What happens if you get a vaccine a few days too early?
You may even know about the minimum ages or minimum intervals between vaccines, but what happens if your child gets a vaccine just a few days early?
Is There a Grace Period for Getting Vaccines?
Fortunately, in most cases, getting a vaccine just a little early isn’t going to mean that the vaccine dose has to be repeated.
“Doses administered too close together or at too young an age can lead to a suboptimal immune response. However, administering a dose a few days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Known as the “grace period”, vaccine doses administered ≤4 days before the minimum interval or age are considered valid; however, local or state mandates might supersede this 4-day guideline.”
General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP)
That’s because the Advisory Committee on Immunization Practices (ACIP) allows a 4-day grace period for most vaccines. So if your child got their vaccines 3 or 4 days before their 1st birthday, instead of on or after turning 12 months old, they would still count!
It is important to keep in mind that:
day 1 is the day before the day that marks the minimum age or minimum interval for a vaccine.
if a vaccine is given 5 or more days too early, beyond the grace period, then the interval to the next dose starts from the day that invalid dose was given. For example, if the second dose of Hib is given two weeks after the first dose (instead of the minimum 4 weeks), then you don’t repeat this invalid dose in two weeks (four weeks from the first dose), but instead wait an additional four weeks from the invalid second dose
live vaccines must be given at least 28 days apart if they are not given at the same time and the grace period can not be used to shorten this interval
Most importantly, in place since 2002, the grace period protects kids from having to repeat vaccines because of minor vaccine scheduling errors.
Why do anti-vaccine folks talk about leprosy (Hansen’s disease) so much?
“LEPROSY. I’m curious why there isn’t a vaccine for leprosy. With all the other bazillion vaccines out there, why not one for leprosy?”
We don’t have anywhere near a bazillion vaccines, but did you know that there actually is a vaccine for leprosy?
“Why aren’t you walking around concerned about leprosy every day? Why aren’t you concerned about someone from another country bringing leprosy into Australia or the US and somehow exposing all of our most vulnerable to this illness? I’ll tell you why. Because there’s no vaccine for leprosy. You are afraid of what we vaccinate for because these illnesses are hyped up all of the time. It’s propaganda. ”
Learn the Risk – Why aren’t we afraid of all diseases?
Don’t expect the leprosy vaccine to be added to our immunization schedule any time soon or to increase your fears about leprosy, as leprosy is not highly contagious and it can be treated, and even cured.
And while there are about 150 to 250 cases in the United States each year, most are in folks who used to live in areas of the world where leprosy is more common. Unlike measles, you aren’t likely to get leprosy at school or daycare or going to Disneyland, although you could get it if you have a pet armadillo.
Leprosy Vaccines
A vaccine against leprosy is important though. As with other diseases, we are seeing multi-drug resistant forms of Mycobacterium leprae, the bacteria that causes leprosy.
The new leprosy vaccine that is being developed will hopefully help to finally eliminate leprosy in parts of the Africa, Asia and Latin America where it is still a problem.
Throughout much of the 20th Century, people with leprosy in the United States were treated at the National Leprosarium in Carville, Louisiana.
But it isn’t the first leprosy vaccine that we will have had.
Various leprosy vaccines have been developed and tested since the 1980s.
Also, the M. bovis BCG vaccine has been known to provide protection against both Mycobacterium tuberculosis (tuberculosis) and the related Mycobacterium leprae (leprosy) since as early as 1939.
“BCG vaccination is recommended in countries or settings with a high incidence of TB and/or high leprosy burden.”
BCG vaccines: WHO position paper – February 2018
The new leprosy vaccine, a sub-unit vaccine, will hopefully be more effective than previous strategies though, and will work to both prevent and treat leprosy.
Another leprosy vaccine, Mycobacterium indicus pranii (MIP), is being developed and tested in India.
Still, leprosy will never be eradicated, as armadillos serve as an animal reservoir for the Mycobacterium leprae bacteria.
What to Know About Leprosy Vaccines
At least two leprosy vaccines are being developed and tested to help eliminate leprosy from the areas of Africa, Asia and Latin America where it is still a problem.
It sounds like a lot because it is an inflated number that is meant to scare parents.
Kids today do routinely get:
13 vaccines, including 5 doses of DTaP, 4 doses of IPV (polio), 3 or 4 doses of hepatitis B, 3 or 4 doses of Hib (the number of doses depends on the vaccine brand used), 4 doses of Prevnar, 2 or 3 doses of rotavirus (the number of doses depends on the vaccine brand used), 2 doses of MMR, 2 doses of Varivax (chicken pox), 2 doses of hepatitis A, 1 doses of Tdap, 2 or 3 doses of HPV (the number of doses depends on the age you start the vaccine series), 2 doses of MCV4 (meningococcal vaccine), and yearly influenza vaccines
protection against 16 vaccine-preventable diseases, including diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, chicken pox, pneumococcal disease, hepatitis A, hepatitis B, meningococcal disease, HPV, rotavirus, Hib, and flu
about 28 doses of those vaccines by age two years (with yearly flu shots)
about 35 doses of those vaccines by age five years (with yearly flu shots)
as few as 23 individual shots by age five years if your child is getting combination vaccines, like Pediarix or Pentacel and Kinrix or Quadracel and Proquad
about 54 doses of those vaccines by age 18 years, with a third of that coming from yearly flu vaccines
How do you get a number like 72?
You can boost your count to make it look scarier by counting the DTaP, MMR, and Tdap vaccines as three separate vaccines each, even though they aren’t available as individual vaccines anymore.
To boost the Vaccine Doses for Children a bit more, they add pregnancy doses too.
This trick of anti-vaccine math quickly turns these 8 shots into “24 doses.”
It’s not a coincidence.
Anti-vaccine folks want to scare you into thinking that vaccines are full of toxins, that kids get too many vaccines, that we give many more vaccines than other countries, and that this is causing our kids to get sick.
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)
None of it is true.
At age four years, when your preschooler routinely gets their DTaP, IPV, MMR, and chicken pox shots before starting kindergarten, how many vaccines or doses do you think they got? Two, because they got Kinrix or Quadracel (DTaP/IPV combo) and Proquad (MMR/chickenpox combo)? Four, because they got separate shots? Or Eight, because you think you should count each component of each vaccine separately?
Know that even if you do want to count them separately, it really just means that with those two or four shots, your child got protection against eight different vaccine-preventable diseases – diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, and chicken pox.
Vaccine-preventable diseases that have not disappeared, something that the “72 doses” sites don’t ever warn you about.
What to Know About Anti-Vaccine Math
Many websites use anti-vaccine math to inflate vaccine dose numbers and scare parents away from vaccinating and protecting their kids.
Have you heard the “news” that Sweden banned mandatory vaccination in their country?
Is that true?
Did Sweden Ban Mandatory Vaccination?
Like most other anti-vaccine myths, this one isn’t true.
Sweden did not ban mandatory vaccination.
“…vaccination coverage is still high and stable, that the diseases covered by the programs are under control…”
Riksdag Social Committee report 2016/17: SoU7
In March 2017, the Riksdag, or Swedish parliament, did vote against a proposal that called for mandatory vaccination. This came as other countries in Europe are seeing lower rates of immunization, rising rates of vaccine-preventable disease, and calls for vaccine mandates. In fact, France and Italy recently implemented vaccine mandates.
“The general vaccination program has a good coverage, and most children are protected against measles and polio, for example. There are, however, skepticism about vaccinations, both the vaccinations included in the basic program and others. In our view, however, it is of societal interest that the vaccination program is implemented in its entirety, and many of the myths and incorrect data circulating about the vaccination program need to be treated and pinned. We therefore consider that the government should provide the appropriate authority with the task of designing an information campaign on the benefits and necessity of the childhood vaccination program.”
Riksdag Social Committee report 2016/17: SoU7
Although the Swedish parliament voted against a motion that would have started a mandatory vaccination plan, there was nothing to ban. Sweden has never had a mandatory vaccination.
The Riksdag did pass a motion to add the rotavirus vaccine to the immunization schedule in Sweden.
It is also clear that they see the problem that anti-vax groups are causing in their country and are working to combat them.
That will hopefully keep them from needing a mandatory vaccination program.
What to Know About the Myth of Sweden Banning Mandatory Vaccination
Sweden, with good immunization levels and low rates of vaccine-preventable disease, did not ban mandatory vaccination.
More on the Myth of Sweden Banning Mandatory Vaccination
The French immunization schedule is published in the Bulletin épidémiologique hebdomadaire and has never included the rotavirus vaccine.
So did France take the rotavirus vaccine off of their schedule?
Technically, France hadn’t yet added the rotavirus vaccine to their schedule, but it had been available since 2006 and they did formally recommend infants get vaccinated beginning in November 2013.
That recommendation was suspended in April 2015, after they recorded 47 cases of intussusception over an 8 year period. This included 14 cases that required surgery and tragically, two deaths, including one child who died at home without getting any medical care. The other developed intussusception after the third dose of vaccine, which is not usually linked to any increased risk.
It is important to note that at least 80 other countries, including the United States, Finland, Germany, Norway, and the UK, haven’t stopped using the rotavirus vaccine.
Why not?
Because the risks of a natural rotavirus infection are much greater than the risk of intussusception. In other words, the benefits of the vaccine exceed its risks.
In France alone, for example, it is estimated that rotavirus vaccines could prevent 30,000 emergency room visits, 14,000 hospitalizations, and 8 to 17 deaths each year, all in children under the age of three years.
And even without the rotavirus vaccine, there are about 200 to 250 spontaneous intussusceptions each year in France. Fortunately, infants with intussusception can almost always be successfully treated, often without surgery.
Why Did France Take the Rotavirus Vaccine off Their Schedule?
It actually makes no sense that France stopped recommending that infants get vaccinated with one of the rotavirus vaccines.
The decision was widely condemned and there are calls to reassess the decision and put the rotavirus vaccine back on the schedule in France.
“After the surprising decision of the CTV-HCSP of April 2015 to suspend its own recommendation for widespread vaccination against Rotavirus (following a false and misleading pharmacovigilance report) against the international recommendations, we advise you to read the meta-analysis on efficacy (in comparative studies) and the effectiveness (field efficacy) of these vaccines.”
The benefits of the rotavirus vaccines far outweigh its risks.
“The estimated benefits of vaccination in our study greatly exceed the estimated risks and our results should contribute to provide further evidence for discussions around rotavirus vaccination in France.”
Larmrani et al A benefit–risk analysis of rotavirus vaccination, France, 2015
Why did France take the rotavirus vaccines off their schedule?
In 1885, four boys from New Jersey went all of the way to France to get Pasteur’s new rabies vaccine, which wasn’t yet available in the US.
That’s a good question.
Another good question? How many infants have died of rotavirus infections since they did? And when will they put the vaccine back on the schedule? Fortunately, the rotavirus vaccines are still available in France, they weren’t banned as some folks say.
Of course, this isn’t the first time that France impulsively suspended a vaccine.
In 1998, France suspended the routine vaccination of teens against hepatitis B because of the possible association of the vaccine with multiple sclerosis. This was done amid “pressure from anti-vaccine groups and reports in the French media have raised concerns about a link between HBV immunisation and new cases or relapses of MS and other demyelinating diseases,” even though “scientific data available do not support a causal association between HBV immunisation and central nervous system diseases, including MS.”
“In 1998, official concerns were first voiced over a possible association between hepatitis B virus (HBV) vaccination and multiple sclerosis (MS). Despite a number of studies that have demonstrated no such association, ten years on the French population’s confidence in the vaccine remains shaken and immunization rates of infants have stagnated beneath 30%. With a chronic carriage of the virus estimated at 0.68%, it seems unlikely that France will be able to control the circulation of the virus. ”
Marta Balinska on Hepatitis B vaccination and French Society ten years after the suspension of the vaccination campaign: how should we raise infant immunization coverage rates?
Do you know where all of this has left France now?
With high rates of vaccine-preventable disease (15,000 cases of measles in 2011, with 16 cases of encephalitis and 6 deaths) and a move towards vaccine mandates. As of January 2018, all infants and toddlers in France must receive DTaP, Hib, HepB, pneumococcal, MMR, and meningococcal C vaccines.
What to Know About France Taking the Rotavirus Vaccine off Their Schedule
In no longer recommending the rotavirus vaccines, officials in France actually put infants at greater risk for sickness and death.
More on France Taking the Rotavirus Vaccine off Their Schedule
“Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected.”
CDC on Transmission of Measles
Unlike measles, which is so contagious that you can get it if you are simply in the same room with someone that is sick, mumps typically requires prolonged, close contact.
“When you have mumps, you should avoid prolonged, close contact with other people until at least five days after your salivary glands begin to swell because you are contagious during this time. You should not go to work or school. You should stay home when you are sick with mumps and limit contact with the people you live with; for example, sleep in a separate room by yourself if you can.”
CDC on Mumps Outbreak-Related Questions and Answers for Patients
How do you get mumps?
Since the virus spreads through saliva and mucus, you can get sick if you are in close contact with someone with mumps and they:
cough or sneeze
use a cup or eating utensil that you then use
touch an object or surface that you then touch (fomites)
And like many other vaccine-preventable diseases, people with mumps are usually contagious just before they begin to show symptoms.
“The mumps virus replicates in the upper respiratory tract and spreads through direct contact with respiratory secretions or saliva or through fomites. The risk of spreading the virus increases the longer and the closer the contact a person has with someone who has mumps.”
CDC on Mumps for Healthcare Providers
The need for prolonged, close contact is likely why most outbreaks these days are on college campuses.
Is Your Child Protected Against the Mumps?
You can prevent the mumps.
The MMR vaccine protects us against mumps – and measles and rubella.
One dose of MMR is 78% effective at preventing mumps, while a second dose increases that to 88%. Unfortunately, that protection can decrease over time.
Kids get their first dose of MMR when they are 12 to 15 months old. While the second dose of MMR isn’t typically given until just before kids start kindergarten, when they are 4 to 6 years old, it can be given earlier. In fact, it can be given anytime after your child’s first birthday, as long as 28 days have passed since their first dose.
“Evidence of adequate vaccination for school-aged children, college students, and students in other postsecondary educational institutions who are at risk for exposure and infection during measles and mumps outbreaks consists of 2 doses of measles- or mumps-containing vaccine separated by at least 28 days, respectively. If the outbreak affects preschool-aged children or adults with community-wide transmission, a second dose should be considered for children aged 1 through 4 years or adults who have received 1 dose. In addition, during measles outbreaks involving infants aged <12 months with ongoing risk for exposure, infants aged ≥6 months can be vaccinated.”
CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices
And although it won’t count as their first dose, in special situations, kids can get an early MMR once they are six months old.
What to Do If Your Unvaccinated Child Is Exposed to Mumps
To be considered fully vaccinated and protected against mumps, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.
“Although mumps-containing vaccination has not been shown to be effective in preventing mumps in persons already infected, it will prevent infection in those persons who are not yet exposed or infected. If persons without evidence of immunity can be vaccinated early in the course of an outbreak, they can be protected prior to exposure.”
Unfortunately, neither a post-exposure dose of MMR nor immune globulin work to prevent mumps after you are already exposed. They should still get an MMR though, as it will provide immunity against measles and rubella, and mumps if they don’t get a natural infection.
“Persons who continue to be exempted from or who refuse mumps vaccination should be excluded from the school, child care, or other institutions until 21 days after rash onset in the last case of measles.”
Manual for the Surveillance of Vaccine-Preventable Diseases
Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.
Unvaccinated kids who are exposed to mumps will likely need to be quarantined, as you watch for signs and symptoms of measles developing over the next 12 to 25 days.
If your exposed child develops mumps, be sure to call your health care provider before going in for a visit, so that they can be prepared to see you and so you don’t expose other people to mumps. Your child with suspected mumps should be wearing a mask before going out in public and if possible, will be put in a negative pressure room in the emergency room or doctor’s office.
It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with mumps could expose others, it just reduces the risk. You still want to avoid other people!
What to Do If Your Vaccinated Child Is Exposed to Mumps
If your fully vaccinated child is exposed to mumps, does that mean you are in the clear?
Again, it depends on what you mean by fully vaccinated.
It also depends on what you mean by exposed. Is it someone in the same school that your child has had no real contact with or a sibling that he is around all of the time?
And is your child fully vaccinated for his age or has he had two doses of MMR?
Since kids get their first dose of MMR at 12 to 15 months and the second when they are 4 to 6 years old, it is easy to see that many infants, toddlers and preschoolers who are following the immunization schedule are not going to be fully vaccinated against mumps, even if they are not skipping or delaying any vaccines.
“In the case of a local outbreak, you also might consider vaccinating children age 12 months and older at the minimum age (12 months, instead of 12 through 15 months) and giving the second dose 4 weeks later (at the minimum interval) instead of waiting until age 4 through 6 years.”
Ask the Experts about MMR
In most cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection. That’s because the focus in controlling an outbreak is often on those folks who don’t have any evidence of immunity – the unvaccinated.
And one dose of MMR is about 78% effective at preventing mumps infections. A second dose does increase the vaccine’s effectiveness against mumps to over 88%.
An early second dose is a good idea though if your child might be exposed to mumps in an ongoing outbreak, has only had one dose of MMR, and is age-eligible for the second dose (over age 12 months and at least 28 days since the first dose). Your child would eventually get this second dose anyway. Unlike the early dose before 12 months, this early dose will count as the second dose of MMR on the immunization schedule.
“Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine to improve protection against mumps disease and related complications.”
Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak
This third dose of MMR is not for post-exposure prophylaxis though, which again, doesn’t work for mumps. It is to prevent mumps from ongoing exposures.
You should still watch for signs and symptoms of mumps over the next 12 to 25 days though, as no vaccine is 100% effective. Your vaccinated child won’t need to be quarantined though.
Most importantly, in addition to understanding that vaccines are safe and necessary, know that the ultimate guidance and rules for what happens when a child is exposed to mumps will depend on your local or state health department.
What to Know About Getting Exposed to Mumps
Talk to your pediatrician if your child gets exposed to mumps, even if you think he is up-to-date on his vaccines, as some kids need a third dose of the MMR vaccine during on-going mumps outbreaks.
MenHibrix was removed from the schedule, which was expected, as this combinationmeningococcal vaccine for high risk kids was discontinued in 2016 because of low demand. Fortunately, this doesn’t mean that any kids will be left unprotected. They can just get one of the other meningococcal vaccines if they need it, with a separate Hib vaccine, just like other infants.
Menomune was removed from the schedule, which was expected, as this older meningococcal vaccine was discontinued in 2017, as it was replaced with the newer meningococcal conjugate vaccines (Menactra and Menveo).
Shingrix, the new recombinant shingles vaccine is added to the schedule for adults aged 50 or older. They should get 2 doses 2 to 6 months apart, even if they have had shingles in the past or have had the older Zostavax already. And Shingrix becomes the preferred shingles vaccine for those who are at least 60 years old.
The other changes are to the formatting of the schedule and schedule footnotes.
“The schedule footnotes are presented in a new simplified format. The goal was to remove unnecessary text while preserving all pertinent information and maintaining clarity. This was accomplished by a transition from complete sentences to bullets, removal of unnecessary or redundant language, and formatting changes.”
CDC on Changes to This Year’s Schedule
So, unless your child is in a mumps outbreak, the new immunization schedule shouldn’t mean any extra vaccines.
What to Know About the 2018 Immunization Schedule
The 2018 immunization schedule from the CDC, AAP, ACOG, and AAFP incorporates the latest recommendations from the ACIP, including that folks in a mumps outbreak might need a third dose of MMR.
