Tag: MMR

Update on the Samoa Vaccine Tragedy

Breaking News – the inquiry into the deaths of two infants a few months ago continues to be delayed, all immunizations were halted by mistake, not just MMR and kids are starting to get vaccine preventable diseases (see below).

Many people remember that two young children died in Samoa in early July, shortly after getting an MMR vaccine.

Two toddlers died after being vaccinated at Safotu Hospital in Samoa.
Two toddlers died after being vaccinated at Safotu Hospital in Samoa.

Both incidents happened on the same day in the same hospital on the island of Savai’i.

“Until the investigations have been completed and reported on we cannot say what did happen.

However, given the batch of vaccine involved had been in use in that country since August last year, and given the same batch of vaccine has been used in South American countries and the Caribbean island nations without incident, it seems unlikely that there was anything wrong with the vaccine.

The reports from the parents of the children affected on Friday indicate the reactions occurred within minutes after vaccination. This would preclude a response to the vaccine viruses as this takes at least a week. While anaphylaxis occurs within minutes and can be fatal when not treated the odds of seeing this twice in a day at the same place, given a chance of 1 in a million doses, is literally astronomical.”

Dr. Helen Petousis Harrison on What happened in Samoa?

And while many people have speculated on what had happened, we didn’t get much new information until the Attorney General Lemalu Herman Retzlaff issued a press statement:

It can be confirmed that one of the nurses involved with the vaccination injections of the two babies who passed away 6th July 2018, was charged by police on Saturday 4th August 2018. She is set to appear in Court 14th August 2018, where the charges will be confirmed publicly.

According to AG Lemalu, “the file was referred to this office for advice last week, after swift and hard-working investigations by the CID section of the Ministry of Police both in Apia and Savaii, which is to be commended.”

“And the decision to charge was thereafter supported by advice; and it is also confirmed by Police, that investigations are still active and on-going.”

Both nurses have now been charged and both have entered not guilty pleas to charges of manslaughter, negligence and conspiracy to defeat the course of justice.

A trial is set for January 21, 2019.

Apparently though, an ongoing investigation into the deaths of the two toddlers that had been adjourned until September 12, as they were still waiting on the the post mortem reports from the pathologist in Australia, has been suspended even further.

“The inquiry into the deaths of two babies in Samoa has been suspended until further information is available from post mortem results”

Delays in Samoa deaths inquiry

So, we still don’t know what happened.

Were the vaccines contaminated somehow?

Was an error made?

Why were the nurses charged with manslaughter? Many think the main issue is that the nurses continued to use the MMR vaccine even after the first baby died.

“This particular vaccine batch lot arrived to Samoa in August 2017 and has been in use since then. The same vaccine batch lot used in Samoa is also in use in a number of South American and Caribbean countries (Belize, Ecuador, St. Vincent, Trinidad Tobago, Chile, Aruba, Dutch Antilles, St. Kitts & Nevis and Cuba) with no reports of adverse events from those countries.”

Government of Samoa – Ministry of Health Press Statement

Whatever happened, it is important to remember that these kinds of tragedies are very rare and that vaccines are safe.

There certainly doesn’t seem to be a good reason to continue to halt all vaccinations in Samoa!

“This stop order is for the M.M.R. to be put on hold for the time being until the case and the investigation are completed,” said Tagaloa.

“But in relation to other vaccines, the ministry did not have any stop order on this. We advise that the other vaccination still continue, especially the vaccinations relating to newborns.”

He added the stop order in question was issued by the National Health Service (N.H.S.) and it involves all vaccinations from the day of the incident.

“But we have already advised them to continue with the other vaccines except for the M.M.R. vaccinations.”

Order to stop immunisation only for M.M.R.

Vaccinations in Samoa, except for MMR, will resume thanks to a push by their Nurses Association.

What’s next? The post mortem results and the trial. Hopefully they don’t wait until the trial to resume MMR vaccinations though…

More on Samoa Vaccine Tragedy

Updated on September 30, 2018

Andrew Wakefield Is Not A Fraud?

Most folks have a good idea of who Andrew Wakefield is and what he did.

Who's to blame for low immunization rates and continuing outbreaks?
Who’s to blame for low immunization rates and continuing outbreaks?

Still, some folks seem to be pathologically optimistic that he didn’t actually do anything wrong.

Andrew Wakefield Is Not A Fraud?

You remember Andrew Wakefield, right?

“To our community, Andrew Wakefield is Nelson Mandela and Jesus Christ rolled up into one.”

J. B. Handley

He is the guy who published the 1998 paper in Lancet in the UK that started folks thinking that the MMR vaccine is somehow associated with autism.

In 1998, a major medical journal based in the UK, The Lancet, published a report headed by Andrew Wakefield, who was at that time a gastroenterological surgeon and medical researcher. The report implied a causal link between the measles, mumps, and rubella (MMR) vaccine and the development of autism combined with IBD in children, which Wakefield described as a new syndrome he named “autistic entercolitis”.

Andrew Wakefield’s Harmful Myth of Vaccine-induced “Autistic Enterocolitis”

But he didn’t actually say that the MMR vaccine caused autism in that paper, did he?

No, he saved that for the press conference for the paper.

If not for the press conference, which in itself was unusual, and all of the media attention over the next few years, his small study, which was “essentially a collection of 12 clinical anecdotes,” would have gone nowhere.

But there was no “Wakefield Factor” on immunization rates in the UK, was there? Didn’t measles cases continue to go down in the 10 years after his Lancet paper was published?

MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn't fully recover until 2012.
MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn’t fully recover until 2012.

Despite the heroic efforts of some folks to manipulate the data, it is clear that MMR vaccination rates dropped and measles cases jumped in the years after Wakefield’s MMR scare.

But even if his paper scared people away from vaccinating and protecting their kids, he was never really found guilty of fraud, was he?

While the findings of the General Medical Council panel that took away Wakefield's medical license never used the word 'fraud,' they described things that are fraudulent.
While the findings of the General Medical Council panel that took away Wakefield’s medical license never used the word ‘fraud,’ they described things that are fraudulent. The words dishonest and misleading come up a lot too.

How do you define fraud?

“The Office of Research Integrity in the United States defines fraud as fabrication, falsification, or plagiarism.13 Deer unearthed clear evidence of falsification. He found that not one of the 12 cases reported in the 1998 Lancet paper was free of misrepresentation or undisclosed alteration, and that in no single case could the medical records be fully reconciled with the descriptions, diagnoses, or histories published in the journal.

Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No.”

Fiona Godlee on Wakefield’s article linking MMR vaccine and autism was fraudulent

Brian Deer wasn’t the only one calling Wakefield a fraud.

But those charges from the General Medical Council were later all overturned, weren’t they?

While charges against John Walker-Smith, a co-author of Wakefield’s study, were dropped on appeal, that doesn’t exonerate Wakefield in anyway. Remember, John Walker-Smith was actually against blaming the MMR vaccine and unlike Wakefield, he and another co-author actually published their own press release stating continued support of the use of the MMR vaccine.

But the other coauthors have stood by the results of the paper, haven’t they?

“We wish to make it clear that in this paper no causal link was established between MMR vaccine and autism as the data were insufficient. However, the possibility of such a link was raised and consequent events have had major implications for public health. In view of this, we consider now is the appropriate time that we should together formally retract the interpretation placed upon these findings in the paper, according to precedent.”

Retraction of an Interpretation

They stood by the idea that it is important that research be done so that gastrointestinal problems in autistic children can be recognized and treated. Almost all of them retracted Wakefield’s interpretation of the paper though.

Yeah, but other studies have proven Wakefield to be right though, haven’t they?

No, they haven’t. In fact, other labs could not even replicate Wakefield’s original study.

Why wasn't Wakefield ever charged in a criminal court?
Why wasn’t Wakefield ever charged in a criminal court?

But Wakefield’s Lancet paper wasn’t retracted because it’s findings were wrong…

Yes it was!

“Following the judgment of the UK General Medical Council’s Fitness to Practise Panel on Jan 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al are incorrect, contrary to the findings of an earlier investigation. In particular, the claims in the original paper that children were “consecutively referred” and that investigations were “approved” by the local ethics committee have been proven to be false. Therefore we fully retract this paper from the published record.”

Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children

Still think Andrew Wakefield isn’t a fraud?

Every time there is a measles outbreak, anti-vaccine folks pop up to defend Andrew Wakefield. The problem is that they get virtually everything about him wrong!

Their false narratives and myths attempt to rewrite history and make you forget that he doesn’t just scare parents away from vaccinating and protecting their kids, he hurts autistic kids and their families.

More on Andrew Wakefield Myths

Vaccines and the Latest Autism Prevalence Report

The Autism and Developmental Disabilities Monitoring (ADDM) Network recently released a report that showed a 15% increase in autism prevalence rates.

What does that have to do with vaccines?

Well, nothing, unless you are an anti-vaccine group that is continually trying to associate vaccines with autism.

Trends in Autism Prevalence

Just about everyone understands that autism prevalence rates have been increasing over the years. It is what makes some folks think that there is a real autism epidemic.

Using ADDM Network numbers, it is easy to see the trend:

  • 1 in 150 children in 2000
  • 1 in 150 children in 2002
  • 1 in 125 children in 2004
  • 1 in 110 children in 2006
  • 1 in 88 children in 2008
  • 1 in 68 children in 2010
  • 1 in 68 children in 2012
  • 1 in 59 children in 2014 (the latest, 2018 report of children born in 2006)

As in previous years, this new report generated headlines from anti-vaccine groups, who continue to think that any increase in autism rates is a new reason to blame vaccines.

Of course, as it is has been shown over and over again, vaccines are not associated with autism.

These CDC reports should even take away any last idea that they are.

Why?

If there was any association with vaccines, then why are autism rates so widely different in the 11 states that are tracked by ADDM?

Are immunization rates different in those states?

Autism and Developmental Disabilities Monitoring (ADDM) Network

Anyone who has read the latest report on autism rates understands that it “is not a representation of autism in the United States as a whole, but is instead an in-depth look at the 11 communities in the ADDM Network.”

Those communities have changed for each report, but this time they were in Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin.

key-finding-asd-prevalence
Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014 (2018 report)

Even then, the ADDM Network doesn’t look at all of the children in those states. They are mostly looking at children near large institutions that are hosts for the ADDM Network, such as the University of Arkansas for Medical Sciences, Johns Hopkins University, and Rutgers University, etc.

The 325,483 8-year-olds in the latest ADDM Network report were born in 2006 and live in:

  • part of Maricopa County in metropolitan Phoenix, Arizona
  • 75 counties in Arkansas
  • Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, and Jefferson counties in Colorado
  • Clayton, Cobb, DeKalb, Fulton, and Gwinnett counties in Georgia
  • Baltimore County, Maryland
  • parts of two counties (Hennepin and Ramsey) including the large metropolitan cities of Minneapolis and St. Paul, Minnesota
  • Franklin, Jefferson, St. Charles, St. Louis, and St. Louis City counties in Missouri
  • Essex, Hudson, Union, and Ocean counties in New Jersey
  • Alamance, Chatham, Forsyth, Guilford, Orange, and Wake counties in North Carolina
  • Bedford, Cheatham, Davidson, Dickson, Marshall, Maury, Montgomery, Rutherford, Robertson, Williamson, and Wilson counties in Tennessee
  • Dane, Green, Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Walworth, and Waukesha counties in Wisconsin

Why is this important?

“Autism prevalence among black and Hispanic children is approaching that of white children,” said Dr. Stuart Shapira, associate director for science at the CDC’s National Center on Birth Defects and Developmental Disabilities. “The higher number of black and Hispanic children now being identified with autism could be due to more effective outreach in minority communities and increased efforts to have all children screened for autism so they can get the services they need.”

It shows that “there continue to be many children living with ASD who need services and support, now and as they grow into adolescence and adulthood.”

Immunization Rates and the Autism and Developmental Disabilities Monitoring Network

It also helps to dispell any last ideas that vaccines are associated with autism…

Just look at the immunization rates in the ADDM Network counties (4 doses of DTaP, 3 doses of IPV, one dose of MMR, 3 doses of Hib, 3 doses of HepB, 1 dose of Varicella, 4 doses of Prevnar, flu shot, and 1 dose of HepA by age 36 months) and compare them to the autism rates in those same counties.

 

County Autism Rate Immunization Rates
Maricopa (AZ) 1 in 71 DTaP 82%, IPV 91%, MMR 90%, Hib 91%, HepB 93%, Var 88%, Prev 75%, flu 32%, HepA 78%
Boulder (CO) 1 in 72 DTaP 87%, IPV 95%, MMR 93%, Hib 89%, HepB 90%, Var 93%, Prev 80%, flu -%, HepA 65%
Jefferson (CO) 1 in 72 DTaP 86%, IPV 93%, MMR 91%, Hib 90%, HepB 94%, Var 90%, Prev 83%, flu 48%, HepA 69%
Cobb (GA) 1 in 59 DTaP 83%, IPV 94%, MMR 91%, Hib 88%, HepB 93%, Var 91%, Prev 80%, flu 40%, HepA 21%
Baltimore (MD) 1 in 50 DTaP 91%, IPV 95%, MMR 95%, Hib 94%, HepB 95%, Var 93%, Prev 86%, flu 46%, HepA 61%
Hennepin (MN) 1 in 42 DTaP 88%, IPV 93%, MMR 92%, Hib 88%, HepB 93%, Var 90%, Prev 82%, flu 42%, HepA 47%
Ramsey (MN) 1 in 42 DTaP 87%, IPV 96%, MMR 93%, Hib 91%, HepB 94%, Var 93%, Prev 79%, flu 42%, HepA 63%
Jefferson (MO) 1 in 71 DTaP 83%, IPV 95%, MMR 90%, Hib 92%, HepB 95%, Var 87%, Prev 82%, flu -%, HepA 51%
Essex (NJ) 1 in 34 DTaP 81%, IPV 91%, MMR 91%, Hib 93%, HepB 91%, Var 91%, Prev 69%, flu -%, HepA -%
Hudson (NJ) 1 in 34 DTaP 78%, IPV 91%, MMR 91%, Hib 92%, HepB 91%, Var 91%, Prev 70%, flu -%, HepA -%
Ocean (NJ) 1 in 34 DTaP 84%, IPV 91%, MMR 91%, Hib 92%, HepB 91%, Var 83%, Prev 74%, flu -%, HepA -%
Union (NJ) 1 in 34 DTaP 89%, IPV 92%, MMR 92%, Hib 91%, HepB 94%, Var 91%, Prev 79%, flu -%, HepA -%
Davidson (TN) 1 in 64 DTaP 89%, IPV 95%, MMR 95%, Hib 93%, HepB 94%, Var 94%, Prev 84%, flu 50%, HepA 35%
Dane (WI)
 1 in 71 DTaP 87%, IPV 93%, MMR 93%, Hib 88%, HepB 93%, Var 90%, Prev 82%, flu -%, HepA 45%

If vaccines were associated with autism, what should you see? Higher rates of autism in the areas with the highest immunization rates. You don’t see that in any of this data though, do you?

The counties in New Jersey, with the highest rates of autism, have good immunization rates, but they aren’t much different from the immunization rates in Colorado counties or Arizona counties with much lower autism rates.

Some other things we know about vaccines and the latest autism report?

  • in 2006, when those kids were born, New Jersey had one of the lowest rates for getting newborns a hepatitis B shot on their first day, as recommended, at just 23%. Arizona, with a much lower rate of autism, did much better, getting 65% of newborns their birth dose of hepatitis B vaccine on time. In fact, Maricopa County had one of the highest rates, at 71%.
  • fewer than half of their mothers likely received a flu shot during their pregnancy, even though they had been recommended since the 1990s
  • extremely few of their mothers received a Tdap vaccine during their pregnancy, as this didn’t become a routine recommendation until 2011

Does any of this surprise you?

How can vaccines be associated with autism, when counties that have higher immunization rates have lower rates of autism?

What to Know About Vaccines and the Latest Autism Prevalence Report

The latest Autism and Developmental Disabilities Monitoring (ADDM) Network report on autism prevalence from the CDC shows a rate that has increased to 1 in 59 children. And as county level trends in vaccination coverage show no correlation to those autism prevalence rates, folks will hopefully stop trying to associate vaccines with autism.

More on Vaccines and the Latest Autism Prevalence Report

Can Vaccines Cause ITP?

ITP is an abbreviation for idiopathic thrombocytopenic purpura.

It is a condition in which our platelets get destroyed, leading to excessive bruising and bleeding, since platelets are needed for normal blood clotting.

What Causes ITP?

To understand what causes ITP, it is important to know it is also often referred to as immune thrombocytopenic purpura, because it is typically the cells of our own immune system that destroys our platelets.

Why?

Well, that’s where the idiopathic part comes in.

We don’t know why people develop ITP, although classically, ITP is thought to follow a viral infection, including Epstein-Barr virus (mono), influenza, measles, mumps, rubella, and varicella (chicken pox). ITP has also been associated with many other viral infections, from Dengue fever to Zika.

“Often, the child may have had a virus or viral infection approximately three weeks before developing ITP. It is believed that the body’s immune system, when making antibodies to fight against a virus, “accidentally” also made an antibody that can stick to the platelet cells. The body recognizes any cells with antibodies as foreign cells and destroys them. Doctors think that in people who have ITP, platelets are being destroyed because they have antibodies.”

Pediatric Idiopathic Thrombocytopenia Purpura (ITP)

These children with ITP, usually under age 5 years, develop symptoms a few days to weeks after their viral infections. Fortunately, their platelet counts usually return to normal, even without treatment, within about 2 weeks to 6 months. Treatments are available if a child’s platelet count gets too low though.

Can Vaccines Cause ITP?

The measles vaccine is the only vaccine that has been clearly associated with ITP.

“The available data clearly indicate that ITP is very rare and the only vaccine for which there is a demonstrated cause-effect relationship is the measles, mumps and rubella (MMR) vaccine that can occur in 1 to 3 children every 100,000 vaccine doses.”

Cecinati on Vaccine administration and the development of immune thrombocytopenic purpura in children

Even then though, the risk of ITP after a measles containing vaccine, like MMR or ProQuad, is much less than after getting a natural measles infection, so worry about ITP is a not a good reason to skip or delay getting vaccinated.

What about other vaccines?

There is no good evidence that other vaccines, including the chicken pox vaccine, DTaP, hepatitis B vaccine, or flu vaccine, etc., cause ITP.

What about Gardasil? ITP is listed in the package insert as an adverse reaction for Gardasil, but only in the postmarketing experience section, so it does not mean that the vaccine actually caused the reaction, just that someone reported it.

Although ITP is listed in the PI for Gardasil, studies have shown that there is no association.
Although ITP is listed in the PI for Gardasil, studies have shown that there is no association.

Several large studies have actually been done that found no increased risk for ITP after getting vaccinated with Gardasil.

What to Know About Vaccines and ITP

Although measles containing vaccines can rarely cause ITP, vaccines prevent many more diseases that can cause ITP.

More on Vaccines and ITP

 

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