single mmr vaccinations or combined? What is best

[foxy1]

Hello - I have a 14 month old son and have a received a letter from the health visitor about the mmr jab (combined) for next monday. I am a bit nervous about this. My sister thinks I should do separate jabs as it is a lot for the body to cope with. I have looked on the internet and seen various places in london offering this service. I am not sure what to do and would appreciate other mums advice. Thank you

It is a difficult decision but I don't think there really is a 'best' choice. you have to do what feels right for you and your DS.There are risks with both options and only you can decide wether or not to take those risks. Talk to your HV, GP friends and family. Opinions on here are very divided for many different reasons. My personal opinion is MMR every time. Good luck with what you decide!

Hello foxy1,

It is quite a tricky decision to make. I gave my DS seperate jabs however its taken him 2 years and 10 months to get all 3(Mumps,measels and rubella. This is largely due to unavailbility of the mumps vaccine in UK. DS had almost no reaction to any of the vaccines. The seperate vaccine is expensive (as against combined-its free)but if it gives you peace of mind,then its worth it.

Why do you think it's a lot for the body to cope with? Do you not mean it "sounds" like a lot for the body to cope with?
The MMR is tried and tested with an excellent safety record on millions of children. The singles are not.

Hi foxy1,

I have to say that I've never been very convinced by the argument that having single jabs is somehow better than having the combined ones.

I've got three boys and they've all in the end had the MMR.

DS1 had his MMR right on time, at about 15 months. However, he'd also had all the previous jabs, including the old jabs that used to have thimerosal in them. Thimerosal is no longer found in the combined vaccines that babies have at two, three and four months. There is a scientific theory, borne out by some research, that it was the combination of thimerosal and the MMR which could put a small number of children at risk of autism.

MY DS1 was diagnosed with high-functioning autism at 3 3/4. HOWEVER, in our case I do not think that the MMR itself made any difference - I was already worried about him long before he had the MMR. However, he had had the earlier jabs containing thimerosal (this was quite along time ago now, he is nearly 7).

With DS2, with the support of my GP at the time, I actually waited until he was over two and I was absolutely sure he was not on the autistic spectrum before he had the MMR. he was absolutely fine.

With DS3, I am not at all sure he is not on the spectrum somewhere! He's nearly 2. However, I have just taken the decisioni for him to have the MMR because (a) he hasn't had the previous thimerosal-containing vaccines (b) there isa lot of measles around in the area and (c) I don't think that the MMR really contribued to DS1's autism.

So, in my case, after a lot of heart-searching, and although there is some autism in teh family, I have chosen the MMR.

BUT things you shoudl think about - is there any autism in your family connection? And is there a history of autoimmune conditions? These two things are factors which might sway you against the MMR.

On the other hand, if neither of these two factors are present, you may well feel that the risk of measles outweighs other risks and decide to vaccinate.

Hard decisions, I know.

p.s. I shoudl say that DS3 had the vaccine two weeks ago and although he was a bit grumpy last weekend, he has not had a bad reactioni to it so far and seems to be his usual self now.

i've never thought twice about the combined mmr jab, dd has had it and the booster and ds is due his very soon. had no doubts at all over the having it and in the area we live it, the take up rate is very low. dh knows a couple who are both doctors and have worked with the guy who made the claims about the links with autism etc, and they told him there was no truth in his argument.

i'm more concerned about them catching measles than having the jab tbh

I think unless you have any specific cause for concern (for example, autoimmune disease in the family, a history in the family of bad reactions to live vaccines or a high risk of autism based on other family members) I would go for the MMR. I am not an expert at all, however. It is one jab and then it's done. FWIW (not much I know but anyway...) neither of my boys had any reaction at all to the MMR either time.

There is no medical evidence linking the MMR with autism, but I know someone who is absolutely convinced that her ds's symptoms of autism started a few hours after his MMR vaccination. For this reason alone, we have chosen single vaccines for our 14 month old ds. It hasn't been easy getting them, and they are expensive, but we just feel it's the best option for us.

My dd is a long way off needing her mmr yet but I'm sure that I willgive it to her based on the current evidence. I haven't come across anything that convinces me re link to autism and think that having single jabs increase the time lo is exposed to the risk of infection, means more jabs and posibly more feverish/unwell episodes that typically occur after immunisation.

Also want to point out that it's got nothing to do with your sister what you do for your ds. Don't be pressurised by her or be made to feel guilty afterwards if you don't do what she thinks you should do. Likewise whilst it's nice to hear what other mumsnetters think it's ultimately up to you and your dp/dh.

One of the factors that rang alarm bells for me was the fact that the guy who wrote the original report highlighting the possible link between MMR and autism is involved in the supply of the (pretty expensive) single vaccines.
I personally could not find any scientific or medical research backing up the link, and both my children have had the MMR jabs with no ill effects.

ds - 13mo - will be having singles because I have suffered from psoriasis and IBS which count as autoimmune, and so am not entirely comfortable with giving him the MMR but do not want to leave him unvaccinated. (He was supposed to be having the measles on Thurs but (mini-rant alert) it appears the paed has forgotten to order the vaccine and is now saying it will take 4 months (!) - looks like I'll have to go in search of a quicker source myself )

I read and read, and even attended university discussions re MMR and singles. And as I sat in the Nurse's room at the Doctor's with DD I was still scared.

My DH and I felt it was the right thing to do, but we were and still are nervous and are watching her carefully.

It didn't help that I used to work in a special school and I could the damage that neurological problems can cause (not MMR related).

One boy's parents were certain that his problems occurred when he had the MMR - but he also suffered from various immunity problems.

My decision was aided by the fact that DD is of robust health - there is no autism in family, there is a measles outbreak in our area, and until I did something I would worry about it and the pros and cons.

Mind you, it didn't help that two days later the Sunday mail ran an article linking the MMR to two infant deaths - kept checking to see if she was snoring all that night.

Sorry - this probably doesn't help, but please believe me, you are not alone to think about the combined vs singles, but my opinion is if of good health, good family history, it should be ok.

if you're worried about it, don't do - either don't do it at all, wait until he's older or have the singles.

Also worth thinking about how healthy he is generally.

I gave my dd the combined vaccine. Firstly there is no real evidence that autism and mmr are linked. However, once you hear something it does stay in your mind and niggle. In the end I just thought, it's such a tiny risk and there is a risk to everything in life. A chance of a child being involved in a car crash is more than the "alleged risk" of them getting autism through mmr, so if I am thinking this out in a logical manner then why should I not do one think and yet do another that might have a greater risk.
Don't know if that way of thinking will help you, but that's what worked for me!

DD had MMR without a moments hesitation and despite my DS having an egg allergy he will also be receiving his MMR. My only concern with the single vaccs is that they are not licenced and for me that is not good enough. Good luck with your decision, it's a very hard one to make for many.

dinosaure - just wanted to say thank you for a great post - in this sea of information and misinformation, you explained (what i understand to be) the heart of the matter very clearly and without bias - very refreshing given the recent, confusing threads on this matter

I had ds1 done without hesitation - at the time there was nothing in the papers to suggest there could be a problems. I had ds2 done amidst the controversy, but had no worries as ds1 had been ok. DS2 is now 3 and has asd, he changed almost overnight although i am not sure that this had anything to do with mmr. Dd is due for hers in the next couple of months and I must admit that I am worried. There is a sneaky element of doubt.

Brand effects have been noted with MMR - significant differences between symptoms, and level of recovery associated with different brands. The "worst" brand has been removed from the market.

this I think is a very useful link Notes that seroconversion for mumps appears to be less effective with the MMR, and that the incidence of febrile illnesses appear to be raised following the MMR rather than monovalents. Monovalents were used for a long time previous to the introduction of the MMR. The MMR safety record has been cristicised by the Cochrane report as being wholly inadequate - although they suggested its continued use, so think its a bit daft to hold the MMR as being so much safer than monovalents.

When people say that the single vaccines aren't licenced and their safety isn't proven, are they different single vaccines for measles and rubella now than the ones which were used for many years before the introduction of mmr?

Sorry the MMR safety studies/trials not record- has been criticised by the Cochrane report.

Anyway for people who can't be bothered to read the whole link I gave interesting though it is, here's the relevant bit about single vs combined. Interesting that you get a higher dose of mumps vaccine with the MMR vs singles.

5.2 Are single vaccines any less effective than the triple vaccine ?

There have been no recent comparative trials of monovalent versus combined vaccines of which I am aware. The best method by which such comparison could be carried out currently would be through case-control study in countries which have relatively low levels of MMR use and have comparison populations who are in receipt of monovalent vaccines.

The earlier studies of single vaccines show equivalent levels of seroconversion when compared to combined vaccine:
Measles:

Vaccine

Total No.

Seroconversion

Edmonson B

258

99%

Schwartz

250

98%

Moraten

273

98%

(data from Hilleman et al 1968)

Mumps:

Vaccine

Total No.

Seroconversion

Jeryl Lynn

174

95.2%

Rubella:

Vaccine

Total No.

Seroconversion

RA27/3

67

100%

(data from Weibel et al 1980)

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In addition, rates of fever and rash are reported in early trial;s as being higher with the combined vaccine than with monovalent measles alone:

Comparative:

Vaccine

Total No.

Fever (>39.4°)

Rash

Measles (Moraten)

43

5%

12%

MMR (RA27/3)

141

11%

20%

MMR (HPV-77;DE-5)

142

8%

17%

Placebo

42

0%

9%

(data from Lerman, Bollinger & Brunken 1981)

A large number of comparative trials were carried out (the Committee is referred to IABS 1986 for an introduction to this area).

As far as I can ascertain, all of the earlier studies were used to justify the view that trivalent MMR vaccines were equally efficacious to and not better monovalent vaccines.

The principal justification used for their introduction at the time would seem to have been financial -

The benefit to cost ratio from introduction of MMR vaccines as opposed to monovalent vaccines in the USA was estimated as changing from 11.9 to 1 to 14 to 1 (White, Coplan & Orenstein 1985), with an estimated saving to the healthcare budget of some $60 million per annum (Markowitz & Katz 1994).

One important difference in the constitution of the trivalent as opposed to monovalent vaccines was the finding that simultaneous administration resulted in substantially reduced seroconversion for mumps though not for measles or rubella (see: Andre & Peetermans 1986; Berger, Just & Gluck 1988), as a consequence of which the number of viable mumps viruses in the trivalent preparation was increased (Gluck & Just 1991).

jimjams link was very interesting indeed

DD1 had the combined.

DD2 will have it, too, but when she is 15 months as I want to make absolutely sure they are giving the pneumoccocal vaccine as well.

Just bear in mind that with singles you get 3 times as much of the adjuvant/preservatives. Though thiomersal has been removed, that doesn't mean the substitute is perfect. You may want to read more about that.