MMR (measles, mumps, rubella) — Vaccine Data Navigator

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disease risks

post-acute and long-term sequelae

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Measles Measles morbillivirus

Disease risks

Acute risks of the infection itself: complications, hospitalisation, ICU, death.

Outcome (O)	Population (P)	Estimate	Design (S)	Source
Pneumonia as a serious complication of measles severity: serious complication case definition: Laboratory-confirmed measles cases in a New York City outbreak	median 3 years, 81.2% aged 18 or younger vaccination status: unvaccinated country: United States setting: community outbreak period: 2018-2019 n: 649 confirmed measles cases Infant <1y1-4y5-11y12-17y18-49y	5.7 proportion of cases with pneumonia (%) per confirmed measles case	outbreak investigation	Zucker et al. 2020 N Engl J Med quote Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. abstract, RESULTS Most patients were unvaccinated. Hospitalisation and ICU admission in the same outbreak are separate records.
Hospitalisation for measles severity: hospitalisation case definition: Laboratory-confirmed measles cases in a New York City outbreak	median 3 years, 81.2% aged 18 or younger vaccination status: unvaccinated country: United States setting: community outbreak period: 2018-2019 n: 649 confirmed measles cases Infant <1y1-4y5-11y12-17y18-49y	7.6 proportion of cases hospitalised (%) per confirmed measles case	outbreak investigation	Zucker et al. 2020 N Engl J Med quote Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. abstract, RESULTS Among those hospitalised, a substantial minority needed intensive care; see the ICU record.
ICU admission among hospitalised measles cases severity: ICU admission case definition: Laboratory-confirmed measles cases in a New York City outbreak	hospitalised measles patients vaccination status: unvaccinated country: United States setting: hospital period: 2018-2019 n: 49 hospitalised measles patients All ages	40.8 proportion of hospitalised cases admitted to ICU (%) per hospitalised measles case	outbreak investigation	Zucker et al. 2020 N Engl J Med quote Serious complications included pneumonia (in 37 patients [5.7%]) and hospitalization (in 49 patients [7.6%]); among the patients who were hospitalized, 20 (40.8%) were admitted to an intensive care unit. abstract, RESULTS Denominator is hospitalised cases, not all cases. Do not multiply it by the hospitalisation rate to obtain a population risk.
Any complication of measles severity: any complication case definition: Cases diagnosed at Lyon university hospitals during an outbreak	all diagnosed cases, highest proportion under 1 year of age vaccination status: not reported country: France setting: hospital period: 2010-2011 n: 407 cases Infant <1y1-4y5-11y12-17y18-49y	18 proportion of cases with at least one complication (%) per diagnosed measles case	outbreak investigation	Huoi et al. 2012 Euro Surveill quote Of the total cases, 72 (18%) had complications. abstract Hospital-diagnosed outbreak cases, so ascertainment favours more severe disease.
Death from measles (case-fatality ratio) severity: death case definition: Measles cases and deaths in community and hospital studies in low- and middle-income countries	all age groups in the included LMIC studies vaccination status: mixed country: low-income and middle-income countries setting: community and hospital period: 1990-2015 All ages	2.2 (0.7–4.5) CFR (%) per measles case	modelling	Portnoy et al. 2019 Lancet Glob Health quote We selected a log-linear prediction model, resulting in a mean case-fatality ratio of 2·2% (95% CI 0·7-4·5) in 1990-2015. abstract, FINDINGS Modelled mean across heterogeneous community and hospital studies. The same review found hospital-based CFRs higher than community-based, so this sits between the two.
Death from measles, projected case-fatality ratio severity: death case definition: Log-linear model fitted to community and hospital studies	all age groups in the included LMIC studies vaccination status: mixed country: low-income and middle-income countries period: projection for 2016 to 2030 All ages	1.3 (0.4–3.7) CFR (%) per measles case	modelling	Portnoy et al. 2019 Lancet Glob Health quote The mean projected case-fatality ratio in 2016-2030 was 1·3% (0·4-3·7). abstract, FINDINGS A projection, not an observation. The same review reports a substantially higher historical case-fatality ratio in the low-income countries studied, which is the record to read next to this one.
Pneumonia among children hospitalised with measles severity: any complication case definition: ICD diagnosis code for measles at a US children's hospital	children 0-18 years of age risk group: predominantly unvaccinated children in outbreak communities vaccination status: unvaccinated country: United States setting: hospital period: 2011-2017 n: 33 hospitalised children Infant <1y1-4y5-11y12-17y	30 proportion of hospitalised cases with pneumonia (%) per hospitalised measles case	case series	Hester et al. 2019 Pediatr Infect Dis J quote Poor feeding was a primary reason for admission (97%); additional complications included otitis media (42%), pneumonia (30%), tracheitis (6%) and keratitis (3%). abstract, RESULTS Small hospital case series from outbreak years. Otitis media, tracheitis and keratitis are reported in the same sentence of the source.

Post-acute and long-term sequelae

What can follow the acute illness: chronic disease, disability, cancers, congenital syndromes, post-infectious conditions.

Outcome (O)	Population (P)	Comparator	Estimate	Design (S)	Source
Subacute sclerosing panencephalitis after measles infection severity: fatal neurodegenerative sequelae case definition: Children treated at German hospitals, capture-recapture adjusted	children who contracted measles below 5 years of age vaccination status: not reported country: Germany setting: hospital period: 2003-2009 Infant <1y1-4y	vs children who did not have measles	1 in 1700 to 1 in 3300 risk of SSPE per measles infection per child infected with measles under 5 years follow-up: latency between measles infection and SSPE onset	cohort	Schönberger et al. 2013 PLoS One quote The risk of developing SSPE for children contracting measles infection below 5 years of age was calculated as 1∶1700 to 1∶3300. abstract The source reports a risk range, not a confidence interval, so no ci_low or ci_high is recorded here. SSPE is uniformly fatal.
Recurrent fever episodes after past measles infection severity: any acute infectious episode case definition: Maternal report of past measles infection and acute symptoms in a national health survey	children aged 9 to 59 months prior infection: reported past measles infection vaccination status: mixed country: Democratic Republic of the Congo setting: community period: 2013-2014 n: 2350 children Infant <1y1-4y	vs children with no history of measles	1.80 (1.25–2.60) OR for fever in previous 2 weeks	cohort	Ashbaugh et al. 2019 J Pediatric Infect Dis Soc quote RESULTS: The odds of fever in the previous 2 weeks were 1.80 (95% confidence interval [CI], 1.25-2.60) among children for whom measles was reported compared to children with no history of measles. abstract, RESULTS Cross-sectional survey with maternal recall of measles history, so recall bias and confounding are possible. Supports immune amnesia indirectly; it is not a direct measure of immune reset.

Vaccine efficacy and effectiveness

Every estimate compiled, annotated by population (P), intervention (I), comparator (C), outcome (O) and study design (S).

Outcome (O)	Population (P)	Intervention / comparator	Estimate	Design (S)	Source
Measles cases severity: any case definition: As defined in the included cohort studies	children up to 15 years risk group: healthy children country: multiple n: 12,039 children 1-4y5-11y12-17y	MMR / MMRV / MMR+V platform: live attenuated doses: 1 vs no vaccination or placebo	95 (0.02–0.13 RR CI) VE (%) = 1 - RR	meta-analysis GRADE: moderate 7 cohort studies	Di et al. 2021 Cochrane Database Syst Rev quote Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). abstract, Effectiveness Confidence bounds are reported by the review on the RR scale, not the percentage scale.
Measles cases severity: any case definition: As defined in the included cohort studies	children up to 15 years risk group: healthy children country: multiple n: 21,604 children 1-4y5-11y12-17y	MMR / MMRV / MMR+V platform: live attenuated doses: 2 vs no vaccination or placebo	96 (0.01–0.28 RR CI) VE (%) = 1 - RR	meta-analysis GRADE: moderate 5 cohort studies	Di et al. 2021 Cochrane Database Syst Rev quote Effectiveness Vaccine effectiveness in preventing measles was 95% after one dose (relative risk (RR) 0.05, 95% CI 0.02 to 0.13; 7 cohort studies; 12,039 children; moderate certainty evidence) and 96% after two doses (RR 0.04, 95% CI 0.01 to 0.28; 5 cohort studies; 21,604 children; moderate certainty evidence). abstract, Effectiveness The second dose raises the point estimate only slightly over one dose; the one-dose figure is what most outbreak control relies on.
Measles after a known exposure severity: any case definition: Post-exposure prophylaxis in exposed children, as defined in the included studies	children exposed to measles prior infection: exposed to measles country: multiple setting: household or close contact n: 283 children 1-4y5-11y12-17y	MMR vaccine platform: live attenuated doses: at least 1 vs no post-exposure vaccination	74 (0.14–0.50 RR CI) VE (%) = 1 - RR	meta-analysis GRADE: low 2 cohort studies	Di et al. 2021 Cochrane Database Syst Rev quote The effectiveness (at least one dose) in preventing measles after exposure (post-exposure prophylaxis) was 74% (RR 0.26, 95% CI 0.14 to 0.50; 2 cohort studies; 283 children; low certainty evidence). abstract, Effectiveness Lower than routine two-dose effectiveness, as expected when the vaccine is given after exposure.
Secondary measles cases among contacts (transmission) severity: any case definition: Cases among household or other close contacts of index cases	children up to 15 years and their contacts country: multiple setting: household contact n: 151 children 1-4y5-11y12-17y	MMR vaccine platform: live attenuated doses: 1 vs unvaccinated contacts	81 (0.04–0.89 RR CI) VE (%) = 1 - RR	meta-analysis GRADE: low 3 cohort studies	Di et al. 2021 Cochrane Database Syst Rev quote The effectiveness in preventing cases among household contacts or preventing transmission to others the children were in contact with after one dose was 81% (RR 0.19, 95% CI 0.04 to 0.89; 3 cohort studies; 151 children; low certainty evidence), after two doses 85% (RR 0.15, 95% CI 0.03 to 0.75; 3 cohort studies; 378 children; low certainty evidence), and after three doses was 96% (RR 0.04, 95% CI 0.01 to 0.23; 2 cohort studies; 151 children; low certainty evidence). abstract, Effectiveness Measures onward transmission from a vaccinated child, a different question from protecting the vaccinated child.
Measles (duration of vaccine-induced immunity) severity: any case definition: Modelled time for antibody titre to fall to the seronegative cutoff, equivocal results counted as negative	children and adults in the national serosurvey, time since the second dose taken from age risk group: born from the early-mid-1990s cohort, minimal natural boosting in an eliminated setting country: South Korea setting: community period: 2019 national serosurvey 5-11y12-17y18-49y	MMR vaccine platform: live attenuated doses: 2 time since vaccination: age used as a proxy for time since vaccination vs antibody persistence after natural measles infection, which lasted lifelong	19 duration of vaccine-induced immunity (years) follow-up: modelled time to seronegative cutoff	modelling	Chun et al. 2026 Int J Epidemiol quote The duration of vaccine-induced immunity was estimated to be 19 years for measles, 9.71 years for mumps, and 31.57 years for rubella when equivocal results were considered negative. abstract, RESULTS Estimate for a two-dose schedule in a country with coverage above ninety-five percent since the mid-nineteen-nineties and no significant outbreaks since the early two-thousands, so antibody decline is not masked by natural re-exposure. Equivocal results are counted as negative here, the more conservative assumption; the permissive assumption is the record below.
Measles (duration of vaccine-induced immunity, equivocal counted as positive) severity: any case definition: Modelled time for antibody titre to fall to the seronegative cutoff, equivocal results counted as positive	children and adults in the national serosurvey, time since the second dose taken from age risk group: born from the early-mid-1990s cohort in an eliminated setting country: South Korea period: 2019 national serosurvey 5-11y12-17y18-49y	MMR vaccine platform: live attenuated doses: 2 time since vaccination: age used as a proxy for time since vaccination vs the same model counting equivocal results as negative	27.32 duration of vaccine-induced immunity (years) follow-up: modelled time to seronegative cutoff	modelling	Chun et al. 2026 Int J Epidemiol quote If equivocal results were considered positive, the duration would be 27.32 years for measles, 15.25 years for mumps, and 39.77 years for rubella. abstract, RESULTS The permissive assumption paired with the conservative one above. The two figures bracket the plausible range and must be shown together, not averaged, because the whole difference is how equivocal titres are treated.
Measles antibody waning after routine vaccination (decay rate) severity: any case definition: Modelled decay of measles IgG measured by enzyme-linked immunosorbent assay, on the log-log concentration scale	children aged 0 to 12 years following the routine two-dose schedule country: China setting: community period: cohorts drawn from Anhua County, Hunan Province n: 408 children and 222 adults Infant <1y1-4y5-11y	Measles vaccine (routine two-dose schedule) doses: 2 time since vaccination: measured across the post-vaccination age range vs naturally acquired measles antibodies, which persisted lifelong at a far lower decay rate	3.0 antibody decay rate (log-log mIU/mL per year) follow-up: longitudinal antibody decline	modelling	Zhao et al. 2025 Vaccines (Basel) quote The decay rate of vaccine-induced antibodies was estimated at 3.0 × 10-3 log-log mIU/mL per year, whereas naturally acquired measles antibodies persisted lifelong with a significantly lower decay rate of 2.30 × 10-5 log-log mIU/mL per year. abstract, Results Vaccine-induced antibodies decay markedly faster than naturally acquired ones in the same population. The contrast with lifelong infection-acquired immunity is central to the birth-cohort findings and is stated in the comparator, since it cannot be filed as a vaccine record of its own.
Measles antibody loss below the protective threshold after routine vaccination severity: any case definition: Modelled age at which vaccine-induced measles IgG falls below the protective threshold of 200 mIU/mL	children vaccinated on the routine two-dose schedule, modelled beyond the sampled age range country: China period: cohorts drawn from Anhua County, Hunan Province n: 408 children and 222 adults Infant <1y1-4y5-11y12-17y	Measles vaccine (routine two-dose schedule) doses: 2 time since vaccination: age used as a proxy for time since vaccination vs naturally infected adults in the same study, who remained above the threshold	15.8 modelled age at loss of protective antibody (years)	modelling	Zhao et al. 2025 Vaccines (Basel) quote Vaccine-induced antibody levels following 8 m/18 m vaccination were estimated to fall below the protective threshold of 200 mIU/mL by age of 15.8, whereas antibody levels following infections remained high. abstract, Results The modelled age at which children given the routine schedule drop below the protective antibody threshold. Adults who gained immunity through natural infection stayed above it, so this shortfall is specific to vaccine-only immunity. This supports an adolescent booster question but is an antibody threshold, not a case count.
Measles duration of protective immunity in a low-incidence birth cohort severity: any case definition: Modelled time for vaccine-induced measles IgG to fall below protection in children born after measles incidence dropped	children born after the low-incidence period, aged 0 to 12 years country: China setting: community period: children born after 2010 n: 408 children Infant <1y1-4y5-11y	Measles vaccine (routine two-dose schedule) doses: 2 time since vaccination: age used as a proxy for time since vaccination vs children born before the low-incidence period, with more natural boosting	12.5 duration of protective immunity (years)	modelling	Zhao et al. 2025 Vaccines (Basel) quote Moreover, vaccine-induced antibody levels in children born after 2010-a period of low measles incidence-declined more rapidly (duration of protective immunity: 12.5 years), compared to those born before 2010. abstract, Results Children born once measles circulation was already low show a shorter protective duration than those born earlier, because re-exposure that would top up antibodies is rare. This is why the youngest cohorts in eliminated settings are the catch-up vaccination target.

Vaccine safety and adverse events

Harms measured after vaccination against an unvaccinated or baseline comparator. Kept separate from post-acute sequelae, which follow the disease, not the vaccine.

Outcome (O)	Population (P)	Intervention / comparator	Estimate	Design (S)	Source
Aseptic meningitis after MMR vaccination severity: aseptic meningitis case definition: Cases of aseptic meningitis in the comparative studies included by the review	children up to 15 years risk group: healthy children country: multiple 1-4y5-11y12-17y	MMR vaccine containing Jeryl Lynn mumps strains platform: live attenuated doses: as reported in the included studies vs MMR vaccines containing Urabe or Leningrad-Zagreb mumps strains	1.30 (0.66–2.56) Rate ratio (RR)	meta-analysis GRADE: low	Di et al. 2021 Cochrane Database Syst Rev quote Safety There is evidence supporting an association between aseptic meningitis and MMR vaccines containing Urabe and Leningrad-Zagreb mumps strains, but no evidence supporting this association for MMR vaccines containing Jeryl Lynn mumps strains (rr 1.30, 95% CI 0.66 to 2.56; low certainty evidence). abstract, Safety The confidence interval crosses one, so this is not a demonstrated increase for the Jeryl Lynn product. The strains that did show an association are no longer used in most national programmes.
Febrile seizure attributable to MMR vaccination severity: febrile seizure case definition: Febrile seizures attributed to vaccination by the review's own estimate	children up to 15 years risk group: healthy children country: multiple Infant <1y1-4y5-11y	MMR vaccine platform: live attenuated doses: 1 vs MMR doses administered, no background comparator	1 per 1700 to 1 per 1150 Attributable risk (cases per doses administered) per MMR dose administered	meta-analysis	Di et al. 2021 Cochrane Database Syst Rev quote The attributable risk febrile seizures vaccine-induced is estimated to be from 1 per 1700 to 1 per 1150 administered doses. abstract, Safety The source gives a range of attributable risk, not a confidence interval. Febrile seizures are alarming but the review describes them as benign outcomes; the same abstract reports the background rate in healthy children.
Immune thrombocytopenic purpura after MMR vaccination severity: immune thrombocytopenia case definition: Cases of ITP attributed to vaccination by the review's estimate	children up to 15 years risk group: healthy children country: multiple Infant <1y1-4y5-11y	MMR vaccine platform: live attenuated doses: 1 vs MMR doses administered, no background comparator	1 per 40,000 Attributable risk (cases per doses administered) per MMR dose administered	meta-analysis	Di et al. 2021 Cochrane Database Syst Rev quote The attributable risk is estimated about 1 case of ITP per 40,000 administered MMR doses. abstract, Safety An attributable-risk estimate rather than a measured rate ratio. The review reports the incidence of naturally occurring ITP in the same abstract, which is the comparison a parent needs.
Encephalitis or encephalopathy after MMR vaccination severity: encephalitis or encephalopathy case definition: Encephalitis and encephalopathy cases in the included observational studies	children up to 15 years risk group: healthy children country: multiple n: 1,071,088 children Infant <1y1-4y5-11y12-17y	MMR vaccine platform: live attenuated doses: as reported in the included studies vs Unvaccinated children	0.90 (0.50–1.61) Rate ratio (RR)	meta-analysis GRADE: low 2 observational studies	Di et al. 2021 Cochrane Database Syst Rev quote There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). abstract, Safety A rate ratio below one with an interval spanning one, i.e. no evidence of increased risk. Certainty is low, so absence of evidence here is not strong evidence of absence.
Autistic spectrum disorder after MMR vaccination severity: autism spectrum disorder case definition: Autistic spectrum disorder diagnoses in the included observational studies	children up to 15 years risk group: healthy children country: multiple n: 1,194,764 children Infant <1y1-4y5-11y12-17y	MMR vaccine platform: live attenuated doses: as reported in the included studies vs Unvaccinated children	0.93 (0.85–1.01) Rate ratio (RR)	meta-analysis GRADE: moderate 2 observational studies	Di et al. 2021 Cochrane Database Syst Rev quote There is no evidence of an association between MMR immunisation and encephalitis or encephalopathy (rate ratio 0.90, 95% CI 0.50 to 1.61; 2 observational studies; 1,071,088 children; low certainty evidence), and autistic spectrum disorders (rate ratio 0.93, 95% CI 0.85 to 1.01; 2 observational studies; 1,194,764 children; moderate certainty). abstract, Safety The largest sample in the review and moderate certainty. The interval excludes a rise, which is why this record is the direct answer to the autism question.

Mumps Mumps orthorubulavirus

Vaccine efficacy and effectiveness

Every estimate compiled, annotated by population (P), intervention (I), comparator (C), outcome (O) and study design (S).

Outcome (O)	Population (P)	Intervention / comparator	Estimate	Design (S)	Source
Mumps cases severity: any strain: Jeryl Lynn mumps strain case definition: As defined in the included cohort studies	children up to 15 years risk group: healthy children country: multiple n: 9915 children 1-4y5-11y12-17y	MMR containing Jeryl Lynn mumps strain platform: live attenuated doses: 1 vs no vaccination or placebo	72 (0.08–0.76 RR CI) VE (%) = 1 - RR	meta-analysis GRADE: moderate 6 cohort studies	Di et al. 2021 Cochrane Database Syst Rev quote The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). abstract, Effectiveness Mumps effectiveness is materially lower than measles effectiveness with the same vaccine; this gap drives mumps outbreaks in two-dose populations.
Mumps cases severity: any strain: Jeryl Lynn mumps strain case definition: As defined in the included cohort studies	children up to 15 years risk group: healthy children country: multiple n: 7792 children 1-4y5-11y12-17y	MMR containing Jeryl Lynn mumps strain platform: live attenuated doses: 2 vs no vaccination or placebo	86 (0.04–0.35 RR CI) VE (%) = 1 - RR	meta-analysis GRADE: moderate 5 cohort studies	Di et al. 2021 Cochrane Database Syst Rev quote The effectiveness of Jeryl Lynn containing MMR vaccine in preventing mumps was 72% after one dose (RR 0.24, 95% CI 0.08 to 0.76; 6 cohort studies; 9915 children; moderate certainty evidence), 86% after two doses (RR 0.12, 95% CI 0.04 to 0.35; 5 cohort studies; 7792 children; moderate certainty evidence). abstract, Effectiveness Two doses lift mumps effectiveness but the figure stays below the measles figure for the same product, which is why mumps outbreaks keep occurring in two-dose populations.
Mumps (duration of vaccine-induced immunity) severity: any case definition: Modelled time for antibody titre to fall to the seronegative cutoff, equivocal results counted as negative	children and adults in the national serosurvey, time since the second dose taken from age risk group: born from the early-mid-1990s cohort in an eliminated setting country: South Korea period: 2019 national serosurvey 5-11y12-17y18-49y	MMR vaccine platform: live attenuated doses: 2 time since vaccination: age used as a proxy for time since vaccination vs antibody persistence after natural mumps infection	9.71 duration of vaccine-induced immunity (years) follow-up: modelled time to seronegative cutoff	modelling	Chun et al. 2026 Int J Epidemiol quote The duration of vaccine-induced immunity was estimated to be 19 years for measles, 9.71 years for mumps, and 31.57 years for rubella when equivocal results were considered negative. abstract, RESULTS Substantially shorter than the measles duration from the same model, consistent with ongoing mumps outbreaks in two-dose populations and with the lower effectiveness the Cochrane review finds for mumps.

Rubella Rubella virus

Vaccine efficacy and effectiveness

Every estimate compiled, annotated by population (P), intervention (I), comparator (C), outcome (O) and study design (S).

Outcome (O)	Population (P)	Intervention / comparator	Estimate	Design (S)	Source
Rubella cases severity: any strain: BRD2 rubella strain case definition: As defined in the single included cohort study	children country: China n: 1621 children Infant <1y1-4y5-11y	Rubella vaccine containing the BRD2 strain platform: live attenuated doses: as reported in the study vs no vaccination	89 (0.03–0.42 RR CI) VE (%) = 1 - RR	meta-analysis GRADE: moderate 1 cohort study	Di et al. 2021 Cochrane Database Syst Rev quote Vaccine effectiveness against rubella, using a vaccine with the BRD2 strain which is only used in China, is 89% (RR 0.11, 95% CI 0.03 to 0.42; 1 cohort study; 1621 children; moderate certainty evidence). abstract, Effectiveness Single-study estimate for a strain used only in China, so it may not transfer to the rubella strains used in most national programmes.
Rubella antibody response after the second MMR dose (peak) severity: any case definition: Geometric mean rubella antibody titre by plaque-reduction neutralisation, lowest detectable titre 1:10	children who received the second MMR dose at age 4 to 6 years country: United States setting: community period: second dose given in 1994-1995, follow-up to 2007 n: 307 children 1-4y5-11y	MMR vaccine platform: live attenuated doses: 2 time since vaccination: one month after the second dose vs antibody titre before the second dose	42 geometric mean antibody titre (reciprocal dilution) follow-up: one month after the second dose	cohort	LeBaron et al. 2009 J Infect Dis quote One month after administration of MMR2, 1% were seronegative, 6% had the lowest detectable titer, and the GMT was 1:42. abstract, RESULTS Peak geometric mean rubella titre one month after the second dose, the starting point for the twelve-year decline recorded next.
Rubella antibody after long-term follow-up of the second MMR dose severity: any case definition: Geometric mean rubella antibody titre by plaque-reduction neutralisation, lowest detectable titre 1:10	the same children twelve years after the second dose, and an older group vaccinated at age 9 to 11 years country: United States setting: community period: second dose given in 1994-1995, follow-up to 2007 n: 307 children 1-4y5-11y12-17y	MMR vaccine platform: live attenuated doses: 2 time since vaccination: twelve years after the second dose vs peak antibody titre one month after the second dose	17 geometric mean antibody titre (reciprocal dilution) follow-up: twelve years after the second dose	cohort	LeBaron et al. 2009 J Infect Dis quote Twelve years after MMR2 administration, 10% were seronegative, 43% had the lowest detectable titer, and the GMT was 1:17. abstract, RESULTS Geometric mean rubella titre twelve years after the second dose, having fallen back toward the pre-second-dose level. The authors conclude rubella antibody wanes to near baseline over roughly a decade.
Rubella (duration of vaccine-induced immunity) severity: any case definition: Modelled time for antibody titre to fall to the seronegative cutoff, equivocal results counted as negative	children and adults in the national serosurvey, time since the second dose taken from age risk group: born from the early-mid-1990s cohort in an eliminated setting country: South Korea period: 2019 national serosurvey 5-11y12-17y18-49y	MMR vaccine platform: live attenuated doses: 2 time since vaccination: age used as a proxy for time since vaccination vs antibody persistence after natural rubella infection	31.57 duration of vaccine-induced immunity (years) follow-up: modelled time to seronegative cutoff	modelling	Chun et al. 2026 Int J Epidemiol quote The duration of vaccine-induced immunity was estimated to be 19 years for measles, 9.71 years for mumps, and 31.57 years for rubella when equivocal results were considered negative. abstract, RESULTS The longest of the three durations from the same model, consistent with rubella elimination being sustained. It is a modelled antibody endpoint, not a count of observed rubella or congenital-rubella cases.

Chickenpox (varicella) Varicella zoster virus

Vaccine efficacy and effectiveness

Every estimate compiled, annotated by population (P), intervention (I), comparator (C), outcome (O) and study design (S).

Outcome (O)	Population (P)	Intervention / comparator	Estimate	Design (S)	Source
Varicella cases of any severity severity: any case definition: As defined in the single included randomised trial	children aged 11 to 22 months risk group: healthy children country: United States n: 2279 children Infant <1y1-4y	Tetravalent MMRV vaccine platform: live attenuated doses: 2 time since vaccination: 10 years follow-up vs no vaccination	95 (0.03–0.08 RR CI) VE (%) = 1 - rate ratio follow-up: 10 years	meta-analysis GRADE: high 1 RCT	Di et al. 2021 Cochrane Database Syst Rev quote Vaccine effectiveness against varicella (any severity) after two doses in children aged 11 to 22 months is 95% in a 10 years follow-up (rate ratio (rr) 0.05, 95% CI 0.03 to 0.08; 1 RCT; 2279 children; high certainty evidence). abstract, Effectiveness This is the tetravalent MMRV product, not plain MMR; it is the highest-certainty effectiveness estimate in the review and the longest follow-up.

Gaps

No MMR record for rubella in pregnancy or congenital rubella syndrome was compiled: the disease-burden sources cached so far cover measles and mumps only. Needs a search of CRS incidence and series before this file can speak to rubella burden.
No mumps burden record (orchitis, deafness, meningitis rates from mumps itself) is compiled. The Cochrane review gives mumps effectiveness but not mumps disease risk.
No rubella burden record (arthritis, CRS risk by gestational age) is compiled.
No measles encephalitis burden record from natural infection is compiled, so the encephalitis safety record (mmr-saf-004) cannot yet be placed against the risk of the disease. A parent comparing the two needs both numbers.
No waning record is compiled for plain MMR measured as clinically confirmed breakthrough measles in a followed cohort: the new duration records (mmr-eff-009 to mmr-eff-015) are serological or modelled from age as a proxy for time since vaccination, not counts of observed cases over a tracked cohort. No record yet quantifies how much mumps protection wanes against real outbreak disease versus antibody titre.
Febrile-seizure and ITP records are attributable-risk estimates quoted from a review, not primary measurements, so they carry no confidence interval here.

Flags for review

The varicella record above (mmr-eff-008) covers the tetravalent MMRV product, not plain MMR. It is included because the Cochrane review assesses MMRV and MMR+V alongside MMR. Confirm this is wanted on the MMR page rather than a separate varicella/MMRV page before publishing.
The Cochrane review (PMID 34806766) reports effectiveness as a percentage while its confidence intervals are on the RR scale. Records mmr-eff-001 through mmr-eff-008 therefore carry ci_scale=RR; a reader who misses that will misread "95 (0.02 to 0.13)" as a percentage interval. build.py was checked and renders these as "95 (0.02-0.13 RR CI)", so the scale is labelled. Verify the same labelling once this data is integrated into the real VDN site, which does not use build.py.
mmr-bur-005 uses hospitalised cases as its denominator and mmr-bur-006 and mmr-bur-007 use hospital-diagnosed cases. These are not population risks and must not be multiplied together or presented next to the community CFR in mmr-bur-001 without labelling.
The burden records are almost entirely measles; mumps and rubella have efficacy records but no burden records. As compiled this file will read as though measles is the only disease the vaccine addresses. Either fill the gap or say so on the page.
The encephalitis and autism safety records come from the same sentence of one review. They are two estimates, not two independent sources; the page should not imply a broader evidence base than this.
Records mmr-saf-002 and mmr-saf-003 are ranges or single attributable-risk figures with no interval. Check whether the site is allowed to display them beside interval-bearing records.
mmr-eff-008 is a varicella estimate from the tetravalent MMRV product. Chickenpox is not in the plain MMR vaccine; verify this belongs on the MMR page.
mmr-eff-009 through mmr-eff-015 are duration and waning estimates modelled from antibody titre, with age used as a proxy for time since vaccination, not counts of clinically confirmed breakthrough cases. They belong beside the Cochrane effectiveness records (mmr-eff-001 to mmr-eff-006), which measure disease prevention, and must not be read as vaccine effectiveness against actual measles, mumps, or rubella cases.
mmr-eff-013, mmr-eff-014 and mmr-eff-015 contrast vaccine-induced with naturally acquired immunity. The natural-infection side cannot be a vaccine record under this schema (a record needs intervention.product and doses), so it is carried in the comparator and in notes. A reader comparing vaccine versus prior-infection protection should know the natural figures are in the cached abstract but are not separate records.
The South Korea model yields two measles durations that differ only by how equivocal titres are counted (mmr-eff-009 counts them negative, mmr-eff-012 counts them positive). Do not present either number alone; show the paired range, and say what the difference is.

Search log (10 searches)

measles natural history case fatality hospitalization complications LMIC · PubMed → Found PMID 30797735 (Portnoy 2019, modelling of measles CFR in LMICs); compiled as mmr-bur-001 and mmr-bur-002.
measles complications outbreak New York 2018 2019 hospitalization intensive care · PubMed → Found PMID 32160662 (NYC outbreak series); compiled as mmr-bur-003, mmr-bur-004, mmr-bur-005.
measles complications children hospitalized United States outbreak · PubMed → Found PMID 31117114 (children's hospital case series); compiled as mmr-bur-006.
measles outbreak complications France Lyon · PubMed → Found PMID 22971330 (Lyon 2010-2011 outbreak); compiled as mmr-bur-007.
subacute sclerosing panencephalitis measles risk Germany · PubMed → Found PMID 23874807 (SSPE risk after measles under 5 years); compiled as mmr-pa-001.
measles immune amnesia infectious morbidity cohort · PubMed → Found PMID 30346573 (DRC cohort, fever episodes after reported measles); compiled as mmr-pa-002.
vaccines measles mumps rubella varicella children Cochrane review · PubMed → Found PMID 34806766 (Di Pietrantonj 2021 Cochrane update, 138 studies); compiled as the eight efficacy and five safety records.
measles rubella duration of vaccine-induced immunity waning serosurvey · PubMed → Found PMID 42201837 (Chun 2026, South Korea MMR2 serosurvey); compiled as mmr-eff-009 to mmr-eff-012.
measles natural infection versus vaccination antibody decay China · PubMed → Found PMID 40573886 (Zhao 2025, vaccine vs naturally acquired measles antibody dynamics); compiled as mmr-eff-013 to mmr-eff-015.
rubella antibody persistence after second MMR dose children · PubMed → Found PMID 19659440 (LeBaron 2009, twelve-year rubella titre follow-up); compiled as mmr-eff-016 and mmr-eff-017.