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Intervention Review

Vaccines for measles, mumps and rubella in children

  1. Vittorio Demicheli1,*,
  2. Tom Jefferson2,
  3. Alessandro Rivetti3,
  4. Deirdre Price4

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 18 DEC 2004

DOI: 10.1002/14651858.CD004407.pub2

Database Title

Additional Information

How to Cite

Demicheli V, Jefferson T, Rivetti A, Price D. Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004407. DOI: 10.1002/14651858.CD004407.pub2.

Author Information

  1. 1

    Regione Piemonte - Azienda Sanitaria Locale ASL AL, Health Councillorship - Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Torino, Piemonte, Italy

  2. 2

    The Cochrane Collaboration, Vaccines Field, Roma, Italy

  3. 3

    Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Alessandria, Piemonte, Italy

  4. 4

    University of Oxford, Department of Clinical Pharmacology, Oxford, Oxon, UK

*Vittorio Demicheli, Health Councillorship - Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Regione Piemonte - Azienda Sanitaria Locale ASL AL, C.so Regina Margherita 153 bis, Torino, Piemonte, 10122, Italy. Vittorio.DeMicheli@regione.piemonte.it. vittorio.demicheli@regione.piemonte.it.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Public debate over the safety of the trivalent measles, mumps and rubella (MMR) vaccine, and the resultant drop in vaccination rates in several countries, persists despite its almost universal use and accepted effectiveness.

Objectives

We carried out a systematic review to assess the evidence of effectiveness and unintended effects associated with MMR.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2004, Issue 4), MEDLINE (1966 to December 2004), EMBASE (1974 to December 2004), Biological Abstracts (from 1985 to December 2004), and Science Citation Index (from 1980 to December 2004). Results from reviews, handsearching and from the consultation of manufacturers and authors were also used.

Selection criteria

Eligible studies were comparative prospective or retrospective trials testing the effects of MMR compared to placebo, do-nothing or a combination of measles, mumps and rubella antigens on healthy individuals up to 15 years of age. These studies were carried out or published by 2004.

Data collection and analysis

We identified 139 articles possibly satisfying our inclusion criteria and included 31 in the review.

Main results

MMR was associated with a lower incidence of upper respiratory tract infections, a higher incidence of irritability, and similar incidence of other adverse effects compared to placebo. The vaccine was likely to be associated with benign thrombocytopenic purpura, parotitis, joint and limb complaints, febrile convulsions within two weeks of vaccination and aseptic meningitis (mumps) (Urabe strain-containing MMR). Exposure to MMR was unlikely to be associated with Crohn's disease, ulcerative colitis, autism or aseptic meningitis (mumps) (Jeryl-Lynn strain-containing MMR). We could not identify studies assessing the effectiveness of MMR that fulfilled our inclusion criteria even though the impact of mass immunisation on the elimination of the diseases has been largely demonstrated.

Authors' conclusions

The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate. The evidence of adverse events following immunisation with MMR cannot be separated from its role in preventing the target diseases.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Using the combined vaccine for protection of children against measles, mumps and rubella

Measles, mumps and rubella are three very dangerous infectious diseases which cause a heavy disease, disability and death burden in the developing world. Researchers from the Cochrane Vaccines Field reviewed 139 studies conducted to assess the effects of the live attenuated combined vaccine to prevent measles, mumps and rubella (MMR) in children. MMR protects children against infections of the upper airways but very rarely may cause a benign form of bleeding under the skin and milder forms of measles, mumps and rubella. No credible evidence of an involvement of MMR with either autism or Crohn's disease was found. No field studies of the vaccine's effectiveness were found but the impact of mass immunisation on the elimination of the diseases has been demonstrated worldwide.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

關於兒童接種麻疹(measles),腮腺炎(mumps)和德國麻疹(rubella)的疫苗

儘管已經廣為使用並且效果也被接受,大眾對於接種麻疹,腮腺炎和德國麻疹的三合一疫苗[the trivalent measles, mumps and rubella (MMR) vaccine]其安全性依然存在著爭議,而這導致了幾個國家的接種率下降.

目標

因此我們想藉由一系統性回顧的研究來評估關於三合一疫苗的有效性和非預期作用的證據.

搜尋策略

我們搜尋了the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2004), MEDLINE (1966 to December 2004), EMBASE (1974 to December 2004), Biological Abstracts (from 1985 to December 2004)和Science Citation Index (from 1980 to December 2004). 來自於評論性文章,徒手搜尋文獻以及諮詢製造商和作者的結果也會被納入使用.

選擇標準

合格的研究包括比較性的前瞻性或回溯性試驗,而這類試驗比較三合一疫苗與安慰劑(placebo),什麼都不施打(donothing)或者在小於15歲的健康受試者施予麻疹,腮腺炎和德國麻疹抗原的效果差異.這些試驗都在2004年前進行或發表.

資料收集與分析

我們找到139篇可能滿足納入標準的文獻且最後收錄了31篇進入本系統性回顧的研究.

主要結論

施打三合一疫苗與安慰劑相比有較低的上呼吸道感染發生率,較高的過敏(irritability)發生率,以及相近的其他副作用發生率.另外含Urabe株的三合一疫苗(Urabe straincontaining MMR)也可能與良性血小板低下性紫癜(benign thrombocytopenic purpura)，腮腺炎(parotitis)，關節和肢體的不適，疫苗接種兩周內發生熱性痙攣(febrile convulsions)以及無菌性腦膜炎(aseptic meningitis)(腮腺炎)相關.接種含JerylLynn株的三合一疫苗(JerylLynn straincontaining MMR)則與克隆氏症(Crohn's disease),潰瘍性結腸炎(ulcerative colitis),自閉症(autism)以及無菌性腦膜炎(腮腺炎)無關.即便大規模的接種已經廣泛地證實能夠消除這些疾病,我們仍無法找出符合納入標準且能評估三合一疫苗有效性的研究.

作者結論

不管是上市前或上市後,針對三合一疫苗安全性研究的設計和報導大多是不足的.接種三合一疫苗之後出現不良反應的證據無法與它在預防疾病的角色上分開.

翻譯人

本摘要由臺灣大學附設醫院溫岳峯翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

兒童接種三合一疫苗來預防麻疹,腮腺炎和德國麻疹 麻疹,腮腺炎和德國麻疹是三種非常危險的傳染性疾病,在發展中國家造成嚴重的危害,失能和眾多的死亡人數.考科藍疫苗領域的研究人員總共檢視了139篇針對兒童接種活性減毒三合一疫苗的研究.三合一疫苗保護兒童免受上呼吸道感染,但很少會導致形成一種良性的皮下出血和較溫和形式的麻疹,腮腺炎和德國麻疹.沒有可靠的證據顯示三合一疫苗與自閉症或克隆氏症有關.目前關於疫苗效力的實地考察研究仍付之闕如,但是大規模接種對消除這些疾病的影響已在世界上被證實.

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