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.

Crumbled, it was the OP who posted the information about efficacy at

I know that. It's the only reference here to a study though, and I was trying to help Caterina out as she can't supply her own.

You haven't explained why wild measles might make a difference?
God, why don't you think about it for five minutes. Sheesh.

antibodies possibly boosted by MMR

Why should antibodies be boosted, possibly or not?? Isn't the idea that the vaccine stimulates the body to produce antibodies, but if someone already has the disease it's going to be stimulated to make them anyway. It's not as though the vaccine is injecting ready made antibodies.

Or would anyone argue that if someone caught wild measles, they should make sure they are exposed to someone else with it, so that they get a second dose, but will make more antibodies? Which seems to be the argument being offered above.

Can I also say, noblegiraffe, that what is astounding (to me) about your posts is the fact that safety is so far off your radar. It doesn't even occur to you. You are utterly mystified by the need for evidence of safety.

Why should antibodies be boosted, possibly or not?

I included 'possibly' as the timescale in which the MMR was given in relation to measles infection seemed to matter.

Re safety, crumbled, that seemed to be covered in the NHS site which said it was safe to give the doses 28 days apart. If you are talking about individual reactions, the OP's child has already had the MMR, presumably without incident as she says she is happy for him to have it again, it is just the timing she is asking about. What else is there to discuss there?

I included 'possibly' as the timescale in which the MMR was given in relation to measles infection seemed to matter.

I don't get the impression that anyone actually knows. All they seem to know for certain is that babies under 6 months will still be protected by their mother's antibodies, assuming she had them.

the link does say that the measles antibodies develop more quickly following vaccination than they do after a natural infection so could work to prevent the person getting measles at all.

I get the impression that you are anti-vax (and a bit rude!)

it does also say that giving the injection within 3 days of exposure can help:

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.

It doesn't say anything about the safety of 2xMMR + wild measles in two months - and you don't seem to think that's a problem at all.

"the NHS site which said it was safe to give the doses 28 days apart."

I can't see any reference to any paper which supports this. I looked at the references supplied earlier and one ("Anon '98" - honestly) said a 3 month gap was safe. I don't think it was 28 days. Even if it was (maybe someone else will open the link and have a look), a single anonymous study 13 years ago doesn't pull my rope when it comes to vaccine safety.

So I do not see any study which has examined safety with regard to this situation in particular. I'm making the assumption that the NHS and various posters do not make this claim as a wild guess so if there IS a study, let's be having you. Link please.

"It isn't harmful to have an MMR vaccination if you are already immune."

This for example, is thoroughly misleading. It may be harmful.

"So, if there is any doubt about whether you have already been vaccinated go ahead and ask your GP for 'catch up' vaccination."

That's pretty much over the counter, Caterina.

I am neither anti-vax, and nor do I see why asking questions is considered rude.

I would just like to see better answers than 'because we say so'.

Crumble do you have any a priori reason to think that combining MMR and measels within 2 months might be dangerous, or are you just engaging in smear by insinuation?

Do you just think that all possible MMR combinations should be tested just in case? MMR and lemon sorbet, MMR and phase of the moon.

Hypotheses get tested because there's a reason to test them, not just because they haven't yet been tested.

The body's assaulted by loads and loads of viruses and bacteria every single day - a huge viral load. I have never understood the vaccine overload theory. The usual riposte is to say 'ah but..... it's into the bloodstream' or 'ah but, it's the adjuvants' etc. Thing is, there never seems to be any actual studies to back these statements up.

It was Crumbledwalnuts I was accusing of rudeness btw

Not viral load..... wrong use of term. Viral onslaught. or some such. My brain's gone to sleep :) ...

"The immune response to one live-virus vaccine might be impaired if administered within 30 days of another live-virus vaccine (28,29). Data are limited concerning interference between live vaccines. In a study conducted in two U.S. health maintenance organizations, persons who received varicella vaccine 30 days after MMR (30). In contrast, a 1999 study determined that the response to yellow fever vaccine is not affected by monovalent measles vaccine administered 1--27 days earlier (21). The effect of nonsimultaneously administering rubella, mumps, varicella, and yellow fever vaccines is unknown.

To minimize the potential risk for interference, parenterally administered live vaccines not administered on the same day should be administered >4 weeks apart whenever possible (Table 2). If parenterally administered live vaccines are separated by 4 weeks after the last, invalid dose. Yellow fever vaccine can be administered at any time after single-antigen measles vaccine. Ty21a typhoid vaccine and parenteral live vaccines (i.e., MMR, varicella, yellow fever) can be administered simultaneously or at any interval before or after each other, if indicated."

The 28 day recommendation is because of reduced immune response, not safety.

www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm

**"Crumble do you have any a priori reason to think that combining MMR and measels within 2 months might be dangerous, or are you just engaging in smear by insinuation?...Hypotheses get tested because there's a reason to test them, not just because they haven't yet been tested."
**I don't understand this way of thinking. This is a medical intervention on a small child - little more than a baby. My thinking would be - we know there are risks with vaccines (of all kinds). We should therefore make sure we know that 2x mmr is safe within 28 days before we recommend it for a small child, little more than a baby. Never mind the wild exposure too. "Smear by insinuation?" You seem to be lashing out.
**Please copy and paste and rude comments I've made, whoever accused me of that
**Noblegiraffe: I gathered from previous posts it was because of immune response, not safety. Hence my comment that safety seems to be off the radar for you.

Crumbled, I had to check the 28 day thing because the recommendation was not to give live vaccines within 28 days of each other. If this was for safety reasons, then there could potentially be an issue with wild measles exposure between the two vaccines (i.e. some sort of measles overload) but as there aren't safety concerns about having the vaccine closer together, that theory goes out of the window.

I'm not sure you've given it as much thought as me because you still haven't come up with a reason as to why it might be problematic.

You've suggested it's misleading to say that it's not harmful to have the MMR if you're already immune, but most children who have the second MMR are already immune, so if it is a problem, don't you think we'd know by know?

You are doing a lot of hand-wringing and looking concerned, but not giving any actual reason as to why.

How about you actually be specific?

Know by now, I meant.

Noblegiraffe: I refer you to my earlier post (just above yours - we may have cross posted).

The immune response to one live-virus vaccine might be impaired if administered within 30 days of another live-virus vaccine (28,29).

This to my mind would suggest that if someone had been exposed to measles, far from another dose of the vaccine helping to offer protection, (which was what said up thread,) it would just not be particularly effective because you've already begun to develop the immunity. This would be comparable with the situation with babies under six months.

I suppose if you were exposed to measles, and immediately whipped down to the surgery to get vaccinated, then the vaccine immunity might kick in before the natural immunity did, but I suspect that there will be more of a delay between exposure and vaccination normally.

I would also like to say this. When you ask for evidence, what kind of evidence do you mean? Pro-vaccine enthusiastists often dismiss accounts of vaccine damage from parents with phrases like "correlation is not causation", "the plural of anecdote is not data" and "distraught parents looking for something to blame" etc. These are used as reasons to dismiss evidence of this nature.

However in this case, if you dismiss evidence of that nature, and will only accept peer-reviewed study, you are going to be disappointed, because there isn't any. Why isn't there any? Because the authorities and corporations which that can afford it (and really ought to carry it out) haven't done it. You are therefore using the absence of peer-review study into safety, as an excuse and a reason not to carry out peer-review study into safety. It's circular, it's self-serving and it's deceitful. And more to the point, it doesn't make any sense at all in terms of real actual children's real actual health.

Ought to carry it out? How exactly do you propose a peer-reviewed study into MMR and measles exposure is conducted, hmm? Given that there are so few cases of measles around? Should they get some kids, give them the MMR, then expose half of them to people that they've carefully infected with measles, and the other half protect in a bubble?

Even in outbreaks like in Swansea, if the 'authorities' (which ones?) swooped in, how could they figure out who had been exposed and when?

And you still haven't actually specified why you think measles exposure might be a problem to someone who has had the MMR.