Measles is a highly infectious disease that can cause complications such as pneumonia and encephalitis. Measles-containing vaccines provide protection against measles, mumps, rubella, and sometimes varicella, and are recommended for children and travelers. Two common measles-containing vaccines are MMR, which protects against measles, mumps, and rubella, and MMRV, which also protects against varicella. Potential adverse effects of these vaccines include fever, rash and injection site reactions. No evidence was found that measles-containing vaccines increase the risk of autism.

1. 1 | N a c k e r d i e n
MEASLES-CONTAINING VACCINES*
Given the controversy regarding an association between measles-containing-vaccines and
autism,1 I have been provided a summary of some of the latest evidence.
Measles ─ a ubiquitous, highly infectious (90% of people close to an infected person who lack
immunity to measles are likely to become infected)2 disease contracted by direct contact or
passed through air ─ is caused by the Morbillivirus (spherical RNA virus belonging to the family
Paramyxoviridae).3 This illness is accompanied by the following symptoms: rash, cough, runny
nose, eye irritation, and fever. Although measles is preventable with effective vaccination,
measles remains one of the leading causes of death among young children across the globe.4
Moreover, complications in poorly nourished or immunocompromised individuals include
pneumonia, laryngotracheitis, otitis media, and encephalitis.3
International travelers (6 months and older), non-immunized adults, and children at least 12
months of age (unless otherwise recommended by public health authorities e.g., during
outbreaks) are candidates for preventive immunization with measles-containing vaccines
according to a pre-specified schedule.2,5 Depending on the composition of each cocktail, the
measles-containing vaccines can provide protection against mumps (causes fever, headache, and
swollen glands), rubella (German measles: causes rash, mild fever, and arthritis [mostly in
women]), and chickenpox (varicella, causes rash, itching, fever, and tiredness) in addition to
generating immunity against measles. Parents may opt to have one of two measles-containing
vaccines administered to their children i.e., the measles-mumps-rubella (MMR; varicella vaccine
given as an additional shot) or measles-mumps-rubella-varicella (MMRV) vaccine.6
* Disclaimer: Information in this paper should be used for research purposes only and do not imply any
endorsement. Please consult your doctorfor any medical advice.
Considerations for initially immunizing a child with two separate shots (three-virus-cocktail
and addition of a varicella vaccine) or with one shot containing an attenuated-four-virus-
cocktail can be found on the US Centers for Disease Control and Prevention site. Parents
should alert doctors of any personal or family history of seizures or a brain injury, if a child
has received blood or plasma transfusions or human serum globulin, or if the child has
active, untreated tuberculosis. In addition, a healthcare provider should be alerted of any
allergies (including allergies to eggs or a prior vaccine), any prescribed or non-prescribed
medications, and any pregnancies or intention to become pregnant within three months
following vaccination.

2. 2 | N a c k e r d i e n
SELECTED INDICATIONS
 A pre-specified immunization regimen of ATTENUVAX®(MERCK,M-M-R®II
[MEASLES, MUMPSAND RUBELLAVIRUSVACCINELIVE]) with precautions, in the
case of non-pregnant adolescent and adult females of child-bear†ing age who are
susceptible to rubella, and (generally) for individuals ≥1 year old has been recommended
by the United States Food and Drug Administration (FDA).5
 Similarly, PROQUAD®(MERCK)has been approved by the FDA for prevention of
measles, mumps, rubella, and varicella in children 12 months through 12 years of age.7
COMMON ADVERSE EVENTS (TYPICALLYIN ≥1-5%OF CASES)
Injection-site reactions, fever, irritability (for a full list, consult doctor and prescribing
information).
Systemic adverse events that have been reported at a significantly greater rate with Proquad®
versus component vaccines administered concomitantly are fever and measles-like rash.
WHO SHOULD NOT TAKE MEASLES-CONTAINING VACCINES
 Pregnant women or females intending to fall pregnant within three months following
vaccination
 Anyone allergic to any of the vaccine components (see patient inserts for separate
vaccines)
 Anyone with a weakened immune system, such as an immune deficiency, an inherited
immune disorder, leukemia, lymphoma, or HIV/AIDS;
 Anyone receiving high-dose steroid therapy (given orally or via injection)
 Anyone with a fever higher than 101.3°F (38.5°C); Drug should be discontinued in
nursing mothers
No convincing evidence was found that early exposure of children to a
combined measles-mumps-rubella vaccination and increasing thimerosal dose
was accompanied by an increased risk of onset of autism-spectrum-disorder
(ASD).1

3. 3 | N a c k e r d i e n
WHAT ARE THE INGREDIENTS OF SELECTEDVACCINES?
ATTENUVAX®8
Active Ingredients: weakened forms of the measles, mumps, and rubella viruses.
Inactive Ingredients: sorbitol, sodium phosphate, potassium phosphate, sucrose, sodium chloride,
hydrolyzed gelatin, recombinant human albumin, fetal bovine serum, other buffer and media
ingredients, neomycin.
PROQUAD®
Each 0.5-mL dose of the vaccine nominally contains 20 mg of sucrose, 11 mg of hydrolyzed
gelatin, 2.5 mg of urea; 2.3 mg of sodium chloride, 16 mg of sorbitol, 0.38 mg of monosodium
L-glutamate, 0.14 mg of sodium phosphate, 0.25 mg of human albumin, 0.13 mg of sodium
bicarbonate, 94 mcg of potassium phosphate, 58 mcg of potassium chloride; residual components
of MRC-5 cells including DNA and protein; 5 mcg of neomycin, bovine serum albumin (0.5
mcg), and other buffer and media ingredients.7
REFERENCES
1 Uno, Y., Uchiyama, T., Kurosawa, M., Aleksic, B. & Ozaki, N. Vaccine, 2015
2 US Centers for Disease Control and Prevention. Transmission of Measles.,
http://www.cdc.gov/measles/about/transmission.html.
3 Epocrates online (BMJ). Measles infection,
https://online.epocrates.com/u/2911217/Measles+infection.
4 World Health Organization. Measles. Fact sheet No. 286.,
http://www.who.int/mediacentre/factsheets/fs286/en/, 2014.
5 US Food and Drug Administration. M-M-R® II (Measles, mumps, and rubella vaccine live)
http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM1237
89.pdf, 2014.
6 United States Centers for Disease Control and Prevention. Vaccines and Immunizations:
Vaccination Options for Preventing Measles, Mumps, Rubella and Varicella.,
http://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmrv/vacopt.htm, 2015.
7 US Food and Drug Administration. Measles, Mumps, Rubella and Varicella Virus Vaccine
Live (Proquad®; refrigerated),
http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM1237
93.pdf.
8 US Food and Drug Administration. Patient Information about M-M-R® .
http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM3750
80.pdf, 2014.