Tag: immunization schedule

Do Kids Really Get 72 Doses of Vaccines?

Most parents vaccinate their kids according to the recommended immunization schedule.

They know that’s the best way to keep them protected.

Do Kids Really Get 72 Doses of Vaccines?

Saying kids get 72 doses of vaccines is a propaganda too to scare parents.
Saying kids get 72 doses of vaccines is a propaganda tool to scare parents.

While kids do get more vaccines than their parents did, that’s only because we have more vaccines available to protect them from more now vaccine-preventable diseases.

Do they get their kids 72 doses of vaccines?

That sounds like a lot…

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.
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?
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.

More on Anti-Vaccine Math

Did Sweden Ban Mandatory Vaccination?

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 passed a motion to add the rotavirus vaccine to the immunization schedule in Sweden.
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

Why Did France Take the Rotavirus Vaccine off Their Schedule?

Have you heard that France took the rotavirus vaccine off their immunization schedule?

Why?

It was supposedly because two babies died of intussusception after being vaccinated.

Rotavirus Vaccines and Intussusception

Intussusception? Wasn’t that just a risk from RotaShield, the original rotavirus vaccine?

While the risk was higher with RotaShield, the current rotavirus vaccines do have a small risk of intussusception.

france-immunization-schedule
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.”

InfoVac Bulletin Novembre 11/2016

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?

News of the Newark kids going to Paris to get Pasteur's rabies vaccine made the front page of the New York Times.
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

 

What to Do If Your Child Is Exposed to Mumps

Although things are much better than they were in the pre-vaccine era, we still have mumps outbreaks in the United States.

How does that work?

Waning immunity and folks who are unvaccinated.

How Contagious is Mumps?

Mumps is contagious, but not nearly as contagious as other vaccine-preventable diseases, such as measles.

“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?

Tips to prevent getting sick with 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.”

Surveillance Manual

If your unvaccinated child is exposed to mumps, you should talk to your pediatrician or local health department, but unlike measles and chicken pox, there are no recommendations to start post-exposure prophylaxis.

Mumps quarantine sign

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.
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

And in some cases, folks should now get a third of dose of MMR.

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.

More on Getting Exposed to Mumps

What Are the Changes in the 2018 Immunization Schedules?

As they do every year, the Advisory Committee on Immunization Practices (ACIP) just released an updated immunization schedule.

The 2018 immunization schedule didn't bring any changes for most kids.
The 2018 immunization schedule doesn’t bring any changes for most kids.

And just like in most other recent years, there were few big changes or announcements.

That means that most kids won’t need any extra shots when they go to their next well check up with their pediatrician or to start school.

What Are the Changes in the 2018 Immunization Schedules?

There are some changes though…

  • A third dose of MMR is now recommended for some people during outbreaks of mumps.
  • MenHibrix was removed from the schedule, which was expected, as this combination meningococcal 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.

More on the 2018 Immunization Schedule

What to Do If Your Child Is Exposed to Measles

Although the endemic spread of measles was eliminated way back in 2000, we still have measles outbreaks in the United States.

How does that work?

They are usually imported from outside the country, often by an unvaccinated child or adult who travels overseas, gets measles, and returns while still contagious.

How Contagious is Measles?

Measles is highly contagious.

“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

In addition to the fact that people with measles are contagious for at least four days before they develop the classic measles rash until four days after, the measles virus can survive for up to two hours in the air and on contaminated surfaces wherever that person cough or sneezed. So you don’t technically need to even be in direct contact with the person with measles – simply entering a room or getting on a bus that the infected person recently left can do it.

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
An infant hospitalized during a measles outbreak in the Philippines in which 110 people died. Photo by Jim Goodson, M.P.H.

Still, you are not going to get measles from simply being in the same city as someone else with measles.

The tricky part though, is knowing what to do if your child is exposed to someone with measles, even if you think they are up-to-date with their vaccines.

Remember, 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 Measles

To be considered fully vaccinated and protected against measles, kids need two doses of MMR – one at 12 to 15 months and another when they are 4 to 6 years.

“During measles, rubella, or mumps outbreaks, efforts should be made to ensure that all persons at risk for exposure and infection are vaccinated or have other acceptable evidence of immunity.”

CDC on Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps, 2013: Summary Recommendations of the Advisory Committee on Immunization Practices

If your unvaccinated child is exposed to measles, you should talk to your pediatrician or local health department about starting post-exposure prophylaxis as soon as possible, including:

  • a dose of immune globulin (IGIM) if they are less than 6 months old
  • either a dose of immune globulin (IGIM) or the MMR vaccine if they are between 6 and 12 months old (this dose of MMR doesn’t count as the first dose of MMR on the immunization schedule and will need to be repeated when the child turns 12 months old)
  • a dose of the MMR vaccine if they are at least 12 months old
  • a dose of immune globulin (IGIV) if they are severely immunocompromised (even if they were previously vaccinated)

Immune globulin should be given within 6 days of exposure, while a dose of MMR vaccine within 72 hours of exposure can decrease their chances of getting measles.

“Persons who continue to be exempted from or who refuse measles 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.
Be sure to alert your pediatrician if you think your child might have measles or another vaccine-preventable disease.

What if your child is incompletely vaccinated, with just one dose of MMR? They could get their second dose of MMR, as long as they are over 12 months old and it has been at least 28 days since their first dose (see below).

Unvaccinated kids who don’t get post-exposure prophylaxis should be quarantined, as you watch for signs and symptoms of measles developing over the next 21 days. Your child might still need to be quarantined if they got immune globulin instead of the vaccine, and the quarantine might extend to 28 days, as immune globulin can prolong the incubation period.

If your exposed child develops measles, 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 measles. Your child with suspected measles 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. If a regular exam room is used, it can not be used again for at least two hours. It is very important to understand that simply wearing a mask doesn’t eliminate the risk that your child with measles 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 Measles

If your fully vaccinated child is exposed to measles, does that mean you are in the clear?

Again, it depends on what you mean by fully vaccinated.

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 measles, 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 some cases, documentation of age-appropriate vaccination with at least one dose of MMR is good enough protection, which means that toddlers and preschoolers don’t necessarily need an early second dose. 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 95% effective at preventing measles infections. A second dose does increase the vaccine’s effectiveness against measles to over 99%, but it isn’t a booster. The second dose of MMR is for those kids that didn’t respond to the first dose.

“Available data suggest that measles vaccine, if given within 72 hours of measles exposure to susceptible individuals, will provide protection or disease modification in some cases. Measles vaccine should be considered in all exposed individuals who are vaccine-eligible and who have not been vaccinated or have received only 1 dose of vaccine.”

AAP RedBook

An early second dose is a good idea though if your child is exposed to measles, 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.

You should still watch for signs and symptoms of measles over the next 10 to 21 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 measles will depend on your local or state health department.

What to Know About Getting Exposed to Measles

Talk to your pediatrician if your child gets exposed to measles to make sure he doesn’t need post-exposure prophylaxis to keep him from getting sick, even if you think he is up-to-date on his vaccines.

More on Getting Exposed to Measles

What Ronald Reagan Can Teach Us About Vaccine Policy

Many U.S. Presidents, even George Washington, worked to get people vaccinated and protected. Well, Washington got them variolated and protected against smallpox, but that still counts.

As can be expected, some Presidents did a better job than others.

“Government’s first duty is to protect the people, not run their lives.”

Ronald Reagan

Do you have to run someone’s life to prevent outbreaks and help make sure folks get protected against vaccine-preventable disease?

Ronald Reagan’s Vaccine Policy

A lot happened in regards to vaccines when Reagan was President. After all, he was the President who signed the National Childhood Vaccine Injury Act (NCVIA) of 1986, which created VAERS and the NVICP!

What else happened?

“…the Reagan Administration starved the Federal program for childhood immunization…”

The Shame of Measles

That’s right, Federal support for vaccine programs reached a low point during Reagan’s years in office, as rates of children living in poverty and without health insurance also increased.

That’s not a good mix!

“During the Reagan years, the price of vaccine went up and Federal funding for childhood immunization went down.”

The Measles Menace

Not only did the price of vaccines go up, but new vaccines were added to the immunization schedule in the mid-1980s.

So even if Federal funding for vaccines had stayed the same, it would essentially have been a big cut!

“Measles is a wholly preventable disease, and it was almost eradicated from the country in 1983, when only 1,497 cases were reported. But by 1990, after Federal budget cuts and the end of the Government’s monitoring of immunization programs, more than 30,000 cases of measles and more than 60 deaths were reported.”

Panel Ties Measles Epidemic to Breakdown in Health System

All of this followed President Jimmy Carter’s National Childhood Immunization Initiative in 1977, which reached its goal of immunizing over 90% of children!

Not surprisingly, this followed a growth in federal grants from $5 million to $35 million towards state immunization budgets. Yes, it costs money to get kids vaccinated and protected. But don’t forget that it costs even more money to control outbreaks once they start.

“Immunization policy during the Carter Administration demonstrated that when both an administration and key congressional actors viewed immunization as a priority and made sufficient funds available to support the public health delivery system and its infrastructure, coverage levels would continue to rise and disease levels continue to decline.”

Johnson et al on Federal immunization policy and funding: A history of responding to crises

Unfortunately, the coverage levels and growth during the Carter administration weren’t sustained for very long after Reagan took office in 1981.

As can be expected, neither were declines in rates of measles.

Instead, we eventually saw big outbreaks of measles across the United States. From 1989 to 1991, at least 123 people died among 55,000 cases, with another 11,000 hospitalized.

“The measles outbreak of 1989–1991 exposed many incorrect assumptions behind the belief that low levels of coverage were sufficient to control the transmission of infectious disease. The changing demographics of society, the mixing of young children in day care settings, new patterns of health care delivery, high rates of uninsured children, and the shrinking size and morale of health departments all fostered circumstances in which disease transmission occurred within major metropolitan areas even though disease reports were low, and state health officials believed statewide immunization coverage was at acceptable levels.”

Calling the Shots: Immunization Finance Policies and Practices

How did it get fixed?

President George HW Bush announced his own immunization action plan to raise vaccinated rates, and we once again put more Federal money into our immunization programs.

The result?

Immunization rates went up and the outbreaks stopped.

The President and the Children

Outbreaks that didn’t have to happen.

A 1987 op-ed in the New York Times warned about was coming and how to prevent it…

“Each dollar spent to immunize young children saves $10 in later medical costs. Yet in 1985, one of four children between ages 1 and 4 was not immunized for rubella, mumps, polio or measles and 13 percent lacked immunization for diphtheria, tetanus and pertussis. Congress would increase funding by about $20 million, enough to immunize 600,000 more youngsters.”

The Reagan administration didn’t listen.

The Children's Defense Budget analysis details how Reagan proposed cutting $2 to $3 million a year from the immunization program beginning with his 1982 budget.
The Children’s Defense Fund budget analysis details how Reagan proposed cutting $2 to $3 million a year from the immunization program beginning with his 1982 budget.

Are we headed for something similar in the years ahead?

Consider that:

  • the Children’s Health Insurance Program (CHIP) expired on September 30 and it has yet to be reauthorized
  • the short-term CHIP “fix” took $750 million cut from the Prevention and Public Health Fund, which provides 40% of the total funding for the CDC’s immunization program
  • the Section 317 Immunization Program was already slated for a big drop in President Trump’s FY 2018 Budget

So we may have fewer kids with insurance and less money for immunization programs.

When did we last see that scenario?

Take Action and remind Congress and our President of the “critical role” they play in protecting our children and that they should #PutKidsFirst.

“As Members of Congress, we have a critical role to play in supporting the availability and use of vaccines to protect Americans from deadly disease.”

Sens. Lamar Alexander et al Dear Colleague Letter

“Supporting the availability and use of vaccines” does not mean decreasing funding for vaccine programs!

And protecting “Americans from deadly disease” certainly does not mean having fewer people covered on insurance plans.

What to Know About Ronald Reagan’s Vaccine Policy

Ronald Reagan essentially starved the Federal program for childhood immunization, which led to lower vaccine rates and deadly outbreaks of measles. Let’s not allow history to repeat itself.

More on Ronald Reagan’s Vaccine Policy