Whereneverever Posted February 5, 2015 Share Posted February 5, 2015 Is anyone who does vaccinate with the MMR considering getting the second shot earlier for their toddler? My 2 year old has his first but I'm considering asking for the second dose sooner than the 4 year old appt. Thoughts? Quote Link to comment Share on other sites More sharing options...
Lara in Colo Posted February 5, 2015 Share Posted February 5, 2015 I wouldn't-- the schedule is made to be overly cautious -- early is probably too early-- the first one is still in effect-- if you are worried have his/her titers checked Quote Link to comment Share on other sites More sharing options...
Lang Syne Boardie Posted February 5, 2015 Share Posted February 5, 2015 Is anyone who does vaccinate with the MMR considering getting the second shot earlier for their toddler? My 2 year old has his first but I'm considering asking for the second dose sooner than the 4 year old appt. Thoughts? According to my research, the second is given right before kids start school because measles are so much more easily spread at school than among preschool-aged kids. Or that was the thinking when the schedule was made -- I can't see how that's not outdated thinking, though, when the vast majority of preschoolers are not home with their mommies but out in crowds (including their own daycares and preschools) all the time. Possibly they all know this but haven't changed it just because the first dose confers immunity to the vast majority. The second is just for the small percentage who need it. (Again, according to what I read recently. I'm not a doctor.) The length of time between doses must be at least 4 weeks. The second shot doesn't have to be given several years later, it just can't be any sooner than 4 weeks after the first. Quote Link to comment Share on other sites More sharing options...
Lang Syne Boardie Posted February 5, 2015 Share Posted February 5, 2015 I wouldn't-- the schedule is made to be overly cautious -- early is probably too early-- the first one is still in effect-- if you are worried have his/her titers checked This is incorrect. The second dose is needed not because the first one wears off but because a small percentage of the population needs a second dose for full immunity. The child receives the second before starting school. Quote Link to comment Share on other sites More sharing options...
Whereneverever Posted February 5, 2015 Author Share Posted February 5, 2015 My 2 year old had his at 1, so definitely more than 4 weeks have passed. Thank you!!! Quote Link to comment Share on other sites More sharing options...
Reefgazer Posted February 5, 2015 Share Posted February 5, 2015 Our doctor was unwilling to do it earlier; not even 2 days earlier. Quote Link to comment Share on other sites More sharing options...
Catherine Posted February 5, 2015 Share Posted February 5, 2015 I can't address this completely knowledgeably but in general the dosing schedule for vaccines is developed based on the timing that has been found to be best to produce long term immunity. So a significant change to the recommended schedule would not accelerate immunity. For MMR, the booster is given to induce longer-term immunity than is usually achieved by a single dose. If a child is going to become immune from the first booster, that will happen before the second is given. Quote Link to comment Share on other sites More sharing options...
Catherine Posted February 5, 2015 Share Posted February 5, 2015 I'm pretty sure the second dose of MMR began to be given in the late 1980's after there were epidemics of measles on college campuses (there was one on mine) and researchers determined that a booster dose would confer longer-term immunity than a single dose gives. Quote Link to comment Share on other sites More sharing options...
LMV Posted February 5, 2015 Share Posted February 5, 2015 Christus asked a similar question here. In short we opted to check titers in our two year old daughter and since she was immune we are opting to wait until she is four for the booster. If she hadn't been immune we would have gone ahead with MMR#2 last week and possibly considered a 3rd dose in adolescence to afford a bit better immunity for rubella and mumps which can have waning immunity. I am an EM physician so her secondary exposure risk may be different than your child and, in that sense I suppose, your mileage may vary. Quote Link to comment Share on other sites More sharing options...
Lang Syne Boardie Posted February 5, 2015 Share Posted February 5, 2015 Christus asked a similar question here. In short we opted to check titers in our two year old daughter and since she was immune we are opting to wait until she is four for the booster. If she hadn't been immune we would have gone ahead with MMR#2 last week and possibly considered a 3rd dose in adolescence to afford a bit better immunity for rubella and mumps which can have waning immunity. I am an EM physician so her secondary exposure risk may be different than your child and, in that sense I suppose, your mileage may vary. Thank you for weighing in. I so appreciate all the doctors and nurses helping us out on these measles threads. Our three eldest boys are getting a 3rd dose booster this weekend. My eldest has a serious health problem and must. not. get. measles. Also, he spends a lot of time in the children's hospital on the hematology/oncology floor, so we're thinking of those families, too. The doctor says there is no risk from the booster to people who had no problems with the first two -- no harm caused by giving it to people who might have immunity to one or more of the diseases, either. If they'd had their MMR doses within the last 10 years my son's doctor would assume immunity and not advise a booster, but since they're older teens we're going ahead with the booster. The cases stemming from the outbreaks are not in our state yet but were just documented to have spread to a neighboring state this week. Quote Link to comment Share on other sites More sharing options...
Alice Posted February 5, 2015 Share Posted February 5, 2015 About 95% of people become immune to measles after the first dose of MMR. The second dose was added in 1989 after there were outbreaks of measles in older kids. Most studies have shown that >99% of people will be immune after the second dose. That immunity should be long term. One important thing to realize with vaccine policy is that it is relying on two things 1) the individual person's immune response and 2) herd immunity. Many people have mentioned titers on these measles threads. Titers are somewhat problematic. If positive, they can confirm immunity. If negative, they do not necessarily mean you are non-immune. Your body may not have a circulating level of measles antibody 10 years after your last MMR vaccine, but you may still be immune. That is why in normal conditions it is not recommended that people who have had two does of MMR get titers, the assumption is that they are immune and if they fall in the tiny percentage of people who are not then they can rely on herd immunity. However, there are conditions where you might worry more (high-risk person, health care worker, travel to epidemic area). The rate of immunity for rubella for the MMR is similar. It used to be recommended that pregnant women get checked for Rubella and get the MMR if they were non-immune. The current recommendation, I believe, is that they should be checked once and only get the MMR for a total of a third dose (not checked again on subsequent pregnancies). I think this changed because the population of women now who are pregnant is shifting from those pre-1989 people who did not routinely get two doses to those post-1989 people who did routinely get two doses. Also, the realization is that negative titers for rubella, like measles, may not truly convey non-immunity. The rate of immunity for mumps is much lower after vaccination, interestingly. This is why you hear of more mumps outbreaks in college students and older people. It doesn't mean that the entire MMR "didn't work" it just means that either the person did not have a good response to the mumps part of the vaccine or that their immunity waned. I think we will see some of the current measles/MMR recommendations change in the coming months/years. There are a lot of questions that I'm being asked by patients there is no official answer to. Should a baby who is between 6mo-12 months and traveling to California get MMR? Not currently as part of the official recommendation that I've seen, however, we do give if if they travel to countries where it is more prevalent, including European countries. Should we give MMR at the 12 month WCC, as early as possible even in kids not traveling? Should we give the second dose before the age of 4 (you can give two doses 28 days apart to someone who is traveling to a high-risk area)? For most of the questions I try and lay out the issues for the parents and then let them decide. I usually will tell them what I would do if it was my child in that scenario. I can't go back and quote now, but someone mentioned that their doctor wouldn't' give the MMR early, even by a couple of days. A lot of times this is decided as much by schools as by actual medical science. For example, schools will not accept an 2nd MMR given before the age of 4. You can give it before then medically but the schools will see the date and send them in for another dose because it doesn't meet the requirements. Do we know that it's ridiculous and that it makes no difference immunologically if a vaccine is given the day before your birthday? Yes. But we also know that the school bureaucracy will argue with the parent and it will cause issues the rest of the time that kid is in school. I'm willing to write letters and tell the school it is ok, but it's easier to just give it the way they will accept it in the first place. Quote Link to comment Share on other sites More sharing options...
LMV Posted February 5, 2015 Share Posted February 5, 2015 About 95% of people become immune to measles after the first dose of MMR. The second dose was added in 1989 after there were outbreaks of measles in older kids. Most studies have shown that >99% of people will be immune after the second dose. That immunity should be long term. One important thing to realize with vaccine policy is that it is relying on two things 1) the individual person's immune response and 2) herd immunity. Many people have mentioned titers on these measles threads. Titers are somewhat problematic. If positive, they can confirm immunity. If negative, they do not necessarily mean you are non-immune. Your body may not have a circulating level of measles antibody 10 years after your last MMR vaccine, but you may still be immune. That is why in normal conditions it is not recommended that people who have had two does of MMR get titers, the assumption is that they are immune and if they fall in the tiny percentage of people who are not then they can rely on herd immunity. However, there are conditions where you might worry more (high-risk person, health care worker, travel to epidemic area). I don't disagree with your points and I do realize that titers can be problematic so perhaps I shouldn't have advocated them (even though if you ask me what I would do well it is exactly what I did do). I completely believe there are some people who probably are truly immune but aren't showing a good titer---we sometimes see this in groups (i.e. health care workers, renal dialysis patients, etc) where we do post series titers after Hep B and sometimes even when we repeat the titers after a second complete series---which is not recommended partially for that reason. So like any test I think you need to have a plan for how you are going to handle the results before you do the test. In our daughters case we were going to go ahead with early MMR and opt for a third dose and let her be cool like her big brother (who got MMR#1 before he was a year old because there was a relatively local outbreak when and that was apparently the recommendation from the state health department at the time, he later got MMR#2 after he turned one and then needed MMR#3 before school). I guess my take on it all was I felt that the risk of her getting MMR#3 is less than the risk of her being not immune and living in a state where there are active cases with a mom who happens to be an EM physician. Continuing on the risk theme I sent her to the well child visit with her dad, went to work an ED physician shift and he brought this all up with her pediatrician. I think our pediatrician probably went through the same risk benefit analysis in her head and ordered the titers along with the regular well child labs. Our pediatrician may also be influenced somewhat by the knowledge that our local school district would not have looked askance at a shot record with MMR#1 at 12 months and MMR#2 at 26 months, as they both happened after the first birthday she would be good to go. Quote Link to comment Share on other sites More sharing options...
Grover Posted February 5, 2015 Share Posted February 5, 2015 When there was an outbreak here they offered second doses early. My DD had her first at 15 months and then was a little over two when the outbreak reached our city and had her second dose. Quote Link to comment Share on other sites More sharing options...
Alice Posted February 5, 2015 Share Posted February 5, 2015 I don't disagree with your points and I do realize that titers can be problematic so perhaps I shouldn't have advocated them (even though if you ask me what I would do well it is exactly what I did do). I completely believe there are some people who probably are truly immune but aren't showing a good titer---we sometimes see this in groups (i.e. health care workers, renal dialysis patients, etc) where we do post series titers after Hep B and sometimes even when we repeat the titers after a second complete series---which is not recommended partially for that reason. So like any test I think you need to have a plan for how you are going to handle the results before you do the test. In our daughters case we were going to go ahead with early MMR and opt for a third dose and let her be cool like her big brother (who got MMR#1 before he was a year old because there was a relatively local outbreak when and that was apparently the recommendation from the state health department at the time, he later got MMR#2 after he turned one and then needed MMR#3 before school). I guess my take on it all was I felt that the risk of her getting MMR#3 is less than the risk of her being not immune and living in a state where there are active cases with a mom who happens to be an EM physician. Continuing on the risk theme I sent her to the well child visit with her dad, went to work an ED physician shift and he brought this all up with her pediatrician. I think our pediatrician probably went through the same risk benefit analysis in her head and ordered the titers along with the regular well child labs. Our pediatrician may also be influenced somewhat by the knowledge that our local school district would not have looked askance at a shot record with MMR#1 at 12 months and MMR#2 at 26 months, as they both happened after the first birthday she would be good to go. I should have made it clear I wasn't really commenting on your post. What you did makes sense to me. I think a lot of times it still makes sense to check titers, but I just wanted to make sure people realized that a negative titer doesn't necessarily mean you are not immune. What we are doing with all the measles questions in our practice is to deal with it very much case by case. The six month old traveling to California? I said, yes I would vaccinate. The 3 year old in my area (no current outbreak)? I probably wouldn't unless they were particularly high-risk. The 3 year old in our area traveling to California? I think it makes sense to get the second MMR early and deal with the schools later. The 3 year old in our area with a newborn sibling....a hard one. I've been asked that a lot in the past week and I'm not entirely sure what I would do. At this point we aren't recommending it but I wouldn't say no if a parent really wanted the vaccine in that situation. And I agree, I consider myself to make my kids higher risk. I definitely am more apt to get them vaccinated against some things knowing that I'm likely to bring it home to them than if I wasn't in medicine. Quote Link to comment Share on other sites More sharing options...
Whereneverever Posted February 5, 2015 Author Share Posted February 5, 2015 Well, I called and talked to the ped and they said even though we are traveling they really wouldn't recommend it for my 2 year old. Thanks, HIve! Quote Link to comment Share on other sites More sharing options...
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