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Separate Measles, Mumps, and Rubella Vaccine Shortage – What Can Parents Do?
One of the hallmarks of my Alternative Vaccine Schedule is to split up the MMR vaccine into separate components spread out over a few years. The reason I believe this is helpful is because MMR vaccine is a live-virus vaccine (most vaccines are killed germs or only fragments of germs). I worry about the safety of giving three live infections simultaneously. Plus, chickenpox vaccine is typically given at the same time as MMR, so that would be 4 live virus shots all at once. The reason I worry about this is that in the natural course of life, kids don’t usually catch 4 major live virus diseases of childhood all at once. Back when kids used to catch these 4 infections throughout childhood, they did so gradually, spread out over years. The immune system was able to process each infection separately, and therefore handle each infection better, with very few harmful consequences from the diseases. Since the MMR and chickenpox vaccines are live viruses, injecting them all on the same day is like exposing a child to all 4 diseases at once. That doesn’t happen in nature, and I feel it is safer to “simulate” these infections one at a time so a child can handle them better. Theoretically, giving each shot separately may allow the immune system to create better immunity to the disease.
Now, I admit that this precaution is completely theoretical. I have no research to show that giving these 4 live virus vaccines together is dangerous. In fact, in safety research virtually all kids who get them together don’t have any apparent problems at all. The problem is this: when kids DO react to the MMR or chickenpox vaccine, the reactions can be quite severe. And the reactions are similar to what a severe case of the disease itself could do (such as severe arthritis reactions – see The Vaccine Book). Fortunately, such reactions are rare. All things considered, I do feel that parents who wish to limit their child’s risk of a vaccine reaction should split the MMR and Chickenpox vaccines according to my schedule.
But right now the entire country has run out of the separate M – M – R vaccines. My office has run out as well. It looks like Measles and Rubella may become available again by the middle of 2009, but Mumps won’t be available until the end of 2009. So the question is; should parents give their babies the full MMR now, or wait until separate ones are available? And, should babies who already got ONE component of the vaccine, who are now due for another component, wait until they are available or go ahead and get the full MMR now?
I advise parents to be patient and wait it out. Fortunately, these diseases are very rare, so the likelihood of any infant or toddler catching them in the meantime is very very low. So far this year there have been 350 cases of Mumps, 131 cases of Measles, and 13 cases of Rubella in the U.S. Out of the 15 million children who are 3 years and younger in the United States the chances are very low that any one child who is waiting to complete the M, M, and R vaccines will actually catch one of these diseases.
Having said that, I also understand the importance of vaccination, and some parents will worry about leaving their toddlers susceptible to these diseases. In such cases I do think it’s fine to go ahead and get the whole MMR. Labels: Alternative Vaccine Schedule
Should Parents Continue to Give Their Infants the Pneumococcal Vaccine (Prevnar) in Light of Current Controversies Over it?
The NY Times published a very interesting article summarizing the challenges with the PC vaccine. http://www.nytimes.com/2008/10/14/health/14vacc.html?_r=1&em&oref=slogin
Since the vaccine came out in 2000/2001, the number of total cases of severe PC disease has declined dramatically (from about 100 cases for every 100,000 children under 5 years of age down to about 20 per 100,000). This occurred because the PC vaccine protected infants and children against the 7 most common PC strains. While these strains are still circulating among the general population, they are no longer causing many severe infections in young children since kids are now protected. Plus, kids aren’t spreading these strains to the elderly, another at-risk age group for severe PC disease. Almost everyone has a variety of strains of the PC bacteria living within their nose and throat. For the most part, the germs are harmless. But occasionally they invade into the body and cause severe internal infections like meningitis, pneumonia, bloodstream infections, and severe ear infections. This vaccine prevents those 7 strains from doing this anymore.
However, there are dozens of OTHER strains of PC bacteria that are not covered by the vaccine, and one particularly nasty strain is now jumping in and replacing some of the vanishing strains. It is called strain 19A. Since the PC vaccine’s use began, 19A has increased from about 3 cases per 100,000 children under 5 to about 11 cases per 100,000. Plus, some areas of the country are reporting that this strain in their area is resistant to most antibiotics (New York and Texas, for example). But in most areas, the strain is likely still susceptible to most antibiotics. Overall, the number of total cases of severe PC disease from all strains combined is much lower than it used to be.
The logical next step would be to update the current PC vaccine to include 19A and other emerging strains, and that’s exactly what vaccine makers Wyeth and Glaxo Smith Kline are doing. However, these vaccines are about 1 to 2 years away. Wyeth has developed one, but safety and efficacy approval testing is a long process. Wyeth hopes to apply to the FDA for review and approval some time next year. I don’t know how far along the GSK company is with their version.
There are now two main questions parents are asking: Should parents stop giving their kids the current PC vaccine since those strains aren’t causing as much severe disease? NO. My opinion is that since those strains ARE still around, living in older kids and adults, any unvaccinated child could catch it and come down with a severe case. I recommend that parents continue with the vaccine for now.
The other question is this: Does getting the current PC vaccine (and therefore preventing those 7 strains from living within that child) make that child more likely to have other strains of PC (namely the 19A strain) set up shop in their nose and throat and possibly cause a severe internal infection that may be antibiotic resistant? I don’t think so. Or rather, I hope not. We just don’t know yet. Someone will have to do the following research: compare the rates of severe PC disease in vaccinated versus unvaccinated kids (I think they’ll find it lower in vaxed kids). But IF the rates are higher in vaxed kids (which I don’t think they’ll find), what strains are they finding and are they antibiotic resistant? If they find that vaxed kids are catching more severe and antibiotic resistant PC diseases compared to unvaxed kids, then the current vaccine would NOT be a good idea. But I just don’t think that they will find that to be true in a research study.
I feel the benefits of the current PC vaccine are still valid and parents should continue to vaccinate with it until an updated version of the vaccine becomes available. Should parents skip the current one and wait for the new one? No – it is at least one, maybe two, years away.
Dr. BobLabels: Vaccines and their diseases
Flu Vaccine Update for the 2008/2009 Season
It’s flu season again, and people are already lining up for their flu shot. Each year, however, the flu shots change to cover what experts predict will be the “going” strains for the coming year. Last year they guessed wrong, and the flu shot wasn’t very effective. Let’s hope they get it right this year (as they did for the few years prior to last year). The available brands are virtually identical to what they were last year as far as manufacturing and ingredients go (including mercury).
The most important thing for infants, children, and pregnant women is to MAKE SURE YOU ARE GETTING A MERCURY-FREE FLU VACCINE. Here are all the flu vaccines for the 2008/2009 flu season:
FLUZONE Shot
This is the only brand approved for all age ranges, from young infants to adults. It comes in four different formulations:
Pre-filled syringe for infants 6 through 35 months – NO mercury.
Pre-filled syringe for children 3 years and older and adults – NO mercury.
Single-dose vial for children 3 years and older and adults – NO mercury.
Multi-dose vial for infants 6 months and older, children and adults – contains the full dose of mercury.
FLUZONE is the only brand of flu shot approved for young infants and toddlers. BEWARE – the multi-dose vial has the full dose of mercury. You have to make sure you are getting a single-dose pre-filled syringe or vial, NOT the multi-dose vial.
FLUMIST Nasal Spray
An alternative to the flu SHOT for young children is the FLUMIST nasal spray. There is no mercury in this formulation. It is approved for children 2 years and older and adults through age 49.
FLUVIRIN Shot
This shot is approved for children 4 years and older and adults. It comes in two formulations:
Pre-filled syringe – has a trace of mercury (see below)
Multi-dose vial – has the full dose of mercury
FLUARIX Shot
This is only for adults 18 years and older. It only comes as a pre-filled syringe with a trace amount of mercury.
FLULAVAL Shot
This is only for adults 18 years and older. It only comes as a multi-dose vial with the full dose of mercury.
AFLURIA Shot
This is only for adults 18 years and older. It has two formulations:
Pre-filled syringe with no mercury
Multi-dose vial with the full dose of mercury
Nasal Spray Versus the Shot?
Overall I have no preference between the two. The nasal spray is a great alternative for anyone who wanted the shot, but can’t find a mercury-free version. It seems that the nasal spray works a little better, but causes flu-like side effects more often. It also shouldn’t be used in anyone with asthma or a history of wheezing. The shot seems to not quite work as well, but may cause fewer side effects.
What is the Difference Between Trace and Full-Dose Mercury?
In trace mercury vaccines, mercury is added to the manufacturing process as a preservative, but is then filtered out at the end before being put into single-dose syringes or vials. A full preservative isn’t needed because this vial or syringe is only opened and used once, and then discarded. The amount of mercury in vaccines that are labeled “trace” is less than 1 microgram. I believe that this amount is completely harmless (as opposed to the full dose).
In full-dose mercury vaccines, the mercury is not filtered out. The preservative is needed for these large 10-dose vials because many doses are drawn out, and the solution needs to stay sterile during that process. The amount of mercury in these large vials is 25 micrograms per dose (any infants through age 3 getting a Fluzone shot from the multi-dose vial with mercury would only be getting a half dose, so each shot would be 12.g micrograms).
Why Not Just Make All Flu Shots Without Mercury?
The challenge is space and money. The five different companies that make the flu shot have to scramble every year to make enough. It costs more money and takes up more manufacturing time and space to put single doses of the flu shot into syringes or single-dose vials, compared to putting 10 doses into larger vials. In order to accommodate the demand, manufacturers have to make most of their product “in bulk” this way. In the future I hope that more companies will change over to mercury-free formulations, or the almost-as-good trace mercury formulations.
Infants and Pregnant Women – Just Say No To Mercury
The debate over whether or not mercury in the flu shot is enough to cause harm continues to rage on, with no clear resolution yet. I believe it is prudent in the mean time to avoid giving any full-dose mercury shots to children under 3 and to pregnant women. What should you do if all you can find is a full-dose version? Just say no, and tell your doctor why. Maybe if enough patients do this, doctors will order and demand more of the mercury-free version for next year. For kids 2 years and older, get the nasal spray instead (this can’t be given to pregnant women).
New Flu Shot Recommendations for This Year?
The ACIP, AAP and CDC have decided that it would be beneficial for all children to get a flu shot every year until age 18. Previously the recommendation was for all children until age 5. They don’t know whether or not to push this new policy for THIS year, or wait until next year, because they don’t know if there will be enough flu vaccine to go around to cover all children and teenagers. They don’t want to make a new policy unless they have enough vaccine to cover it. But whether it goes into effect this year or next, it is now believed by medical experts that it’s best to get a flu vaccine for all children and teens every year.
ALL OF THE INFORMATION IN THE VACCINE BOOK REGARDING FLU SHOTS FOR LAST YEAR IS STILL THE SAME FOR THIS YEAR (with the one exception that in the book I state that Fluvirin brand only has trace mercury, and this they also make a full-dose mercury version). FOR MORE INFORMATION ON DECIDING WHETHER OR NOT TO GET A FLU VACCINE, VISIT www.TheVaccineBook.com
YOU CAN VIEW THE PRODUCT INSERTS FOR THIS YEAR’S FLU VACCINES YOURSELF AT www.fda.gov/cber/flu/flu2008.htm
Labels: Vaccine News
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