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Logo of mjafiGuide for AuthorsAbout this journalExplore this journalMedical Journal, Armed Forces India
Med J Armed Forces India. 2000 July; 56(3): 275–276.
Published online 2017 June 10. doi:  10.1016/S0377-1237(17)30205-8
PMCID: PMC5532110


Dear Editor,

There are some practitioners who advocate Measles, Mumps and Rubella (MMR) vaccinations among infants. The epidemiological impact of this in our country can have adverse consequences. The following clinico-epidemiological factors have to be considered.

Measles is a severe disease in infancy and milder in older children and adults, therefore measles vaccine has a well earned placed in the Universal Immunisation Programme (UIP).

Mumps on the other hand, is a mild disease in infancy and more severe during adulthood. Orchitis occurs in about one in four males who develop mumps after puberty and may lead to sterility [1]. In developed countries, 85% of infections occurred in children younger than 15 years prior to widespread childhood immunisation-now disease occurs in young adults, producing epidemics in colleges/workplace [2]. Why should we repeat the mistakes of developed countries? More so as we cannot afford immunisation at puberty/adulthood as advocated by Western medical literature [3]. Having the disease in childhood is preferable to escaping it then and possibly acquiring it in adult life when protection afforded by vaccine may have been lost [4].

Rubella. Prior to rubella vaccine programmes in developed countries, the peak incidence of the disease was in children 5–14 years of age-now most cases occur in susceptible teenagers and young adults [2]. It is especially important that girls have immunity to rubella during child bearing age, either by contracting the natural disease or by active immunisation. In USA, Australia and Nordic countries, a second dose of MMR is recommended for teenagers for both genders [3]. In our country the priority should be first to protect women of childbearing age and only then to interrupt transmission of rubella by universal immunisation of children (and not the other way round as is being advocated by premature introduction of MMR in UIP). As no programme exists for teenage/adult women immunisation in our country (and not likely in the near future), MMR during infancy should be withheld lest it cause epidemiological shift towards older age group of teenage/adult women leading to increased incidence of congenital rubella syndrome.

Because of above considerations, only measles vaccination should continue during infancy. MMR is like a chess gambit, concealing a lot of dangerous traps and snares [5], which we can ill afford.


1. Geddes AM, Bryceson ADM, Thin CN, Mitchell DM. Diseases due to infection. Davidson’s principles and practice of medicine. 1995:66–189.
2. Maldanado Y. Rubella/Mumps. Nelson’s text book of paediatrics. 1996:871–875.
3. Benenson AS. Control of communicable diseases manual. American Public Health Association. 1995
4. Christie AB. Infectious disease; epidemiology and clinical practice, 3rd ed. Churchill Livingstone. 1980
5. Yudovich Y. The Gambit. Planeta Publishers, Moscow. 1989

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