MMR vaccine and lupus information: what MMR is, why it matters in SLE, when it is safe, who should avoid it, timing, side effects, and who needs measles titres.
What Is MMR?
The MMR vaccine is a vaccination against measles, mumps, and rubella.
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Measles can lead to pneumonia or encephalitis.
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Mumps can cause meningitis, orchitis, and infertility.
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Rubella is dangerous if a woman gets rubella during pregnancy, as it can harm the fetus/baby.
The MMR vaccination is a live vaccine, whereas most adult vaccinations are not live. Live vaccines have an extra risk of immunocompromised patients actually getting an infection; but this is very rare.
Why Is It Important in Lupus?
People with SLE are immunocompromised due to their disease and medications (such as prednisone, azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide, rituximab, belimumab, anifrolumab and obinutuzumab). It is fine to receive the MMR vaccine if taking hydroxychloroquine.
In general, SLE patients can become sicker with these infections versus the general population. While many adults are already immune from childhood vaccination or past infection, gaps in immunity can exist. Confirming immunity and vaccinating if needed is important to prevent outbreaks. There have been outbreaks of measles recently.
Should I Get the MMR Vaccine?
MMR is a live vaccine, which means it should generally be avoided in patients on high-dose immunosuppression or biologics.
However, if you are stable, not on strong immune suppression, and lack immunity (blood test showing negative antibodies), you may be a candidate.
Testing for measles, mumps, and rubella IgG is recommended before giving MMR in adult lupus patients.
Ideally, all women should determine if they have immunity to rubella and get vaccinated prior to pregnancy. All pregnant women are tested for rubella immunity and are vaccinated postpartum if not immune. Rubella can cause birth defects and fetal death.
When Should I Get It?
Most people in Canada have received the full MMR vaccination schedule as children.
If not vaccinated, MMR should be given before starting strong immune suppression (such as rituximab, cyclophosphamide, or high-dose steroids).
If you are already immunosuppressed, your healthcare provider may recommend waiting or avoiding this vaccine until prednisone dose is reduced, SLE is less active, or strong immune suppression is paused if possible.
Side Effects and Lupus Flares
Most side effects are mild (fever, rash, sore arm). Joint pain can occur, particularly in adult women.
Lupus flares after MMR are rare and transient.
Who Should NOT Get MMR?
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Pregnant women (should wait until after delivery), as the vaccine can harm the fetus/baby in utero.
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Patients on biologics (rituximab, belimumab, etc.), high-dose steroids, or strong immunosuppression.
This is because it is a live vaccine, so theoretically someone who is strongly immunosuppressed could develop measles, mumps, or rubella, and the vaccine response may also be weak.
Who With SLE Should Get Measles Titres?
1. Patients With Uncertain Vaccination History
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Anyone with SLE unsure whether they received two doses of MMR (or measles vaccine) in childhood.
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Those born before universal measles immunization (e.g., in Canada, before 1970).
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Healthcare workers who may need documented immunity.
2. Patients Without Documented Immunity
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If vaccination records are incomplete or missing, measles IgG titres should be checked.
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A positive titre means no further vaccination is required.
3. Patients at Higher Risk of Exposure
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Those living in or traveling to areas experiencing measles outbreaks.
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Healthcare workers, teachers, and others with frequent public or child contact.
4. Patients NOT on High-Level Immunosuppression
MMR is a live vaccine and contraindicated on biologics or high-dose immunosuppression.
Patients who are clinically stable, on no or low-dose immunosuppression, and lack immunity may be considered for vaccination.
5. Patients Planning Pregnancy
Women of childbearing age with lupus who are non-immune should ideally be vaccinated before conception, since rubella immunity is included in MMR.
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Check measles IgG titres if vaccination history is unclear.
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Vaccinate if non-immune, only if not pregnant and not on strong immunosuppression.
If on high-dose immunosuppression, vaccination should be deferred. Exposure risk may be managed by:
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Cocooning (ensuring household contacts are vaccinated)
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Masking
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Avoiding crowds
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Seeking rapid medical attention if exposed
Authors: Daniel Tingey and Doctor Janet Pope
Note: Please consult your healthcare provider or local health authorities for up-to-date vaccine recommendations.