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Evidence summaries

Vaccines for Measles, Mumps and Rubella and Varicella in Children

MMRvaccination and MMRV vaccination appear highly effective in preventing clinical measles (HASH(0x2f82cc8) 95%), mumps (HASH(0x2f82cc8) 86%), rubella(HASH(0x2f82cc8) 89%) and varicella (HASH(0x2f82cc8) 95%) cases in children and adolescents. Level of evidence: "B"

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).

Vaccine effectiveness against measles/mumps/rubella/varicella

OutcomeRelative effect(95% CI)Risk of measlesamongstunvaccinated(Control)Risk of measlesamongstvaccinated (intervention) (95% CI)of participants(studies)Certainty of the evidence
Measles: Cohort studies - 1 doseRR 0.05(0.02 to 0.13)66 per 10003 per 1000(1 to 9)12039(7 observational studies)Moderate
Measles: Cohort studies - 2 dosesRR 0.04(0.01 to 0.28)19 per 10001 per 1000(0 to 5)21604(5 observational studies) Moderate
OutcomeRelative 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 doseRR 0.24(0.08 to 0.76)91 per 100022 per 1000(7 to 69)9915(6 observational studies) Moderate
Mumps: Cohort studies - Jeryl Lynn strain - 2 dosesRR 0.12(0.04 to 0.35)74 per 10009 per 1000(3 to 26)7792(5 observational studies) Moderate
OutcomeRelative 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 strainRR 0.11(0.03 to 0.42)--1621 (1 observational study)Moderate
OutcomeRelative 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 yearsRR 0.05(0.03 to 0.08)271 per 100014 per 1000(8 to 22)3022(1 RCT) High
Varicella: MMRV randomised controlled trial - any severity - 2 doses, follow-up 5 - 10 yearsRR 0.05(0.04 to 0.06)437 per 100022 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).

References

  • Di Pietrantonj C, Rivetti A, Marchione P et al. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev 2020;(4):CD004407. [PubMed]

Primary/Secondary Keywords