Cochrane · systematic review · CD004407
Vaccines for measles, mumps, rubella, and varicella in children
Di Pietrantonj, C, Rivetti, A, Marchione, P, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
104
current version
GRADE rated
104
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 6 · 5.8%Low 68 · 65.4%Moderate 16 · 15.4%High 14 · 13.5%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsEffectiveness against measles
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort studies ‐ 1 dose | RR 0.05 [0.02, 0.13] | 7 studies · 12039 participants | Moderate Downgraded: risk of bias |
Cohort studies ‐ 2 doses | RR 0.04 [0.01, 0.28] | 5 studies · 21604 participants | Moderate Downgraded: risk of bias |
Cohort studies household contacts ‐ 1 dose | RR 0.19 [0.04, 0.89] | 3 studies · 151 participants | Low Downgraded: risk of bias |
Cohort studies household contacts ‐ 2 doses | RR 0.15 [0.03, 0.75] | 3 studies · 378 participants | Low Downgraded: risk of bias |
Cohort studies household contacts ‐ 3 doses | RR 0.04 [0.01, 0.23] | 2 studies · 151 participants | Low Downgraded: risk of bias |
Cohort studies postexposure prophylaxis | RR 0.26 [0.14, 0.5] | 2 studies · 283 participants | Low Downgraded: risk of bias |
Effectiveness against mumps
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort studies ‐ Jeryl Lynn strain ‐ 1 dose | RR 0.24 [0.08, 0.76] | 6 studies · 9915 participants | Moderate Downgraded: risk of bias |
Cohort studies ‐ Jeryl Lynn strain ‐ 2 doses | RR 0.12 [0.04, 0.35] | 5 studies · 7792 participants | Moderate Downgraded: risk of bias |
Cohort studies ‐ Jeryl Lynn strain ‐ unspecified number of doses | RR 0.23 [0.14, 0.35] | 4 studies · 2011 participants | Low Downgraded: risk of bias |
Cohort studies ‐ Jeryl Lynn strain ‐ household contacts | RR 0.26 [0.13, 0.49] | 3 studies · 1036 participants | Moderate Downgraded: risk of bias |
Cohort studies ‐ Urabe strain ‐ unspecified numbers or at least 1 dose | RR 0.23 [0.12, 0.44] | 4 studies · 2721 participants | Low Downgraded: risk of bias |
Cohort studies ‐ Rubini strain ‐ unspecified numbers or at least 1 dose | RR 0.96 [0.55, 1.65] | 4 studies · 4219 participants | Low Downgraded: risk of bias |
Cohort studies ‐ mumps strain not reported or any strain | RR 0.52 [0.29, 0.94] | 2 studies · 769 participants | Low Downgraded: risk of bias |
Cohort studies ‐ third dose versus 2 doses | RR 0.59 [0.33, 1.05] | 2 studies · 5417 participants | Low Downgraded: risk of bias |
Effectiveness against rubella
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort studies secondary cases ‐ any strain | RR 0.11 [0.03, 0.42] | 1 study · 1621 participants | Moderate Downgraded: risk of bias |
Effectiveness against varicella
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
MMRV randomised controlled trial ‐ any severity ‐ 2 doses ‐ | Rate ratio 0.05 [0.03, 0.08] | 1 study · 3022 participants | High |
MMRV randomised controlled trial ‐ any severity ‐ 2 doses ‐ | Rate ratio 0.05 [0.04, 0.06] | 1 study · 3023 participants | High |
MMRV randomised controlled trial ‐ any severity ‐ 2 doses ‐ | Rate ratio 0.05 [0.04, 0.06] | 1 study · 3023 participants | High |
MMRV randomised controlled trial ‐ moderate/severe cases ‐ 2 doses ‐ | Rate ratio 0 [0, 0.02] | 1 study · 3022 participants | High |
MMRV randomised controlled trial ‐ moderate/severe cases ‐ 2 doses ‐ | Rate ratio 0.01 [0, 0.02] | 1 study · 3023 participants | High |
MMRV randomised controlled trial ‐ moderate/severe cases ‐ 2 doses ‐ | Rate ratio 0.01 [0, 0.02] | 1 study · 3023 participants | High |
MMR+V randomised controlled trial ‐ any severity ‐ 2 doses ‐ | Rate ratio 0.35 [0.28, 0.43] | 1 study · 3006 participants | High |
MMR+V randomised controlled trial ‐ any severity ‐ 2 doses ‐ | Rate ratio 0.33 [0.29, 0.38] | 1 study · 3010 participants | High |
MMR+V randomised controlled trial ‐ any severity ‐ 2 doses ‐ | Rate ratio 0.33 [0.29, 0.38] | 1 study · 3010 participants | High |
MMR+V randomised controlled trial ‐ moderate/severe cases ‐ 2 doses ‐ | Rate ratio 0.09 [0.06, 0.14] | 1 study · 3006 participants | High |
MMR+V randomised controlled trial ‐ moderate/severe cases ‐ 2 doses ‐ | Rate ratio 0.1 [0.07, 0.13] | 1 study · 3010 participants | High |
MMR+V randomised controlled trial ‐ moderate/severe cases ‐ 2 doses ‐ | RR 0.1 [0.08, 0.14] | 1 study · 3010 participants | High |
Safety: short‐term side effects (local or systemic reactions)
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Temperature ‐ RCT/CCT axillary | RR 2.04 [1.09, 3.83] | 1 study · 420 participants | Low Downgraded: risk of bias |
Temperature ‐ RCT/CCT rectal | RR 0.84 [0.67, 1.06] | 1 study · 170 participants | Low Downgraded: risk of bias |
Temperature ‐ RCT/CCT measurement site not reported | RR 1.36 [0.83, 2.23] | 2 studies · 520 participants | High |
Temperature ‐ cohort studies orally | RR 1.37 [1.04, 1.81] | 1 study · 334 participants | Very low |
Temperature ‐ cohort studies measurement site not reported | RR 1.12 [0.84, 1.49] | 4 studies · 457123 participants | Very low |
Rash ‐ cohort studies | RR 1.49 [0.73, 3.04] | 3 studies · 457261 participants | Very low |
Lymphadenopathy ‐ RCT/CCT | RR 1.32 [0.52, 3.33] | 3 studies · 1156 participants | Moderate |
Lymphadenopathy ‐ cohort studies | RR 1.98 [0.19, 20.97] | 2 studies · 454085 participants | Very low |
Coryza ‐ RCT/CCT | RR 0.45 [0.12, 1.63] | 2 studies · 831 participants | Moderate Downgraded: risk of bias |
Coryza ‐ cohort studies | RR 1.13 [1.05, 1.2] | 1 study · 3176 participants | Low Downgraded: risk of bias |
URTI (rhinitis pharyngitis) ‐ RCT/CCT | RR 0.31 [0.06, 1.56] | 2 studies · 831 participants | Low Downgraded: risk of bias |
URTI (rhinitis pharyngitis) ‐ cohort studies | RR 1.44 [1.26, 1.64] | 1 study · 966 participants | Very low |
Cough ‐ RCT/CCT | RR 1.99 [0.45, 8.81] | 2 studies · 831 participants | Low Downgraded: risk of bias |
Rash ‐ RCT/CCT | RR 2.05 [1.21, 3.48] | 4 studies · 1156 participants | High |
Safety: encephalitis or encephalopathy
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Case‐control: MMR (risk interval from 0 to 90 days) | OR 0.98 [0.64, 1.5] | 1 study · 452 participants | Low |
Self‐controlled case series/person‐time cohort | Rate ratio 0.9 [0.5, 1.61] | 2 studies · 1071088 participants | Low |
Safety: aseptic meningitis
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Case‐control ‐ Jeryl Lynn ‐ risk interval 0 to 30 days | OR 0.85 [0.21, 3.41] | 1 study · 59 participants | Low |
Case cross‐over ‐ Urabe or Hoshino | OR 4 [2.23, 7.2] | 2 studies · 2 participants | Low |
Case cross‐over ‐ Jeryl Lynn or Rubini | OR 0.6 [0.18, 1.99] | 1 study · 1 participants | Low |
Self‐controlled case series ‐ any strain | Rate ratio 12.4 [3.12, 49.35] | 1 study · 1 participants | Low |
Self‐controlled case series ‐ Urabe | Rate ratio 30.71 [13.45, 70.1] | 3 studies · 564635 participants | Low |
Self controlled case series ‐ Leningrad‐Zagreb | Rate ratio 6.4 [0.78, 52.47] | 1 study · 1 participants | Low |
Person‐time cohort ‐ Jeryl Lynn | Rate ratio 1.3 [0.66, 2.56] | 1 study · 1071088 participants | Low |
Case‐only ecological method ‐ Urabe | Rate ratio 9.12 [5.73, 14.52] | 1 study · 1054305 participants | Low |
Case‐only ecological method ‐ Leningrad‐Zagreb | Rate ratio 18.56 [12.09, 28.51] | 3 studies · 1164964 participants | Low |
Safety: seizures (febrile/afebrile)
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort studies ‐ within 1 week after MMR vaccination | Rate ratio 2.45 [2.21, 2.71] | 2 studies · 1451990 participants | Moderate |
Cohort studies ‐ between 1 and 2 weeks after MMR vaccination | Rate ratio 3.16 [2.89, 3.46] | 2 studies · 2147638 participants | Moderate |
Cohort studies ‐ > 2 weeks after MMR vaccination | Rate ratio 0.97 [0.49, 1.94] | 1 study · 1018998 participants | Low |
Self‐controlled case series/person‐time ‐ between 1 and 2 weeks after MMR vaccination | Rate ratio 3.36 [2.65, 4.24] | 5 studies · 505493 participants | Low |
Self‐controlled case series/person‐time ‐ > 2 weeks after MMR vaccination | Rate ratio 1.18 [0.93, 1.5] | 3 studies · 102099 participants | Low |
Self‐controlled case series/person‐time ‐ between 1 and 2 weeks after vaccination; MMRV | Rate ratio 6.08 [4.95, 7.47] | 2 studies · 180480 participants | Low |
Self‐controlled case series/person‐time ‐ between 1 and 2 weeks after MMR+V vaccination | Rate ratio 3.13 [2.38, 4.1] | 1 study · 181088 participants | Low |
MMRV vs MMR+V ‐ by brand ‐ from 0 to 42 days after vaccination (Priorix‐Tetra) | RR 1.95 [0.85, 4.48] | 1 study · 115022 participants | Low |
MMRV vs MMR+V ‐ by brand ‐ from 7 to 10 days after vaccination (Priorix‐Tetra) | RR 1.69 [0.93, 3.07] | 1 study · 114922 participants | Low |
MMRV vs MMR+V ‐ by brand ‐ from 0 to 42 days after vaccination (ProQuad) | RR 1.3 [1.17, 1.44] | 4 studies · 1381609 participants | Low |
MMRV vs MMR+V ‐ by brand ‐ from 7 to 10 days after vaccination (ProQuad) | RR 2.01 [1.7, 2.38] | 4 studies · 1381609 participants | Low |
MMRV vs MMR ‐ by brand ‐ from 0 to 42 days after vaccination (Priorix‐Tetra) | RR 1.28 [1, 1.64] | 2 studies · 292535 participants | Low |
MMRV vs MMR ‐ by brand ‐ from 7 to 10 days after vaccination (Priorix‐Tetra) | RR 2.49 [1.66, 3.74] | 2 studies · 292535 participants | Low |
MMRV vs MMR ‐ by brand ‐ from 0 to 42 days after vaccination (ProQuad) | RR 1.6 [1.42, 1.82] | 3 studies · 1049831 participants | Low |
MMRV vs MMR ‐ by brand ‐ from 7 to 10 days after vaccination (ProQuad) | RR 1.46 [1.32, 1.61] | 4 studies · 1989157 participants | Low |
Safety: autistic spectrum disorders
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort studies ‐ all children, MMR | Rate ratio 0.93 [0.85, 1.01] | 2 studies · 1194764 participants | Moderate |
Cohort studies ‐ autism risk (low), MMR | Rate ratio 1 [0.89, 1.14] | 1 study · 93071 participants | Moderate |
Cohort studies ‐ autism risk (moderate/high), MMR | Rate ratio 0.8 [0.64, 0.98] | 1 study · 1914 participants | Low |
Safety: inflammatory bowel disease
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Case control ‐ all IBD, MMR | OR 1.42 [0.93, 2.16] | 3 studies · 409 participants | Moderate |
Case control ‐ ulcerative colitis, MMR | OR 1.35 [0.81, 2.23] | 2 studies · 292 participants | Moderate |
Case control ‐ Crohn's disease, MMR | OR 0.64 [0.42, 0.98] | 3 studies · 514 participants | Moderate |
Safety: cognitive delay ‐ developmental delay
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort study ‐ MDI‐BSID II 24th month, MMR | OR 1.35 [0.15, 12.07] | 1 study · 337 participants | Low |
Cohort study ‐ MDI‐BSID II 36th month, MMR | OR 0.37 [0.03, 4.28] | 1 study · 337 participants | Low |
Cohort study ‐ Raven 5th year, MMR | OR 1.22 [0.23, 6.51] | 1 study · 337 participants | Low |
Cohort study ‐ WISC‐R verbal 6th year, MMR | OR 1.23 [0.09, 16.92] | 1 study · 337 participants | Low |
Safety: idiopathic thrombocytopenic purpura
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Case‐control ‐ case cross‐over ‐ case controls MMR | OR 2.8 [1.5, 5.23] | 2 studies · 410 participants | Low |
Self‐controlled case series ‐ MMR vaccine ‐ age from 9 to 23 months | Rate ratio 4.21 [2.28, 7.78] | 5 studies · 3723677 participants | Moderate |
Safety: Henoch‐Schönlein purpura
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Case‐control ‐ MMR vaccine | OR 3.4 [1.18, 9.81] | 1 study · 288 participants | Low |
Safety: type 1 diabetes
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort study MMR ‐ all children | Rate ratio 1.09 [0.98, 1.21] | 2 studies · 1666829 participants | Low |
Cohort study MMR ‐ children with at least 1 sibling with type 1 diabetes | Rate ratio 0.86 [0.34, 2.16] | 1 study · 3848 participants | Low |
Safety: asthma
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort study (rate ratio) ‐ all ages | Rate ratio 1.05 [0.8, 1.39] | 3 studies · 1067712 participants | Low Downgraded: risk of bias |
Cohort studies (risk ratio) ‐ all ages | RR 0.63 [0.24, 1.63] | 3 studies · 886 participants | Low Downgraded: risk of bias |
Safety: eczema ‐ dermatitis
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort study (rate ratio) | Rate ratio 3.5 [2.38, 5.15] | 1 study · 14353 participants | Very low |
Cohort study (risk ratio) | RR 0.75 [0.29, 1.94] | 1 study · 555 participants | Low |
Safety: hay fever, rhinoconjunctivitis, hypersensitivity/allergy
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cohort study ‐ rhinoconjunctivitis | OR 0.64 [0.19, 2.11] | 1 study · 489 participants | Low Downgraded: risk of bias |
Cohort study ‐ hypersensitivity/allergy | OR 0.63 [0.14, 2.77] | 1 study · 544 participants | Low Downgraded: risk of bias |
Case control ‐ hay fever | OR 1.16 [0.92, 1.45] | 0 studies · 2 participants | Low Downgraded: risk of bias |
Safety: acute leukaemia
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Case‐control ‐ acute leukaemia | OR 0.97 [0.76, 1.24] | 2 studies · 941 participants | Low |
Case‐control ‐ acute lymphoblastic leukaemia | OR 0.91 [0.72, 1.14] | 4 studies · 1375 participants | Low |
Case‐control ‐ acute myeloblastic leukaemia | OR 0.56 [0.29, 1.07] | 1 study · 62 participants | Low |
Safety: demyelinating diseases ‐ multiple sclerosis ‐ acute disseminated encephalomyelitis
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Case‐control ‐ multiple sclerosis | OR 1.13 [0.62, 2.05] | 1 study · 206 participants | Low |
Case‐control ‐ ADEM | OR 1.03 [0.44, 2.42] | 1 study · 272 participants | Low |
Safety: gait disturbances
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐controlled case series (hospitalisations) ‐ hospitalisations ‐ risk period: 0 to 60 days | Rate ratio 0.46 [0.16, 1.34] | 1 study · 127 participants | Low |
Self‐controlled case series (GP visits) ‐ GP visit ‐ risk period: 0 to 5 days | Rate ratio 1.88 [1.3, 2.72] | 1 study · 1398 participants | Low |
Self‐controlled case series (GP visits) ‐ GP visit ‐ risk period: 6 to 60 days | Rate ratio 0.93 [0.78, 1.11] | 1 study · 1398 participants | Low |
Safety: bacterial or viral infections, immune overload
Population: children 9 months to 15 years old
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self‐controlled case series ‐ lobar pneumonia ‐ lobar pneumonia risk period (0 to 90 days) | Rate ratio 0.75 [0.64, 0.89] | 2 studies · 2412 participants | Low |
Self‐controlled case series ‐ invasive bacterial infections ‐ invasive bacterial infections risk period (0 to 90 days) | Rate ratio 0.9 [0.71, 1.13] | 2 studies · 2412 participants | Low |
Self‐controlled case series ‐ encephalitis meningitis ‐ encephalitis meningitis risk period (0 to 90 days) | Rate ratio 0.84 [0.2, 3.51] | 1 study · 2025 participants | Low |
Self‐controlled case series ‐ herpes ‐ herpes risk period (0 to 90 days) | Rate ratio 1.17 [0.56, 2.46] | 1 study · 2025 participants | Low |
Self‐controlled case series ‐ pneumonia ‐ pneumonia risk period (0 to 90 days) | Rate ratio 0.72 [0.32, 1.6] | 1 study · 2025 participants | Low |
Self‐controlled case series ‐ varicella zoster ‐ varicella zoster risk period (0 to 90 days) | Rate ratio 0.93 [0.68, 1.27] | 1 study · 2025 participants | Low |
Self‐controlled case series ‐ miscellaneous viral infections ‐ miscellaneous viral infections risk period (0 to 90 days) | Rate ratio 0.68 [0.43, 1.08] | 1 study · 2025 participants | Low |