Any research on late MMR vaccination?

[MomTo2Cuties]

Hi all,
We have been using a delayed schedule for vaccinating our children. My son is 7 years old, and is "caught up" with all of his vaccines except MMR. We are thinking about having him get the MMR vax this summer. Any concerns with late MMR vaccination? I know that most of the concerns with MMR are the MMR/autism connection. My son has already been diagnosed with Asperger's. Would the MMR vaccine make his Asperger's worse? Or is the MMR/autism concern only when they are 12-15 months old? We have delayed this one the longest because our son was already showing symptoms of an autism spectrum disorder BEFORE he was scheduled to get the MMR vaccine. So, we delayed it, and delayed it, and here we are at 7 years old and he has not received it yet...and he still has Asperger's (even without receiving MMR). I would like for him to receive this last vaccine (I'm not anti-vaccine...just of the belief that the current schedule gives too many at once), but I don't think there has been any research on children who receive the MMR vaccine later in life and if there is a connection to loss of speech/autism symptoms. Because my son already has Asperger's, I don't want to do anything to cause it to become worse.

Thanks for any help you can offer!

[MomTo2Cuties]

Giving this a bump. Anyone? Any bad reactions, problems, etc., developing after an MMR shot later in life?

[Zoesmama]

Well honestly I don't think so. I think most of that link run-around was disproved but I still agree that vax can be harmful.

I'd be scared to but I have friends that have never vax'd and their children have Autism. I also have a friend who's oldest son is mildly Autistic and fully and regularly vax'd as called for and its never worsened in any way.

Can you get a tither test for MMR?? You might try that route if that is possible. Then just skip the booster.

[MomTo2Cuties]

Originally Posted by Zoesmama

Well honestly I don't think so. I think most of that link run-around was disproved but I still agree that vax can be harmful.

I'd be scared to but I have friends that have never vax'd and their children have Autism. I also have a friend who's oldest son is mildly Autistic and fully and regularly vax'd as called for and its never worsened in any way.

Can you get a tither test for MMR?? You might try that route if that is possible. Then just skip the booster.

The titer for MMR would not apply in this case as my son had never received the MMR vaccination. He has never been exposed to measles, mumps or rubella either, so he would have no immunity to any of those diseases.

So, here's what we decided to do. Last week, we had him receive his first MMR shot at 7 years old. So far, no reaction at all (other than him not being very happy about getting a shot). We are keeping a close eye this next week for any symptoms of reaction, because (from what I've read) they usually appear one week - 10 days after receiving the vaccine. I'll keep this thread updated as to whether or not we notice any vaccine reaction, or any changes in him at all. If he has no problems with the initial MMR shot, then we will most likely just go ahead and have him get the second dose in one month to just get it over with and get him completely up-to-date on the school-required shots (we have skipped all other vaccines that are NOT school required).

[mama2soren]

One doesn't necessarily have to have an obvious case of measles, mumps or rubella to have high enough titre levels. A sub-clinical infection could, in theory, cause enough of an immune response to have a rise in titres.

[KMK_Mama]

And you can also previously have had one of those diseases and not be immune. I've had the mumps and 3 MMR's in my life and I got my titers checked and I'm not immune to the mumps. Getting titers drawn is expensive unless your insurance is willing to cover it.

My girls both had the MMR. My first had it on schedule and got the measles (CDC confirmed) so we delayed it with my 2nd DD. I never got their boosters and we sign vaccine waivers for school. My son has never had the MMR and only a few other vaccines in his life. I'm not sure whether I will vaccinate him later or not. I told myself I would take a little time to research and it's been 3 years. LOL

You could always get titers drawn now that he has had the first MMR to see where his immunities are. The first MMR supposedly causes immunity in 90% of the population and the booster is for the 10% that didn't get immunity from the first shot. Some people never get immunity though no matter how many shots they've gotten.

[Hazelnut]

If you are concerned, why not get his titers checked after the first shot? You can show proof of immunity and not have to provide an exemption for school.

[MomTo2Cuties]

Just to update...no reaction whatsoever to the MMR shot. He never had any fever, etc., from the shot and continues to be his same wonderful self. I'm still not sure what we will decide to do...get his titers checked or just opt for the 2nd dose of MMR. Either way, we're giving ourselves a year to decide. We had initially discussed having him get the 2nd dose one month after the first (supposedly is ok to do), but decided to give his body a year before the next dose. A month seems too soon, and if we wait 2 months, then we'll be back in school. I don't want him to get any shots during the school year, just in case he does have a reaction. So, next summer we'll either do titers or 2nd dose.

[ma2two]

Since you have concerns, I can't imagine why you would take the risk of a second dose, when there is the option of the titer test.

[carriebft]

I think the issue with titres and the MMR is that each portion of the vaccine seems to give different immunity numbers. measles is found to cover up to 95% with one dose while mumps are significantly lower and rubella wanes faster with only one dose given. so you draw blood and go through that to find out that you have pretty good measles but missed out on mumps or rubella. Then you get the second vaccine and you have unnecessarily put the child through the blood draw.

While it can be a "win situation" if you find you are one of the ones that has full coverage for all three diseases, it can also be a major "lose" kwim? Also, there is literature out there that a second dose really helps prolong your rubella immunity. I am not exactly sure why that is, but I appreciate that, with a second dose, my daughter will be less likely to find out during pregnancy that she is not immune.

I am not saying don't do the titres; just adding in an opinion on why it's not exactly "black and white" for everyone, kwim?

at seven years old, you would probably have good measles protection with one dose. mumps and waning rubella would be your only concerns.

[MomTo2Cuties]

Originally Posted by ma2two

Since you have concerns, I can't imagine why you would take the risk of a second dose, when there is the option of the titer test.

Well, the initial concern was if there had been any research with late MMR vaccination. However, that is a non-issue now that we have had him get his first dose and there were no problems whatsoever. It's not really a "concern", just a matter of what we will decide to do. Read below...

Originally Posted by carriebft

I think the issue with titres and the MMR is that each portion of the vaccine seems to give different immunity numbers. measles is found to cover up to 95% with one dose while mumps are significantly lower and rubella wanes faster with only one dose given. so you draw blood and go through that to find out that you have pretty good measles but missed out on mumps or rubella. Then you get the second vaccine and you have unnecessarily put the child through the blood draw.

While it can be a "win situation" if you find you are one of the ones that has full coverage for all three diseases, it can also be a major "lose" kwim? Also, there is literature out there that a second dose really helps prolong your rubella immunity. I am not exactly sure why that is, but I appreciate that, with a second dose, my daughter will be less likely to find out during pregnancy that she is not immune.

I am not saying don't do the titres; just adding in an opinion on why it's not exactly "black and white" for everyone, kwim?

at seven years old, you would probably have good measles protection with one dose. mumps and waning rubella would be your only concerns.

This is exactly what I don't want to have happen...get the titer and then him need the 2nd dose also.

[ma2two]

Originally Posted by carriebft

measles is found to cover up to 95% with one dose while mumps are significantly lower and rubella wanes faster with only one dose given

From the MMR package insert: "a single injection of the vaccine induced measles hemagglutination-inhibition (HI) antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of susceptible persons. However, a small percentage (1-5%) of vaccinees may fail to seroconvert after the primary dose." http://www.fda.gov/downloads/Biologi.../UCM123789.pdf

Could you share your sources about rubella waning faster with only one dose given? If that is true, that might be a reason to get a girl re-tested at some time after puberty. That doesn't sound like a good reason to risk a 2nd dose during childhood, especially for a boy.

Originally Posted by carriebft

While it can be a "win situation" if you find you are one of the ones that has full coverage for all three diseases, it can also be a major "lose"

I would hardly consider a blood draw and a copay to be a "major lose" no matter what the results of the test were. However, I would consider any adverse effect, no matter how small, to be unacceptable if it were from an unnecessary 2nd dose of vaccine.

[carriebft]

There is tons of literature out there on the seroconversion rate of 1 mumps vaccine being only somewhere between 70-90%. Here is one such study:

http://www.ncbi.nlm.nih.gov/pubmed/8578851


a few more (adding as I find):

http://www.sciencedirect.com/science...bca85182195bee

http://pediatrics.aappublications.or...act/120/4/e862

will get the rubella lit as well when i find it.

[carriebft]

I cannot find the rubella paper I am looking for,but essentially it talks about the second dose acting as a booster and that evidence or recollection of a second vaccine dose was positively associated with rubella immunity at reproductive age whereas lack of the second dose was positively associated with waning immunity.

[carolinagirl1]

Check the requirements in your state. In my state, the requirements are: 2 doses of measles, 1 dose of mumps, and 1 dose of rubella. Since my daughter already had one MMR, we only did a titer for measles (not mumps or rubella), and she was immune to measles so now she is up to date on measles, mumps, and rubella. If your state has the same requirements, you could do that and not worry about the titers for mumps and rubella....unless you have the concerns about the rubella as mentioned in the previous posts.

[greenmom17]

Originally Posted by carolinagirl1

Check the requirements in your state. In my state, the requirements are: 2 doses of measles, 1 dose of mumps, and 1 dose of rubella. Since my daughter already had one MMR, we only did a titer for measles (not mumps or rubella), and she was immune to measles so now she is up to date on measles, mumps, and rubella. If your state has the same requirements, you could do that and not worry about the titers for mumps and rubella....unless you have the concerns about the rubella as mentioned in the previous posts.

This is great to know! Thank you.

[buttercup]

Pink Book on CDC website - http://www.cdc.gov/vaccines/pubs/pin...k-chapters.htm


Measles:
http://www.cdc.gov/vaccines/pubs/pin...loads/meas.pdf

Page 166/ Page 10 of 20 on PDF
Immunogenicity and Vaccine Efficacy
Measles vaccine produces an inapparent or mild, noncommunicable infection. Measles antibodies develop in approximately 95% of children vaccinated at 12 months of age and 98% of children vaccinated at 15 months of age. Seroconversion rates are similar for single-antigen measles vaccine, MMR, and MMRV. Approximately 2%–5% of children who receive only one dose of MMR vaccine fail to respond to it (i.e., primary vaccine failure). MMR vaccine failure may occur because of passive antibody in the vaccine recipient, damaged vaccine, incorrect records, or possibly other reasons. Most persons who fail to respond to the first dose will respond to a second dose. Studies indicate that more than 99% of persons who receive two doses of measles vaccine (with the first dose administered no earlier than the first birthday) develop serologic evidence of measles immunity.

Page 167/ Page 11 of 20 on PDF
A second dose of MMR is recommended to produce immunity in those who failed to respond to the first dose. The second dose of MMR vaccine should routinely be given at age 4–6 years, before a child enters kindergarten or first grade. The recommended visit at age 11 or 12 years can serve as a catch-up opportunity to verify vaccination status and administer MMR vaccine to those children who have not yet received two doses of MMR.


MUMPS:
Pink Book Chapter on Mumps: http://www.cdc.gov/vaccines/pubs/pin...oads/mumps.pdf

Page 193/ Page 5 of 10 on PDF
Immunogenicity and Vaccine Efficacy
Mumps vaccine produces an inapparent, or mild, noncommunicable
infection. More than 97% of recipients of a single dose develop measurable antibody. Seroconversion rates are similar for single antigen mumps vaccine, MMR, and MMRV. Postlicensure studies conducted in the United States during 1973–1989 determined that one dose of mumps or MMR vaccine was 75%–91% effective. A study from the United Kingdom documented vaccine effectiveness of 88% with two doses. The duration of vaccine-induced immunity is believed to be greater than 25 years, and is probably lifelong in most vaccine recipients.


Rubella
Pink Book Chapter on Rubella: http://www.cdc.gov/vaccines/pubs/pin...ds/rubella.pdf

Page 264/ Page 8 of 16 on PDF
Immunogenicity and Vaccine Efficacy
RA 27/3 rubella vaccine is safe and more immunogenic than rubella vaccines used previously. In clinical trials, 95% or more of vaccinees aged 12 months and older developed serologic evidence of rubella immunity after a single dose. More than 90% of vaccinated persons have protection against both clinical rubella and viremia for at least 15 years. Follow-up studies indicate that one dose of vaccine confers long-term, probably lifelong, protection. Seroconversion rates are similar for single-antigen rubella vaccine, MMR, and MMRV.

...

A second dose of MMR is recommended to produce immunity to measles and mumps in those who failed to respond to the first dose. Data indicate that almost all persons who do not respond to the measles component of the first dose will respond to a second dose of MMR. Few data on the immune response to the rubella and mumps components of a second dose of MMR are available. However, most persons who do not respond to the rubella or mumps component of the first MMR dose would be expected to respond to the second dose. The second dose is not generally considered a booster dose because a primary immune response to the first dose provides long-term protection. Although a second dose of vaccine may increase antibody titers in some persons who responded to the first dose, available data indicate that these increased antibody titers are not sustained. The combined MMR vaccine is recommended for both doses to ensure immunity to all three viruses.