Measles, mumps, and rubella vaccine is not associated with lower hospitalization rates for non-targeted infections in infants

1. There was no difference in rates of hospitalization for non-targeted infection at 12 months of age, among infants randomized to receive either placebo or the measles, mump, and rubella (MMR) vaccine, between 5 and 7 months of age.

2. There was also no difference in severe hospitalization rates or prescription of antibiotics among infants randomized to placebo or the MMR vaccine.

Evidence Rating Level: 1 (Excellent)

Study Rundown: With the introduction of the measles vaccine, there were reports from low income countries of a decrease in child mortality rates lower than would be expected from reduction in measles deaths alone. This led to a hypothesis that live attenuated vaccines confer protection against non-measles related health issues. While systematic reviews have found no benefit from the vaccine for non-measles related morbidity and mortality, the baseline rate of child mortality in high income countries may be too low to detect any benefit. Therefore, this double-blinded, randomized controlled trial based in Denmark investigated whether infants randomized to receive the measles, mumps, and rubella (MMR) vaccine had a lower risk of hospitalization for infections not targeted by the MMR vaccine. All recruited infants were healthy, and received either the MMR vaccine or placebo between 5 and 7 months of age, where typically, the MMR is scheduled for 15 months and 4 years of age. The follow-up period was from randomization to 12 months of age. Overall, the study found no difference between the MMR and placebo groups for rates of hospitalization for non-targeted infection, hospitalization for longer than 12 hours, or for prescription of antibiotics. 

Click here to read the study in BMJ

Relevant Reading: Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review

In-depth [randomized-controlled trial]: Caregivers of over 50,000 infants were invited to participate in the study between 2019 and 2021. Parents and study staff were blind to the randomization at the time of injection. Infants were randomized 1:1, and there were ultimately 3264 infants in the MMR group and 3272 in the placebo group. No vaccines were administered during the follow-up period, as the DTaP-IPV-HiB+PCV vaccine was scheduled for 5 and 12 months. The primary outcome was hospitalization for non-targeted infection at 12 months. Secondary outcomes included severe hospitalization, as indicated by a hospitalization lasting longer than 12 hours, as well as prescription for antibiotics. In total, there were 786 hospitalizations in the MMR group and 762 in the placebo group by 12 months of age. There was no difference in rate of hospitalizations for non-targeted infection (hazard ratio 1.03, 95% CI 0.91-1.18). As well, there was no difference in hospitalizations lasting longer than 12 hours (HR 1.25, 95% CI 0.88-1.77) or prescription for antibiotics (HR 1.02, 95% CI 0.88-1.23). Overall, this study found no differences in the assessed morbidity outcomes for infants receiving either the MMR vaccine or placebo before 12 months of age.

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