Contents

11 Measles

11.4 Vaccines

11.4.1 Available vaccines

The measles vaccine is only available as one of the components of MMR vaccine. This vaccine is a freeze-dried preparation containing live-attenuated measles, mumps and rubella viruses.

Funded vaccine

The funded MMR vaccine (MMR II, MSD), is a sterile lyophilised preparation of:
  • Attenuvax (Measles Virus Vaccine Live, MSD), a more attenuated line of measles virus, derived from Enders’ attenuated Edmonston strain and propagated in chick embryo cell culture
  • Mumpsvax (Mumps Virus Vaccine Live, MSD), the Jeryl Lynn (B level) strain of mumps virus propagated in chick embryo cell culture
  • Meruvax II (Rubella Virus Vaccine Live, MSD), the Wistar RA 27/3 strain of live attenuated rubella virus propagated in WI-38 human diploid lung fibroblasts.
  • ​The reconstituted vaccine also contains sorbitol, sodium phosphate, sucrose, sodium chloride, hydrolysed gelatin, recombinant human albumin, fetal bovine serum and neomycin. The vaccine contains no preservative.

Other vaccines

Another MMR vaccine registered (approved for use) and available (marketed) in New Zealand is:

A quadrivalent measles, mumps, rubella and varicella vaccine (MMRV, see chapter 21) is also registered but not currently available in New Zealand:

11.4.2 Efficacy and effectivenessTop

Measles vaccines are highly efficacious, and immunisation programmes have controlled measles to the point of elimination in many populations.15 Outbreaks and epidemics continue to occur where low immunisation rates and/or sufficient numbers of susceptible members of communities are present. A 2012 Cochrane review of the safety and effectiveness of MMR vaccine concluded that a single dose of MMR vaccine is at least 95 percent effective in preventing clinical measles and 92 percent effective in preventing secondary cases among household contacts aged 6 months and older.16 This was a systematic review of clinical trials and studies, and involved approximately 14.7 million children.

Seroconversion to all three viruses of MMR vaccine occurs in 85–100 percent of recipients. ‘Primary vaccine failure’ refers to the lack of protective immunity despite vaccination. It is due to failure of the vaccine to stimulate an immune response. This occurs in 5–10 percent of recipients after the first dose and is rare after a second dose.

Duration of immunity

Even though antibody levels decline over time, secondary vaccine failure (ie, vaccine failure due to waning of protective immunity) has only rarely been documented for any of the three components of the vaccine, most commonly mumps. A meta-analysis of the measles vaccine found no evidence of secondary vaccine failure in the US-manufactured vaccine currently used in New Zealand.17

In Finland in 1982 a cohort was recruited at the start of the national MMR vaccination programme to study the persistence of vaccine-induced antibodies. By the mid-1990s Finland had eliminated measles, mumps and rubella and there was little opportunity for natural boosting to occur. The follow-up of this cohort has shown that while antibodies wane over time, 20 years after the second MMR dose immunity to rubella was secure, 95 percent of people remained sero-positive for measles and immunity to mumps declined, with 74 percent being sero-positive.18 The antibody avidity also decreased over time, by 8 percent for measles and 24 percent for mumps.19

Waning of both the concentration and the avidity of antibodies might contribute to measles and mumps infections in individuals who have received two doses of MMR. New Zealand will have to consider the possibility that further doses of MMR in adults may be required in the future. Information from Finland and elsewhere will assist decision-making as to whether adult booster doses of MMR are required.

See section 21.4.2 for efficacy and effectiveness data for the varicella vaccine.

11.4.3 Transport, storage and handlingTop

Transport according to the National Guidelines for Vaccine Storage and Distribution.20 Store in the dark at +2oC to +8oC. Do not freeze.

MMR vaccine must be reconstituted only with the diluents supplied by the manufacturer. Use MMR vaccine as soon as possible after reconstitution. If storage is necessary, reconstituted MMR vaccine can be stored in the dark at +2oC to +8oC for up to eight hours.

See section 21.4.3 for MMRV vaccine information.

11.4.4 Dosage and administrationTop

The dose of MMR is all of the reconstituted vaccine (approximately 0.5 mL) administered by subcutaneous injection in the deltoid area of the upper arm, to all age groups (see section 2.3).

Co-administration with other vaccines

MMR vaccine can be given concurrently with other vaccines, as long as separate syringes are used and the injections are given at different sites. If not given concurrently, live vaccines should be given at least four weeks apart.