• MMR vaccine in 14 months old children, intramuscular versus subcutaneous administration

      Lafeber AF; Klis FRM van der; Marzec AHJO; Labadie J; Ommen R van; Strieder TG; Berbers GAM; Utrecht Stichting Thuiszorg Stad Utrecht (STSU), Ouder- en Kindzorg; Amersfoort Stichting Thuiszorg Eemland (STE), Ouder- en Kindzorg; LVO (Rijksinstituut voor Volksgezondheid en Milieu RIVM, 2001-10-26)
      In this study we compared the recommended subcutaneous administration of the RIVM MMR vaccine with the intramuscular administration for both safety and immunogenicity. Study subjects were 14 months old children, living in Amersfoort or Utrecht, who were eligible for their first MMR vaccination. The participants (N=67) were 'at random' assigned to one of the study groups based on route of administration of the vaccine (intramuscular or subcutaneous). Pain immediately after vaccination was the most reported adverse reaction. Serious pain was more often reported after subcutaneous vaccination. But because of the low number of participants in this study it is only an indication without an exact statistical foundation. It is known that adverse reactions due to infection by the vaccine virus are often seen in the second week after the MMR vaccination. In this study we also found a peak in the general health complaints in the second week after vaccination. The route of administration of the vaccine did not influence these complaints. It is difficult to assess which complaints are directly related to the MMR vaccine, because they often can not be distinguished from symptoms of common diseases in 14 months old children. Both subcutaneous and intramuscular administered MMR vaccine induced a good immune response. The levels of the ELISA antibodies against mumps and rubella after subcutaneous vaccination are the same as those after intramuscular vaccination. The titres against measles were somewhat higher after subcutaneous vaccination as compared to those after intramuscular injection, both for ELISA antibodies as well as antibodies measured with the virus neutralisation assay. However, this difference was not statistically significant. Besides, the injection route had no effect on the percentages of children with antibodies above the protective level against mumps (92%), measles (100%) and rubella (100%). This study shows that inadvertent intramuscular administration of MMR vaccine is no reason for revaccination. In the future it can be considered to adjust the instructions for use of the RIVM MMR vaccine so that both subcutaneous and intramuscular vaccination are allowed.