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June 26th, 2006, 09:29 PM
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beck12 beck12 is offline
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tang17- Geesh - what is the deal with the Rubella shot????

Just so you know...a little anecdotal story ( I seem to be full of them ).

My sister tested lacking immunity to Rubella with her first pg. Right away after delivery they gave her a shot. Next pg - same thing - no immunity...again another shot.... Follow up with that Ob a year later - no immunity - told er to go to health clinic & get it again

She went to a immunologist - pushed her Dr to send her - they study immune disorders - she wanted answers as to why she didn't have immunity. THat specialist told her she didn't need more shots - that her body had it's own immunity & was killing off the live culture they were injecting. She was glad to get not get another shot - but Pi$$ed that she had done the 2 previous - each time she got flu like symptoms, ran a temp, etc & while trying to recover with a c-section. In Michigan there is a immunology clinic (where you can go for specialized vaccines) that I visited in ALma prior to travelling overseas. That Dr told me that I should get a booster for my Rubella - but it was really not necessary he said - he said I should have the immunity from my childhood records - but i too came up as not having immunity. He told me thne that it would potpone TTC & we weren't - so he said it might be a good idea & since I was traveling to a 3rd world country (Bali - which got canned anyway because we were due to leave right after Sept 11th) I got it - he said he wouldn't have recommended it if I were staying in the US...that it probably was fine & I probably did have my own immunity.

There are some risks associated with MMR - although I believe it is more mild than many...I have copied & pasted this for you...make sure to read up before you decide anything...best wishes! (I know it's a lot of info...but it's the most thorough I could find..your Dr should be able to give you more specific info about it - they usually have pamplets, etc that tell all hte possible complications & benefits, etc.)

Quote:
MMR (measles, mumps, and rubella)
[This section last updated on October 23, 1999.]

Q3c.1 What is measles, and what are the risks of the disease?

Measles is one of the most contagious infectious diseases. "A child can catch measles by breathing the air in a doctor's waiting room two hours after an infected child has left." (Fettner) 90% of susceptible household contacts get the disease (Harrison). Measles spreads very rapidly in unexposed populations. In 1951, it was introduced to Greenland by a recently arriaved visitor who went to a dance as he was coming down with it, and in three months it spread to more than 4000 cases and 72 deaths. The attack rate was 999 cases per 1000 people. In 1875, measles was introduced to Fiji and killed 30 percent of the population (Smith).

In areas where it was endemic, before the measles vaccine, measles epidemics used to occur at regular intervals of two to three years, usually in the spring, with small local outbreaks in intervening years. Mortality is low in healthy, well-nourished children unless complications ensue (Merck), but nevertheless there were 400 deaths a year before an improved measles vaccine was introduced in 1966 (Pantell, Fries, and Vickery). Complications include brain infection, pneumonia, convulsions, blindness, various bacterial infections, encephalitis, and SSPE (a fatal complication which can occur years after a person has had measles). Pregnant women who get measles have a 20% chance of miscarriage.

Worldwide, measles is one of the leading causes of childhood mortality. "Measles has been called the greatest killer of children in history." (Clements, Strassburg, Cutts, and Torel) In 1990, "45 million cases and around 1 million deaths were estimated to occur in developing countries. Thus measles is still responsible for more deaths than any other EPI target diseases. The true number dying as a result of measles may be twice the estimated 1 million if the recently documented delayed effect of the disease is taken into account." (Ibid.) Mortality is higher in developing countries due to a difference in the age at which most people catch it (measles is a more dangerous disease in the very young), poorer nutrition, less availability of treatment for bacterial chest infections, and other environmental factors. However, "Even in countries with adequate health care and healthy child populations, the complication rate can reach 10%." (Ibid.)

More information on the incidence of measles complications is found in the answer to Q3c.2.

Q3c.2 How common was measles before routine vaccination, and how common is it now?

************************************************** ***********************
From Anthony C.:

I havent finished reading this thread so pardon if someone else has
already posted this information

Rates of complications of measles and measles immunization
Measles per 10^5 Vaccine per 10^5
Encephalomylelitis 50-400 .1
sspe .5-2.0 .05-.1
Pneumonia 3800-1000
Seizures 500-1000 .02-19
Deaths 10-10000 .01

These statistics are worldwide, hence the variablility in numbers. The
higher rates of pneumonia and death represent figures collected from
India, Nambia, Nigeria, bangladesh and other countries with developing
health care industries.

As far as the number of people afflicted with measles in the US
Cases Deaths
1963 385,566 364 Inactivated measles type vaccine available
1964 458,093 421
1966 204,136 261 public health administration of vaccine
1967 62,705 81
1968 22,231 24
.
.hovers around 20-70,000
.
1977 57,345 15
1978 26,871 11
1979 13,597 6
1980 13,506 11
1981 3,032 2
1982 1,697 2
1983 1,497 4
1984 2,587 1
1985 2,822 4
1986 6,273 2
1987 3,588 2
1988 2,933 not available
1989 16,236 41
1990 26,520 97

iMajor foci of retransmission barring the complete elimination of measles:
1) unimmunized indigent, inner city youngsters.
2) illegal aliens.

I hope this is useful. My source is Zinsser microbiology, 20th edition
pages 1013-1015, joklik et al.
************************************************** ***********************

As the above table shows, there was a marked increase in measles incidence in the US from 1989 to 1991. This resulted in more than 50,000 cases including 125 deaths (http://www.immunize.org/nslt.d/n21/paradx21.htm). Measles has been on the decline again in the US since 1990 (MMWR Feb 4, 1994, p. 57). Colleges enforcing the requirement for a second measles vaccine report fewer measles outbreaks than schools with no requirement (JAMA, Oct 12, 1994, p. 1127). (Both of these citations from Journal Watch for Jan 15, 1995 - paper edition, or Feb 7, 1995 - electronic edition.) During 1998, a provisional total of 100 measles cases was reported to the CDC, making for a record low, 28% lower than the 138 cases reported in 1997 (MMWR 48(34);749-753, 1999. Centers for Disease Control).

Q3c.3 How effective is the measles vaccine?

The Merck Manual and the Physician's Desk Reference estimate its effectiveness at 95%. This estimate is based on studies of the immunity induced by a series of vaccinations beginning at 15 months. Another article, estimating the immunity induced in field conditions (including some Third World countries, which may have less reliable vaccine storage) by a series of injections beginning at 9 months (the injections are started earlier in areas where measles is widespread), estimated effectiveness as 85% (Clements, Strassburg, Cutts, and Torel).

A recent article in Pediatric News (Imperio. Vaccine-Exempt At Higher Risk For Measles. Pediatric News 33(9):9, 1999.) reported that "Individuals aged 5-19 years who were not vaccinated due to religious or philosophical exemptions were, on average, 35 times more likely than vaccinated individuals to contract measles, according to a population-based, retrospective cohort study."

Q3c.4 How long does the measles vaccine last?

The Merck Manual describes it as "durable." The PDR says that all of the antibody levels induced by MMR have been shown to last up to 11 years without substantial decline, and "continued surveillance will be necessary to determine further duration of antibody persistance."

Q3c.5 What are some of the risks of the measles vaccine?

There is a small chance of complications similar to the complications of measles (pneumonia, encephalitis, SSPE). Information on the frequency of these complications is included in the answer to Q3c.2. There is some risk of anaphylaxis. This risk is low; from the time that VAERS was instituted in 1990 till the publication of Update: Vaccine Side Effects, Adverse Reactions, Contraindications, and Precautions by ACIP in 1996, >70 million doses of MMR vaccine had been distributed in the US, and only 33 cases of anaphylactic reactions had been reported to VAERS. It has been traditionally believed that this risk is mainly for people allergic to eggs or neomycin. However, recent studies indicate that anaphylactic reactions are not associated with egg allergies, but with some other component of the vaccine. There have been some case reports, in the US and Japan, of anaphylactic reactions to the MMR vaccine in people with an anaphylactic sensitivity to gelatin.

In rare instances, MMR vaccine can cause clinically apparent thrombocytopenia within 2 months after vaccination. Passive surveillance systems report an incidence of 1 case per 100,000 doses in Canada and France, and 1 per million in the US. Prospective studies have reported a range from 1 in 30,000 in Finland and Great Britain to 1 in 40,000 in the US, with a clustering of cases about 2-3 weeks after vaccination.

An article in the Feb 28, 1998 Lancet (based on 12 cases) about a possible association between inflammatory bowel disease, autism, and MMR vaccine (Wakefield et al) raised concerns that the vaccine might increase the risk of autism. Wakefield and his colleagues did not claim to have actually shown that the vaccine caused autism, but rather called for further investigation of the question. An accompanying editorial in the same issue of Lancet expressed concerns about the validity of the study.

The article, and the public concern it raised, led to several further investigations of whether such an association existed. A research letter in the May 2, 1998 issue of Lancet reported on a 14-year prospective study, in Finland, of children who had experienced gastrointestinal symptoms after receiving the MMR vaccine. 31 children (out of 3 million vaccine doses) reported gastrointestinal symptoms; all recovered, and none developed autism. A Working Party on MMR Vaccine of the United Kingdom’s Committee on Safety of Medicines (1999) examined hundreds of reports, collected by lawyers, of autism or Crohn's disease (a gastrointestinal disease) and similar problems, after the MMR vaccine, and concluded that there was no causal relationship. A Swedish study (Gillberg and Heijbel 1998) found no difference in the prevalence of autism in children born before the introduction of MMR vaccine in Sweden, and children born after. Wakefield and colleagues did laboratory assays in patients with inflammatory bowel disease (the mechanism which they had proposed for autism following the MMR vaccine), and found them negative for measles virus (Chadwick 1998, Duclos 1998, cited by the CDC at http://www.cdc.gov/nip/vacsafe/vaccinesafe...cts/autism.htm).

Finally, a study in the June 12, 1999 issue of Lancet examined children born with autism since 1979 in eight North Thames health districts, to look for changes in incidence or age at diagnosis since the introduction of MMR vaccination in the UK in 1988. The study found a steady increase in cases of autism, with no sudden change in the trend after the introduction of the MMR vaccine. Parents most frequently reported first noticing symptoms of autism at around the age of 18 months, after the MMR vaccine would have been received, but there was no difference in age at diagnosis between those vaccinated before and after 18 months and those never vaccinated. Developmental regression (which occurred in about a third of the cases of autism) was not clustered in the months after vaccination.

Q3c.6 What is mumps, and what are the risks of the disease?

Mumps is a viral disease which is less contagious than measles or chicken pox. It causes swollen salivary glands. The most common complication is swelling of the testes (in about 20 percent of males post puberty) and, less commonly, ovaries. Rarely, it can lead to sterility. Other complications are meningitis (less common than in measles) and acute pancreatitits. (A much longer list of complications can be found in the Merck Manual.)

Q3c.7 How common was mumps before routine vaccination, and how common is it now?

105,00 cases were reported in 1970; by 1990 the rate of reported cases was down to 5,300.

Q3c.8 How effective is the mumps vaccine?

The Merck Manual estimates its effectiveness at 95%. The Physician's Desk Reference gives its effectiveness as 96%. Switzerland has gotten lower efficacy rates, for mumps, out of its strain of the MMR vaccine, and Swiss scientists have been comparing the efficacy of different strains to improve this situation (Swiss Medical Weekly, http://www.smw.ch/archive/1997/127-26-360-96.html and http://www.smw.ch/archive/1998/128-17-351-98.html).

Q3c.9 How long does the mumps vaccine last?

The Merck Manual describes it as "durable." "Mumps immunization provides protection through the blood serum antibodies for at least 12 years, and possibly much longer." (Pantell, Fries, and Vickery) (See also Q3c.4 for the PDR's description of the duration of all the MMR-induced antibodies.)

Q3c.10 What are some of the risks of the mumps vaccine?

"Rarely, side effects of mumps vaccination have been reported, including encephalitis, seizures, nerve deafness, parotits, purpura, rash, and prurittis." (Merck. Encephalitis and convulsions were also on Merck's list of complications for mumps itself.) According to ACIP's 1996 report on vaccine adverse reactions, "Aseptic meningitis has been epidemiologically associated with receipt of the vaccine containing the Urabe strain of mumps virus, but not with the vaccine containing the Jeryl Lynn strain, the latter of which is used in vaccine distributed in the United States." [MMWR 45(No. RR-12), 1996]

Q3c.11 What is rubella, and what are the risks of the disease?

Rubella is a mild illness, consisting of a mild fever and rash. Rare complications include ear infections and encephalitis, but the real danger is to pregnant women. During the last rubella epidemic, in 1964, 20,000 children were born with birth defects caused by rubella. Birth defects include deafness, cataracts, microcephaly, and mental retardation. Children born with congenital rubella are als susceptible to rubella panencephalitis in their early teens.

Q3c.12 How common was rubella before routine vaccination, and how common is it now?

Before the development of the rubella vaccine, epidemics used to occur at irregular intervals in the spring, with major epidemics at 6 to 9 year intervals. (This means that one was just about due when the vaccine came out in 1969.) There have been no major epidemics since 1969, but the number of cases of rubella and congenital rubella syndrome increased starting in 1989 (Merck, also California Morbidity for November 19, 1993). (It was still a small fraction of the pre-vaccine number, though, see table of disease frequencies in section 1.) "Serological surveys conducted in the late 1970s and the 1980s indicated that 10 to 25 percent of United States women of child-bearing age were shown to be susceptible to rubella." (California Morbidity, November 19, 1993) It now appears to be declining again: "Following a resurgence of rubella and congenital rubella syndrome (CRS) during 1989-1991, the reported number of rubella cases during 1992 and 1993 was the lowest ever recorded." (MMWR, cited in June 9, 1994 HICNet Medical News Digest.)

Q3c.13 How effective is the rubella vaccine?

The Merck Manual estimates its effectiveness at 95%. The Physician's Desk Reference gives its effectiveness as 99%.

Q3c.14 How long does the rubella vaccine last?

The Merck Manual describes it as "sustained." (See also Q3c.4 for the PDR's description of the duration of all the MMR-induced antibodies.)

Another reference, from Heather Madrone:

************************************************** ***********************
D. M. Horstmann "Controlling Rubella: Problems and Perspectives"
_Annals of Internal Medicine_, vol. 83, no. 3, pg. 412

Horstmann found reduced antibody formation 3-5 years after administering
the vaccine and 25% of those tested showed no immunity to rubella at
all.
************************************************** ***********************

Q3c.15 What are the pros and cons of vaccinating all infants for rubella versus vaccinating females only at puberty?

There is still some uncertainty about the most desirable rubella vaccination policy. In 1969, when the vaccine came out, it was decided to avert the expected epidemic by vaccinating all children over one year, so that they would not spread rubella to their possible pregnant mothers - the first time one group of people was vaccinated to avoid having them spread a disease to a different group of people. Supporters of this policy point out that the expected epidemic didn't occur. The possible disadvantage is that we aren't sure how long the immunity lasts. Now that generation of children is old enough to have children, and some of them may no longer be immune. In the past, 80% of the population was immune due to having had rubella in childhood.

Some countries follow a policy of vaccinating girls at puberty if they don't have rubella antibodies (Pantell, Fries, and Vickery). The disadvantage is that vaccine side effects are more common at this age. The most common is joint pain, which occurs in 10% of women who are vaccinated in adolescence or later. In some cases, it has lasted as long as 24 months. (Pantell, Fries, and Vickery) The PDR describes this same side effect in somewhat milder terms, saying that it generally does not last very long and "Even in older women (35-45 years), these reactions are generally well tolerated and rarely interfere with normal activities." It does agree with Pantell, Fries, and Vickery that the incidence of this side effect increases with age: 0-3% of children and 12-20% of women have joint pain, and the pain is more marked and of longer duration in the adult women. A few women (between 1 in 500 and 1 in 10,000) experience peripheral neuropathy (tingling hands). Another risk of vaccinating later is the risk that a woman may be pregnant. So far, no connection with birth defects has been demonstrated, but women are advised to avoid pregnancy for three months after getting the vaccination.

Current US policy is to vaccinate all children at 15 months, and give a booster during school years. Adult women are advised to get an antibody test before becoming pregnant, and, if it comes up negative, get vaccinated and wait three months before getting pregnant.

There has not been a rubella epidemic since 1964, either in countries which vaccinate all children at 15 months, or in countries which vaccinate girls only at puberty.

Q3c.16 What are some of the risks of the rubella vaccine?

The PDR has a long list of possible adverse reactions (besides arthritis and arthralgia, usually short-lived, see above). Most of them are either mild or rare.

Q3c.17 When is the MMR vaccine contraindicated?

People with an anaphylactic or anaphylactoid allergy to eggs or neomycin should not get the vaccine. Other allergies or chicken or feather allergies are not a contraindication. Vaccination should be deferred in case of fever. The PDR give active untreated tuberculosis as a contraindication, but the AHFS says that there is no evidence of a need to worry about TB. Both give immune deficiency as a contraindication (see PDR for a long list of immune deficiencies involved). Immune globulin preparation or blood/blood product received in the preceding 3 months. The same contraindications apply individually to measles and mumps vaccines, but the rubella vaccine can be given by itself to people with an anaphylactic egg allergy. The other contraindications still apply to the rubella vaccine alone. (California Morbidity, October 31, 1987)

Vaccine components capable of causing adverse reactions: for mumps and measles, chick fibroblast components; for mump, measles, and rubella, neomycin (Travel Medicine Advisor).[/b]
__________________
B - Crazy momma to my two boys
We've begun to raise daughters more like sons... but few have the courage to raise our sons more like our daughters. ~Gloria Steinem

If a man has been his mother's undisputed darling he retains throughout life the triumphant feeling, the confidence in success, which not seldom brings actual success along with it. ~Sigmund Freud
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