London MMR: Single MMR Vaccinations, Mumps, Measles and Rubella and where to get vaccinated in London
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Frequently Asked Questions
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Mumpsvax no longer available from Merck
Mumpsvax no longer available from Merck - 13/11/2009
Unfortunately, much to our shock and dismay, Merck have announced that they have decided not to resume production of the single vaccines for Measles (Attenuvax), Rubella (Rudivax) and Mumps (Mumpsvax).

At the beginning of November 2009, Dr Mark Feinberg, the Vice President of Merck Vaccines stated the following:

"Based on input from the Advisory Committee on Immunization Practices (ACIP), professional societies, scientific leaders, and customers, Merck has decided not to resume production of ATTENUVAX (Measles Virus Vaccine Live), MUMPSVAX (Mumps Virus Vaccine Live), and MERUVAXII (Rubella Virus Vaccine Live). This science-based decision will support vaccination of the largest group of appropriate individuals. We will continue to focus necessary resources to ensure that we can help meet current and future global public health needs for our combination measles, mumps, and rubella vaccine, M-M-RII (Measles, Mumps and Rubella Virus Vaccine Live).

"The combination vaccine M-M-RII is recommended by the ACIP, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP), and is preferred over the monovalent vaccines because it eliminates the need for 3 separate injections and reduces the chance of delays in helping protect against any of these potentially serious diseases. There is no medical reason to administer the measles, mumps, and rubella antigens separately, and ACIP guidelines do not support their use."

Even though we have an uninterrupted supply of Measles and Rubella vaccines from our regular manufacturer, Merck has the exclusive rights to the Jeryl Lynn strain of the Mumps virus used both in the combined MMR and the single Mumps vaccinations. The Jeryl Lynn strain is the strain deemed the safest and most efficient for Mumps protection and no other monovalent (single) Mumps vaccine has been passed for use by the Medicines and Healthcare Regulatory Agency (MHRA). Therefore, as Merck is the only manufacturer for the Jeryl Lynn strain, no single Mumps vaccine will be available in the UK for the foreseeable future.

How does this affect you or your child?
The London MMR Clinic will continue to support those parents who prefer the single vaccinations as they have a right to choose what is best for their child. We still believe that it is extremely important for children to be protected via immunisations and we fear that parents may choose not to immunise their children at all if they cannot obtain single vaccines. Therefore, we will continue to offer the Measles and Rubella vaccinations which are readily available from other reputable manufacturers.

If you have started the programme with us, you should have received an email or letter in the post in November 2009 on how to proceed. If you have not, please contact us for more information or if you require a refund.

If you are intending to commence the single vaccination programme with us, we can administer the single Measles and Rubella vaccines for your child at the age of 14 months. You can either come back to us for the booster of the two or opt for the combined MMR vaccine as a booster (when your child is about three and a half to four years old).

After this, we suggest that your child is either blood tested for Mumps antibodies at about 11 to 12 years old, or has another combined MMR vaccine at that age to ensure they are sufficiently covered for Mumps pre-adolescent (especially for boys).

If your child has had an initial mumps immunisation and is awaiting the booster vaccine/s, a simple blood test can be undertaken to determine immunity status. In our experience, many children have maintained a good level of immunity to all three vaccinations and may not require a repeat immunisation. Please contact us for further details.

We understand that this is very distressing and disappointing news for all parents awaiting the Mumps vaccine and we apologise for any inconvenience this may cause you. Please call us on 0207 078 3828 for any further details you may require.

What is Mumps?
Mumps is a contagious viral infection that usually affects children. The most common symptom of mumps is a swelling of the parotid glands, near the ears.

Further information on Mumps.

The Vaccines
Where are the single vaccines made?
They are manufactured in Europe large multinational pharmaceutical companies. See the separate vaccine sheets for more information on this.

How are the vaccines transported to the clinic?
They are imported by a company that specialises in importing drugs from abroad and has approval from the DoH to import the single vaccines. They arrive at our premises in temperature controlled conditions like all our other vaccines.

How do you store the vaccines?
They are stored, along with other vaccines, in temperature controlled fridges especially designed for vaccine storage.

How long can the vaccines be stored?
The 'shelf life' or expiry date will vary from batch to batch, but is usually a year or longer.

Do the vaccines contain mercury?
Neither the MMR nor any of the measles, mumps or rubella single vaccines contain mercury since they are live attenuated vaccines, and hence do not need mercury as a preservative. They are transported, stored and preserved via the 'cold chain' system.

Why should I use London MMR for the separate jabs?
London MMR is based at the well known Ten Harley Street, famous for its medical facilities in central London. You will be assured of a comfortable surrounding and friendly staff at all times. Unlike many other clinics, a standard consultation with the doctor is not necessary, although available for anyone who requires it and we do not charge any registration or admin fees. The procedure is done by a Registered Nurse, qualified and experienced in paediatric immunisations, who will guide you through the entire process and try to make it as comfortable as possible.

What qualifications do your medical staff have?
The nurses at London MMR are Nurse Practitioners qualified and experienced in children's immunisations. In addition, our clinics are always covered by an on-site General Practitioner. The nurse would always refer to the doctor if there was any cause for concern.

All medical staff at London MMR undergo regular training in Cardio Pulmonary Resuscitation (CPR) and Management of Anaphylaxis.

Are the single vaccines safe?
They are at least as safe as the combined MMR.

Do the vaccines have side-effects?
All vaccines have side-effects. The vaccines offered by London MMR have no additional side-effects to those occurring with the MMR vaccine. (For the list of side-effects, click on the appropriate vaccine on the top of the page).

Why should I immunise my child with the Separate MMR Vaccinations?
Children that are not immunised against Measles, Mumps and Rubella are at risk from catching the diseases and rely on other people immunising their child in order to avoid infection.

Due to ongoing media speculation surrounding the controversial MMR vaccine and its links to autism and bowel disorders, numerous parents are reluctant to vaccinate their children. In spite of reassurances, many still have anxieties and therefore do not vaccinate at all. If more parents choose not to immunise their child, more children will become susceptible to the diseases and the chances of an outbreak occurring increases. It is strongly recommended by the Department of Health that all children must be vaccinated against Measles, Rubella and Mumps. Separate MMR vaccines are therefore offered as an alternative to those parents whose children may otherwise go unvaccinated.

What are the disadvantages of giving the vaccines separately?
The DoH have several concerns about giving the MMR as separate vaccines, a course of action of which they strongly disapprove:
  • There will be periods when your child will be unprotected against one or more of the illnesses whilst waiting to have the next vaccine
  • The single vaccine route requires your child to have more injections.
  • The single Mumps vaccine has been discontinued
  • The DoH are concerned that you may not bring your child back to have all the vaccines
Are the single vaccines as effective as the MMR?
Individually, they are at least as effective as the MMR. However, your child will not be protected against all three illnesses at the same time with the single vaccines.

Do the three separate vaccines contain the same strength as the MMR?
They contain the identical or equivalent strength of vaccine.

Which vaccine do you recommend my child has first?
Measles, because this illness poses more of a risk to your child than Rubella. We then recommend Rubella as the next immunisation. However if they is an outbreak of Rubella in your area, we then recommend that vaccine to be administered first.

How long do you recommend between the vaccines?
We recommend a minimum of six weeks between each immunisation. However some clinics recommend longer, even up to six months. There are no hard and fast rules to this, but we happy to go with your preferences on this matter as long as there is a minimum of six weeks.

Is it necessary for my child to have all three vaccines?
In order to conform with the DoH policy, we strongly advise parents who choose the separate MMR vaccine programme to finish the course of all three vaccines of Measles, Rubella and Mumps.

However, as the Mumps vaccine was suddenly taken out of production in November 2009, we will continue to support those parents who prefer the single vaccinations and will still offer the Measles and Rubella vaccinations. Thereafter you can either come back to us for the booster of the two (if you choose for your child not to have the Mumps vaccine at all) or for the combined MMR vaccine, which will protect against Mumps.

After this, we suggest that your child either gets blood tested for Mumps antibodies at about 10 to 11 years old or has another combined MMR vaccine then, to ensure they are sufficiently covered for Mumps pre-adolescent (especially for boys).

What happens if my child has received another vaccine; can he/she still be vaccinated at London MMR?
If your child receives another vaccine, such as a HIB/DTP booster or PCV, or any travel vaccines, please allow 6 weeks minimum before vaccination with the separate MMR vaccines.

What strains do your vaccines contain?
The vaccines we currently offer contain the strains mentioned below. However, please bear in mind that these may change from time to time because of supply problems. We would never use any vaccine that we did not feel was one of the safest and most effective available.

Measles: Schwartz strain.
Rubella: RA 27/3 strain.


Can I make a booking online for all three vaccines in advance?
We strongly recommend that you book as you go along, i.e. one vaccine at a time, since children are unpredictable and can get ill before their first appointment. This will cause the appointment to be cancelled in most cases resulting in subsequent appointments also having to be cancelled. Once the child has the vaccine, you are then free to book the next one, either online or by giving us a call on 0207 078 3828.

I'm still undecided. Where can I get more information to help me choose which route I'd like my child to have?
We suggest you have a look at jabs.org.uk which gives you the latest news, research and cases surrounding the combined jab.

My Child
What if my child has an egg allergy?
It is recommended that your child still has the vaccines. If the allergy is mild, i.e a rash occurs with egg protein, then we can give the vaccine at our base. However if the allergy is worse than that, i.e shortness of breath, wheezing then it must be given where there is a Paediatric ICU. We suggest you try an NHS unit and are happy to let you have all 3 vaccines to take there.

My child is healthy. What would the clinical reason be to order the single vaccines for my child?
If, after appropriate counselling, you refuse to allow your child to be given the MMR vaccine, then your child is at risk of contracting measles, mumps and rubella. The only way to protect your child in these circumstances is to give him or her the single vaccines. This is the clinical indication.

What is the minimum age my child can be given one of the single vaccines?
They can be given at any time from 12 months, but it may be preferable to wait until 14-15 months by which time the body's immune response should have reached a maximum.

What if my child is ill before the day of the vaccination?
If your child has a raised temperature (above 38.5C) and other symptoms of sickness (e.g. productive cough, diarrhoea, vomiting) we suggest you cancel the appointment. However if your child just has only a mildly raised temperature then keep the appointment. Give them Calpol before they come in.

Also, if your child has any sort of infection, where viral or bacterial, or taking any antibiotics, we suggest that you cancel the appointment for about a month. If you are unsure for any reason, please call 0207 078 3828, where you will be put through to the nurse who will advise you accordingly.

What if my child was a premature baby?
If your child was born before 36 weeks gestation, then please add a month's wait to the scheduled time of their first measles vaccination. Add more time if your child was born even more prematurely.

What if there is an outbreak at my child's school?
If there is an outbreak of Measles, Mumps or Rubella in your child's community, and your child has not had the relevant vaccination yet, please contact us as we will prioritise your child for the appropriate vaccination (combined MMR vaccine recommended if there is a Mumps outbreak).

On The Day
What should I bring?
Please bring:
  • Your child's Red Book so that we may enter information on the Immunisations Page.
  • A favourite toy in case you have to wait.
  • A treat for your child as a reward after the vaccination.
What happens?
  • Please aim to arrive at least 10 minutes before your scheduled appointment time.
  • On arrival please inform the receptionist that you are here.
  • You will be brought through to see the nurse who will do the vaccination.
  • The vaccine is injected into your child's thigh, so please make sure it has appropriate clothing.
  • The vaccination is given very quickly and with minimal fuss. The nurse will distract your child with a lolly or a toy. In 80% of cases the child will not even know that it has had an injection.
  • A plaster is applied if there is a drop of blood.
  • The vaccine ID number will be written into your Red Book and you will then be free to leave and book your next appointment.
  • This will all take between five and seven minutes.
  • Please be aware that a child will pick up on a parent's anxiety. Please try to be as relaxed as possible, as this will make it less painful for your child.
  • NOTE: Consultation with a doctor is NOT included in London MMR's vaccination program, but advice on your child's readiness for the vaccines can be obtained prior to your appointment by calling 0207 078 3828.
Afterwards
Will I be able to travel after my child has been given the vaccine?
Yes. Unless your child shows immediate signs of a bad reaction to the vaccine (which is extremely unlikely) you will be allowed to leave shortly after your child has received the immunisation. Just carry your Calpol with you.

Is there any way I can tell if my child is already protected against measles, mumps or rubella, either from previous immunisation or from natural infection?
Yes, there is a blood test available to do this. We can arrange this for you if you wish. Please contact our lab on 020 7806 4022 by telephone for further information.

What can or can't my child do after the vaccination?
As side effects are rare, your child can do anything it would normally do e.g. Swimming, going to a party or school. If your child has been fractious after the vaccination, then try giving Calpol on your return home.

Boosters
Will my child require a booster?
Yes they will as no vaccine is 100% effective. If your child has had all three single vaccine (Measles, Mumps and Rubella), then prior to boosting at around three and a half to five years old, you could have your child blood tested to check their immunity status. From the results, you would know exactly what jabs they need, and repeat those only, but if they have well above the recommended levels, then there is no need to boost. If your GP does not want to do the blood test, you can have it done at the Hospital of St John and Elizabeth, in St Johns Wood.

Should you wish to have the blood test, there is no need to book an appointment as it is a walk in service available anytime between Mondays to Fridays, 8am - 4pm at the hospital. At the main reception, please ask for directions to Phlebotomy or the blood testing department and once there, please explain that you require the MMR blood test and they will arrange everything then and there for you. The cost is approximately £100 to test for all three vaccines and please budget about an hour and a half to get it done, as they would need to numb the child's skin beforehand. Results are posted to you about a week later. Please refer to the blood test FAQ for interpretation. Should you require further information on the blood testing procedure, please call the lab at the hospital on 0207 806 4022.

Please note that the single mumps vaccine has been discontinued by the manufacturer. Should your child require the mumps vaccine post blood testing, you will need to consider getting the combined MMR vaccine done. The single measles and rubella vaccines are still readily available.

Alternatively you could bypass the blood testing route and opt for the combined MMR vaccine.

If your child did not have the initial mumps vaccine due to it being discontinued by the manufacturer, we recommend that your child has the combined MMR vaccine as a booster. After this, we suggest that your child is either blood tested for mumps antibodies at about 10 to 11 years old, or has another combined MMR vaccine at that age to ensure they are sufficiently covered for mumps pre-adolescent (especially for boys).

Interpreting the Blood Test
I have had my child's antibody levels tested at the Hospital of St John and St Elizabeth. How do I interpret the results?
You will find your child's immunity levels under 'Referrals' and the reference table below the results are your guide to interpreting it.

For measles, anything above 300 IU/L is positive, mumps above 500 U/L is positive and rubella above 9.9 kUI/L. However we recommend that your child should have levels well above the baseline such so that they have the immunity to carry them into later life.

Measles and mumps should ideally be at least a 1000 and above and rubella above 100.

Should your child currently need a repeat of measles and rubella, please use an alternative clinic to have the booster. If the mumps levels are insufficient, then you would need to consider getting the combined MMR vaccine done.

Miscellaneous
What should I do if my child has been given the measles vaccine previously by another doctor?
This does not prevent your child from having any of the other single vaccines.

My child has had measles. Does he still need the measles vaccine?
The DoH still believes that your child should be immunised (with the MMR) whether or not he or she has had measles. This is partly because the diagnosis may not have been correct. However, if your child has definitely had measles, then he or she has long term natural protection and immunisation is unnecessary.

Is it necessary for my son to be given the rubella vaccine?
The DoH strongly recommends all children to be immunised against measles, mumps and rubella to prevent an epidemic in the community. It is given primarily to boys to prevent them from catching rubella and passing it on to a pregnant woman. If she is not protected, this could cause serious damage to her unborn baby. If you wish to discuss this further, please call 0207 078 3828

Legal Issues
Are doctors allowed to give the single vaccines for Measles and Rubella?
Yes, doctors are legally allowed to obtain and give these vaccines, provided they comply with the Department of Health regulations on unlicensed medicines. This is also checked during our annual Quality Care Commission inspection.

Then why do NHS doctors not offer them?
Because doctors are under strong pressure from the Department of Health (DoH) to promote and give the combined MMR vaccine, in the same way as you are being encouraged to give it to your children. Most doctors believe that the combined vaccine is a better and safer option than the single vaccines for your child and the population at large.

Are 'unlicenced' vaccines safe for my child?
Yes. The word 'unlicensed' does not mean it is illegal. It means that the DoH have not renewed the licenses for these single vaccines to be manufactured in the UK, and is not used in the NHS. Separate MMR vaccines were used pre-MMR. All vaccines that London MMR uses is MHRA approved as per DoH regulations, meaning that we are allowed to administer unlicenced vaccines legally in the UK as long as it passes through the MHRA regulating body.

Are they 'licensed' for use in other countries?
Yes, they are all licensed for use in other countries including many major European countries and/or the USA.

Who is liable if something goes wrong?
We at London MMR remain responsible in the normal way for any advice or treatment that we offer. The pharmaceutical companies remain responsible for the quality of their product.

How will my GP know that my child has been immunised with the separate MMR vaccines?
We can inform them on your behalf. Simply provide us with their details on your child's consent form.

Do you keep a record of the batch number of the vaccines?
Yes, we keep a record of the batch number of the vaccines in our own records. We also give this information to you at the time of immunisation by writing it in your child's Red Book.

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