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Hanson KE, Marin M, Daley MF, Groom HC, Jackson LA, Sy LS, Klein NP, DeSilva MB, Panagiotakopoulos L, Weintraub E, Belongia EA, McLean HQ. Safety of measles, mumps, and rubella vaccine in adolescents and adults in the vaccine safety Datalink. Vaccine X 2023; 13:100268. [PMID: 36814595 PMCID: PMC9939709 DOI: 10.1016/j.jvacx.2023.100268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/13/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
Background Measles, mumps, and rubella vaccine (MMR) is routinely administered to children; however, adolescents and adults may receive MMR for various reasons. Safety studies in adolescents and adults are limited. We report on safety of MMR in this age group in the Vaccine Safety Datalink. Methods We included adolescents (aged 9-17 years) and adults (aged ≥ 18 years) who received ≥ 1 dose of MMR from January 1, 2010-December 31, 2018. Pre-specified outcomes were identified by diagnosis codes. Clinically serious outcomes included anaphylaxis, encephalitis/myelitis, Guillain-Barré syndrome, immune thrombocytopenia, meningitis, and seizure. Non-serious outcomes were allergic reaction, arthropathy, fever, injection site reaction, lymphadenopathy, non-specific reaction, parotitis, rash, and syncope. All serious outcomes underwent medical record review. Outcome-specific incidence was calculated in pre-defined post-vaccination windows. A self-controlled risk interval design was used to determine the relative risk of each outcome in a risk window after vaccination compared to a more distal control window. Results During the study period, 276,327 MMR doses were administered to adolescents and adults. Mean age of vaccinees was 34.8 years; 65.8 % were female; 53.2 % of doses were administered simultaneously with ≥ 1 other vaccine. Serious outcomes were rare, with incidence ≤ 6 per 100,000 doses for each outcome assessed, and none had a significant elevation in incidence during the risk window compared to the control window. Incidence of non-serious outcomes per 100,000 doses ranged from 3.4 for parotitis to 263.0 for arthropathy. Other common outcomes included injection site reaction and rash (157.0 and 112.9 per 100,000 doses, respectively). Significantly more outcomes were observed during the risk window compared to the control window for all non-serious outcomes except parotitis. Some variability was observed by sex and age group. Conclusion Serious outcomes after MMR are rare in adolescents and adults, but vaccinees should be counseled regarding anticipated local and systemic non-serious adverse events.
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Key Words
- ACIP, Advisory Committee on Immunization Practices
- Adolescents
- Adults
- CDC, Centers for Disease Control and Prevention
- CI, confidence interval
- ED, emergency department
- GBS, Guillain-Barré syndrome
- ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification
- ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification
- IQR, interquartile range
- ITP, immune thrombocytopenia
- MMR
- MMR, measles, mumps, and rubella vaccine
- MMRV, measles, mumps, rubella, and varicella vaccine
- RR, relative risk
- SCRI, self-controlled risk interval
- Safety
- VAERS, Vaccine Adverse Event Reporting System
- VSD, Vaccine Safety Datalink
- Vaccine
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Affiliation(s)
- Kayla E. Hanson
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 N Oak Ave, ML2, Marshfield, WI 54449, United States,Corresponding author at: Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 North Oak Avenue, ML2, Marshfield, WI 54449, United States.
| | - Mona Marin
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA 30333, United States
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S Parker Rd, Suite 200, Aurora, CO 80014, United States
| | - Holly C. Groom
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227, United States
| | - Lisa A. Jackson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, United States
| | - Lina S. Sy
- Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA 91101, United States
| | - Nicola P. Klein
- Vaccine Study Center, Kaiser Permanente Northern California, 1 Kaiser Plaza, Oakland, CA 94612, United States
| | - Malini B. DeSilva
- HealthPartners Institute, 8170 33 Ave S, Bloomington, MN 55425, United States
| | - Lakshmi Panagiotakopoulos
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS V18-4, Atlanta, GA 30333, United States
| | - Eric Weintraub
- Immunization Safety Office, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS V18-4, Atlanta, GA 30333, United States
| | - Edward A. Belongia
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 N Oak Ave, ML2, Marshfield, WI 54449, United States
| | - Huong Q. McLean
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, 1000 N Oak Ave, ML2, Marshfield, WI 54449, United States
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Kuter BJ, Marshall GS, Fergie J, Schmidt E, Pawaskar M. Prevention of measles, mumps and rubella: 40 years of global experience with M-M-R II. Hum Vaccin Immunother 2021; 17:5372-5383. [PMID: 35130794 PMCID: PMC8903938 DOI: 10.1080/21645515.2021.2007710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Measles, mumps, and rubella are highly contagious diseases that caused significant global mortality and morbidity in the pre-vaccine era. Since its first approval in the United States over 40 years ago, M-M-RII has been used in >75 countries for prevention of these diseases. The vaccine has been part of immunization programs that have achieved dramatic global reductions in case numbers and mortality rates, as well as the elimination of measles and rubella in several countries and regions. This report summarizes over four decades of global safety, immunogenicity, efficacy, and effectiveness data for the vaccine. We include studies on the use of M-M-RII in different age groups, concomitant use with other routine childhood vaccines, administration via different routes, persistence of immunity, and vaccine effectiveness during outbreaks of measles and mumps. We conclude that M-M-RII is well tolerated and has shown consistently high performance during routine use in multiple countries, in randomized controlled trials with diverse designs, and in outbreak settings, including use as measles postexposure prophylaxis. Physicians, parents, and the public can continue to have a high degree of confidence in the use of M-M-RII as a vital part of global public health programs.
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Affiliation(s)
| | - Gary S. Marshall
- Norton Children’s and University of Louisville School of Medicine, Louisville, KY, USA
| | - Jaime Fergie
- Infectious Diseases, Driscoll Children’s Hospital, Corpus Christi, TX, USA
| | - Elvira Schmidt
- Certara Germany GmbH, Evidence and Access, Loerrach, Germany
| | - Manjiri Pawaskar
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA,CONTACT Manjiri Pawaskar Merck & Co., Inc., Center for Observational and Real-World Evidence, 351 North Sumneytown Pike, North Wales, PA19454, USA
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