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Immunization : Measles, Mumps and Rubella MMR Vaccine

Vaccines (or needles or baby shots) are the best way to protect against some very serious infections. The Canadian Paediatric Society and the National Advisory Committee on Immunization strongly recommend routine immunization.

The MMR vaccine is a three-in-one needle that protects against measles, mumps and rubella (German measles). It should be given to children soon after their first birthday. A second dose is given in combination with varicella (chicken pox), as MMRV (a four-in-one needle) at 4-6 years of age. Vaccination against measles, mumps and rubella is required by law for all children attending school in Ontario (unless exempted).

This vaccine should also be given to adults who are not protected against measles, mumps or rubella. Pregnant women who have been told that they are not protected against rubella, should receive MMR vaccine as soon as they are no longer pregnant.

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 four 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.

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.

Rubella (German Measles)

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.

How well does MMR vaccine protect against measles, mumps and rubella?

The effectiveness of a single dose of measles-containing vaccine given at 12 or 15 months of age is estimated to be 85 per cent to 95 per cent. With a second dose, effectiveness is approximately 97 per cent. Effectiveness of mumps vaccination after one dose is estimated to be between 62 per cent and 91 per cent and between 76 per cent and 95 per cent after two doses.  At least 95 per cent of individuals develop rubella immunity after a single dose.  Protection from measles, mumps and rubella after getting the vaccine is life-long and further doses are not required.

Is the MMR vaccine safe?

The MMR vaccine is safe and effective. Most individuals will have no reaction. The vaccine can cause a malaise and fever, possibly with a rash, in approximately five per cent of children six to 23 days  after MMR immunization. Allergic reactions to the MMR vaccine are very rare. There is no evidence that the MMR vaccine causes autism.
The vaccine is safe for household members of people with immune system problems and household members of pregnant women. Breastfeeding women can receive the MMR vaccine.
Speak with your health care provider or local public health unit about the benefits and risks of the vaccine, as well as the risks of not getting vaccinated.

Who should not have MMR vaccine?

There are some groups who should generally not be given the vaccine such as, but not limited to:

  • Individuals who are pregnant (Women of childbearing age should be advised to avoid pregnancy for at least 1 month following immunization with MMR vaccine)
  • Individuals who have a history of anaphylaxis after previous administration of the product (or components of the vaccine)
  • Those who have medical conditions that may be contraindicated (for example, individuals with history of convulsions, certain immunosuppressant medications, congenital or hereditary immunodeficiency)

People who have problems with their immune system should speak with their health care provider to determine when MMR vaccine should be given. The vaccine is safe for household members of people with immune system problems.

Who should I talk to if I have any questions?

Talk to your health care provider or call your local public health unit.

Your record of protection

After you or your child receives any immunization, make sure the doctor updates the personal immunization record, the "Yellow Card". This will be your record to keep so that you know what immunizations you have received.

April 2015

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