Please advise r.e lack of mumps vaccine for single jabs.

[Ninks]

Hello

I'm asking on behalf of a friend of mine in SE Essex. Her DD had the single jabs but her DS has only had the rubella and measles because the clinic has said that the mumps vaccine is now unavailable.

They've told her that it's no problem because he can have the triple, well actually quadruple jab including the latest one - (pneumonia?) but that isn't the point, surely?

My mate paid for single jabs and now they're messing her around. I'd be after a refund, they didn't fulfil the contract and saying, "oh it's OK your DS can have the MMR" thus giving him a double dose...

I am woefully ignorant about such things as my DD and DS both had the triple.

Any advice would be very welcome. TIA

Thanks Riven, the older DD has had the mumps jab, (sorry not made myself clear) but the DS aged two hasn't. I'm worried as a vaccine novice that mumps will be worse for a boy.

It's not entirely the clinics fault - the supplier has decided to stop manufacture altogether now, but there were a number of problems with supply prior to that because of various safety failures within production. So clinics may have been saying they could get, or were waiting for, supplies of the vaccine in good faith.

Although some of the clinics, I think, are now suggesting they can still get the mumps vaccine in order to get people to fork out for the other 2, (knowing full well they can't get it)some are a bit more honest and are suggesting that boys in particular get the MMR. Medically there's no problem with having two vaccinations for measles or rubella.

Your friend will have to consider her choices again and weigh up the risks. I suppose in some ways she could look at it that she's saved £100, as the MMR is free!

Also - just to make a point in answer to Riven's post - don't forget that before MMR, Measles was the commonest cause of viral meningitis and one of the leading causes of hearing loss in younger children. 'Mild' is not the same as risk-free.

of course. Measles is not risk free, mumps is not risk free and, as the mother of a vaccine damaged child, vaccination in any form is not risk free.
We can only seek to find the safest options for our children and for society. There is no risk free choice.

My clinic is still swearing blind that they'll have the mumps vaccine next month. And I pay for each jab separately and have had the measles and rubella done at two different clinics so they've got nothing to gain from me by lying. Still believe it when I see it though.

Sorry, Riven, my typo - I was talking about Mumps. It may be that many other things can 'turn into' meningitis, but there are signs of meningitis in 10% of mumps patients. It can also cause encephalitis (one in 6000).

The MMR mumps component is believed to be 90% after one dose, and they have the booster, too, so it's not likely to 'wear off'.

it does wear off

where do you think the epidemics in university students came from

that's mumps at a time when it's much more dangerous

"Aseptic meningitis is common, rarely fatal condition usually caused by certain viruses. It is an illness characterized by serious inflammation of the linings of the brain (ie, meninges), usually with an accompanying mononuclear pleocytosis. Clinical symptomatology is varied and includes predominantly headache and fever. The illness is usually mild and runs its course without treatment.

Fifteen per cent of patients with mumps have an aseptic meningitis. Encephalitis is rare occurring in less than 260 out of 100,000 cases.

Sensorineural deafness occurs in 4 per cent of mumps patients and has also been reported following MMR vaccination. A seven year old girl developed total deafness in the left ear 11 days after an MMR injection without recovery and a three year old girl who received MMR at 15 months developed moderate to severe unremitting sensorineural deafness."

Principles of Neurologic Infectious Diseases, 2005

I think the epidemics in universities came about because that age group was too old to have been offered the MMR.

Only 2.4% of those cases were found in individuals who would have been offered 2 doses of MMR (please note offered, not necessarily taken up)

Savage et al, British Medical Journal, 2005

Lets not scaremonger, eh?

No they didn't, and and speak for yourself scaremongering. People who say "they were too old" forget about the 1994 measles epidemic "scare" and vaccine catch up, when approx 3.2 million children between 5 and 16 were vaccinated with MR or MMR.

Quick sum: 16 in 1994 means you could be over thirty now (also undermining the argument that the rise in autism began before the MMR was introduced).

That's certainly old enough to have been vaccinated and still have the mumps as a student.

It doesn't make sense even on the bleeding obvious scale: if they were all non immune why didn't they catch it as children? There were certainly enough of them to have undermined your famed "herd immunity" as evidenced by the epidemics later they were all crushed together in schools, just like in unis and 5-10 is the prime age for mumps. Why didn't they catch it then?

They didn't because they'd been vaccinated, which gave them a few mumps free years before the most dangerous age to catch mumps -- adolescence.

Your survey is four years old. What's the point of that when you're talking about continued epidemics and the ages of the students?

Let's not mislead, eh?

Because you didn't specify a particular epidemic in University students, I assumed it was the one I referenced. The study is four years old because it is research into an epidemic at a particular point in time.

I haven't said anything about ages of students or continued epidemics - you have. I merely quoted the results of the actual, scientific research into the epidemic I had heard of.

I'm not sure I understand your argument against herd immunity, given that the students who were affected at universities were hardly likely to be at school together. Nor am I sure why herd immunity should be 'mine' - I'm not a scientist - or 'famed'. Herd immunity is simply that if fewer people are susceptible to a disease, fewer get it so it is harder for that disease to spread. Clearly if someone with the disease encounters another, unprotected person, then it is likely to be passed on. It's just less likely the fewer people have it.

If you have a reference to any scientific study that shows that Mumps vaccine 'wears off', I'd be very interested.

Why would you assume it referred to a particular epidemic? There have been mumps outbreaks every autumn winter for the last four years. 2006 and 2007 weren't so bad: 2008/2009 cases increased again. Didn't you know there'd been further outbreaks? Have you been waiting for the BMJ to report it?

You want any scientific study that shows that mumps vaccine wears off? I'd say you didn't need it when you've got a "once in a lifetime" vaccine that goodness me has to be "boostered" ie given twice before the age of five. I'd say that's a pretty clear signal that -- yes, it wears off. I'd also say you didn't need it when you've got a vaccinated population and significant mumps outbreaks.

You're just saying you want "actual scientific research" as an excuse to close your eyes and pretend it isn't happening. There is a vaccinated population: there are mumps outbreaks. The one thing these students ARE too old for is the drop in MMR uptake after Andrew Wakefield. So you can't blame that either.

You don't want to know because it doesn't support your belief system, basically, which you know, is your choice, but it's a bit pathetic really if it's all you've got to go on.

Herd immunity in a vaccinated population is a nonsense. What you've described is not herd immunity.

@mmrsceptic: I'm afraid that just saying "No they didn't" isn't really good enough to convince many people of your argument. It's adundantly clear (see this graph) that the vast majority of individuals in the 2004 outbreaks had not been vaccinated with MMR at all. You also need to bear in mind that the catch-up campaign to counter the measles threat was by no means universal, and the MR vaccine which was offered to some, did not contain mumps.

It is acknowledged that in at least one study the effectiveness of the mumps component of MMR seems to be below the population level required, but you can't get away from the fact that the overwhelming number of people in the recent outbreaks had simply not been vaccinated against mumps.

Epidemiology has its own 'bleedin' obvious scale' which provides another interpretation for why susceptible children were not part of any mumps epidemic whilst still at school. They were probably protected through their school years by the initial success of MMR, when good population coverage rates were possible and the circulation of mumps virus in the community was interrupted. When MMR coverage rates drastically reduced towards 2003 - due to the scares over the vaccination - the virus could begin to circulate to a wider degree and with a pool of susceptible individuals remaining it was inevitable that large outbreaks would occur. Just to note that these outbreaks in university and other educational establishments were not in "adolescents", but in adults.

I was interested by your quoted figures for the complications of childhood mumps infection; 15% (~1 in 6) of cases have aseptic meningitis, 4% (1 in 25) have sensorineural deafness, and 260 per 100,000 (~1 in 40) have encephalitis. You think that these figures indicate the complications of childhood mumps were "rare"?

Even then, the figures conceal the fact that children usually require admitting to hospital for suspected meningitis, and that there is an inherent delay for a laboratory diagnosis. It's all right saying it is mild and self-limiting, but that's when you have the diagnosis and the cumulative effects on the health service of looking after mumps patients - not to say the stress on the parents of a child with meningitis - make it a disease worth eliminating.

Musukeba how on earth do you get away with saying: "you cannot get away from the fact that the overwhelming number of people in the recent outbreaks had simply not been vaccinated against mumps."

Why on earth do you think this? It's just something you want to think.

Mumps became notifiable in 1988, and notifications were around 700 odd. By 1990 they'd dropped to under a hundred and stayed there for around five years. I think you'd put this down to the introduction of MMR? I guess we can agree on that.

That speaks of a good and successful uptake.

But a second dose of MMR was recommended for both 10-14 years in 1992, and seven years later the age of the second dose was lowered to 4-5 years, after notifications jumped back over 400 in 1997. Why was the second dose needed?

Because a. one dose was working? or b. one dose wasn't working?

One dose was wearing off.

Not primary vaccine failure but waning immunity. Even the CDC accepts that that outbreaks in 2006 in the US were caused by two-dose failure/waning immunity.

So no actual science, then?

I'm saying I want actual scientific research not to 'pretend' something isn't hapening, but to have proof of it. I think it's fairly clear who has nothing to go on to substantiate their claims. I asked for any kind of study because I do want to know - to make an informed choice.

I'm also interested in what herd immunity is? Apparently you think you can have herd immunity in an unvaccinated population, then? Can't wait to hear that one. Will it have any science in it, or is just all 'clear' to anyone who shares your belief system?

We are not talking about one outbreak here, but continuing outbreaks. As the years go by, it will be interesting to see what other excuses you can come up with for these vaccinated people contracting mumps at a dangerous age. Within five years you will be able to blame the drop in MMR uptake caused by the Andrew Wakefield study. Between now and then you are going to be contradicting yourselves: you can either accept waning immunity or you have to claim that earlier uptake was low, in which case you lose your claim that it reduced school age mumps.

Er of course you can have herd immunity in an unvaccinated population

ask musukebba to explain it

I'm looking for the right figures on update and notifications. Will link.

"Why on earth do you think this? It's just something you want to think."

No - and you seem to be missing this. Musukebba and I are basing our opinions on science. On the graphs, for example, that are actual research into real people, not made up because it's 'bleedin' obvious'.

The second booster dose is to improve the rate of immunity. They did actual tests on actual children, and found two doses was better. Not that anything 'wore off', but that the most effective way of making the maximum number of children immune was two doses at these particular times.

I certainly would ask Musukebba or anyone else who was willing to explain how they arrive at a conclusion and what evidence they used. And sme people can do that, and some people have to resort to calling other people pathetic.

Improve the rate of immunity -- yes well in old money that means that one vaccine didn't work. It did work for a time: hence the drop in mumps cases: and then it wore off.

It's a shame you need a study in the BMJ to prove this to you but there it is. If it hadn't worn off then a further dose wouldn't have been needed.

Immunity waned. Big shock. Even the CDC has accepted that two doses of the vaccine do not protect against significant outbreaks. Why do you find it so hard?

here

look at Fig E2

showing vaccine uptake steady at around 90 per cent and the flat line of mumps cases until 2003/4

note : that uptake includes the years of catchup campaigns

"The duration of vaccine-induced immunity is unknown. There are many studies demonstrating a drop in antibody levels over time (i.e., waning immunity).15,18,19,22-24 The length of antibody persistence is unknown in settings with high vaccine coverage but low or no circulating wild virus, and no data are currently available correlating specific antibody titres with susceptibility to mumps. Students vaccinated > 3 years before a Tennessee outbreak in 1991 had a moderately greater risk of mumps than those vaccinated more recently (relative risk [RR] 2.9, 95% CI: 0.7-11.6).19 Those vaccinated
4 years before an outbreak in Kansas in 1988-89 appeared to have a higher attack rate (RR 4.3, 95 % CI: 0.6-30.0), but this association was not significant when risk was evaluated on the basis of the number of vaccine doses received.18 Students who had received only one dose of vaccine were at greater risk than those who had received two doses (RR 5.2; 95% CI: 1.0-206.2). During a 1995-96 outbreak in Bruges, Belgium, the proportion of vaccinated children with mumps increased progressively with increasing time interval since the last dose of mumps-containing vaccine was administered. The contribution of waning immunity was estimated using a logistic regression model. In this model, the odds of developing mumps increased rapidly with increasing time interval between the last vaccination and the outbreak.15 A study during the recent UK outbreak estimated that the effectiveness of one dose of mumps-containing vaccine was 95.9% (95% CI: 81.1%-99.1%) in 2-year-olds decreasing to 65.9% (95% CI: 30.3%-83.3%) in those aged 11-12; the effectiveness of two doses was 98.8% (95% CI: 97.0%-99.5%) in children 5-6 years old and decreased to 86.4% (95% CI: 74.1%-92.9%) in children 11-12 years olds.14 This statistically significant relationship of vaccine effectiveness decreasing with increasing age for those who received either one or two doses (p < 0.001) also suggests that there is waning immunity."

This from a big study by Canada's public health agency two years ago.

this is the link if you want but it's ten pages long

I haven't taken out the reference number notes from the text I copied.
I haven't taken out the r