Consumer medicine information

M-M-R II

Measles vaccine, live; Mumps vaccine, live; Rubella vaccine, live

BRAND INFORMATION

Brand name

M-M-R II

Active ingredient

Measles vaccine, live; Mumps vaccine, live; Rubella vaccine, live

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using M-M-R II.

What is in this leaflet

This leaflet answers some common questions about M-M-R II. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines and vaccines have risks and benefits. Your doctor has weighed the risks of you being given M-M-R II against the benefits they expect it will have for you.

If you have any concerns about being given this vaccine, ask your doctor or pharmacist.

Keep this leaflet. You may need to read it again.

What M-M-R II is used for

M-M-R II is a vaccine used to help protect people from getting measles, mumps and rubella (German measles). It can be given to people 12 months of age and older.

Protection against these infections is important as they can cause serious problems in some people.

Measles is a serious disease that causes a high fever (temperature), runny nose, cough, conjunctivitis and a rash. It usually lasts for about 1 to 2 weeks. It is very easily passed from one person to another in the tiny droplets of moisture which are expelled during coughing or sneezing. One out of every 10 children who catch measles will also have an ear infection or pneumonia. On rare occasions, measles can also cause an infection of the brain that could lead to seizures, hearing loss, mental retardation, and even death. Babies and adults who catch measles are often much sicker for a longer time or are more likely to die than school children and teenagers who catch measles.

Mumps causes fever, headache, and swollen, painful glands under the jaw (salivary glands) and usually lasts several days. It is easily passed from one person to another by the tiny droplets of moisture expelled during coughing or sneezing. Mumps can sometimes be a very serious disease, causing a mild inflammation of the coverings of the brain and spinal cord (meningitis) in about one person in every 10 who catch it. About one out of every 4 teenage or adult males with mumps will have a painful swelling of the testicles for several days. This does not usually affect their ability to father children, but can cause sterility in rare cases. Teenagers and adults, especially males, who catch mumps are often much sicker and more likely to suffer longer than children do.

Rubella is usually a mild disease that causes a mild fever, swollen glands in the neck, pain and swelling in the joints, and a rash that lasts for 2 or 3 days. Rubella is very dangerous if a pregnant woman catches it. Pregnant women who catch rubella can have babies who are stillborn, or have heart disease, blindness, deafness, or problems with learning. Rubella is also spread to others in the tiny droplets of moisture expelled during coughing or sneezing.

M-M-R II contains weakened strains of living measles, mumps and rubella viruses. These strains of live viruses cause either mild or no symptoms of infection. When injected the vaccine causes the body to produce its own protection by making disease-fighting substances (antibodies) against these infections. If a vaccinated child comes into contact with measles, mumps or rubella virus, the body is usually ready, and produces antibodies to destroy the virus. However, as with all vaccines, 100% protection against measles, mumps and rubella cannot be guaranteed. Also it may take up to 4-6 weeks for maximum protection to develop, so occasionally infections may occur during this time.

The chance of a severe reaction from M-M-R II is very small, but the risks from not being vaccinated are very serious.

Before you are given M-M-R II

When you or your child must not be given it

Do not have the vaccine if you have an allergy to M-M-R II or any of the ingredients listed at the end of this leaflet, including gelatin.

Do not have M-M-R II if you have a serious allergy to:

  • the antibiotic neomycin
  • eggs - this is because the strains of measles and mumps viruses used to make M-M-R II are grown in eggs.

Symptoms of a serious allergic reaction include swelling of the face, lips, tongue, throat, difficulty in breathing, or hives.

Do not have M-M-R II if:

  • you have an infection with fever (high temperature)
  • you have active untreated tuberculosis (TB)
  • you are taking medicines which decrease the body's immune defence system (eg, corticosteroids, cyclosporin, cancer medicines).
    This does not include taking corticosteroids (eg, cortisone, prednisone) as replacement therapy for Addison's disease.
  • you have diseases which decrease the body's immune defence system, such as cancers of the blood cells (eg, leukaemia, lymphoma) and AIDS

Do not have M-M-R II if you are pregnant. Also, do not become pregnant for 3 months after being given the vaccine.

Do not have M-M-R II if the expiry date on the pack has passed. If the vaccine is used after the expiry date has passed, it may not work.

If you are not sure whether you or your child should have M-M-R II, talk to your doctor.

Before you or your child are given it

Tell your doctor if:

  1. you have the following medical conditions or a family history of them:
  • febrile convulsions (fits or seizures due to a high temperature)
  • brain damage
  • epilepsy
  • low blood platelet count
  • HIV
  1. you have recently had a blood transfusion or been given immune serum globulins
    Your doctor may need to delay giving the vaccine for 3 months.
  2. you are breast feeding
    Your doctor will discuss the possible risks and benefits of you being given M-M-R II while breast-feeding.
  3. you have allergies to any other medicines or vaccines, or any other substances, such as foods, preservatives or dyes.
  4. you have a blood clotting disorder or bleed or bruise more easily. In this case your doctor will give you the vaccine under the skin (subcutaneously).

If you have not told your doctor about any of the above, tell them before you or your child are given M-M-R II.

Taking other medicines

Tell your doctor if you are taking any other medicines, including any that you buy without a prescription from your pharmacy, supermarket or health food shop.

M-M-R II may not work as well as it should if you or your child are taking medicines that decrease the immune system, such as corticosteroids (eg. prednisone) or cyclosporin.

Your doctor will advise you if you are taking any of these or other medicines that decrease the immune system. Your doctor will decide whether or not to give the vaccine.

M-M-R II should be given one month before or after administration of other vaccines. However, other schedules have been used. Your doctor will decide the vaccination schedule.

How M-M-R II is given

How much is given

The dose for children, teenagers and adults is 0.5 mL.

How it is given

M-M-R II is usually injected just under the skin or into the muscle (subcutaneously or intramuscularly) of the upper arm or in the area of the outer thigh by a doctor or trained nurse.

If your child has a blood-clotting disorder or bleeds or bruises more easily, the vaccine should be given under the skin because bleeding may occur following administration into the muscle.

The vaccine should not be injected directly into blood vessels (intravascularly).

Vaccination schedule

M-M-R II is usually given once to people 12 months of age or older. If the vaccine is given to children younger than 12 months old, a second injection should be given on or after 15 months of age.

Keep a record of your child's vaccinations and update this after each injection.

Keep your child's follow-up appointment with your doctor or clinic. It is important for your child to have the follow-up dose of M-M-R II, if indicated, at the appropriate time to make sure the vaccine has the best chance of providing protection against measles, mumps and rubella.

If you miss a dose

If you miss a scheduled dose, talk to your doctor and arrange another visit as soon as possible.

Side Effects

Tell your doctor or pharmacist as soon as possible if you or your child does not feel well during or after having had an injection of M-M-R II.

M-M-R II helps protect most people from measles, mumps and rubella, but it may have unwanted side effects in a few people. All medicines and vaccines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical treatment if you get some of the side effects.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor if you or your child have any of the following and they are troublesome or ongoing:

  • mild burning and/or stinging at the injection site
  • local reaction around the injection site such as soreness, redness, swelling, or a hard lump
  • fever, feeling unwell, sore throat, cough, runny or blocked nose
  • dizziness, headache
  • feeling sick (nausea), vomiting, diarrhoea
  • unsteadiness when walking
  • irritability
  • limited rash
  • swelling of the glands in the neck
  • swelling of the salivary glands (in front of the ear and/or under the back of the jaw)
  • unusual bleeding or bruising under the skin, and swelling of the testicles
  • swelling of the epididymis, a part of the male reproductive system
  • itchiness of the skin
  • Transient joint pain and/or swelling have occurred more frequently in adult females; sometimes these symptoms may be chronic

These are the more common side effects of M-M-R II. For the most part these have been mild. They usually improve or disappear within a few days.

Tell your doctor immediately if you notice any of the following:

  • rash all over the body
  • aches or pains in joints, arthritis
  • bruising or purple spots on the skin
  • swelling of the lungs causing coughing, difficulty breathing and wheezing with or without fever, chills, shortness of breath, cough, phlegm and occasionally blood

These are serious side effects. You may need urgent medical attention. Serious side effects are rare.

Tell your doctor immediately or go to accident and emergency at your nearest hospital if you or your child get any of the following:

  • a seizure or convulsion, which may or may not be accompanied by a very high fever
  • headache and fever, progressing to hallucinations, confusion, stiff neck and sensitivity to light
  • pain, numbness, or tingling of the hands, arms, legs or feet
  • fainting
  • severe blisters with bleeding in the lips, eyes, mouth, nose or genitals

These are serious side effects. You may need urgent medical attention. Serious side effects are rare.

Other side effects may also occur rarely and some of these may be serious. These include allergic reactions, seizures, and inflammation of the nervous system (brain and/or spinal cord).

Allergic Reaction:

As with all vaccines given by injection, there is a very small risk of a serious allergic reaction.

Tell your doctor immediately or go to accident and emergency if you notice any of the following:

  • wheezing or shortness of breath
  • swelling of the face, lips, mouth, throat or neck which may cause difficulty in swallowing or breathing
  • swelling of the hands, feet, or ankles
  • pinkish, itchy swellings on the skin, also called hives or nettlerash
  • skin rash, itchiness

If you have these, you may have had a serious allergic reaction to M-M-R II. You may need urgent medical attention or hospitalisation. Most of these side effects occur within 15-30 minutes of vaccination, before you or your child leave the doctor's surgery or clinic.

Other side effects not listed above may also occur in some people. Tell your doctor if you notice any other effects.

Tell your doctor promptly about any of these or any other unusual symptoms. If the condition persists or worsens, seek medical attention.

Do not be alarmed by this list of possible side effects. You or your child may not experience any of them.

Storage

M-M-R II is usually stored in the doctor's surgery or clinic, or at the pharmacy. However if you need to store M-M-R II:

  • Keep it where children cannot reach it.
  • Keep it in the refrigerator at a temperature between 2°C and 8°C, but not in the door compartment. Do not freeze it.
  • Protect the injection from light by keeping it in the original pack until it is time for it to be given.

Product description

What it looks like

M-M-R II comes as white powder in glass vials. It is reconstituted with a special diluent to make a solution suitable for injection.

Ingredients

The active ingredients of M-M-R II are weakened strains of measles, mumps and rubella (German measles) viruses.

Inactive ingredients:

  • neomycin
  • sorbitol
  • hydrolysed porcine gelatin
  • dibasic sodium phosphate
  • sucrose
  • monobasic sodium phosphate
  • dibasic potassium phosphate
  • monobasic potassium phosphate
  • phenolsulfonphthalein
  • sodium bicarbonate
  • monosodium glutamate monohydrate

This product may also contain residual recombinant human albumin, foetal bovine serum and other buffer and media ingredients.

The product contains no preservative.

The manufacture of this product includes exposure to bovine derived materials. No evidence exists that any case of vCJD (considered to be the human form of bovine spongiform encephalopathy) has resulted from the administration of any vaccine product.

Supplier

M-M-R II is supplied in Australia by:

Seqirus (Australia) Pty Ltd
63 Poplar Road
PARKVILLE VIC 3052

This leaflet was prepared in February 2020.

Australian Register Numbers:

AUST R 118449

AUST R 118451

AUST R 201877

(WPPI-V205C-I-092016)

Published by MIMS April 2020

BRAND INFORMATION

Brand name

M-M-R II

Active ingredient

Measles vaccine, live; Mumps vaccine, live; Rubella vaccine, live

Schedule

S4

 

Notes

Sponsored by Merck Sharp & Dohme (Australia) Pty Ltd

1 Name of Medicine

Measles, mumps and rubella virus vaccine live.

6.7 Physicochemical Properties

Chemical structure.

Not applicable.

CAS number.

Not applicable.

2 Qualitative and Quantitative Composition

M-M-R II is a sterile lyophilised preparation containing a more attenuated line of measles virus, derived from Enders' attenuated Edmonston strain and propagated in chick embryo cell cultures; the Jeryl Lynn (B level) strain of mumps virus propagated in chick embryo cell cultures; and the Wistar RA 27/3 strain of live attenuated rubella virus propagated in human diploid cell (WI-38) culture. The three viruses are mixed before being lyophilised.
The reconstituted vaccine is for subcutaneous (SC) or intramuscular (IM) administration. When reconstituted as directed, the dose for injection is 0.5 mL and contains not less than the equivalent of 1000 TCID50 (50% tissue culture infectious doses) of measles virus; 12,500 TCID50 of mumps virus; and 1000 TCID50 of rubella virus.
Powder for injection.
Before reconstitution, the lyophilised vaccine is a light yellow crystalline powder. M-M-R II, when reconstituted, is clear yellow.
Excipients with known effect: The vaccine contains 14.5 mg of sorbitol.
For the full list of excipients, see Section 6.1 List of Excipients.
This product may also contain residual recombinant human albumin, foetal bovine serum and other buffer and media ingredients.
The product contains no preservative.
The manufacture of this product includes exposure to bovine derived materials. No evidence exists that any case of vCJD (considered to be the human form of bovine spongiform encephalopathy) has resulted from the administration of any vaccine product.

3 Pharmaceutical Form

See Section 2 Qualitative and Quantitative Composition.

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Mechanism of action.

See Section 5.1 Pharmacodynamic Properties, Clinical trials.

Clinical trials.

Clinical studies of 284 triple seronegative children, 11 months to 7 years of age, demonstrated that M-M-R II is immunogenic in a high proportion of cases and generally well tolerated. In these studies, a single injection of the vaccine induced measles haemagglutination inhibition (HI) antibodies in 95 percent, mumps neutralising antibodies in 96 percent and rubella HI antibodies in 99 percent of susceptible persons. However, a small percentage (1-5%) of vaccinees may fail to seroconvert after the primary dose.
The RA 27/3 rubella strain in M-M-R II elicits higher immediate postvaccination HI, complement fixing and neutralising antibody levels than other strains of rubella vaccine and has been shown to induce a broader profile of circulating antibodies including antitheta and anti-iota precipitating antibodies. The RA 27/3 rubella strain immunologically simulates natural infection more closely than other rubella vaccine viruses. The increased levels and broader profile of antibodies produced by RA 27/3 strain rubella virus vaccine appear to correlate with greater resistance to subclinical reinfection with the wild type virus.
Vaccine induced antibody levels following administration of M-M-R II have been shown to persist for at least two years without substantial decline. However, continued surveillance will be required to establish the long-term persistence of antibodies following vaccination with M-M-R II.
A comparative study in 752 subjects aged 12 to 19 months who received M-M-R II either by intramuscular route or subcutaneous route demonstrated a similar immunogenicity profile between both administration routes.

5.2 Pharmacokinetic Properties

Absorption.

Not applicable.

Distribution.

Not applicable.

Metabolism.

Not applicable.

Excretion.

Not applicable.

5.3 Preclinical Safety Data

Genotoxicity.

No data available.

Carcinogenicity.

No data available.

4 Clinical Particulars

4.1 Therapeutic Indications

M-M-R II is indicated for simultaneous immunisation against measles, mumps and rubella.
Refer to the NHMRC Australian Immunisation Handbook (AIH) for vaccination recommendations and schedule.
There is some evidence to suggest that infants immunised against measles at less than 12 months of age, or who are born to mothers who had wild type measles and who are vaccinated at less than one year of age may not develop sustained antibody levels when later revaccinated. The advantage of early protection must be weighed against the chance for failure to respond adequately on reimmunisation.
Infants who are less than 12 months of age may fail to respond to one or more components of the vaccine due to presence in the circulation of residual antibodies of maternal origin, the younger the infant, the lower the likelihood of seroconversion. In geographically isolated or other relatively inaccessible populations for whom immunisation programmes are logistically difficult, and in population groups in which wild type measles infections may occur in a significant proportion of infants before 15 months of age, it may be desirable to give the vaccine to infants at an earlier age. Infants vaccinated under these conditions at less than 12 months of age should be revaccinated after reaching 12 to 15 months of age.
Previously unvaccinated children older than 12 months who are in contact with susceptible pregnant women should receive live attenuated rubella vaccine to reduce the risk of exposure of the pregnant woman.

Nonpregnant adolescent and adult females.

Immunisation of susceptible nonpregnant adolescent and adult females of childbearing age with live attenuated rubella virus vaccine is indicated if certain precautions are observed (see Section 4.4 Special Warnings and Precautions for Use; Section 4.6 Fertility, Pregnancy and Lactation). Vaccinating susceptible postpubertal females confers individual protection against subsequently acquiring rubella infection during pregnancy, which in turn prevents infection of the foetus and consequent congenital rubella injury. Congenital malformations do occur in up to seven percent of all live births, and their chance appearance after vaccination should be borne in mind.
Women of childbearing age should be advised not to become pregnant for three months after vaccination against rubella (which is included in M-M-R II) and should be informed of the reasons for this precaution. (See Section 4.6 Fertility, Pregnancy and Lactation, Use in pregnancy.)
The Australian Immunisation Handbook recommends that effort should be made to identify and immunise nonpregnant seronegative women of childbearing age.
Women of childbearing age who are potential candidates for vaccination can have serologic tests to determine susceptibility to rubella. However, rubella vaccination of a woman who is not known to be pregnant and has no history of vaccination is justifiable without serologic testing. Please refer to AIH for recommendations for further information regarding serological testing for immunity to rubella.
Postpubertal females should be informed of the frequent occurrence of generally self limited arthralgia and/or arthritis beginning 2 to 4 weeks after vaccination against rubella (see Section 4.8 Adverse Effects (Undesirable Effects)).

Postpartum women.

It has been found convenient in many instances to vaccinate rubella susceptible women in the immediate postpartum period using an appropriate rubella containing vaccine. (See Section 4.6 Fertility, Pregnancy and Lactation, Use in lactation.)

Revaccination.

Children vaccinated when younger than 12 months of age should be revaccinated at 12 to 15 months of age. Persons who were vaccinated originally when 12 months of age or older should be revaccinated with a MMR containing vaccine, as per the recommended vaccination schedule. Revaccination is intended to seroconvert those who did not respond to the first dose. However, data on long-term persistence of antibodies are limited and continued surveillance will be required to allow firm recommendations to be made on revaccination. However, persons should be revaccinated if there is evidence to suggest that initial immunisation was ineffective.

4.3 Contraindications

Hypersensitivity to any component of the vaccine, including gelatin.
Do not give M-M-R II to pregnant females; the possible effects of the vaccine on foetal development are unknown at this time. If vaccination of postpubertal females is undertaken for protection against rubella, pregnancy should be avoided for three months following vaccination. (See Section 4.6 Fertility, Pregnancy and Lactation, Use in pregnancy.)
Anaphylactic or anaphylactoid reaction to neomycin (each dose of reconstituted vaccine contains approximately 25 microgram of neomycin). A history of contact dermatitis to neomycin is not a contraindication; however, the possibility of a flare-up of skin lesions should be borne in mind.
History of anaphylactic or anaphylactoid reaction to eggs (see Section 4.4 Special Warnings and Precautions for Use, Hypersensitivity to eggs).
Any febrile respiratory illness or other active febrile infection.
Active untreated tuberculosis.
Patients receiving immunosuppressive therapy. This contraindication does not apply to patients who are receiving corticosteroids as replacement therapy, e.g. for Addison's disease.
Individuals with blood dyscrasias, leukaemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic systems.
Primary and acquired immunodeficiency states, including patients who are immunosuppressed in association with AIDS or other clinical manifestations of infection with human immunodeficiency viruses; cellular immune deficiencies; and hypogammaglobulinaemic and dysgammaglobulinaemic states.
Measles inclusion body encephalitis (MIBE), pneumonitis and death as a direct consequence of disseminated measles vaccine virus infection have been reported in severely immunocompromised individuals inadvertently vaccinated with measles containing vaccine.
Individuals with a family history of congenital or hereditary immunodeficiency, until the immune competence of the potential vaccine recipient is demonstrated.

4.4 Special Warnings and Precautions for Use

Adequate treatment provisions including adrenaline, should be available for immediate use should an anaphylactic or anaphylactoid reaction occur.
Patients should be observed for a sufficient period (at least 20 minutes) for the occurrence of early onset reactions seen with measles vaccine (see Section 4.8 Adverse Effects (Undesirable Effects)).
Due caution should be employed in administration of M-M-R II to persons with individual or family histories of convulsions, cerebral injury or any other condition in which stress due to fever should be avoided. The physician should be alert to the temperature elevation which may occur following vaccination (see Section 4.8 Adverse Effects (Undesirable Effects)).
Vaccination should be deferred for at least 3 months following blood or plasma transfusions, or administration of human immune serum globulin.
Excretion of small amounts of the live attenuated rubella virus from the nose or throat has occurred in the majority of susceptible individuals 7-28 days after vaccination. There is no confirmed evidence to indicate that such virus is transmitted to susceptible persons who are in contact with the vaccinated individuals. Consequently, transmission through close personal contact, while accepted as a theoretical possibility, is not regarded as a significant risk. However, transmission of the rubella vaccine virus to infants via breast milk has been documented (see Section 4.6 Fertility, Pregnancy and Lactation, Use in lactation).
There are no reports of transmission of live attenuated measles or mumps viruses from vaccinees to susceptible contacts.
It has been reported that live attenuated measles, mumps and rubella virus vaccines given individually may result in a temporary depression of tuberculin skin sensitivity. Therefore, if a tuberculin test is to be done, it should be administered either before or simultaneously with M-M-R II.
As for any vaccine, vaccination with M-M-R II may not result in seroconversion in 100% of susceptible persons given the vaccine.

Hypersensitivity to eggs.

Live measles vaccine and live mumps vaccine are produced in chick embryo cell culture. Persons with a history of anaphylactic or anaphylactoid or other immediate reactions (e.g. hives, swelling of the mouth and throat, difficulty in breathing, hypotension or shock) subsequent to egg ingestion may be at an enhanced risk of immediate type hypersensitivity reactions after receiving vaccines containing traces of chick embryo antigen and should not be vaccinated with M-M-R II.
The potential risk to benefit ratio should be carefully evaluated before considering vaccination in such cases. Such individuals may be vaccinated with extreme caution, having adequate treatment on hand should a reaction occur.

Thrombocytopenia and coagulation disorders.

This vaccine should be given subcutaneously to individuals with thrombocytopenia or any coagulation disorder because bleeding may occur following an intramuscular administration in these individuals. Individuals with current thrombocytopenia may develop more severe thrombocytopenia following vaccination. In addition, individuals who experienced thrombocytopenia with the first dose of M-M-R II (or its component vaccines) may develop thrombocytopenia with repeat doses. Serologic status may be evaluated to determine whether or not additional doses of vaccine are needed. The potential risk to benefit ratio should be carefully evaluated before considering vaccination in such cases (see Section 4.8 Adverse Effects (Undesirable Effects)).

Use in the elderly.

No data available.

Paediatric use.

Safety and effectiveness of measles vaccine in infants below the age of 6 months have not been established. Safety and effectiveness of mumps and rubella vaccine in infants less than 12 months of age have not been established.

Other.

Children and young adults who are known to be infected with human immunodeficiency viruses and are not immunosuppressed may be vaccinated. However, the vaccinees who are infected with HIV should be monitored closely for vaccine preventable diseases because immunisation may be less effective than for uninfected persons (see Section 4.3 Contraindications).
Children under treatment for tuberculosis have not experienced exacerbation of the diseases when immunised with live measles virus vaccine; no studies have been reported to date of the effect of measles virus vaccines on untreated tuberculosis children.

Effects on laboratory tests.

See Section 4.4 Special Warnings and Precautions for Use for further information.

4.5 Interactions with Other Medicines and Other Forms of Interactions

Administration of immune globulins concurrently with M-M-R II may interfere with the expected immune response. Vaccination should be deferred for 3 months or longer following administration of immune globulin (human) and blood or plasma transfusions.

Use with other vaccines.

M-M-R II should not be given less than one month before or after administration of other live viral vaccines.
Routine administration of DTP (diphtheria, tetanus, pertussis) and/or OPV (oral poliovirus vaccine) concomitantly with measles, mumps and rubella vaccines is not recommended because there are insufficient data relating to the simultaneous administration of these antigens. However, in some circumstances, particularly when the patient may not return, some practitioners prefer to administer all these antigens on a single day. If done, separate sites and syringes should be used for DTP and M-M-R II.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No data available.
(Category B2)
Currently available live virus vaccines have not caused teratogenic effects in humans. Caution needs to be exercised as live virus vaccines have been shown to cross the placenta and infect the foetus. Some live virus vaccines have caused birth defects in animals.
It is not known whether M-M-R II can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Therefore, the vaccine should not be administered to pregnant females; furthermore pregnancy should be avoided for three months following vaccination (see Section 4.3 Contraindications).
Women of childbearing age should be tested for rubella antibodies prior to pregnancy. All seronegative women, provided they are not pregnant, should be offered rubella vaccine.
In counselling women who are inadvertently vaccinated when pregnant or who become pregnant within 3 months of vaccination, the physician should be aware of the following: (1) in a 10 year survey involving over 700 pregnant women who received rubella vaccine within 3 months before or after conception (of whom 189 received the Wistar RA 27/3 strain), none of the newborns had abnormalities compatible with congenital rubella syndrome; (2) mumps infection during the first trimester of pregnancy may increase the rate of spontaneous abortion. Although mumps vaccine virus has been shown to infect the placenta and fetus, there is no evidence that it causes congenital malformations in humans; and (3) reports have indicated that contracting of wild type measles during pregnancy enhances fetal risk. Increased rates of spontaneous abortion, stillbirth, congenital defects and prematurity have been observed subsequent to infection with wild type measles during pregnancy. There are no adequate studies of the attenuated (vaccine) strain of measles virus in pregnancy. However, it would be prudent to assume that the vaccine strain of virus is also capable of inducing adverse fetal effects. Based on this experience, rubella vaccination during pregnancy need not be the reason to recommend interruption of pregnancy. The final decision must be made by the patient and her physician.
It is not known whether measles or mumps vaccine virus is secreted in human milk. Recent studies have shown that lactating postpartum women immunised with live attenuated rubella vaccine may secrete the virus in breast milk and transmit it to breastfed infants.
In the infants with serological evidence of rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of acquired rubella. Caution should be exercised when M-M-R II is administered to a nursing woman. (See Section 4.1 Therapeutic Indications, Postpartum women.)

4.8 Adverse Effects (Undesirable Effects)

The adverse reactions associated with the use of M-M-R II are those which have been reported following administration of the combination vaccines.

Common.

Burning and/or stinging of short duration at the injection site.

Occasional.

Body as a whole.

Fever (38.3°C or higher).

Skin.

Rash, or measles-like rash, usually minimal but may be generalised. Generally, fever, rash, or both appear between the 5th and the 12th days.

Rare.

Body as a whole.

Mild local reactions such as erythema, induration and tenderness; sore throat, malaise, atypical measles, syncope, irritability.

Cardiovascular.

Vasculitis.

Digestive.

Parotitis, nausea, vomiting, diarrhoea.

Haematologic/lymphatic.

Regional lymphadenopathy, thrombocytopenia, purpura.

Hypersensitivity.

Allergic reactions such as wheal and flare at injection site, anaphylaxis and anaphylactoid reactions, as well as related phenomena such as angioneurotic oedema (including peripheral or facial oedema) and bronchial spasm, urticaria in individuals with or without an allergic history.

Musculoskeletal.

Arthralgia and/or arthritis (usually transient and rarely chronic (see below)), myalgia.

Nervous/psychiatric.

Febrile convulsions in children, afebrile convulsions or seizures, headache, dizziness, paresthesia, polyneuritis, polyneuropathy, Guillain-Barre syndrome, ataxia, acute disseminated encephalomyelitis (ADEM), transverse myelitis, aseptic meningitis (see below), measles inclusion body encephalitis (MIBE) (see Section 4.3 Contraindications), encephalitis/encephalopathy (see below).

Respiratory system.

Pneumonia, pneumonitis (see Section 4.3 Contraindications), cough, rhinitis.

Skin.

Erythema multiforme, Stevens-Johnson syndrome, Henoch-Schönlein purpura, acute haemorragic oedema of infancy, vesiculation at injection site, swelling, pruritus.

Special senses.

Forms of optic neuritis, including retrobulbar neuritis, papillitis, and retinitis; ocular palsies, otitis media, nerve deafness, conjunctivitis.

Urogenital.

Epididymitis, orchitis.

Other.

Death from various, and in some cases unknown, causes has been reported rarely following vaccination with measles, mumps and rubella vaccines; however, a causal relationship has not been established in healthy individuals (see Section 4.3 Contraindications). No deaths or permanent sequelae were reported in a published post-marketing surveillance study in Finland involving 1.5 million children and adults who were vaccinated with M-M-R II during 1982 to 1993.

Children who received M-M-R II intramuscularly.

In a clinical trial of 752 children aged 12-19 months who received M-M-R II, either intramuscularly or subcutaneously. The general safety profile of either administration routes were comparable, although injection-site reactions were less frequent in the IM group (15.8%) compared with the SC group (25.8%).

Arthralgia and/or arthritis.

Arthralgia and/or arthritis (usually transient and rarely chronic), and polyneuritis are features of injection with wild type rubella and vary in frequency and severity with age and sex, being greatest in adult females and least in prepubertal children.
Chronic arthritis has been associated with wild type rubella infection and has been related to persistent virus and/or viral antigen isolated from body tissues. Only rarely have vaccine recipients developed chronic joint symptoms.
Following vaccination in children, reactions in joints are uncommon and generally of brief duration. In women, incidence rates for arthritis and arthralgia are generally higher than those seen in children (children: 0-3%; women: 12-20%), and the reactions tend to be more marked and of longer duration. Symptoms may persist for a matter of months or, on rare occasions, for years. In adolescent girls, the reactions appear to be intermediate in incidence between those seen in children and in adult women. Even in older women (35-45 years), these reactions are generally well tolerated and rarely interfere with normal activities.

Subacute sclerosing panencephalitis (SSPE).

There have been reports of subacute sclerosing panencephalitis (SSPE) in children who did not have a history of wild type measles but did receive measles vaccine. Some of these cases may have resulted from unrecognised measles in the first year of life or possibly from the measles vaccination. Based on estimated measles vaccine distribution in the U.S.A., the Centre for Disease Control have estimated that the association of SSPE cases to measles vaccination is about one case per million vaccine doses distributed. This is far less than the association with wild type measles, 6-22 cases of SSPE per million cases of measles in the U.S.A. The results of a retrospective case controlled study conducted by the Centre for Disease Control suggest that the overall effect of measles vaccine appears to be to protect against SSPE by preventing measles with its inherent high risk of SSPE.

Aseptic meningitis.

Cases of aseptic meningitis have been reported following measles, mumps, and rubella vaccination. Although a causal relationship between the Urabe strain of mumps vaccine and aseptic meningitis has been shown, there is no evidence to link Jeryl Lynn mumps vaccine to aseptic meningitis.

Encephalitis/encephalopathy.

Encephalitis/encephalopathy have been reported approximately once for every 3 million doses of the measles, mumps, and rubella vaccine manufactured by Merck & Co., Inc. Since 1978, post-marketing surveillance indicates that serious adverse events such as encephalitis and encephalopathy continue to be rarely reported. The risk of such serious neurological disorders following live measles virus vaccine administration remains far less than that for encephalitis and encephalopathy with wild type measles (one per one thousand reported cases).
In severely immunocompromised individuals inadvertently vaccinated with measles containing vaccine, measles inclusion body encephalitis, pneumonitis, and fatal outcome as a direct consequence of disseminated measles vaccine virus infection have been reported (see Section 4.3 Contraindications); disseminated mumps and rubella vaccine virus infection have also been reported.
The Centre for Disease Control has pointed out that a certain number of cases of encephalitis may be expected to occur in a large childhood population in a defined period of time even when no vaccines are administered. However, CNS adverse reactions, such as encephalitis and encephalopathy occurring within 30 days after vaccination, have been associated with measles vaccine approximately once every million doses. The risk of such serious neurological disorders following live measles virus vaccine administration is believed to be far less than that for encephalitis and encephalopathy with wild type measles (one per two thousand reported cases).

Panniculitis.

Panniculitis has been reported rarely following administration of measles vaccine.
Forms of optic neuritis, including retrobulbar neuritis, papillitis and retinitis, may infrequently follow viral infections, and have been reported to occur 1 to 3 weeks following inoculation with some live virus vaccines; otitis media and conjunctivitis.
Infrequently, reactions comprising choking or cough, vomiting, respiratory difficulty and cyanosis have been reported within 30 minutes of vaccination. These reactions generally pass off without any treatment. However, appropriate equipment, medicines and personnel to manage the acute reaction should be readily available (see Section 4.4 Special Warnings and Precautions for Use).
Clinical experience with live attenuated measles, mumps, and rubella virus vaccines given individually indicates that encephalitis and other nervous system reactions have occurred very rarely. These might occur also with M-M-R II.
There have been isolated reports of ocular palsies and Guillain-Barre syndrome occurring after immunisation with vaccines containing live attenuated measles virus. The ocular palsies have occurred approximately 3-24 days following vaccination. No definite causal relationship has been established between either of these events and vaccination. Isolated reports of polyneuropathy including Guillain-Barre syndrome have also been reported after immunisation with rubella containing vaccines. Measles inclusion body encephalitis (MIBE) has occurred (see Section 4.3 Contraindications).

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.2 Dose and Method of Administration

For subcutaneous or intramuscular administration. Do not inject intravascularly.
The preferred injection sites are the anterolateral area of the thigh in younger children and the deltoid area in older children, adolescents, and adults.
The vaccine should be administered subcutaneously in patients with thrombocytopenia or any coagulation disorder.
Refer to the Australian NHMRC Immunisation Handbook for vaccination recommendations and schedule. This handbook is available online at http://www.immunise.health.gov.au.
Do not give immune globulin (IG) concurrently with M-M-R II. (See Section 4.5 Interactions with Other Medicines and Other Forms of Interactions.)
The dosage of vaccine is the same for all persons. Inject the total volume of the single dose vial (about 0.5 mL) subcutaneously, preferably into the outer aspect of the upper arm.

Caution.

A sterile syringe free of preservatives, antiseptics, and detergents should be used for each injection and/or reconstitution of the vaccine because these substances may inactivate the live virus vaccine. A 25 gauge, 16 mm needle is recommended.
To reconstitute, use only the diluent supplied, since it is free of preservatives or other antiviral substances which might inactivate the vaccine.
Parenteral drug products should be inspected visually for particulate matter and discolouration prior to administration whenever solution and container permit.

Single dose vial.

Product is for single use in one patient only. Discard any residue.
The product may be reconstituted using diluent supplied in a vial or prefilled syringe. If using diluent from a vial, first withdraw the entire volume of diluent into the syringe to be used for reconstitution.
Inject all the diluent in the syringe into the vial of lyophilised vaccine, and agitate to mix thoroughly. Withdraw the entire contents into a syringe and inject the total volume of reconstituted vaccine subcutaneously.
It is important to use a separate sterile syringe and needle for each individual patient to prevent transmission of infectious agents from one person to another.
Each dose contains not less than the equivalent of 1000 TCID50 of measles virus, 12,500 TCID50 of mumps virus and 1000 TCID50 of rubella virus. Each dose contains approximately 25 microgram neomycin, an antibiotic.

4.7 Effects on Ability to Drive and Use Machines

The effects of this medicine on a person's ability to drive and use machines were not assessed as part of its registration.

4.9 Overdose

Overdose has been reported rarely and was not associated with any serious adverse events.
For information on the management of overdose, contact the Poison Information Centre on 131126 (Australia).

7 Medicine Schedule (Poisons Standard)

S4.

6 Pharmaceutical Particulars

6.1 List of Excipients

Sorbitol, monobasic sodium phosphate, dibasic potassium phosphate, dibasic sodium phosphate, monobasic potassium phosphate, hydrolysed porcine gelatin, phenolsulfonphthalein, sodium bicarbonate, sucrose, neomycin, monosodium glutamate monohydrate.

6.2 Incompatibilities

Not applicable. See Section 4.5 Interactions with Other Medicines and Other Forms of Interactions for further information.

6.3 Shelf Life

The expiry date can be found on the packaging. In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG).

6.4 Special Precautions for Storage

Before reconstitution, store the vial of lyophilised vaccine at 2-8°C or colder. The diluent may be stored in the refrigerator with the lyophilised vaccine or separately at room temperature. Do not freeze the diluent.
To reduce microbiological hazard, it is recommended the vaccine be used as soon as possible after reconstitution. If storage of reconstituted vaccine is necessary, store in a dark place at 2°C-8°C and discard if not used within 8 hours.
The vaccine must be maintained at a temperature of 2-8°C during shipment, to ensure that there is no loss of potency. Freezing during shipment will not affect potency of the vaccine.
Protect the vaccine from light at all times, since such exposure may inactivate the viruses.

6.5 Nature and Contents of Container

M-M-R II is supplied as:
(1) a combination pack of a single-dose vial of lyophilised vaccine and a diluent-containing syringe.
(2) a box of ten combination packs of single-dose vials of lyophilised vaccine with diluent-containing syringes.
(3) a single-dose vial of lyophilised vaccine and a vial of diluent.
(4) a box of five combination packs of single-dose vials of lyophilized vaccine with diluent-containing vials.
(5) a box of ten combination packs of single-dose vials of lyophilised vaccine with diluent-containing vials.
(6) a single-dose vial of lyophilised vaccine, with diluent supplied separately.
(7) a box of ten single-dose vial of lyophilized vaccine, with diluent supplied separately.
Combination pack containing lyophilised vaccine and diluent together should be stored at 2-8°C.
Not all presentations and pack sizes may be marketed.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of by taking to your local pharmacy.

Summary Table of Changes