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.

noblegiraffe - this is a good paper, obviously, exposure was "accidental":

www.ncbi.nlm.nih.gov/pubmed/2230231

**Noblegiraffe: obviously a good start would be a safety review into 2XMMR in 28 weeks: if there is one, please link. If there is no such safety review, claims such not be made that it is known to be safe. And it such be made clear that 2xMMR within 28 days is not safety tested. And if it is impossible to carry out a review into 2xMMR + wild virus, claims should not be made that it is known to be safe: as it is not known. (in addition we already know that safety testing into MMR in the first instance was inadequate).
**Caterina: that study does not address safety but antibody response, I think.

If you are going to make claims about safety referencing "the NHS" or other health authorities, it should be made clear that parents are relying on the assumptions and credentials of those medical authorities (which of course many parents will be happy to trust) and NOT passed off as safety tested.

You seem to be projecting your anger crumble. You need to take a step back, calm down , and stop thinking that it is everyone else that is angry.

"When you ask for evidence, what kind of evidence do you mean?"

Evidence which is verifiable and reproducible.

Just because a group believes something, that doesn't make it true. The whole of woo rests on such foundations; effects that mysteriously disappear when non-believers observe.

"we already know that safety testing into MMR in the first instance was inadequate"

Cochrane found 30-odd decent MMR-autism studies, which did not support a link.

Please copy and paste any posts where I've seemed angry. I'm not the one lashing out and projecting, JotheHot.

"Evidence which is verifiable and reproducible."
Please refer to my post above. You are asserting that the absence of safety studies showing harm means that safety studies are not needed, therefore a product does not cause harm. Do you understand what a circular argument is?

If you can counter-argue anything in my post above yours, please do so.

With regard to Cochrane, of course I should have said the safety studies were found to be "largely inadequate". I believe also the review did not rule out an ASD link; it found MMR unlikely to be a "main cause". But at the same time, many of the studies it used were inadequate to the purpose.

And of course the risks of MMR are not limited to this: even if one grits one's teeth, which I am prepared to do, and acknowledges only the risks acknowledged by the manufacturer, it's plain that the risk of 2xMMR doubles those risks. That's not the point with regard to safety studies on 2xMMR close together, however: the point is that research is needed into whether those risks increase exponentially with 2XMMR within 28 days, ie are more than doubled. Particularly since the effects of MMR last up to 21 days after immunisation and possibly longer. Now, I don't think it's a subject of utter mystification as to why those safety studies would be needed. And I certainly don't think anyone should be object to the idea that parents should know that the hypothesis has not been safety tested.

I've just read on another thread that a woman has been advised by a paediatrician that having the disease (different disease) before vaccination would be more likely to lead to side effects because the previously infection would be likely to react badly to the vaccine. I assume this to be a true anecdote. You can see why people get confused.

it's plain that the risk of 2xMMR doubles those risks

Actually, there are fewer adverse reactions after the second dose. And the OP doesn't seem to mention any reaction to the first dose.

Also, there seems to be a reduced risk of bacterial infection for about 3 months following the MMR.

www.ncbi.nlm.nih.gov/pmc/articles/PMC1719482/pdf/v088p00222.pdf

Are you sure your study says what you say it says?

Table 1 shows the relative incidence (RI) of admission for a bacterial infection within 90 days of MMR vaccination and in the month before vaccination.

None of the post-vaccination risk periods showed an RI significantly greater than one. RIs in those admitted with pneumonia were consistently below one, the RI in the 0?90 day period being 0.70 (0.50?0.97).

The RI in the prevaccination low risk period was also significantly less than one, 0.25 (0.09?0.64) for pneumonia and invasive infection codes combined.

Perhaps a statistician here can explain: relative incidence post vaccination seems to be average 0.7 and relative incidence pre-vaccination 0.25. Isn't that more than double? It doesn't seem to support this summary of the study Combined measles, mumps, and rubella (MMR) vaccine did not increase the risk of hospitalisation with invasive bacterial infection in the three months after vaccination; rather there was a protective effect.

That wasn't the study about adverse events but bacterial infection. Did you not read the conclusion, it should have been fairly obvious?

I don't have access to the studies for adverse reactions, but it's in the Green Book.

Yes, I read the whole thing, did you? Did you look at the table? The conclusion doesn't seem supported by the findings. Again, if a statistician is here and can explain how an post vacc incidence of 0.7 is not more than three times greater than a pre-vacc incidence 0.25 I would certainly and genuinely be interested.

You didn't post a study about adverse events to support your claim. Have you got one? I don't have a Green Book, I don't know what that is.

Well I've done some of your homework for you and looked at the titles of all the referenced papers under the Green Book chapters on vaccine safety and measles vaccine. None seems to apply to the 28 day double does or your claim about fewer adverse events second time round at longer than 28 days. Can you post the evidence to support your claim above please.

Try google for the green book.

The statistical analysis 'problem' suggests you have misunderstood the figures. If you read the report, the two week pre vaccination period is a low risk for infection because if they have an infection in the two weeks prior to the vaccination date, they usually don't have the vaccination.

The relative risk is compared to normal background rate. So you'd be really unlikely to have had a bacterial infection in the two weeks before your vaccination (as they wouldn't have given it), and you're also less likely than normal to have one in the three months following. So you're comparing the 0.7 to a value of 1 (lower risk) than the value of 0.25.

looked at the titles

Erm, there would be a problem with that, don't you think? Like I said, the claim is in the green book, with references to the paper, but I don't have access to the paper.

Erm, there would be a problem with that, don't you think?" Erm, What problem would that be? I'm not going to read 40 papers on the off chance and the titles usually give a good idea of what's inside them

You're making the claim, I already spent time on it, you can't be bothered to support your own claim. Fine, we can leave it unsupported.

The two week pre vaccination period is a low risk for infection because if they have an infection in the two weeks prior to the vaccination date, they usually don't have the vaccination.

(Is the study not discussing hospital admissions for infection, not just infection? This doesn't relate to for example ear infections treated with anti-bs or anything that doesn't require admission.)

Anyway I think your analysis is wrong here because the study specifically says that if there was severe infective incidence before vacc, and such incidence after vacc was counted as the original infection not a vaccine reaction. It doesn't say they usually don't have the vaccination. In effect these people were excluded from the study, even if they did have the vaccination.

It doesn't change the findings of RI before vacc and post vacc.

Crumbled you don't need to read 40 papers, the claim is referenced next to the claim.

Anyway I think your analysis is wrong

Not only my analysis but the analysis of the statistician who contributed to the paper? . What are your qualifications, btw?

It doesn't say they usually don't have the vaccination

The vaccine would probably be delayed (as pointed out in the paper). The vaccination is a fixed point on their medical record. If a kid has had a vaccination you can say it's unlikely that they were seriously ill in the two week prior to that vaccination because kids who are seriously ill usually have their vaccination delayed to a point in time clear of illness. Do you see?

Why don't you link it then - I'm not going back to it and I couldn't find the claim. Or we can leave that claim unsupported. Given the quality of your other link, perhaps it's not worth it anyway.

The analysis of the person who compiled the paper is that it doesn't show an immune overload by vaccines because the RI remains lower than one. It doesn't show what it says in the summary, that MMR offers a protective effect on bacterial infection. I suspect you read the summary and not the body of the paper. I also suspect that you didn't read the conclusion, which refers to another completely random paper and says by the way, this other paper is interesting, I think it shows we should carry out further research into whether there's a protective effect.

Why don't you A. link to a paper to support your first claim and B. read the paper which doesn't support your second claim.

Noblegiraffe: your last paragraph is irrelevant to RI. Try to explain the RI. Are you saying the RI post vacc is lower than the RI pre vacc?

I've got a baby and am a bit busy trying to hold your hand through this relatively straightforward paper at the moment.

Normal risk of (specific) infection is 1.
When you look at the medical records:
Children are much less likely than normal to have had an infection two weeks prior to their jab (because only healthy children get it)
Children are less likely than normal to have had an infection in the 3 months after their jab - possibly because the vaccine stimulates the immune system and offers some protection.

The study was conducted to see if the 'immune system overload' theory surrounding the MMR was correct. If it was, and the immune system was surpressed by the vaccine you would expect to see:
Less likely to have infection 2 weeks prior to the jab (same as before)
More likely to have an infection (relative risk greater than 1) in the three months after the jab.

Hold my hand? You made the claim. I'm trying to help you out by supporting a claim you are unable to. Find the link later if you like. Go see to the baby. Have a nice day.

I'm well aware of what the study was conducted to find out, and it doesn't find what you say it finds.

I really have not like the sneery tone of your posts I must admit. If you can find the link I'll look at it, but your posts seem to get sneery when you are not sure of yourself. I wish that wouldn't happen. It's not nice.

I am sure that you don't understand the paper that you claim is incorrect in its conclusions.

Yes you are 3 times as likely to have an infection in the 3 months post jab to the two week prior, but you are four times as likely to have an infection at any other time than in the two weeks prior to the jab. So you are less likely than normal in the post-jab period to have the specified infections.

And if I sound sneery, it's more incredulity that you are dismissing the analysis of the statistician who did it as incorrect, based on your bodged understanding.

Noblegiraffe: the flaw is this.

The study selects a group outside the general background rate of infection, with a lower risk than the general background rate of infection. It then compares the rate of incidence of this lower risk group, with the general background rate of infection. A lower risk group is selected, and the risk compared with the risk of a higher risk group (general background rate) thus making the risk seem lower than one.

Combined with the finding that you are three times more likely to have a hospitalising infection post vacc, the finding that vaccs have a protective effect is dubious to say the least.

I've certainly seen this before in studies: where a general background rate is manipulated or selected. I've seen it in safety studies, where the control group rate is used as a "general background rate" when it was highly misleading to do so.

Eh? They used the group of (healthy) kids who had an infection, then looked at MMR records to see how many of them had had their MMR in the 3 months prior to their infection. The MMR group is a subgroup of the background group.

Combined with the finding that you are three times more likely to have a hospitalising infection post vacc

But four times more likely to have one after the post-vaccine period, or more than two weeks prior. That's what you're missing.