A Cochrane review [Abstract] 1 included 138 studies with a total of 10 248 159 children. The review assessed the effectiveness and safety of the trivalent vaccine, containing measles, rubella, mumps strains (MMR), or concurrent administration of MMR vaccine and varicella vaccine (MMR+V), or tetravalent vaccine containing measles, rubella, mumps, and varicella strains (MMRV), given to children aged up to 15 years. Vaccine effectiveness was high (table T1).
| Outcome | Relative effect(95% CI) | Risk of measlesamongstunvaccinated(Control) | Risk of measlesamongstvaccinated (intervention) (95% CI) | №of participants(studies)Certainty of the evidence |
|---|---|---|---|---|
| Measles: Cohort studies - 1 dose | RR 0.05(0.02 to 0.13) | 66 per 1000 | 3 per 1000(1 to 9) | 12039(7 observational studies)Moderate |
| Measles: Cohort studies - 2 doses | RR 0.04(0.01 to 0.28) | 19 per 1000 | 1 per 1000(0 to 5) | 21604(5 observational studies) Moderate |
| Outcome | Relative effect(95% CI) | Risk of mumpsamongstunvaccinated(Control) | Risk of mumpsamongstvaccinated (intervention) (95% CI) | №of participants(studies)Certainty of the evidence |
| Mumps: Cohort studies - Jeryl Lynn strain - 1 dose | RR 0.24(0.08 to 0.76) | 91 per 1000 | 22 per 1000(7 to 69) | 9915(6 observational studies) Moderate |
| Mumps: Cohort studies - Jeryl Lynn strain - 2 doses | RR 0.12(0.04 to 0.35) | 74 per 1000 | 9 per 1000(3 to 26) | 7792(5 observational studies) Moderate |
| Outcome | Relative effect(95% CI) | Risk of rubellaamongstunvaccinated(Control) | Risk of rubellaamongstvaccinated (intervention) (95% CI) | №of participants(studies)Certainty of the evidence |
| Rubella: Cohort studies secondary cases - any strain | RR 0.11(0.03 to 0.42) | - | - | 1621 (1 observational study)Moderate |
| Outcome | Relative effect(95% CI) | Risk of varicellaamongstunvaccinated(Control) | Risk of varicellaamongstvaccinated (intervention) (95% CI) | №of participants(studies)Certainty of the evidence |
| Varicella: MMRV randomised controlled trial - any severity - 2 doses, follow-up at 5 years | RR 0.05(0.03 to 0.08) | 271 per 1000 | 14 per 1000(8 to 22) | 3022(1 RCT) High |
| Varicella: MMRV randomised controlled trial - any severity - 2 doses, follow-up 5 - 10 years | RR 0.05(0.04 to 0.06) | 437 per 1000 | 22 per 1000(17 to 26) | 3023(1 RCT) High |
There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rate ratio 1.30, 95% CI 0.66 to 2.56). There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01). Additionally, there is no evidence supporting an association between MMR immunisation and cognitive delay, type 1 diabetes, asthma, dermatitis/eczema, hay fever, leukaemia, multiple sclerosis, gait disturbance, and bacterial or viral infections.
Comment: The quality of evidence is upgraded one level for large effect size (non-critical risk of bias in studies).
Primary/Secondary Keywords