Should A Third Dose of MMR Be Added to the Schedule? - Mothering Forums

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#1 of 36 Old 03-18-2017, 05:55 PM - Thread Starter
 
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Should A Third Dose of MMR Be Added to the Schedule?

Now that it's pretty clear that vaccine failure is primarily driving recent mumps outbreaks, Offit is suggesting that a third dose of MMR be added to vaccine requirements.

Keep in mind that according to a 2010 lawsuit filed by two virologists at Merck, (I'll give a cyber-hug to whomever provides that link ), the drug company was dishonest about the vaccine's weakening efficacy.

Another factor to consider is that there's no monovalent mumps vaccine, so everybody would be getting third doses of measles and rubella vaccines, as well.

Here's Offit's take on the matter:

Quote:
“Could you make a better mumps vaccine which has no side effects and has better protection? I think that you could, but it would probably be a two-decade long effort and it would mean a company like Merck, which is the sole manufacturer in the United States, will essentially be competing against themselves -- so I don’t see that happening. I think the more likely scenario is that you give out a third dose of the current vaccine at 11 or 13 years of age,” Offit tells FOX Business.
Do you agree with Offit that everyone should start getting three doses? Or should we be demanding a better product? Something else/other?
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#2 of 36 Old 03-18-2017, 06:04 PM
 
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Now that it's pretty clear that vaccine failure is primarily driving recent mumps outbreaks, Offit is suggesting that a third dose of MMR be added to vaccine requirements.

Keep in mind that according to a 2010 lawsuit filed by two virologists at Merck, (I'll give a cyber-hug to whomever provides the that link ), the drug company was dishonest about the vaccine's weakening efficacy.

Another factor to consider is that there's no monovalent mumps vaccine, so everybody would be getting third doses of measles and rubella vaccines, as well.

Here's Offit's take on the matter:
Quote:
“Could you make a better mumps vaccine which has no side effects and has better protection? I think that you could, but it would probably be a two-decade long effort and it would mean a company like Merck, which is the sole manufacturer in the United States, will essentially be competing against themselves -- so I don’t see that happening. I think the more likely scenario is that you give out a third dose of the current vaccine at 11 or 13 years of age,” Offit tells FOX Business.

Do you agree with Offit that everyone should start getting three doses? Or should we be demanding a better product? Something else/other?
Do you think Offit realized that he was pointing to a major defect in the current system for producing and assessing vaccines? Probably not.

Links to news articles and press releases about the Merck lawsuit
http://ahrp.org/former-merck-scienti...fficacy-fraud/
http://www.reuters.com/article/healt...0YQ0W820150604
https://www.forbes.com/sites/gergana.../#20c6bddf9678 (I especially love the Forbes version of reality...)
https://www.law360.com/articles/5743...ine-to-advance
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#3 of 36 Old 03-18-2017, 06:41 PM
 
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I think if you are pro-vax a third dose makes sense in mid adolescence.
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#4 of 36 Old 03-19-2017, 04:16 AM
 
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The other question is should it be funded or is it just recommended and up to the individual to pay for it (as is the case here now with Bexsero...well, if anyone could find any). I can't see the government funding it, and then compliance comes into play. People are less keen to do vaccines when they have to pay for them. I read some parents on other sites livid that they have to pay for Bexsero themselves, but heck, if Bexsero was that important to me, I'd find the money.

I think if the government were keen on getting all their ducks in a row, public health wise, they would not be expend all their energy on the no jab, no pay/play, but also look at the adults whose measles and mumps immunity is long gone and urge doctors to check titres and discuss boosters with those whose results are unsatisfactory. It could be done as part of an annual physical or work physical, whatever. Most of the recent measles cases here have been previously vaccinated adults. The lack of a monovalent option though is also unfortunate, but it's something most women have had to put up with all this time when told that they need a rubella booster.
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#5 of 36 Old 03-19-2017, 07:29 AM
 
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I think if the government were keen on getting all their ducks in a row, public health wise, they would not be expend all their energy on the no jab, no pay/play, but also look at the adults whose measles and mumps immunity is long gone and urge doctors to check titres and discuss boosters with those whose results are unsatisfactory. It could be done as part of an annual physical or work physical, whatever. Most of the recent measles cases here have been previously vaccinated adults. The lack of a monovalent option though is also unfortunate, but it's something most women have had to put up with all this time when told that they need a rubella booster.
Most pro-vaxxers (all?) believe vaccines are super safe and side effects super rare. I believe most do not worry at all about serious vaccine side effects - in the same way I do not worry if I pop one aspirin. Yes, I know an aspirin could cause issues (it is a drug) but i think it is extremely unlikely to, so i just do it and move on with my life. As such, who cares if an individual has high or low titres? Vaccines are super safe, nothing bad will happen if you take one, just do it (and you will have some protection from whatever disease the vaccine is trying to prevent). I think this is why they do not care if something is a monovalent vaccine or not - it is super safe, who cares if you get an added vaccine in there? It might even be a plus -extra protection against other diseases.

There might be a small hiccup in this even for pro-vaxxers (but probably not the professional ones - who will never admit any flaw in vaccine dogma unless they have already fixed the problem). The r in MMR is for rubella, and the rubella vaccine carries a known risk of arthritis type symptoms, and the older you get the vaccine, the more likely you are to experience such a reaction.
From the package insert: "Following vaccination in children, reactions in joints are uncommon and generally of brief duration. In women, incidence rates for arthritis and arthralgia are generally higher than those seen in children (children: 0-3%; women: 12-26%),{17,56,57} 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. In adolescent girls, the reactions appear to be intermediate in incidence between those seen in children and in adult women. Even in women older than 35 years, these reactions are generally well tolerated and rarely interfere with normal activities."

For the pro-vaxxers: is a risk of arthritis type symptoms in females worth a routine (aka on the schedule) vaccine booster in mid adolescence, especially given the booster is really about mumps, a disease females are typically less concerned with in adulthood?
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#6 of 36 Old 03-19-2017, 07:51 PM - Thread Starter
 
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I think if you are pro-vax a third dose makes sense in mid adolescence.
Yes and no. Pro-vaxxers seeking and choosing a third dose for themselves or their children makes sense.

But calling for a third dose to be added to the schedule, and therefore school requirements, (at least in the U.S.), does not make sense. What I can't wrap my head around is this mentality that if a product fails, you don't demand a better product; you just A) demand a mandate for more of the weak product and B) blame the people who declined to use it.
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#7 of 36 Old 03-20-2017, 05:21 AM
 
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Yes and no. Pro-vaxxers seeking and choosing a third dose for themselves or their children makes sense.

But calling for a third dose to be added to the schedule, and therefore school requirements, (at least in the U.S.), does not make sense. What I can't wrap my head around is this mentality that if a product fails, you don't demand a better product; you just A) demand a mandate for more of the weak product and B) blame the people who declined to use it.
Ah, but I suspect you are thinking like a selective delayer and not a pro-vaxxer

If a pro-vaxxer thinks a vaccine is a good idea - then they think everyone should think it is a good idea (and the names they call if you disagree with this!). If vaccine specialists think a vaccine is a good idea then in pro-vax world it should be on the schedule. Arguments for it being on the schedule would include insurance paying for it, and compliance rates (which they like to see high - herd immunity and all that).

Don't misunderstand me: I don't think there should be mandates at all. It does not matter to me if the product is good or bad - I do not want mandates for prophylactic drugs. I do not want them her or there, I do not want them anywhere. That is overstepping with regard to government interference. I suspect, but don't really know, that pro-vaxxers who want mandates are mixed on what they want mandated. Should everything on the schedule be mandated? Should something only be mandated if the disease is scary and the vaccine meets an effectiveness bar (and what is that bar set at?). I don't give a hoot whether insurance companies pay for it, and I don't even care if the country (aka taxes) picks up the bill (I am sure they have spent my money on worse ways...although the nepotism involved in giving more money to Big Pharm for a meh product does sting a bit). I think policy makers should care, as I am not sure paying for a third MMR vaccine makes the most sense. It might make more sense to let rubella and mumps circulate and then offer said vaccines for free to those who do not display proper titres in mid adolescence.
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#8 of 36 Old 03-20-2017, 07:45 AM
 
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No one (those who vaccinate on & per state requirements) won't bat an eye at another dose!

Dtap-5 doses, plus each pregnancy, new grandparents, not sure when you last was-no problem! Remember that old only one every ten years? No longer valid.

CP-one dose, no two-ok!

These are the same people that go yearly for their pets "shots" and think nothing of it!

A 3rd MMR- well if an out break you can do one prior to 12 months, plus 2 more, so saying s 3rd won't mean a thing! 4th or more-go for it!

They will line up and roll up their sleeves and not say a peep!
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and I don't even care if the country (aka taxes) picks up the bill (I am sure they have spent my money on worse ways...although the nepotism involved in giving more money to Big Pharm for a meh product does sting a bit).
If only we all had money trees in our back gardens.

But we don't.

And spending more tax money on a prophylactic medical procedure (outside of huge epidemics) that doesn't always deliver benefits and has many risks whilst hospitals are struggling to provide acute and timely care does concern me. It also concerns me and many others that school districts don't have all the resources they need to accommodate the needs of those 4-10% of the population said to have an LD; LD's that may be associated with receipt of vaccines.

And we should care that our tax dollars are being handed over to hugely profitable companies when no one - whether it be that company, the government, the medical association or the doctor who adminsters the shots is held responsible for the injuries they cause.
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#10 of 36 Old 03-20-2017, 09:23 AM - Thread Starter
 
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Ah, but I suspect you are thinking like a selective delayer and not a pro-vaxxer

If a pro-vaxxer thinks a vaccine is a good idea - then they think everyone should think it is a good idea (and the names they call if you disagree with this!). If vaccine specialists think a vaccine is a good idea then in pro-vax world it should be on the schedule. Arguments for it being on the schedule would include insurance paying for it, and compliance rates (which they like to see high - herd immunity and all that).
Yes, well, that is doesn't make sense to me may be why I'm S/D. Offit just thinks of economics. It's more cost-effective for the drug companies if a third dose is imposed. In short, he wants taxpayers to pick up the tab.

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#11 of 36 Old 03-20-2017, 11:19 AM
 
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If only we all had money trees in our back gardens.

But we don't.

And spending more tax money on a prophylactic medical procedure (outside of huge epidemics) that doesn't always deliver benefits and has many risks whilst hospitals are struggling to provide acute and timely care does concern me. It also concerns me and many others that school districts don't have all the resources they need to accommodate the needs of those 4-10% of the population said to have an LD; LD's that may be associated with receipt of vaccines.

And we should care that our tax dollars are being handed over to hugely profitable companies when no one - whether it be that company, the government, the medical association or the doctor who adminsters the shots is held responsible for the injuries they cause.
As I said, I do not care that my taxes are spent on vaccines I never use. There are lots of ways the government spends money that I am not onboard with - my only recourse is to vote accordingly, but frankly, vaccine dollars are small compared to overall health budgets and things like education. It is not something I overly concern myself with as an individual and whether or not to fund xyz vaccine would not make it onto my list of issues when deciding on a candidate (although whether a candidate was mindful on health issues in general might)

I do indeed think policy makers should care, though, and should try to get the most bang for their buck without decreasing safety ( and I think you would have a hard time arguing letting children get rubella but vaxxings those who don't in adolescence is dangerous).

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#12 of 36 Old 03-20-2017, 03:09 PM
 
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We need to keep clear the difference between recommendations and mandates.

Mandates aren't necessary for insurance reimbursement, just the ACIP recommendation.

Note also that giving a third dose is currently just fine, even though it isn't a recommendation (as in on the schedule) if there is an outbreak.

So the only thing that would immediately happen if it was recommended is that more doctors would be pushing the shot on the age group who fits the recommendation. Then all the state health departments or legislatures would have to decide if they want to shove through an actual mandate. It could be several years or forever before it was actually required for school in all states.

We mostly benefit from the inefficiency of US vaccine policy. Things could be much worse.

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#13 of 36 Old 03-20-2017, 04:30 PM - Thread Starter
 
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So the only thing that would immediately happen if it was recommended is that more doctors would be pushing the shot on the age group who fits the recommendation. Then all the state health departments or legislatures would have to decide if they want to shove through an actual mandate. It could be several years or forever before it was actually required for school in all states.
I'm not so sure. Look how swiftly the middle school dose of TDaP got added to state requirements. My guess is that with an already established vaccine, like TDaP or MMR, health departments can get additional doses of those lickity split via administrative fiat. Gardasil and flu shots won't enjoy similar success.

Also, I need to find a link to qualify this, but I remember reading that health departments receive a lot of federal funding on a carrot-and-stick basis, i.e. their funding is contingent on mandating ACIP recommendations.

Does anyone have a break down on how many states get their vaccine mandates from health departments vs. state legislatures?
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#14 of 36 Old 03-20-2017, 04:33 PM
 
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I'm not so sure. Look how swiftly the middle school dose of TDaP got added to state requirements. My guess is that with an already established vaccine, like TDaP or MMR, health departments can get additional doses of those lickity split via administrative fiat. Gardasil and flu shots won't enjoy similar success.

Also, I need to find a link to qualify this, but I remember reading that health departments receive a lot of federal funding on a carrot-and-stick basis, i.e. their funding is contingent on mandating ACIP recommendations.

Does anyone have a break down on how many states get their vaccine mandates from health departments vs. state legislatures?
Hmm. Of course! Merck would get a considerable boost in income, mumps might decline a bit which would help them dodge the whistleblower lawsuit a bit longer...no wonder Offit is pushing for a third dose. He is very cuddly with Merck.

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#15 of 36 Old 03-20-2017, 04:36 PM - Thread Starter
 
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Hmm. Of course! Merck would get a considerable boost in income, mumps might decline a bit which would help them dodge the whistleblower lawsuit a bit longer...no wonder Offit is pushing for a third dose. He is very cuddly with Merck.
This.

When a vaccine fails, someone's going to have to pick up the tab---the drug companies with an improved vaccine or the taxpayers with more doses of same-'ol-same-'ol. Offit is clearly pushing a case for the latter.
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As I said, I do not care that my taxes are spent on vaccines I never use. There are lots of ways the government spends money that I am not onboard with - my only recourse is to vote accordingly, but frankly, vaccine dollars are small compared to overall health budgets and things like education. It is not something I overly concern myself with as an individual and whether or not to fund xyz vaccine would not make it onto my list of issues when deciding on a candidate (although whether a candidate was mindful on health issues in general might)

I do indeed think policy makers should care, though, and should try to get the most bang for their buck without decreasing safety ( and I think you would have a hard time arguing letting children get rubella but vaxxings those who don't in adolescence is dangerous).
I don't see the issue as being whether taxes should only be spent on items we all use. The criteria should be whether something is a necessity and whether what we are funding with our tax dollars is the best option for that necessity.

It's just a cash grab for the vaccine manufacturers to sell the government on a trivalent vaccine when only a monovalent vaccine is indicated. What conclusions can we draw from the fact that although there are whistleblowers alleging that Merck fudges efficacy numbers, when outbreaks do occur in the vaccinated government agencies are considering another dose rather than demanding the vaccine be improved. With that sort of security, what stops a company with a monopoly from playing with the virus load of anyone of those components in order to create more demand for their product? Especially when the FDA calls ahead to notify of upcoming inspections and no misdeeds ever result in jail time; such a win for management and the shareholders.

As for the which budget uses more tax dollars, again that isn't the issue. The issue is whether something is a necessity and if the proposed solution is the best solution. Paying more money for, recommending, and administering a trivalent vaccine when there is no need for it is a waste of taxpayer dollars. Wasting tax payer dollars this way whilst denying increases for disability payments or money for educational supports is particularly grating for those involved.

It's hard to know how much profit is derived from the MMR as vaccine manufacturers are not forthcoming, but this article from the G&M dated 2010 states:
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Since the late 1990s, prices for flu vaccine in North America have soared from $2 per dose to as high as $12 in 2007. The price has recently fallen back to about $8 as buying volumes increased in the face of H1N1. But that's still a healthy margin, as some analysts estimate it costs about $1 to make each dose.
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#17 of 36 Old 03-21-2017, 12:14 PM
 
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I don't see the issue as being whether taxes should only be spent on items we all use. The criteria should be whether something is a necessity and whether what we are funding with our tax dollars is the best option for that necessity.
Speaking globally, I am not so sure that is true.

Governments fund things that are not necessary all the time - be it because it supports a core belief or to enhance quality of life.

I had one of my three children at home with a midwife. I am glad the government of Ontario typically (not always) believes in choice - ergo my ability to choose a birth location with the type of care attendant I wanted. I am ok with taxes going for a third MMR if they can make a solid case for it, for those that choose to use it.

Is there a solid case for a third MMR? Not sure. The measles and rubella portion work well enough, but the mumps portion does not. It could be throwing good money after bad - and just delaying the problem. Instead of a bunch of 22 yr olds getting mumps, we might be seeing a bunch of 30 somethings getting mumps. If the immunity wears off, the immunity wears off. There is also no current alternative to MMR, and RD can take some time. Some might want a solution now (not I - mumps do not bother me). Even if they do make a new vaccines, there are still issues: it is new - no safety track record, are we looking at mass immunisation and boosters to get everyone the "new" vaccine? Frankly, I am a big fan of healthy children getting mild childhood diseases (it beats messing around with vaccine immunity wearing off). Alas, the government is unlikely to consider that.
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#18 of 36 Old 03-21-2017, 01:32 PM
 
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Governments fund things that are not necessary all the time - be it because it supports a core belief or to enhance quality of life.

I had one of my three children at home with a midwife. I am glad the government of Ontario typically (not always) believes in choice - ergo my ability to choose a birth location with the type of care attendant I wanted.
I disagree that your example illustrates paying for an enhancement rather than a necessity. The necessity is some provision of childbirth care; childbirth care being acute care (as opposed to the prophylactic nature - outside of epidemics - for vaccination). Homebirth with a midwife is considerably cheaper than a hospital birth with a midwife or a hospital birth with a doctor so by choosing to homebirth you saved the taxpayer's money. This is for BC but I would think the premise would be similar for ON.

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There is also no current alternative to MMR, and RD can take some time.
Previous to the MMR (and for some years concurrently) , there were monovalent vaccines for measles, mumps and rubella.

From the CDC:

Quote:
On October 21, 2009, Merck announced that 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).
From the CDC pink book

Quote:
In 1977, one dose of mumps-containing vaccine was routinely recommended for all children 12 months of age and older. In 1989, children began receiving two doses of mumps vaccine because of the implementation of a two-dose measles vaccination policy using the combined measles, mumps, and rubella (MMR) vaccine. In 2006, a two-dose mumps vaccine policy was recommended for school-aged children, students at post high school educational institutions, healthcare personnel, and international travelers.
My underline

It is interesting that only one dose was required up until they started combining the mumps vaccine with rubella and measles.

Quote:
A single dose induced an antibody response in approximately 97 percent of susceptible children and 93 percent of susceptible adults.
https://www.ncbi.nlm.nih.gov/pmc/art...01593-0001.pdf

And with the combined MMR:
Quote:
The mumps component of the MMR vaccine is about 88% (range: 66-95%) effective when a person gets two doses; one dose is about 78% (range: 49%−92%) effective.
I think there is a definite issue with combining mumps vaccine with the other live virus vaccines. Merck wouldn't have been playing with the virus load otherwise. I am making the argument that a 3rd MMR would be a waste of tax payer money; money that could be better spent elsewhere. I am not arguing against a taxpayer funded monovalent mumps vaccine and I would argue for scrapping the MMR altogether and having only monovalent vaccines. I do feel that live virus vaccines would be better given in isolation and most likely would have the added benefit of overall taxpayer savings due to less injuries etc.
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#19 of 36 Old 03-22-2017, 06:18 AM
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Has anyone ran across any studies regarding a third dose of MMR, for protection against mumps?

This matched case–control study from a measles outbreak investigation in a high school in Quebec, gave some information that I found concerning.
Particularly, under conclusions (bottom of the paper),the suggestion that earlier vaccination (12 to 13 mos as opposed to >15mos) may permanently alter the ability to respond to subsequent doses, and even adding a third or fourth dose may not provide long-lasting protection.

http://pediatrics.aappublications.or...2/5/e1126.full

The ability of vaccination to alter subsequent response to disease is something that we don't hear enough about.

I'm just skimming the paper again and wondering about the odds of maternal natural mumps exposure vs vaccinated, and how it might play into the mumps outbreaks for those who were first vaccinated at 12 months vs >15.
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I disagree that your example illustrates paying for an enhancement rather than a necessity.


I think there is a definite issue with combining mumps vaccine with the other live virus vaccines. Merck wouldn't have been playing with the virus load otherwise. I am making the argument that a 3rd MMR would be a waste of tax payer money; money that could be better spent elsewhere. I am not arguing against a taxpayer funded monovalent mumps vaccine and I would argue for scrapping the MMR altogether and having only monovalent vaccines. I do feel that live virus vaccines would be better given in isolation and most likely would have the added benefit of overall taxpayer savings due to less injuries etc.
Well, another example then:

The library I work at recently added a 3-d printer to its repertoire of goodies. That is definitely an enhancement as opposed to a necessity - and it was taxpayer funded.

Moving on....I rather like the idea of the government paying for a mumps only booster for those who want it. Mumps is the disease we are having issues with, and it might be safer. MMR is not a particularly safe vaccine, IMHO. ( and the stats on arthritis type reactions for MMR in women are down right daunting!).

I doubt the government will go for a monovalent vaccine, though - they do not like them, and worry that they decrease overall vaccine compliance. Having a monovalent available might open Pandora's box.

I think it really will come down to: is a third shot a good idea? I think they are unlikely to consider monovalent vaccines, building a new vaccine, etc, etc. I still do not overly care if they add a third shot in Canada. I do not think it is well advised: I think they are going to do it and hope for the best. Shrug. It might buy some time, but mark my words, if they add a third dose and do manage to convince huge swathes of the public to get it, we will see a decrease in mumps over the next 10 years and then a gradual increase again. I think the idea that one shot works for life, on a population basis, for any vaccine, is likely rubbish. I would care if I were American, though. The USA has this nasty habit of turning recommended vaccines into mandated vaccines, and a third MMR vaccine being on the schedule with such little evidence it works would bother me. Of course, that is the way with pertussis and flu as well...it would just be another vaccine with little science behind it that someone is insisting I get to participate in school or the workforce.
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Well, another example then:

The library I work at recently added a 3-d printer to its repertoire of goodies. That is definitely an enhancement as opposed to a necessity - and it was taxpayer funded.
kathymuggle, you don't see investing in and providing the latest technology as a necessity for either your library or the country as a whole? You'd be happy to go back to stuffing library cards into those pockets on the inside of back covers? (Yes I know the 3D printers are unrelated but many moons ago someone could have made the argument that computers and scanners were enhancements and not necessities - after all - scribbling on library cards seemed to do the job forever.)

Most likely your printer was funded through a provincial grant (taxpayer dollars) designed to stimulate interest in that technology. So apart from being ultra cool it is a teaching tool and it is important that as a country we are keeping up with the latest advances in technology. 3D Printers are being used to construct everything from prosthetic limbs to houses. I believe 3D printers are still in that "costs a king's ransom" phase so it would be prohibitive to put it in every school using taxpayer dollars. The community library is actually a better place to showcase and provide this technology because libraries are open to the general public whereas schools aren't.

So sorry, this example doesn't work either.
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Quote:
Another factor to consider is that there's no monovalent mumps vaccine, so everybody would be getting third doses of measles and rubella vaccines, as well.
Japan has a monovalent mumps vaccine. Now if an American doctor wants to order one or more, I am sure he would get some unwanted attention.

Don't believe me?

https://www.jpeds.or.jp/uploads/file...%20ENGLISH.pdf
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Quote:
Originally Posted by samaxtics View Post
kathymuggle, you don't see investing in and providing the latest technology as a necessity for either your library or the country as a whole? You'd be happy to go back to stuffing library cards into those pockets on the inside of back covers? (Yes I know the 3D printers are unrelated but many moons ago someone could have made the argument that computers and scanners were enhancements and not necessities - after all - scribbling on library cards seemed to do the job forever.)

Most likely your printer was funded through a provincial grant (taxpayer dollars) designed to stimulate interest in that technology. So apart from being ultra cool it is a teaching tool and it is important that as a country we are keeping up with the latest advances in technology. 3D Printers are being used to construct everything from prosthetic limbs to houses. I believe 3D printers are still in that "costs a king's ransom" phase so it would be prohibitive to put it in every school using taxpayer dollars. The community library is actually a better place to showcase and provide this technology because libraries are open to the general public whereas schools aren't.

So sorry, this example doesn't work either.
I think the line is wobbly. As a former librarian, I did my best to stock my little, rural library with books and technology. But there were always decisions to be made.

Here is how I usually worked out the difference between something that was a must have versus something that was optional--

1) Could the purchase be put off for some amount of time?
2) Could we find space for whatever it was?
3) Could we support the use of the gadget or resource? (This was a big problem with downloadable eBooks and audiobooks--we never had enough people volunteering or working at the library to help people figure out how to actually use the resource effectively).

It isn't a simple formula. It is almost always easy to make something sound super nifty on paper, but making it actually work in a real library ain't easy.

Same thing with delivering public health services. Suppose that someone started a program to teach parents how to feed their children a healthier diet on a small budget. You have to find a curriculum, you've got to have a space for the program, you have to have appropriate supporting resources (shopping lists, recipes, maybe even discount coupons for cooking pots) and you have to market the program and reach the target audience. And it has to be a program that actually works or the entire effort is a waste of time and money.

So, yeah, a third dose of the MMR is a big waste of money if it won't work on the target population.

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kathymuggle, you don't see investing in and providing the latest technology as a necessity for either your library or the country as a whole? You'd be happy to go back to stuffing library cards into those pockets on the inside of back covers?
It seems you and I define necessity differently.

I have no issues with the government funded 3D printer, but I am not trying to claim it is a necessity or that governments should only fund necessities.

I still maintain this example works well as an example of governments funding non-necessities.
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Has anyone ran across any studies regarding a third dose of MMR, for protection against mumps?

This matched case–control study from a measles outbreak investigation in a high school in Quebec, gave some information that I found concerning.
Particularly, under conclusions (bottom of the paper),the suggestion that earlier vaccination (12 to 13 mos as opposed to >15mos) may permanently alter the ability to respond to subsequent doses, and even adding a third or fourth dose may not provide long-lasting protection.

http://pediatrics.aappublications.or...2/5/e1126.full

The ability of vaccination to alter subsequent response to disease is something that we don't hear enough about.

I'm just skimming the paper again and wondering about the odds of maternal natural mumps exposure vs vaccinated, and how it might play into the mumps outbreaks for those who were first vaccinated at 12 months vs >15.
Thanks for posting that study Bow.

My ds was given both doses of the MMR when we lived in BC; one MMR at 12 mos and the other at 18 mos. Our neighbour's child who was the same age received the same. (Both children ended up dx'd on the spectrum.) We tested ds' titres for measles and they came back zero. Sometime later, the schedule was changed to one dose at 12 mos and the other at 4-6 years.

Quote:
The risk of measles was 2 to 4 times greater when children were first vaccinated between 12 and 14 months versus ≥15 months.14 Older age at the second dose or longer interval between doses did not influence this observation.14
my bold

So what would happen if they tested all those kids born in my ds' birth cohort? There doesn't seem to much interest for it by physicians as shown in this scenario:
Quote:
The only way to tell whether the child is a non-responder would be to draw blood for an antibody titer. The physician explained that if her son were to experience a needle-stick, the child might as well receive the vaccination.
But if 95% of the public are allegedly responding to the first dose and if everyone had a titre test that confirmed it, then what would compel those people to buy into the second dose? These doctors don't seem to want to consider that exposing someone to the risks of vaccination for no added benefit is not patient centered care. They become glorified drug reps who are looking to benefit from increased profits.

Quote:
Across the 26-year period during which Canada relied on a single dose of measles vaccine delivered at 12 months of age (1970–1996), there was strong evidence of greater protection with delivery of this dose at ≥15 months.5 The greater vulnerability of those vaccinated at 12 months was reasoned to be caused by interference from maternal antibodies, addressed through second-dose administration.9–11,21 Measles vaccine protection thereafter was considered to provide lifelong immunity.8 Increasing the age of the first dose to 15 months in a 2-dose program was therefore assumed unnecessary. Our findings challenge this assumption.
my underline

This illustrates why a one size fits policy only services the needs of the pharmaceutical companies and those aligned with them and not the patient/consumer.
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#26 of 36 Old 03-24-2017, 07:22 AM
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@samaxtics

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But if 95% of the public are allegedly responding to the first dose and if everyone had a titre test that confirmed it, then what would compel those people to buy into the second dose? These doctors don't seem to want to consider that exposing someone to the risks of vaccination for no added benefit is not patient centered care. They become glorified drug reps who are looking to benefit from increased profits.
I think it depends on when the titers are drawn. At 2nd dose (or 3rd?), you might see the initial increase but if they rapidly decline to pre 2nd dose levels, it appears the best you can hope for is avoidance during an outbreak or short term protection?

You might be interested in these too.

I need to spend a little time with the first one. Would love to hear any thoughts.

http://jamanetwork.com/journals/jama...ef-poa60088-27
Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a Postelimination Environment

Then you have to consider:

https://www.ncbi.nlm.nih.gov/pubmed/23256739
The genetic basis for interindividual immune response variation to measles vaccine: new understanding and new vaccine approaches.

https://www.ncbi.nlm.nih.gov/pubmed/26602762
Variability in Humoral Immunity to Measles Vaccine: New Developments.

So much emphasis on humoral immunity.

These decisions become almost impossible for older children or young adults with suspicion or evidence of immune dysfunction. I strongly agree that most medical professionals are useless in these discussions.






I
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An attempt to rescue the mumps (MMR) from accusations of failure. Study done in Arkansas. http://fortune.com/2017/03/23/brains...h-daily-03-23/

Quote:
But, as Majumder notes in a piece for NPR, simply having this data wasn't quite enough to suss out the outbreak's overall progression since it lacked historical context. And so the researchers used a HealthMap tool called the Digital Surveillance System to crawl through social media and news reports and then turn it into information that can be used for epidemiological studies. This same tool has previously been used to predict and map flu outbreaks based on local trends and Google searches.With this new information in hand, the team was then able to project exactly how many cases had resulted over the course of the outbreak. And, even more interestingly, the scientists were able to piece together how low the vaccination rates were in the large Arkansas counties from where the disease spread by combining surveillance data on vaccinations and mathematical models. Their conclusions? The communities where the outbreak hit particularly hard likely had two-dose mumps vaccination rates of anywhere from 70% to 89% - considerably lower than the requisite 96% immunization rate which is thought to provide herd immunity.
Mathematical models? Social media? News reports? Surveillance data?

Too many opportunities to fudge the data, methinks.

but a valiant try!

And the mention of the 96% immunization rate is also fun. Given that the vaccine has a claimed rate of 88% at best and has fallen far below that in outbreaks.

I think the significance of the Arkansas outbreak is that many of the cases were in CHILDREN. Which definitely points to vaccine failure, rather than declining immunity which COULD account for the college outbreaks.

Gotta protect Merck.
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[quote=Bow;19653442] @samaxtics


http://jamanetwork.com/journals/jama...ef-poa60088-27
Persistence of Measles Antibodies After 2 Doses of Measles Vaccine in a Postelimination Environment [QUOTE]

Quote:
Immunocompromised and other children who might not receive, or respond to, MMR were excluded from our study, and these children may form a growing and important group of susceptible individuals in the future. Attrition reduced the kindergarten group by more than half and the middle school group by almost a third. Our categorization of antibody levels is based primarily on 2 studies. We did not assess cellular-mediated responses to measles virus, and low titers are not necessarily equivalent to lack of immunity.
I was surprised that the 621 participants enrolled were down to 364 by study's end. I get that some participants leave before study's end but this seems excessive.

The median age for first dose was 16 months so not quite the schedule we followed. I am also wondering what they meant by the "other children" (that I bolded).
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#29 of 36 Old 03-29-2017, 10:05 AM
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I was surprised that the 621 participants enrolled were down to 364 by study's end. I get that some participants leave before study's end but this seems excessive
If you look under STATISTICAL AND MODELING METHODS you can see where they were anticipating a 50% attrition since it was over a 10 year period.
Table one shows who showed up over the time points for serum collection in both groups.

@Turquesa
Quote:
Do you agree with Offit that everyone should start getting three doses? Or should we be demanding a better product? Something else/other?
Would like a chance to role play with Offit regarding his more likely scenario of third MMR at 11 to 13. Maybe he has information that I haven't found yet, cause a couple of these don't have me feelin it. Of course, I would hope if I ever got that chance, he would refrain from using profanity so I wouldn't start
to

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324223/
Mumps Antibody Response in Young Adults After a Third Dose of Measles-Mumps-Rubella Vaccine

https://www.ncbi.nlm.nih.gov/pmc/art...PMC2832748/#R9
Predominant Inflammatory Cytokine Secretion Pattern in Response to Two Doses of Live Rubella Vaccine in Healthy Vaccinees

Would a younger age of administration make a difference?
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I keep saying that everyone should get titer tests for the required vaccines and prove immunity using those lab reports. The number of arguments have gone way down since I ordered them and show up with copies of the results. Some good resources that I used:

MMR Titer
Varicella Titer
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