MMR while nursing and before TTC

[MommatoGray]

Hello ladies,

My DS is 13 months. While I was pregnant they checked titers for rubella, I was non-immune. They told me that when I took DS in for his vaxes they would give me another does of mmr. Well, DS has not gone to the health unit yet, and I did not want to get mmr while nursing. I still don't really want to get it while nursing.

I guess what I am asking is WWYD? I was hoping to just continue nursing and get pregnant whenever, I wanted to be pretty laid back when deciding to "not care" if we got pregnant. I could wait till I am done nursing, but didn't want my babes too far apart. I could quit nursing to get the shot - really don't want to do that! Or I could just pass on the vax. I did get my immunization records, I only had one mmr at one years old.

I suppose my thoughts are that I know that rubella is rare, but crs is not nice and if it happens to your child it probably won't seem that rare. I don't want to put my unborn baby in danger. On the other hand, if I have not got it in 28 years, why am I so worried about getting it in the first 20 weeks of my pregnancy?

Please any thoughts would be greatly appreciated!

- A side question - what is the mon-measles shot for? I am assuming that is a measles only? I don't know why the health nurse saw me in 2004, saw I only had one mmr, one mon-measles, and then told me there was no boosters needed - weird right? Or am I missing something?

[emmy526]

When is the last time you heard of a rubella outbreak in this country?  that should help you decide....and i have not heard of a "non-measles" shot...what is that?? a shot for  anything other than measles?   was it tdap?  and i think mmr vaccine passes thru breastmilk.  

[MommatoGray]

Thanks for the reply! Its true I have not heard of any out breaks....

Mon-measles, I am assumning it stands for monovalent measles.

Should I worry about getting it from my DS, he is not vaxed at all?

Thanks for your help!

[emmy526]

Originally Posted by MommatoGray 

Thanks for the reply! Its true I have not heard of any out breaks....

Mon-measles, I am assumning it stands for monovalent measles.

Should I worry about getting it from my DS, he is not vaxed at all?

Thanks for your help!

http://justthevax.blogspot.com/2010/07/merck-not-to-resume-production-of.html

 

Quote:

THURSDAY, JULY 8, 2010

Merck NOT to resume production of monovalent measles, mumps and rubella

 

A recent rumor stated that Merck might be supplying their monovalent measles, mumps and rubella vaccines again "some time in 2011". Before anyone gets their hopes up, I went to Merck's webpage. This is their most recent statement (last checked 12 June 2011, my bold):

Based on input from the Advisory Committee on Immunization Practices (ACIP), professional societies, scientific leaders, and customers, Merck has decided not to resume production of ATTENUVAX® (Measles Virus Vaccine Live), MUMPSVAX® (Mumps Virus Vaccine Live), and MERUVAX®II (Rubella Virus Vaccine Live). This science-based decision will support vaccination of the largest group of appropriate individuals. Merck will continue to focus necessary resources to ensure that they can help meet current and future global public health needs for their combination measles, mumps and rubella vaccine, M-M-R®II (Measles, Mumps, and Rubella Virus Vaccine Live).

Edited by emmy526 - 2/6/12 at 3:56am

[Taximom5]

Originally Posted by emmy526 

monovalent measles vaccine and mmr vaccine are the same thing, just worded differently. 

http://justthevax.blogspot.com/2010/07/merck-not-to-resume-production-of.html

 

I don't think so.  Monovalent measles vaccines means a measles-ONLY vaccine (not containing the mumps and rubella antigens).  MMR is a vaccine containing measles AND mumps AND rubella antigens.

[emmy526]

Originally Posted by Taximom5 

I don't think so.  Monovalent measles vaccines means a measles-ONLY vaccine (not containing the mumps and rubella antigens).  MMR is a vaccine containing measles AND mumps AND rubella antigens.

there is a lot of confusing info out there about it..if you google monovalent mmr, it brings many conflicting links. 

[nia82]

Are you in Europe? A rubella only vaccine is available there, as well as in Japan. I had the MMR at 24 for the rubella component and was told there are no separate shots (liars!) and I would not do it again if I had a chance. I had a horrible reaction to it and was sick (intestinal cramps, lots of weight loss, to the point of 99lbs at 5'6" which lead to catching all colds and such) for 6 months. Then the cramps suddenly stopped. It all started with a 105 fever about 8 days or so after vaccination. Idiot me hadn't even checked titers before, I probably still had some.... Ugh. 

Apart from that, I would not do a live vaccine when nursing, and if I got MMR or another live vaccine would wait at least 6 months before TTC...

[Taximom5]

Originally Posted by emmy526 

there is a lot of confusing info out there about it..if you google monovalent mmr, it brings many conflicting links. 

Just googled it, and you're right, it does bring a lot of confusing links.The confusing issue is whether or not Merck is making the monovalent (separate) measles, mumps, and rubella vaccines. They used to make them; they stopped making them; they announced they would make them again.  But they don't seem to be making them.

But the meaning of the word "monovalent" is consistent. Monovalent measles vaccine is a measles-only vaccine; it is not an MMR.

One of the links that came up was an old thread from Mothering.com!

http://www.mothering.com/community/t/510619/please-help-chose-monovalent-mmr

[GoGoGirl]

Well, why wouldn't you consider just going ahead and getting MMR while nursing?  I would much rather get MMR while nursing than wean my baby or delay my ideal child spacing. 

I actually need to get my MMR updated too, because I'm not immune to rubella anymore.  I'm nursing a 3 month old and an almost 3 year old and I'm still planning to get the MMR in a few weeks.  (I wanted to wait a while, because I just got a tetanus booster this week).  I can't even think why someone wouldn't want to get it while nursing. 

[slmommy]

http://www.kellymom.com/health/meds/vaccines-bf.html#mmr

Kellymom has some info about this (pulled from CDC...)

Quote:

Neither inactivated nor live vaccines administered to a lactating woman affect the safety of breast-feeding for mothers or infants. Breast-feeding does not adversely affect immunization and is not a contraindication for any vaccine. Limited data indicate that breast-feeding can enhance the response to certain vaccine antigens. Breast-fed infants should be vaccinated according to routine recommended schedules.

"Although live vaccines multiply within the mother's body, the majority have not been demonstrated to be excreted in human milk. Although rubella vaccine virus might be excreted in human milk, the virus usually does not infect the infant. If infection does occur, it is well-tolerated because the viruses are attenuated. Inactivated, recombinant, subunit, polysaccharide, conjugate vaccines and toxoids pose no risk for mothers who are breast-feeding or for their infants."

Quote:

"Breastfeeding does not interfere with the response to MMR vaccine. Vaccination of a woman who is breastfeeding her infant poses no risk to the infant being breastfed. Although it is believed that rubella vaccine virus, in rare instances, may be transmitted via breast milk, the infection in the infant is asymptomatic."

GoGoGirl - I think some people are worried about live viruses being trasmitted through breastmilk. Also, if you were worried about yourself personally having a reaction, that could complicate things while nursing/caring for baby, or TTC soon after... 

[slmommy]

http://www.mothering.com/community/t/576738/vaccines-while-nursing (this is an old thread with the same issue but got way off topic...)

but there was a link there to:

http://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf

Quote:

Nursing Mothers 

It is not known whether measles or mumps vaccine virus is secreted in human milk. Recent studies 

have shown that lactating postpartum women immunized with live attenuated rubella vaccine may secrete 

the virus in breast milk and transmit it to breast-fed infants.49

 In the infants with serological evidence of 

rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of 

acquired rubella.50,51

 Caution should be exercised when M-M-R II is administered to a nursing woman. 

[MommatoGray]

Thank you for the info! I guess I just need to keep researching! Ugh....wish I could make my decison.

GoGoGirl - there are lots of reasons that have made me pause. If you search the archives you will find lots of info, I started this post because I wanted some current opinions and articles. There is a study that suggests that recieving mmr while nursing can later affect your child when they get their mmr vaccine. 20/25 women in the study had one or more children with autism and/or development issues, miscarriages, the list goes on. This is why I am unsure of what I want to do. Not to mention the problems associated with an adult recieving the shot, arthristis, and other issues (can't remember others off the top of my head). I am also concerned, considering my son has had no vaxes, the mmr sheds. Are you babes vaxed, were you concerned of shedding.

slmommy - would like to know if you have gotten the shot while nursing? Thanks for the links I am off to check them out : )

Thanks ladies!

[slmommy]

well i found some more info for you... 

http://www.jstor.org/pss/30117534

Quote:

Abstract

The transmission of rubella virus to newborn infants via the process of breast-feeding was studied after immunization of 16 breast-feeding and 10 non-breast-feeding mothers with HPV-77 DE5 live, attenuated rubella virus vaccine administered subcutaneously or RA 27/3 live, attenuated rubella virus vaccine administered intranasally or subcutaneously in the immediate postpartum period. Infectious rubella virus or virus antigen was observed in the breast milk of 11 (68%) of the 16 vaccinated, breast-feeding women studied. After maternal immunization, infectious rubella virus or virus antigen was recovered from the nasopharynx and throat of 56% of the breast-fed infants and from none of the non-breast-fed infants. Of the breast-fed infants, 25% showed transient seroconversion to rubella virus but without any clinical disease. No rubella virusspecific seroconversion was observed in the non-breast-fed infants. These observations provide strong support for the communicability of rubella virus to neonates via the process of breast-feeding.

I also wonder about the Merck link above:

Quote:

 In the infants with serological evidence of rubella infection, none exhibited severe disease; however, one exhibited mild clinical illness typical of acquired rubella

... I wonder how large the group was?? but I didn't find that.

Well, if you want to know my personal opinion - I would not get MMR while nursing, but I wouldn't get it while not nursing, and don't see myself getting many or any vax for the rest of my life. But I also have rubella immunity last time checked, although I don't think I would feel differently if I didn't. I also have some auto immune issues and some vax reactions in the past (although DTP not MMR).

Someone else pointed out how rare rubella is in the US, 

WHO's got 3 cases in 2009, 16 in 2008, and 12 in 2007 and 11 in 2006.

http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileresult.cfm?C=usa

 

You went through one pregnancy without... did you know early on in the pregnancy that you didn't have immunity, or did they test you at the end? If you knew early, what did your dr. tell you? What would you do or how would you feel if you accidentally got pregnant tomorrow?

 

One thing I also wonder about, is clearly it is possible for rubella to transmit through bm, but probably all of the mothers/babies studied were very young infants, not 13 mo. I definitely would not get MMR while nursing a newborn. At least your DS has a more developed immune system. 

 

 

[Taximom5]

I would also wonder how many pregnant mums might be exposed to rubella from a recently-vaccinated child, who would be shedding live virus cells (which is the reason they tell you not to expose your recently-vaxxed child to someone undergoing chemotherapy, or who is on steroids, or is otherwise immunocompromised).

[slmommy]

Taximom, this is what the Merck insert is saying about MMR II:

Quote:

Excretion of small amounts of the live attenuated rubella virus from the nose or throat has occurred in the majority of susceptible individuals 7 to 28 days after vaccination. There is no confirmed evidence to indicate that such virus is transmitted to susceptible persons who are in contact with the vaccinated individuals. Consequently, transmission through close personal contact, while accepted as a theoretical 

possibility, is not regarded as a significant risk.33

 However, transmission of the rubella vaccine virus to infants via breast milk has been documented (see Nursing Mothers). 

There are no reports of transmission of live attenuated measles or mumps viruses from vaccinees to susceptible contacts.

 

...

 

 Measles inclusion body encephalitis60 (MIBE), pneumonitis61 and death as a direct consequence of disseminated measles vaccine virus infection have been reported in immunocompromised individuals inadvertently vaccinated with measles-containing vaccine. 

So I guess that definitely merits the caution for keeping recently vaxed kids, who could theoretically shed the virus, away from immunocompromised individuals.

here's some other interesting things Merck says about MMR II- 

don't ttc for at least 3 months after:

Quote:

Women of childbearing age should be advised not to become pregnant for 3 months after vaccination and should be informed of the reasons for this precaution.

and:

Quote:

Postpubertal females should be informed of the frequent occurrence of generally self-limited arthralgia and/or arthritis beginning 2 to 4 weeks after vaccination (see ADVERSE REACTIONS). 

 

...

 

In women, incidence rates for arthritis and arthralgia are generally higher than those seen in children (children: 0-3%; women: 12-26%),17,52,53 and the reactions tend to be more marked and of longer duration. Symptoms may persist for a matter of months or on rare occasions for years....Even in women older than 35 years, these reactions are generally well tolerated and rarely interfere with normal activities.  

...Don't know if I would want to deal with that while nursing and taking care of a baby and/or ttc, although they say it's "well tolerated" 

Edited by slmommy - 2/8/12 at 5:43pm

[Taximom5]

Whoa.  They're saying that arthritis and/or arthralgia is a COMMON occurence 2-4 weeks post-vaccination in "post-pubertal females?"

I swear, if I didn't know that this was deadly serious, I'd think it was a spoof.

WHO THE HECK DECIDED THAT ARTHRITIS/ARTHRALGIA IN WOMEN IS AN ACCEPTABLE SIDE EFFECT????

AND HOW DID THEY DECIDE THAT IT IS "GENERALLY TOLERATED WELL?"  What the heck does that mean--that between going to work, cooking, cleaning, and taking care of the kids,  if the women's doctors told them there wasn't anything they could do about, it was "tolerated well???"

This is just...sick.

[slmommy]

... I guess the product inserts say the darnest things.

somewhere between 1/4 and 1/8 chance of arthritis/arthralgia, and new moms are regularly given this vaccine. Nevermind the whole passing virus to baby through breastmilk part.

Ha, and vaccine reactions are "rare".... 

Symptoms may persist for a matter of months or on rare occasions for years

I don't think I would tolerate that very well.

[MommatoGray]

Again, thanks to all of you for your thoughts!

I think I have made some progress on trying to decide what to do. I am not too worried about my personal reactions to the vaccine. To be honest I have had a lot of shots, I travelled all around the world and of course got everything they recommended - before I knew better. Another thing is that I am not anti-vaccine I think I am more anti-schedule. Not sure what we will do in the future, just knew up till now I did not want to get any for DS.

So I digress....

I had a good friend who actually did my travel vaxes, I use to babysit all her children when they were young, house sat, dog sat, etc... The point is that I feel comfortable chatting with her and talking about her point of view. I can not believe that I had never thought of contacting her before this. Anyways, she called and we talked for over an hour. So I am still not convinced about vaxing him, that is what she pushed.

But I did come up with an idea and would really like to know your thoughts. She told me that yellow fever is not recommended during breastfeeding, but, if (you know the usual saying) the benefit outways the risk they will give it. And they tell the Mom to pump and dump for ten days.

So considering we are pretty sure mmr goes into breast milk then what if I pumped and dumped for a few days after. My concerns are the following:

1) He won't take a cup (obviously we would try before I went to do the shot)

2) He won't want to go back to nursing after he has had cup (my biggest concern)

3) He won't take the cup from me (which means mom would have to come stay)

4) Not sure how long to pump and dump (I know it says virus can shed via nose 7-28 days following vaccination)

My old boss (I was a nanny) left her 10 month old with me cause she had to go on a business trip. He took the cup just fine while she was gone and then went right back to nursing once she returned. He continued till just a few months ago until she weaned because she was pregnant and felt too tired to do it anymore.

My little man sure does love nursing, so my hopes would be that he would go back, my heart would break a little if he didn't.

I guess it comes down to the fact that I know myself and who I am, amd even though I could tell myself a million times that rubella is rare, I know I would worry my whole pregnancy. And I LOVE being pregnant and I really just want to enjoy it. Plus I know that we want 3+ kids so there hopefully be more pregnancies.  And if I did get it and something happened to baby I would never forgive myself

So, what do you think? Pump and dump and if I got the shot in March I was thinking to wait at least till July/August to TTC. Thanks so much for listing and for your help!!

I also have one more question:

After maternal immunization, infectious rubella virus or virus antigen was recovered from the nasopharynx and throat of 56% of the breast-fed infants and from none of the non-breast-fed infants. Of the breast-fed infants, 25% showed transient seroconversion to rubella virus but without any clinical disease. No rubella virusspecific seroconversion was observed in the non-breast-fed infants. These observations provide strong support for the communicability of rubella virus to neonates via the process of breast-feeding.

I think that I don't really understand this. Is it so bad if he did get it, isn't that what we are all so upset about - our kids don't have the opportunity to contract "common" childhood illness? I can see that in a newborn it would be bad. But by the time I got the shot, DS would be 14 months.

Oh man, I don't know!! Even after writing all this I am still so unsure

[slmommy]

As far as I understand it (and I'm not an expert and also can't read the whole study...)...

In that study, they found rubella virus or antigen (viral substance which causes response) in 56% of the breastfed babies and no virus or antigens in the non-breastfed babies.

Of those 56%, 25% of them had some immune response, but none got a clinical case of rubella. The study was from 1982 and it was not using MMR II, just rubella vaccine(s).

The study was with neonates, 16 in the breastfeeding group and 10 in non-breastfeeding group. So 9/16 babies had virus or antigen passed through breastmilk and 2/16 had some sort of immune response, 0 got a clinical case of rubella.

[MommatoGray]

Hi again,

Ok, so what is the negative involved with that?

And is what it is saying then that there was an immune response?

Edited by MommatoGray - 2/10/12 at 2:41pm