Early mmr booster - should we have one?

[blossombath]

I posted about this on AIBU a week ago, if you are interested the original thread is here

Basically there was one case of measles at my son's nursery and we were given conflicting advice about whether to give him an early MMR booster (six weeks after his first). In the end, after reading green book and making own assessment of the urgency of his need we decided against it. Would have meant taking him out of normal vaccination schedule and we felt the risk was not large enough to merit this since he is otherwise healthy and will get the next booster in six weeks anyway (it is routinely given at 16 mo in our area).

Perhaps unsurprisingly there is now another case of measles at his nursery; so am worrying that we should in fact give him the early booster.

If there are any experts out there I would really value advice on the following points to help our decision

• if he has already been infected and we give him the booster, will this help or harm him to fight off the virus in his system?
• He is only at nursery 1.5 days a week and I'm not sure he crosses over with the second child who has measles - am I wildly optimistic to think this small time at nursery reduces his risk?

And any general advice really welcome; I am not anti vaccine and will definitely give him the booster; it's just a question of whether it is worth doing this early.

Another thing, sorry I am probably being very pfb...we're due to visit family in a few weeks with a baby under 1yo so obviously not vaccinated yet (though still with some passive immunity, as I understand it).

Even if we gave DS the early MMR it would be too late for him to have acquired immunity by this time and he might take the infection with him to this younger baby. Would it be an overreaction to remove him from nursery until the visit, to minimise chance of him getting it?

What does your GP advise? If they are advising you to have the booster early, and there's a only a month or so in it anyway (booster is given routinely at 16 mos where you are?), then I'd do it.

We've had different advice from different GPs and from different nurses in the practice; it comes down to the urgency of the need and the clinical risk, I guess, which are obviously subjective things to judge at the moment (ie without a wider agency like HPA or someone coming in to advise all GPs to give it early).

What is the risk of having it earlier than normal? That it won't be as effective?

Yes, exactly that. According to green book a baby can be given second jab four weeks after first, but if it is less than three months and the baby is under 18 mo then they will need another booster at 3yrs to ensure it has been effective. So we'd need to make sure he got this - not a massive hassle but in preparation for requestiong that jab in two years time I'd rather have it on his records that he needed this early jab than having it on there that his pushy mum requested it.

though obviously would push for it if DH and I could feel certain that its needed; at the moment we just feel a bit confused!

in Germany ALL babies get their first MMR at 11 to 14 months and their second at 15 to 24 months. I would get the early booster.

It's not a booster. It's to catch babies who aren't already immune from the first MMR, not to "boost" immunity. The chances are 95/100 that he is already immune. Use that to calculate the risk.

a 5% risk of measles in a small child is unacceptable, plus MMR does boost immunity in borderline immune children, so getting the second MMR is the best option.

That's your opinion, you are advising someone to have a medical intervention, someone you don't know, never met, don't know the family history, don't know the medical history, don't know the child, don't know the response to earlier vaccines. You're obviously comfortable with that. I wouldn't be.

Might be worth considering just how contagious measles is. "Measles is highly contagious and can be spread to others from four days before to four days after the rash appears. 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 with the measles virus."

www.cdc.gov/measles/about/transmission.html

Absolutely - if the child isn't immune it's highly likely to catch measles. However it's highly likely to be immune. It's up to the mum. Those are the risks. I don't know anything about having two vaccinations so close together. There must be a reason why they don't normally recommend it though.

and I maintain that if measles are circulating in the OP's daycare, the best course of action is to give the booster now.

- if he has already been infected and we give him the booster, will this help or harm him to fight off the virus in his system?

If he has been exposed in the past 3 days, a booster will help fight the virus

- He is only at nursery 1.5 days a week and I'm not sure he crosses over with the second child who has measles - am I wildly optimistic to think this small time at nursery reduces his risk?

There might be more children coming down "downstream" of the second patient. I would not risk it.

Thank you all for your advice - I know that ultimately this is our choice and assessing levels of risk is very personal to our circumstances. Rationally I can see that there is no real harm in giving the second one early; or else the green book wouldn't say it is possible to do so. Somehow I feel uneasy about it but am coming round to thought that harm of not giving it is greater than my uneasiness.

Anyway, thanks again for the advice and thoughts - we have taken DS out of nursery for now to minimise his contact with the infection and will speak again to the practice nurse tomorrow. Making decisions about your children's health is bloody hard, I hope I never have to make a serious call about something if I'm getting this worked up over a few weeks and a second MMR jab!

"If he has been exposed in the past 3 days, a booster will help fight the virus"

Have you got a link? I think this is deeply irresponsible advice.

Blossombath: I would have taken him out of nursery too. Hope everything works out for the best.

Crumbled - I honestly don't care what you think, but for the benefit of blossum

www.immunize.org/askexperts/experts_mmr.asp

Measles vaccine, given as MMR, may be effective if given within the first 3 days (72 hours) after exposure to measles

That is not a study. It's publicity material. Where are the studies on effectiveness and safety for an under two year old given 2 MMRs two months apart with wild measles exposure in between?

the nhs website says this:

MMR during measles outbreaks

In the event of a measles outbreak, the MMR vaccine can be given to protect people who have come into contact with the condition in the previous three days. This is because measles antibodies develop more quickly following vaccination than they do after a natural infection.
It isn't harmful to have an MMR vaccination if you are already immune. So, if there is any doubt about whether you have already been vaccinated go ahead and ask your GP for 'catch up' vaccination.

The advice given by CatherinaJTV was perfectly correct and not irresponsible advice at all.

p.s. nhs also says the second jab can be given as quickly as 3 months after the first jab i.e. not as soon as 6 weeks after

although another page says this:

*Babies aged six to 12 months in outbreak areas can be vaccinated with an early first dose of MMR then revert to the normal schedule with a second dose at 12-13 months and a third at three years and four months.

*Children aged up to three in outbreak areas who have had their first MMR dose at 12-13 months or later, can have their second MMR dose one month after the first.

thank you Ilovepowerhoop

Yes ilovepowerhoop its not clear cut; as far as I understand it, it's safe to give after four weeks but not as effective which is why the basic advice is to wait at least three months and only give after four weeks if "urgently" required.
The [https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147832/Green-Book-updated-140313.pdf green book]] says:

"A second dose [of MMR] is normally given before school entry but can be given routinely at any time from three months after the first dose. Allowing three months between doses is likely to maximise the response rate, particularly in young children under the age of 18 months where maternal antibodies may reduce the response to vaccination (Orenstein
et al. , 1986; Redd et al ., 2004; De Serres et al ., 1995). Where protection against measles is urgently required, the second
dose can be given one month after the first (Anon., 1998). If the child is given the second dose less than three months after the first dose and at less than 18 months of age, then the routine pre-school dose (a third dose) should be given in order to ensure full protection. "

Sorry for green book fail! here

The NHS website is also publicity material. The hypothesis that three combined vaccines + wild measles virus + three more combined vaccines within three months is safe for a child of about 15 months is untested, so far as I know - unless you can provide some evidence. Blossombath you seem to know where to look for the sort of information you need to get. Good luck, hope you're happy with the decision and everything turns out well