This article provides clarification on the following MMR issues:

1. Requests for bringing forward MMR doses.
2. Requests for MMR doses in adults including HCWs.
3. MMR requirements for GP Practice staff
4. National MMR catch-up campaign

Requests for bringing forward MMR doses

MMR doses are routinely given at 1 year (MMR1) and 3 years and 4 months of age (MMR2).

UKHSA have clarified that the current recommendation is that MMR doses should not routinely be given early in any part of the East Midlands including areas with a local upsurge of cases.

GPs should only give doses early in exceptional circumstances when directed to do so by UKHSA.  This may be for some cases and contacts of measles or as part of the response to a measles outbreak in specific settings (eg nursery setting).

The rationale for this is:

• the response to MMR in children under 1 is suboptimal and 2 further doses would therefore still be required at the recommended ages.
• Children under 1 are protected by ensuring older children in their family and local area are vaccinated, reducing the spread of measles.  Babies under 1 rarely acquire measles from another baby under 1 year of age.
• Parents requesting early MMR doses should be advised to ensure:
  • MMR doses are administered as soon as possible after the scheduled age (1 year for MMR1 and 3 years 4 months for MMR2)
  • Other household members are protected with MMR.
• We understand that the NHS website explains that MMR1 can be given early in outbreaks and are liaising with the national team to amend the wording so that it is clearer that this does not mean parents in the East Midlands need early doses.
• For more details see page 55 General Medical Services Statement of Financial Entitlements Directions 2023 (publishing.service.gov.uk)

Requests for MMR doses in adults including HCWs

Practices must offer outstanding MMR doses to any eligible adult (including HCWs) who requests it with no upper age limit.

• IMMFORM free MMR stock can be used for this.
• Am item of service fee can be claimed.
• Adults are eligible if they have had 0 or 1 valid dose of MMR previously.
• Antibody testing is not required pre or post MMR vaccination.
• Some unvaccinated patients may not be sure if they need vaccination and should be advised as per the Green Book guidance in Appendix 1. All HCWs of any age should be advised that MMR is recommended.

MMR requirements for GP Practice staff

• All practice staff (including non-clinical) require evidence of having received two doses of MMR or having had positive antibody tests for measles & rubella.
• Practices can encourage susceptible staff to get the MMR vaccine from their own GP.
• Staff susceptible to measles can pose reputational and business resilience risks. They can infect vulnerable patients. HCWs exposed to a measles case without satisfactory evidence of protection can be excluded from work for 21 days.

National MMR catch-up campaign

• We have had feedback that practices are being contacted by patients who have had national MMR invites but on review are already fully vaccinated. We apologise for the inconvenience and are feeding this back to the national team and will update you if further information is available.
• In the meantime, please consider the following:
  • Check that the MMR doses given are valid - the following doses are invalid and should be discounted:
    • MMR1 given before 1 year of age.
    • MMR2 given before 15 months of age.
    • MMR2 given < 1 month after MMR1.
    • Single measles vaccine given in a private clinic using unlicensed product.
  • Check that the MMR doses are coded correctly - see page 16 of attached GP toolkit.

If you have any further queries, please contact the East Midlands Immunisation Clinical Advice Service (ICAS) england.emids-imms@nhs.net