gov/mmwr/PDF/rr/rr4708.pdf. Retrieved 26 January 2020. 
  12. ↑ 12.0 12.1 "Administering the MMR Vaccine". 26 January 2021. https://www.cdc.gov/vaccines/vpd/mmr/hcp/administering-mmr.html. 
  13. ↑ 13.0 13.1 13.2 13.3 13.4 "Addressing misconceptions on measles vaccination". 15 April 2014. https://ecdc.europa.eu/en/measles/prevention-and-control/addressing-misconceptions-measles. 
  14. ↑ 14.0 14.1 "Measles Fact Sheet". 5 December 2019. https://www.who.int/en/news-room/fact-sheets/detail/measles. 
  15. ↑ 15.0 15.1 15.2 15.3 "MMR (Measles, Mumps, and Rubella) Vaccine Information Statement". U.S. Centers for Disease Control and Prevention (CDC). January 2025. https://www.cdc.gov/vaccines/hcp/current-vis/mmr.html. 
  16. ↑ 16.0 16.1 16.2 16.3 16.4 16.5 16.6 "Vaccines for measles, mumps, rubella, and varicella in children". The Cochrane Database of Systematic Reviews 2021 (11). November 2021. doi:10.1002/14651858.CD004407.pub5. PMID 34806766. 
  17. ↑ "The Anti-vaccination Movement: A Regression in Modern Medicine". Cureus 10 (7). July 2018. doi:10.7759/cureus.2919. PMID 30186724. 
  18. ↑ 18.0 18.1 "Vaccine Adverse Events: Separating Myth from Reality". American Family Physician 95 (12): 786–794. June 2017. PMID 28671426. 
  19. ↑ 19.0 19.1 19.2 "Measles 50 Years After Use of Measles Vaccine". Infectious Disease Clinics of North America 29 (4): 725–743. December 2015. doi:10.1016/j.idc.2015.08.001. PMID 26610423. 
  20. ↑ "Measles: information about the disease and vaccines Questions and Answers". November 2018. https://www.immunize.org/catg.d/p4209.pdf. 
  21. ↑ 21.0 21.1 21.2 "Information Sheet Observed Rate of Vaccine Reactions, Measles, Mumps, and Rubella Vaccines". May 2014. http://fdaghana.gov.gh/img/vacine/MMR%20vaccine%20information.pdf. 
  22. ↑ "Measles, mumps, rubella (MMR): use of combined vaccine instead of single vaccines". https://www.gov.uk/government/publications/mmr-vaccine-dispelling-myths/measles-mumps-rubella-mmr-maintaining-uptake-of-vaccine. 
  23. ↑ "Modern measles". The American Journal of the Medical Sciences 228 (3): 334–361. September 1954. doi:10.1097/00000441-195409000-00013. PMID 13197385. 
  24. ↑ "Summary of notifiable diseases, United States, 1993". MMWR. Morbidity and Mortality Weekly Report 42 (53): i-xvii; 1–73. October 1994. PMID 9247368. https://www.cdc.gov/mmwr/PDF/wk/mm4253.pdf. Retrieved 26 January 2020. 
  25. ↑ "Summary of Notifiable Diseases --- United States, 2007". MMWR Morb. Mortal. Wkly. Rep. 56 (53). July 2009. https://www.cdc.gov/mmwr/pdf/wk/mm5653.pdf. Retrieved 26 January 2020. 
  26. ↑ Epidemiology and Prevention of Vaccine-Preventable Diseases (13th ed.). Washington D.C.: U.S. Centers for Disease Control and Prevention (CDC). 2015. ISBN 978-0-9904491-1-9. https://www.cdc.gov/pinkbook. Retrieved 9 September 2017. 
  27. ↑ "Health impact of measles vaccination in the United States". Pediatrics 76 (4): 524–532. October 1985. doi:10.1542/peds.76.4.524. PMID 3931045. 
  28. ↑ "Progress in reducing global measles deaths, 1999-2004". MMWR. Morbidity and Mortality Weekly Report 55 (9): 247–249. March 2006. PMID 16528234. https://www.cdc.gov/mmwr/pdf/wk/mm5509.pdf. Retrieved 26 January 2020. 
  29. ↑ 29.0 29.1 "Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States". The New England Journal of Medicine 355 (5): 447–455. August 2006. doi:10.1056/NEJMoa060775. PMID 16885548. 
  30. ↑ "Measles--United States, 2005". MMWR. Morbidity and Mortality Weekly Report 55 (50): 1348–1351. December 2006. PMID 17183226. https://www.cdc.gov/mmwr/pdf/wk/mm5550.pdf. Retrieved 26 January 2020. 
  31. ↑ "Measles Outbreak - Minnesota April-May 2017". MMWR. Morbidity and Mortality Weekly Report 66 (27): 713–717. July 2017. doi:10.15585/mmwr.mm6627a1. PMID 28704350. PMC 5687591. https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6627.pdf. Retrieved 26 January 2020. 
  32. ↑ "Measles, Mumps, Rubella (MMR) Vaccine and Immunization Information". 22 April 2010. https://www.immunizationinfo.org/vaccines/rubella/. 
  33. ↑ Male infertility: a guide for the clinician. Malden, MA: Blackwell Publishing. 2000. p. 118. ISBN 978-0-632-05129-8. https://books.google.com/books?id=ULWh1Wc1nKMC. Retrieved 24 September 2016. 
  34. ↑ 34.0 34.1 "Increasing coverage and efficiency of measles, mumps, and rubella vaccine and introducing universal varicella vaccination in Europe: a role for the combined vaccine". The Pediatric Infectious Disease Journal 26 (7): 632–638. July 2007. doi:10.1097/INF.0b013e3180616c8f. PMID 17596807. 
  35. ↑ "MMR vaccine questions and answers". U.S. Centers for Disease Control and Prevention (CDC). 2004. https://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmr/faqs-mmr-hcp.htm. 
  36. ↑ "10-minute consultation: MMR immunisation". BMJ 323 (7303): 32. July 2001. doi:10.1136/bmj.323.7303.32. PMID 11440943. 
  37. ↑ "Acute arthritis complicating rubella vaccination". Arthritis and Rheumatism 14 (1): 19–26. 1971. doi:10.1002/art.1780140104. PMID 5100638. https://deepblue.lib.umich.edu/bitstream/2027.42/37715/1/1780140104_ftp.pdf. Retrieved 1 September 2019. 
  38. ↑ 38.0 38.1 "Consequence or coincidence? The occurrence, pathogenesis and significance of autoimmune manifestations after viral vaccines". Vaccine 23 (30): 3876–3886. June 2005. doi:10.1016/j.vaccine.2005.03.005. PMID 15917108. 
  39. ↑ "MMR immunisation. True anaphylaxis to MMR vaccine is extremely rare". BMJ 323 (7317): 869. October 2001. doi:10.1136/bmj.323.7317.869a. PMID 11683165. 
  40. ↑ "Egg allergy and MMR vaccination". The British Journal of General Practice 53 (495): 801–802. October 2003. PMID 14601358. PMC 1314715. http://openurl.ingenta.com/content/nlm?genre=article&issn=0960-1643&volume=53&issue=495&spage=801&aulast=Fox. 
  41. ↑ "Approval for label change". https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm394905.htm. 
  42. ↑ Institute of Medicine (2012). Adverse Effects of Vaccines. Washington, D.C.: National Academies Press. doi:10.17226/13164. ISBN 978-0-309-21435-3. 
  43. ↑ Institute of Medicine (1994). "Measles and mumps vaccines". Adverse Events Associated with Childhood Vaccines: Evidence Bearing on Causality. National Academies Press. doi:10.17226/2138. ISBN 978-0-309-07496-4. Bibcode: 1994nap..book.2138I. http://books.nap.edu/openbook.php?record_id=2138&page=131. Retrieved 29 August 2007. 
  44. ↑ 44.0 44.1 "Withdrawal of a mumps vaccine". European Journal of Pediatrics 153 (6): 467–468. June 1994. doi:10.1007/BF01983415. PMID 8088305. 
  45. ↑ "Commentary: Ongoing debate over the safety of the different mumps vaccine strains impacts mumps disease control". International Journal of Epidemiology 31 (5): 983–984. October 2002. doi:10.1093/ije/31.5.983. PMID 12435772. 
  46. ↑ "Do childhood vaccines cause thrombocytopenia?". Paediatrics & Child Health 14 (1): 31–32. January 2009. doi:10.1093/pch/14.1.31. PMID 19436461. 
  47. ↑ "MMR vaccine and idiopathic thrombocytopaenic purpura". British Journal of Clinical Pharmacology 55 (1): 107–111. January 2003. doi:10.1046/j.1365-2125.2003.01790.x. PMID 12534647. 
  48. ↑ "Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children". Lancet 351 (9103): 637–641. February 1998. doi:10.1016/S0140-6736(97)11096-0. PMID 9500320. http://briandeer.com/mmr/lancet-paper.htm. Retrieved 5 September 2007.  (Retracted, see doi:10.1016/S0140-6736(10)60175-4, PMID 20137807,  Retraction Watch)
  49. ↑ "GMC brands Dr Andrew Wakefield 'dishonest, irresponsible and callous'". The Telegraph (London). 29 January 2010. https://www.telegraph.co.uk/news/health/7095145/GMC-brands-Dr-Andrew-Wakefield-dishonest-irresponsible-and-callous.html. 
  50. ↑ ((The Editors of The Lancet)) (February 2010). "Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children". Lancet 375 (9713): 445. doi:10.1016/S0140-6736(10)60175-4. PMID 20137807. 
  51. ↑ "Lancet accepts MMR study 'false'". 2 February 2010. http://news.bbc.co.uk/2/hi/health/8493753.stm. 
  52. ↑ "General Medical Council, Fitness to Practise Panel Hearing, 24 May 2010, Andrew Wakefield, Determination of Serious Professional Misconduct". General Medical Council. http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf. 
  53. ↑ "MMR row doctor Andrew Wakefield struck off register". The Guardian (London). 24 May 2010. https://www.theguardian.com/society/2010/may/24/mmr-doctor-andrew-wakefield-struck-off. 
  54. ↑ "Wakefield's article linking MMR vaccine and autism was fraudulent". BMJ 342 (jan05 1; c7452). January 2011. doi:10.1136/bmj.c7452. PMID 21209060. 
  55. ↑ 55.0 55.1 National Health Service (2004). "MMR: myths and truths". http://www.mmrthefacts.nhs.uk/basics/truths.php. 
  56. ↑ "Measles, Mumps, Rubella (MMR) Vaccine". U.S. Centers for Disease Control and Prevention (CDC). 24 August 2018. https://www.cdc.gov/vaccinesafety/vaccines/mmr-vaccine.html. 
  57. ↑ "Autism and Vaccines - Vaccine Safety". U.S. Centers for Disease Control and Prevention (CDC). 24 August 2018. https://www.cdc.gov/vaccinesafety/concerns/autism.html. 
  58. ↑ Institute of Medicine (2004). Immunization Safety Review. Washington, D.C.: National Academies Press. doi:10.17226/10997. Bookshelf ID: NBK25344. ISBN 978-0-309-09237-1. 
  59. ↑ "MMR (measles, mumps and rubella) vaccine". 4 July 2022. https://www.nhs.uk/conditions/vaccinations/mmr-vaccine/. 
  60. ↑ MMR vs three separate vaccines:
  61. ↑ "Doctors issue plea over MMR jab". BBC News. 26 June 2006. http://news.bbc.co.uk/2/hi/health/5118166.stm. 
  62. ↑ "Paranoia strikes deep: MMR vaccine and autism". Psychiatric Times 27 (3): 1–6. 2010. https://www.psychiatrictimes.com/view/paranoia-strikes-deep-mmr-vaccine-and-autism. 
  63. ↑ "No effect of MMR withdrawal on the incidence of autism: a total population study". Journal of Child Psychology and Psychiatry, and Allied Disciplines 46 (6): 572–579. June 2005. doi:10.1111/j.1469-7610.2005.01425.x. PMID 15877763. 
  64. ↑ "Measles, mumps, rubella vaccine (Priorix; GSK-MMR): a review of its use in the prevention of measles, mumps and rubella". Drugs 63 (19): 2107–26. 2003. doi:10.2165/00003495-200363190-00012. PMID 12962524. 
  65. ↑ "Human fibroblasts infected with rubella virus produce a growth inhibitor". Science 156 (3775): 659–661. May 1967. doi:10.1126/science.156.3775.659. PMID 6023662. Bibcode: 1967Sci...156..659P. 
  66. ↑ "The serial cultivation of human diploid cell strains". Experimental Cell Research 25 (3): 585–621. December 1961. doi:10.1016/0014-4827(61)90192-6. PMID 13905658. 
  67. ↑ "Attenuvax Product Sheet". Merck & Co. 2006. p. 1. http://www.merck.com/product/usa/pi_circulars/a/attenuvax/attenuvax_pi.pdf. 
  68. ↑ Merck Co. (2002). "MUMPSVAX (Mumps Virus Vaccine Live) Jeryl Lynn Strain". Merck Co.. http://www.merck.com/product/usa/pi_circulars/m/mumpsvax/mumpsvax_pi.pdf. 
  69. ↑ "Experiences with Jeryl Lynn strain live attenuated mumps virus vaccine in a pediatric outpatient clinic". Pediatrics 40 (5): 798–803. November 1967. doi:10.1542/peds.40.5.798. PMID 6075651. 
  70. ↑ "About the Vaccine – MMR and MMRV Vaccine Composition and Dosage". U.S. Centers for Disease Control and Prevention (CDC). 26 January 2021. https://www.cdc.gov/vaccines/vpd/mmr/hcp/about.html. 
  71. ↑ "Rubella Vaccines". Plotkin's Vaccines. 2018. pp. 970–1000.e18. doi:10.1016/B978-0-323-35761-6.00052-3. ISBN 978-0-323-35761-6. 
  72. ↑ 72.0 72.1 72.2 "Application of a fast and cost-effective 'three-in-one' MMR ELISA as a tool for surveying anti-MMR humoral immunity: the Hungarian experience". Epidemiology and Infection 148. February 2020. doi:10.1017/S0950268819002280. PMID 32014073. 
  73. ↑ "A measles and rubella vaccine microneedle patch in The Gambia: a phase 1/2, double-blind, double-dummy, randomised, active-controlled, age de-escalation trial". Lancet 403 (10439): 1879–1892. May 2024. doi:10.1016/S0140-6736(24)00532-4. PMID 38697170. 
  74. ↑ 74.0 74.1 74.2 "Vaccines and porcine gelatine". Public Health England. August 2015. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/751199/Vaccines_porcine_gelatine.pdf. 
  75. ↑ "'Monkey, Rat and Pig DNA': How Misinformation Is Driving the Measles Outbreak Among Ultra-Orthodox Jews". The New York Times. 9 April 2019. https://www.nytimes.com/2019/04/09/nyregion/jews-measles-vaccination.html. 

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