Category: Immunization Schedules

Do You Need Another Dose of the MMR Vaccine?

The measles outbreaks have a lot of people concerned about measles.

And that means measles and vaccines are getting a lot of extra attention.

Unfortunately, getting extra attention doesn’t always translate into getting great advice, especially when it is leading a lot of folks into thinking they need to rush out and get another dose of MMR or to check their titers to make sure they are protected.

Do You Need Another Dose of the MMR Vaccine?

So are you protected against measles?

Have you had two doses of MMR? (Remember, kids typically get their first dose at age 12-15 months and a second dose when they are 4-6 years old, with early doses in high-risk situations.)

If you have documentation of two doses of MMR (or a measles containing vaccine), then you can confidently say that you are protected. No, it’s not 100% protection, but it’s close.

“Documented age-appropriate vaccination supersedes the results of subsequent serologic testing. If a person who has 2 documented doses of measles- or mumps-containing vaccines is tested serologically and is determined to have negative or equivocal measles or mumps titer results, it is not recommended that the person receive an additional dose of MMR vaccine. Such persons should be considered to have presumptive evidence of immunity.”
Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices (ACIP)

If you haven’t had two doses of MMR, then know that two doses are your best protection against measles.

Have you heard that people born before 1989 may need another dose?

What is the significance of the year 1989?

The recommendation to give a routine second dose of MMR started in 1990, so folks born much before then likely only had one dose, unless they were considered high risk and had the second dose before traveling out of the country, starting a healthcare job, or going to college, etc.

Instead of 1989, the typical cutoff year for protection is around 1986, since those kids would have been turning four years old in 1990, so would have gotten their second dose of MMR on schedule. If you were born before 1986, you would have started kindergarten before the recommendation to get a second dose.

The other years that are important are 1963 to 1967, as that’s when the very first measles vaccine was used, a vaccine that was later found to not be very effective. If that is the only time you were vaccinated, then you should be vaccinated again.

What about 1957?

In general, if you were born before 1957, we assume that you had measles because most people had measles back then. Maybe you didn’t though, so in a high-risk situation, like traveling out of the country or in the middle of an outbreak, this could be a good situation to check your measles titer to confirm that you are immune. If you aren’t, then get two doses of MMR.

So here are your scenarios:

Were you born before 1957? Then you probably had measles, but can check your titers to make sure you are immune, especially if you will be in a high-risk situation, like near an outbreak or traveling.
Did you get a dose of measles vaccine between 1963 and 1967? If this was your only dose, then you should get a dose of MMR now.
Did you get a measles vaccine between 1968 and 1971, before the MMR became available? That counts as a dose of measles containing vaccine. If that is your only dose, then you might get another dose of MMR, if you will be in a high-risk situation, like near an outbreak or traveling.
Have you only had only one dose of MMR or other measles containing vaccine, which is more likely if you were born well before 1990? Then get another dose of MMR if you will be in a high-risk situation, like near an outbreak or traveling.
Have you had two doses of MMR vaccine or or other measles containing vaccine (and have your immunization records to prove it)? Then you should be protected. You don’t need to check your titers and you don’t need a third dose of MMR.

What if you aren’t sure? Then get at least one more dose of MMR.

If you don’t think that you were ever vaccinated against measles, then you might get two doses of MMR.

If you aren’t sure, but think that you already were vaccinated, then this would be a good situation to check your titer. Be prepared to get your MMR vaccines again if you are negative though.

Do all adults need two doses of MMR?

Surprisingly no, although that is considered the best protection against measles, there was never a general catch up program for older folks with the recommendation to get a second dose in 1990. So if you have had one dose of MMR and aren’t at any extra risk to get measles – no travel, no nearby outbreaks, and not a health professional, etc., then one dose might be enough… for now.

Who Needs an MMR Vaccine?

The MMR vaccine protects people against measles, mumps, and rubella.

It has been available since 1971, first as a single dose, then with a second dose added to the immunization schedule in 1990.

Who Needs an MMR Vaccine?

With the rise in measles cases and outbreaks, you might be wondering if you need an extra dose of the MMR vaccine.

Are you fully vaccinated and protected against measles?

Have you had one dose or two doses of the MMR vaccine?

Are you traveling out of the country or do you have any other risk factors for getting measles?

Did you get one of the original, inactivated measles vaccines that were used between 1963 and 1967, before the live vaccine became available? If you did, or you aren’t sure which vaccine you got at that time, you likely aren’t fully protected and need another dose.

Vaccine preventable diseases are just a plane ride away.

In general, adults who have had two doses of MMR are considered to be fully vaccinated. You do not need to check your titers and you do not need another dose for measles protection.

You are also likely protected if you were born before 1957, as most people had measles back then, in the pre-vaccine era.

Confusing matters a bit, some adults who were born before the recommendation to get a second dose might still be considered fully vaccinated if they are not high risk.

What makes someone high risk?

traveling out of the country!
working in healthcare
being a student in college or other post-high school educational institution
living with someone who has a compromised immune system
people with HIV infection

So to be considered fully vaccinated and protected against measles, these high risk adults should have two doses of MMR.

What about kids?

If following the immunization schedule, kids will get two doses of MMR, with the first dose at age 12-15 months and a second dose when they are 4-6 years old.

There are situations in which they should get an early dose of MMR though, including:

infants 6 through 11 months of age who are traveling out of the United States should receive one dose of MMR vaccine, a dose that will have to be repeated when they are 12 months old.
children 1 to 3 years of age and older who are traveling out of the United States should receive two doses of MMR vaccine (instead of waiting to get the second dose when they are 4-6 years old), separated by at least 28 days. This second dose doesn’t have to be repeated.

Being exposed to measles or simply getting caught up in an outbreak might be another reason for young children to get an early first or second dose of MMR and for adults to get caught up.

What if you aren’t traveling out of the country, but are traveling to an area inside the United States that is experiencing a large outbreak of measles?

To help control their large outbreak, kids in Rockland County should get their MMR doses early.

If you can’t delay your travel plans, check the local health department recommendations, and talk to your pediatrician if your child needs an early MMR.

The MMR vaccine is safe, with few risks.

Having measles isn’t.

Is It Too Late to Get a Flu Shot?

Have you gotten your kids their flu vaccine yet?

Have you gotten yours?

While I made sure to get my flu shot well before the start of flu season, it is not too late to get vaccinated and protected.

Believe it or not, it’s not too late.

Is It Too Late to Get a Flu Shot?

Why would anyone think it could be too late?

“Balancing considerations regarding the unpredictability of timing of onset of the influenza season and concerns that vaccine-induced immunity might wane over the course of a season, it is recommended that vaccination should be offered by the end of October.”

CDC on Timing of Vaccination

Lots of folks focus on the “end of October” as being the best time to get a flu vaccine.

It’s Not Too Late to Get a Flu Vaccine

While it is a good idea to get vaccinated and protected well before flu season starts, this is one of those better late than never kind of things.

Have you gotten a flu vaccine yet?

“CDC recommends that people get a flu vaccine by the end of October. Getting vaccinated later, however, can still be beneficial. As long as flu viruses are circulating, it is not too late to get vaccinated, even in January or later. While seasonal flu outbreaks can happen as early as October, most of the time flu activity peaks between December and February, although activity can last as late as May.”

CDC on Misconceptions about Seasonal Flu and Flu Vaccines

Then it’s not too late.

Get vaccinated and protected for the rest of the flu season.

But don’t wait much longer or you will risk getting the flu before your flu vaccine has a chance to start working.

Get your flu vaccine now.

At What Age Should Kids Get a Meningococcal Vaccine?

Knowing when to give or get a vaccine doesn’t usually cause any confusion.

You simply have to check the immunization schedule.

Take the meningococcal vaccines, for example. Most parents and pediatricians understand that kids get them before entering middle school and again before going off to college. And some high risk kids should get them even earlier, as infants.

Simple, right?

At What Age Should Kids Get a Meningococcal Vaccine?

Actually, there are some things that make it a little more complicated than it should be…

Why?

some overnight and summer camps are actually starting to require a dose of meningococcal vaccine for younger kids, even though this is not a formal recommendation of the CDC or AAP
some parents might request a dose of meningococcal vaccine for younger kids going to overnight and summer camps, even though this is not a formal recommendation of the CDC or AAP
some folks are misunderstanding recommendations that campers be up-to-date on all immunizations as a recommendation that they get an early meningococcal vaccine
getting an early dose, before age 10 years won’t count as the middle school dose, and will need to be repeated
some states have very strict laws on timing, like that kids have to get their meningococcal vaccine before starting 6th grade, but only after they turn 11 years old, which creates a problem for those kids who start 6th grade before they are 11 years old
many folks don’t understand the recommendations for the MenB vaccines

What’s the answer?

It is not to skip or delay your child’s meningococcal vaccine, of course.

Older teens and young adults are at much higher risk of meningococcal disease than younger school age children.

Instead, states should likely institute their meningococcal vaccine laws to require a dose before entering 7th grade, that way, most will have plenty of time to get it while they are in 6th grade. Or at least keep to the standard minimum age of 10 years for a dose to count towards middle school requirements.

What about a meningococcal vaccine for campers?

“In New York State, PHL Article 21, Title 6, Section 2167 also requires the notification of campers and parents about recommendations for and the availability of meningococcal vaccine for all campers attending overnight camps for a period of 7 or more consecutive nights. Meningococcal ACWY (MenACWY) vaccine is recommended at age 11 or 12 years, with a booster dose at age 16 years. Please note that the NYSDOH does not recommend that campers receive either dose of MenACWY vaccine before the recommended ages. Students who are vaccinated before the recommended ages may need to have the doses repeated in order to attend school.”

Recommended Immunizations for Campers

Unless they are in a high risk group, folks should likely stick to the standard ages of the immunization schedule to get their kids vaccinated.

And keep in mind that if your child does get an early dose, it won’t count as part of the routine series and will have to be repeated.

“Doses of quadrivalent meningococcal vaccine (either MPSV4 or MenACWY) given before 10 years of age should not be counted as part of the routine 2-dose series. If a child received a dose of either MPSV4 or MenACWY before age 10 years, they should receive a dose of MenACWY at 11 or 12 years and a booster dose at age 16 years.”

Ask the Experts Meningococcal ACWY

Talk to your pediatrician about an early dose if the extra coverage is important to you though. It will protect your child, but isn’t a general recommendation because younger kids have a lower risk for disease and vaccinating everyone likely wouldn’t impact disease rates that much.

Another situation in which getting an extra dose may be required is if you are traveling to a high risk part of the world. In this case, the extra dose is essential, even if it has to be repeated later.

How Does a Mother’s Flu Shot Protect a Newborn Baby?

We know that pregnant women are supposed to get a flu vaccine.

Although recommendations on exactly when to get it have changed over the years, it has been a universal recommendation since at least the 1994-95 flu season.

But why?

How Does a Mother’s Flu Shot Protect a Newborn Baby?

One obvious way that a flu shot provides protection during pregnancy is that it reduces your risk of getting the flu while you are pregnant.

A flu shot during your pregnancy protects both you and your baby.

That’s good, as having the flu while you are pregnant can lead to preterm labor, a premature birth, birth defects, or a miscarriage. And of course, the flu can be life-threatening for pregnant women.

Getting a flu shot while you are pregnant can also help to make sure that you don’t get the flu after your baby is born, which not only keeps you healthy, but decreases the chance that your baby will be exposed to the flu. After all, if you get the flu, no matter how much you try to cover your cough and wash your hands, there is a good chance that you will give it to your baby.

And since babies can’t get flu shots of their own until they are at least six months old, a flu shot during pregnancy helps to make sure that your baby gets some of antibodies to protect them from the flu.

“When you get a flu shot, your body makes antibodies that also pass to your fetus. This means your baby has protection against the flu after birth. This is important because infants less than 6 months of age are too young to get the flu shot.”

Frequently Asked Questions for Patients Concerning Influenza (Flu) Vaccination During Pregnancy

Do you have to wait until late in your pregnancy to make sure that the most antibodies get passed to your baby?

While that might seem like a good idea, especially since that’s what we do for the Tdap vaccine and protection against pertussis, there are several reasons that we don’t do that with the flu vaccine, including that:

pregnant mothers need the protection before flu season hits, so waiting would not be safe and could mean that you get sick with the flu before getting your shot
protection from the flu vaccine shouldn’t wane or wear off so quickly that you need to get it later, after all, the earliest that you can get vaccinated is when flu vaccines first become available in August or September and that should provide good protection past the peak of flu season

When you get your flu shot while pregnant is going to have more to do with when you got pregnant in relation to the start of flu season more than anything else.

“The flu shot can be safely given during any trimester. Pregnant women can get the flu shot at any point during the flu season (typically October through May). Pregnant women should get the shot as soon as possible when it becomes available. If you are pregnant, talk with your obstetrician–gynecologist (ob-gyn) or other health care provider about getting the flu shot.”

Frequently Asked Questions for Patients Concerning Influenza (Flu) Vaccination During Pregnancy

Most importantly, remember that flu shots are considered an “essential component of prenatal care.”

While everyone should get a flu vaccine each year, since pregnant women are in a high risk group for flu complications, you should especially make sure that you get vaccinated and protected if you are pregnant. Everyone around you should get vaccinated too!

How Many Doses of Flu Vaccines Do My Kids Need?

One dose or two?

How many doses of flu vaccine will your kids need this year? — How many doses of flu vaccine will your kids under age 9 years need this year?

That’s right, some kids actually need two doses of the flu vaccine to get the best protection – a priming dose and a booster dose.

How Many Doses of Flu Vaccines Do My Kids Need?

You child might need two doses of flu vaccine, separated by at least 4 weeks, if they are 8 years old or younger and:

this is the first year that they are getting a flu vaccine, or
they have not received two or more total doses of flu vaccine before

That second part is a little confusing.

That’s because the two doses do not have to have been in the same season or even in consecutive seasons. As long as a child has had at least 2 or more doses of flu vaccine in the past, then they only need one dose this year.

And even if they have never had a flu vaccine before, kids who are already 9 years old, only get one dose.

“Evidence from several studies indicates that children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Why do they get 2 doses?

“The first dose “primes” the immune system; the second dose provides immune protection.”

Study Looks at Flu Vaccine Dosing in Children

Because studies show that getting 2 doses of flu vaccine like this works best!

Catch-Up Immunization Plans for Adults

It isn’t hard to figure out how to catch-up kids when they fall behind on their vaccines.

After all, the CDC publishes catch-up immunizations schedules for both younger kids and teens.

Catch-Up Immunization Plans for Adults

What happens when an unvaccinated adult needs to get caught up?

Adults need vaccines too, especially if they have never been vaccinated before.

They essentially follow the catch-up immunization plan for teens, with a few exceptions:

the polio vaccine isn’t typically given to teens over age 18
the HPV vaccines aren’t typically given to young adults over age 26, although they are now approved to be given through age 45 years
Hib and Prevnar are only typically given to adults with specific conditions that put them at high risk for disease

Are you an adult that needs to get caught up because you have never been vaccinated, your parents skipped or delayed some vaccines, or you lost your immunization records?

Get caught up! It’s likely easier than you think.

VAXOPEDIA

Do You Need Another Dose of the MMR Vaccine?

Do You Need Another Dose of the MMR Vaccine?

More on MMR Vaccines