Staggering Vaccinations?

[Clearlymisunderstood]

What's the benefit of it? My DD will be having all of her vaccinations but I've heard of people staggering then so was just wondering why basically and whether that is something I should consider? Apologies if I sound ignorant but googling has made my brain hurt!

Sorry to sound like an interrogation, but I like to get to the nitty-gritty....

If you suspect an immune dysfunction, I suppose it would be prudent not to vaccinate any of your DC. As this dysfunction is poorly understood, I can't see how an individual risk assessment for each disease would be truely possible. The riskier whole cell pertussis vaccines have been replaced now, haven't they (they have in France)? As I understand it, vaccine reactions (apart from food-type allergies) are merely reflect the disease itself. So, if your child is more susceptible to febrile convulsions, they would benefit more than average by being vaccinated as the full-on disesae could be devestating. But this is just thinkiing aloud.

Also, be careful, as even catching wc is no guarantee of immunity. It can also wane after as little as four years.

But wc is not generally serious post infancy (I wouldn't want a baby to have it, at least in a child it's easier to recognise and not spread anywhere compared to a teenager - it's certainly not the health risk to the individual as a child/teen/adult that it is when the individual is a baby). Yes wP has replaced aP and is supposedly safer although really I would have expected this study to have been done sooner but aP doesn't work as well as wP - so you are exposing to a reduced, but still some risk for something that is less likely to protect. And post babyhood the main advantage of whooping cough vaccination is to protect babies - not yourself. I presume a new aP will be released soon as this one does seem to be causing problems in other countries at a population level. See this for example www.uq.edu.au/news/index.html?article=25059

Of course you can carry a risk assessment for a disease. We don't travel (can't get on a plane with ds1) so the risk from polio is incredibly small. Ditto diptheria. The risk from meningitis C for ds2 and ds3 will be higher when they are 18 than it is for them now (and if it's available to them then maybe they'll choose to have it). The risk from mumps is incredibly small, particularly while children. The risk from measles is higher (and they're more likely to get it if exposed to it, although the risk of exposure might be small). The risk from tetanus is hard to quantify - hard to get it, but potentially very serious if they do. And so on and so forth.

If they had the general Joe Public risk from the vaccination then yeah sure dish it out (which is what we did with ds1). But knowing that their risk from vaccination is quite possibly higher - well then what? Why protect against polio if they're not going to come into contact with it? Vaccinating for the social good is only ethical imo if the risk to the individual from the vaccination is incredibly small - that may well not be the case for my kids - when we thought it was we vaccinated.

Oh, and of course, after being infected with one strain, there will be partial to little/no immunity against other strains. Whereas the vaccine provides (tempory) protection against multiple strains. Bit of a shame about what's going on in Australia. The whole-cell had many more antigens so they think the newer one was more targeted and promoted resistant strains.

I was talking about your specific risk assessment wrt potential immunity issues. If not much, if anything, is known about the immunity disease, how can you estimate the vaccination risks? And many would not criticize you if you chose not to vaccinate at all.

To try and keep the debate general: an extremely rare immunity disease maybe a good reason to not vaccinate, but this isn't the case for the vast, vast majority who are thinking about whether to vaccinate, or whether to stagger the jabs. I am still having difficulty understanding why one would want to stagger.

I don't think it a good reason to not vaccinate because the disease is now rare (in part, because of vaccination) btw. That is my personal view - like it or not. That was the argument my neighbour gave...didn't stop her two children contracting measles though. Wrt polio - I met a man just the other day. Spends his life in a wheelchair and living off the state because of contracting polio as a child. He's only 50. Sometimes these diseases seem like things we only read about in a Dicken's book...

With the greatest respect if ds2 or ds3 regressed in the way ds1 has you would not be helping me out. Your life would not be affected in the slightest so you don't get to decide which risks my children take. I obviously haven't given the entire family medical history on here and nor an I going to. I have discussed what happened to ds1 with ds1's paediatricians, neurologist and geneticist and am happy with our decision. If the information changes (which it will actually - the neurologist said to give it 20-30 years) then we might make a different decision (not that it will be our decision to make then).

You're never going to understand my decision because you don't believe some children are at higher risk of vaccination than others.

Please, please, please don't take everything I say as though I'm judging you or as though I don't believe you or that it is all personal!!! It's very fustrating and prevents debate, which is the reason why, I assume, you are on this thread.

How many times do I have to say - if I were you, I doubt very much I would vaccinate ANY of my DC. You are making a sweeping judgement by saying I "don't believe some children are at higher risk of vaccination than others".

How does this help the average MNer who has come on this thread to find out why people stagger vaccinations?

Just to be cristal clear: sweeping and inaccurate judgement

Well why say it's not a good reason to not vaccinate just because a disease is rare? If a child is at higher risk than average then it's a bloody good reason not to vaccinate. Whereas if they were at likely to catch a dangerous disease then even with an known increased risk from a vaccination it might still be worth taking the risk?

You're asking me specific reasons about my family then answering generally. No wonder it's confusing.

I gave another reason earlier - to be able to identify the trigger for any adverse reaction. May be relevant for some especially if there was a family history. Or maybe someone would want to avoid specific vaccinations at specific times (there could be reasons for this that I cba to get into here) but they didn't want to delay the other vaccinations in thr combination. Or maybe they're unhappy with the safety trials of thr combined vaccine but not the singles. I must say as I think in general safety trials do not follow up for long enough I'd much prefer to give an older vaccination where possible (less likely to overestimate efficacy as well). That's just a few potential reasons.

And no I'm not on the thread to prevent debate

Or maybe they want a specific strain. This bmj paper seems to saying the rubini strain does not protect against mumps infection (or have I read it wrong? I'm on iPod and can't quite believe a vaccination that ineffective would be in widespread use ) but anyway if one strain was in a combined jab and one in a monovalent (theoretically) you might choose one over the other.

bestpractice.bmj.com/best-practice/evidence/intervention/0316/0/sr-0316-i3.html

"not a good reason to not vaccinate just because a disease is rare" note the highlight.

1/ One can't assume one vaccine would trigger but not another. If one did trigger, then all vaccinations would stop - you wouldn't know if other vaccines triggered or not. So I still don't see the point of spreading out.

2/ Don't understand about specific timings.

3/ Are combined vaccines more dangerous?

3/ In general, the newer vaccines are safer (possibly less effective as a result, like the wc vaccine)

1./if you have a family history of reacting to a particular vaccination you might wish to avoid this (see recent threads for examples of a family history of reactions to specific vaccinations)

2./ cba to go into it as it's for very specific cases - recalling a conference presentation (academic)

3./ Who knows? They might be less effective (think Hib). My point wasn't whether the combined or single is more or less effective (this will vary according to specific strains for starters) but that they may be concerned by the lack of safety studies on a combined vaccination. They're not always done when a vaccination is added to a combination. To quite from the JAMA paper I linked to above (published this year) Vaccination with whole-cell pertussis vaccine carries an increased risk of febrile seizures, but whether this risk applies to the acellular pertussis vaccine is not known I would honestly have expected this work to be done before introduction of aP - it suggests a reliance on passive surveillance. Someone may decide they prefer to go with an older vaccination where passive surveillance has been carried out for a number of years.

4./ See above.

These are simply example of why someone might want to stagger. There might be many more reasons.

Why are you so against staggering if someone has concerns (whatever they are)? Why do you feel people should only vaccinate by giving several at once if there's a choice for an equally effective set of singles? What about the the gardasil vs cervarix discussion? Should people be allowed a choice of brand or should they only have access to the NHS approved one (a decision which may have been made partly on cost)? I don't see the discussion as any different from that tbh. I believe people should be able to choose alternatives (as they can with other drugs) (with payment if necessary). Again it comes down to my belief that decisions about any medication should be individual rather than population level ones.

1/ which threads? I'm skeptical when people talk about 'reacting' to a vaccine. Reactions occur, obviously. By and large, these are allergic reactions to the egg or gluten content in the vaccine. If my DC had a, let's say, seizure, directly after a jab, I would be reluctant to continue to vaccinate at all. I don't think I'd be playing the game of 'let's try this vaccine and see what happens'. If an immunologist recommends single vaccines/staggering vaccines, I see no reason not to do so. If the vaccines are not available, they should be.

straight to 3/4/ As others regularly point out, vaccine reactions (outside ones mentioned above) are often so low that statistically significant results cannot be obtained UNTIL they are rolled out to the population - this is highly unfortunate, but because these sorts of reactions are fortunately so rare, this is the nature of the beast. As you know, the newer pertussis vaccine has been designed to avoid these febrile seizures i.e. to be safer. This is an almost ubiquitous trend. You are aware of the research involved in making vaccines safer for everyone. I'm not aware of a case where a more dangerous vaccine was introduced to replace a less effective, safer version (though my education in this area is poor). I can't believe that saftey studies are not done with combined vaccines...put me right if this is so.

To address your final points:

Choice of vaccine - there is a long standing debate about this type of thing in France. Here we have lists of medications which are reimbursable - e.g. not all pill brands are reimbursable by the state. This is because to have a wide and open choice is, frankly, utopian - desirable, perhaps, but like it or not, we live in a world of compromises. As long as good brands that work and meet saftey standards are handed out, I have no problem with limiting choice.

I see two problems with making single jabs easily and cheaply available. They have the effect of making people question the safety/efficacy of combined version, even where no difference exists. People don't complete the course. They frequently just don't. I'm almost certain this happened in the aftermath of the Wakefield paper.

The particular case i was talking about concerned a poster whose sister was left severely brain damaged (has to drink from a sippy cup as an adult), her brother (iirc) had a similar reaction at the time but luckily recovered and so the poster herself was unvaccinated. The poster made a few posts. You can search for them if you like. That was the sort of reaction I was thinking of when I said people might like to avoid a particular vaccination. Or in RL a friends whose two eldest children both had a severe reaction to the MMR, both are severely brain damaged, in once case the paediatrician has said he believes it to be linked - don't think he was involved in the second child - she has two younger children as well, it might be easier for her if she knew the dangerous vaccination for her kids was the mumps component for example, then she could still give measles protection, rather than none. Yes you might prefer to avoid all vaccinations, but some might not, if the rogue component was known then there's a choice.

According to the a letter I received from the Dept of Health in 2001 there was no significant drop in vaccination rates post MMR, there was a slight dip and then it climbed again and they had no concerns about coverage. (Which I was a bit tbh given what they were saying at the time - I need to scan this letter tbh). They said I was mistaken to believe that there had been a loss of confidence in the MMR amongst parents, and that their focus groups and surveys revealed the opposite. This was ten years ago. If Wakefield wasn't having an effect then (and remember this was the dept of health telling me he wasn't) then there is no reason for him to be having an effect now. If you check out the latest figures you will find that MMR coverage is high (From the BBC yesterday: Latest data on immunisations across England shows uptake rates of 93% for the first MMR jab and 87% for the second. In Wales, the figures are 92% and 87%. - add in those receiving singles - which the figures don't - and you're almost certainly over your 95% for primary vaccination. Although I notice they give MMR at 12 to 13 months now when it's slightly less effective that at 15-18 months - the old time of giving it - making the booster more important I guess, looks like they have some work ahead to persuade people to have boosters).

IME people are keen to complete the course - they can't often because mumps supply is unreliable. I don't know anyone who has opted for singles who hasn't taken their child for as many vaccinations as possible. For starters you often have to pay for the whole course in advance. Perhaps you have access to figures I don't?

I have a feeling the twain shall never meet. So, just for the record.

low MMR rates in 2003/4

I can't be bothered to google numbers of children partially completing MMR courses + boosters when administered separately (are these figures even available?). It seems logical to me. It's a commonly quoted fear in the medical profession. Perhaps you mix with equally conscientious parents? There are plenty of people on these threads who admit to being slack about getting around to vaccinating with combined vaccines...

If the lady in question's DC reacted to the MMR, then she has no idea which vaccine, or combination thereof, caused it. She would not benefit by staggering/separating the vaccines. Also, you're assuming a 'rouge element'. It could quite equally be a general immune issue with the child meaning you were playing russian roulette with each and every jab. But of course, it is a long way from observing a correlation and being sure of a causation. But you know this and this is old ground. As I said, the twain will never meet....

Never mind not agreeing you have misunderstood what I said. Yes I said that the reports at the time were that MMR rates were low. My point was the Dept of Health - the part of the dept responsible for vaccination - wrote and told me that I was MISTAKEN to believe that there had been any loss of confidence in the MMR. That they kept a careful track of this to be sure (according to their letter). I am glad we agree that their response is slightly strange given the reports at the time and either they were wrong in their response to me or the BBC was wrong in their report.

No they're not kept - well I've never managed to find any figures for anything to do with singles so definitely not for partially completed courses of vaccination. I'm not sure why if someone had taken the time to opt out of the standard course they would suddenly become unable to see a course through but still. Seems rather a lame excuse for preventing any access to singles at all.

And yes that's entirely my point. If I was going to vaccinate I would want to give singles so that if there was a problem I would know which specific component was the issue. Rather than being left not knowing which one of five had caused a problem. Yes of course one response might be not to vaccinate siblings at all, but a lot of people are not happy with that response. They would rather give, for example,a tetanus shot. If they knew pertussis was a problem then they could go ahead and give tetanus. The point I'm making is that some might choose to give singles to avoid the situation my RL friends are in.

You asked for general reasons why someone might want singles. I've given some. Not said they're the only options, just the sorts of reasons why people might not be happy giving combinations.

I think this'll be my last post as we're going round in circles and I'm finding this an utterly unsatisfactory argument.

History (if not your letter) shows that where an apparently 'safer' single vaccines are available, vaccination rates drop. This is a powerful argument for making single vaccines difficult to get hold of.

I've said already that access to single vaccinations should be available IF an immunologist (or other suitably qualified professional i.e. not a GP or paediatrician) recommends it. Supply issues might make this difficult to do in reality as often large orders have to be made to the pharma companies.

I have already made my point about staggering single vaccines. I can't say it any clearer. You disagree. I have nothing to add.

I will remain confused as to why people want to stagger vaccinations, apart from cases where one vaccine is, a priori, objected to and the rest in the combined are only available singly.

Please can you tell me where you have found figures showing that vaccination rates drop when single vaccines are made available. Please note I am talking about people choosing to have single vaccinations rather than being forced to have either the combined or nothing.

I still hope for an individual approach to vaccination - which I see this as bring part of- (with the advent of genomics in medicine maybe that isn't so far fetched) - this looks promising

OK jimjams: after a very quick google search (I'm sure there is more) here is a paper that may interest you. I haven't read it in great detail. I find it quite complex.

To summarise: they looked at immunisation status for children born in 2000-2002. 1998 MMR rates were at all time high of 92%. This study, MMR rates were at 88.6% (recovering from low of 79% in 2003). The group were are interested in: single vaccinators - 634 of 13013 had at least one single jab. If we lump individuals with all three jabs (335) with those who vaccinated with measles and rubella (227 - assuming, generously, all these would have had mumps if this were available) then this leaves 72 who did not complete the course. This is half a percent of the total who vaccinated. Not massive. But a drop nonetheless which in fact represents a quater of the difference between the 1998 rates and the time of this study.

If this doesn't convince you, then you can always make the comparison of rates in the era pre-MMR when singles were all that were available.

Thanks for the genomics link. On a personal note, I find the promises of the genomic screening movement have been poorly realised. They work for diseases with comparitively simple genetic bases...but things like risk of autism and susceptibility to seizures and the like seem so complicated with a large environmental component that I'm not holding my breath for it. Hopefully I wrong (perhaps I'm one of life's pessimists!).

I can't help myself. This will have to be the last post . THis is quite a good summary of another POV - that of the govenement:

If the government were to offer separate vaccines as an alternative to MMR, it could be legitimately accused of putting political expediency before its responsibility to public health. Demanding the right to choose separate vaccines amounts to asking the public health authorities to collude with parents? decisions to expose their own children?and other people?s children, irrespective of their parents? choices?to an increased risk of infectious diseases.

But LeBFG - some may have chosen not to have all three. I've only skim read - will look properly later if I get the chance - so I may be missing something completely obvious - but I can't see any sort of discussion relating to why the course wasn't completed. And those 72 may have had nothing if the choice was MMR or nothing. That's my point. My kids for example would have had a tetanus jab by now if we could easily get a single one. Instead they have had nothing. One of them might have had a measles jab as well, we just haven't been able to afford it until recently. But if the choice is MMR or nothing then I'll go with nothing. If the only option is MMR then ds2 and ds3 are never going to receive a measles containing vaccine until the medical profession is capable of telling me what happened to ds1. If singles are available and we are able to afford them then ds2 may well receive a single measles jab in the next few years, and ds3 may do later (or may not). They will not be getting a rubella or mumps vaccination under any circumstances.

The other quote is from the dear Doctor Fitzpatrick who is at least very open with his agenda. I pretty much don't agree anything he's ever written (although I do quite like his son's sunken trampoline).

LeBFG, I did point out why I thought the quote I posted was relevant to the discussion irt how other parts of the body play a role in our immune response.

No, my interest in alternative vaccines is nothing to do with a fear of needles. I don't love them but they don't really bother me that much.

I thought I had made it clear about alternative vaccines not injecting antigens straight into the body.

Wrt whooping cough, I think the woman whose daughter currently has whooping cough had been vaccinating so I'm not sure why you're so relieved that your child is vaccinated. It's obviously not a guarantee. Some studies are showing that protection from it wanes in as little as a year.

You're back bm. I have to look back a bit and see where we were. Ah, yes.

What's so wrong about injecting 'straight into the body'? The antigens are getting in pretty quick when they are inhaled. Passing through the mucous membranes acts to stimulate antibody production there so the vaccine works better in the long run. but once in the bloodstream, how is this different from a jab? And remind me why this is important to staggering jabs?

Did you know natural immunity to wc can wane after as little as four years?? I was shocked to find that out.

It's the fact that the skin, mucous membranes etc prevent the antigens from getting into the bloodstream in the first place.

I mentioned its relevance in my first post in response to your link about babies being exposed to so many antigens in everyday life.

I have heard that natural whoping cough immunity can wane but I haven't heard it do so in as little as 4 years. Did you read that somewhere you can link to?