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Separate Measles, Mumps, and Rubella Vaccines No Longer Available? What Can Parents Do?
One of the most challenging and controversial parts of the alternative vaccine schedule is splitting up the MMR into three separate shots, spread out over a few years. The reasoning behind this idea is to expose a child to only one live viral vaccine at a time to allow the child’s immune system to better handle each vaccine and possibly experience fewer side effects. Although there is no medical evidence that this precaution is necessary or even useful, some parents, long before my book came out, have been skipping the MMR over fear of side effects. Some of these parents are more open to getting the separated vaccines. I present this option as a way to allow such families to vaccinate for these diseases. I don’t claim that it is the best way to go. I simply acknowledge it as an option.
Now, however, it seems that this option has been taken away from these families. The official word on Merck’s website is that these vaccines are not available for order. I’ve called Merck to ask if they are planning to start making more, but I can’t get anyone from the company to call me back. I have heard from numerous people and some news reports that Merck isn’t currently making the vaccine. I haven’t heard that they’ve decided to stop permanently, just that they aren’t producing any at this time. So, it’s pretty clear that, at least for the time being, there is no more to be had. It is probably safe to say that there won’t be any more for at least 6 months to 1 year. It is also possible that they won’t ever make the separate vaccines again.
This puts many parents in a difficult position. Some children have already received part of the series and are now left without a way to finish it without getting the entire MMR (and thus accepting extra doses of some components). Part of me wonders if Merck has stopped production as a way to force parents into an all-or-nothing decision. The AAP and CDC continue to insist on a “one size fits all” approach to vaccinating, without offering any suggested alternatives. Is this their way of forcing parents into the full MMR? I don’t know. The official word from Merck is that they need to devote all of the manufacturing capabilities to the full MMR and Chickenpox. They also state that the demand for the separate vaccines is so low that it doesn’t justify its production. One news story stated that the separate components only make up about 2% of the total MMR demand. Well, with 5 million babies being born each year in the U.S., that could be as many as 100,000 families searching for the separate vaccines each year. That would be a lot of unvaccinated children if these parents refused the full MMR.
One issue that I don’t understand is that the separate rubella vaccine is routinely used for adult women after they have a baby. Any new mom who doesn’t have rubella immunity is given the vaccine. If Merck stops making it, such women will have to get the full MMR, even if they still have good measles and mumps immunity.
The separate mumps vaccine also has its usefulness. During the outbreak of 2005/2006, many teens and adults needed a mumps booster to help contain the disease. If separate mumps vaccine isn’t made available for such events, the full MMR will have to be used. The same would be true if a measles epidemic occurs.
So, what can parents do? Parents hate to give their children an extra dose of a vaccine if it isn’t needed. You’ve gone to all the trouble to try to split it up, and now you are faced with having to give it all together anyway. I know it’s frustrating. One note of encouragement is that there is no known harm in getting an extra dose, other than the fact that you are taking the small risk of a side effect an extra time and the frustration of knowing the separate shot you gave earlier was all for naught. If a child already has some immunity to one of the diseases from a previous vaccine, I’ve never seen any research that shows a child is any more likely to react to a second dose compared to anyone just getting their first dose. I’ve seen no evidence that getting an extra dose is dangerous. I know it’s very small consolation, but I just mention this so that parents aren’t afraid to get any extra components of the MMR if they decide to.
Part of me wants to rally the nation’s parents in a campaign to insist that Merck begin making the shots again. Write your Senators, email Merck (politely!), refuse to get the full MMR! But that just isn’t responsible. Skipping the shots altogether leaves children at risk, the riskiest disease being measles. Of course, parents do have the option to skip the vaccine altogether. Even in states with mandatory vaccines laws, parents can still exercise a religious exemption (except for West Virginia and Mississippi).
But for those of you (which is most of you) who do want MMR protection, I will offer you some choices. There isn’t one right choice here. When it comes to MMR there is so much controversy that I don’t believe there is one clear option. So, I will lay out all the choices so you can think it through. Most people who are very pro-vaccine feel my MMR recommendations should more closely reflect the standard American vaccine schedule. Now that the separate M-M-R vaccines are no longer available, most such vaccine advocates are hoping that I will now begin recommending the MMR at the standard ages of 1 and 5 years. To these people I would like to point out that I don’t make absolute recommendations. I present options. That’s what I’m going to do here.
Here are all the options, depending on whether or not your child has received some of the separate components:
CHILDREN WHO HAVE NEVER HAD ANY MMR COMPONENTS
- Parents who feel confident in the safety of the MMR vaccine should go ahead and vaccinate at the recommended age of 1 and 5 years.
- Parents who were planning to do it separately because they have some worry about side effects should wait until a later age to get the full MMR. I suggest waiting until a child is either 4 years of age or enters school, whichever comes first. The reason for the 4-year recommendation is two-fold: 1. Many kids don’t enter school until age 4, so their risk of catching measles, mumps, or rubella is very low, and the risk that they would expose other kids if they got sick is very low, and 2. Most states only require one dose of mumps and rubella if that one dose is given at age 4 or older, because the vaccine works much better for older kids like this. Some states do require a second dose of measles, however. See the State Requirements section below.
- Parents who don’t feel comfortable leaving their children susceptible to these three diseases until age four, but want to delay it for at least a little while, can get the MMR at whatever age you feel most comfortable. If your toddler or young child is entering early preschool at age 2 or 3, you may want him to have the disease protection. If you get the MMR before age 4, your child would need a second dose around age 5 according to the regular vaccine schedule. This second dose is given because a small percentage of kids lose their immunity from the first dose and need a booster. From a health care cost perspective, it isn’t economical to test every child’s blood at age 5 to see which kids need a booster, then only give those kids a booster. So, the routine practice is to just give the two doses to everybody. If you don’t want to simply follow this routine 2-dose schedule, and instead want to try to get by with just one dose, you can do the one dose at any age, then get a blood test around age 5 to check immunity, then repeat the MMR if needed.
- When you do get the MMR, I would suggest getting it alone, without any other shots. You can pick any time in the vaccine schedule to do it. There is no exact time that I would place it into my Alternative Vaccine Schedule. It’s an individual choice for each parent. If you get the shot at 1, 2, or 3 years of age, you can then either get the booster at 5, or do blood testing to confirm immunity and skip the booster if your child is still immune to all 3 diseases. There is also the possibility that in a few years we will have separate M, M, R component vaccines again, and you can give a booster shot for only those diseases your child needs a booster for, based on the blood immunity results. If the separate shots are not available, and 1 or 2 parts of the first shot (but not all three) have worn off, it’s okay to get the full MMR again. Or, you could just leave your child susceptible to a disease. The choice is yours.
The risk of skipping or delaying the MMR
Although these diseases are rare, outbreaks can occur. I encourage you to re-read the MMR chapter to refresh your memory on these diseases. The riskiest disease is probably measles. While most kids weather the disease without problems, occasional complications do occur. The risk of suffering a fatality from measles is about 1 in 1000 to 1 in 3000 cases. The risk of suffering a non-fatal complication that requires hospitalization (such as pneumonia, dehydration, and a variety of others) is unclear, but is probably 1 in 100 to 1 in 300 cases. Many years have gone by in the U.S. without a measles fatality. I pray it stays that way.
CHILDREN WHO HAVE ALREADY HAD ONE DOSE OF ALL THREE MMR COMPONENTS EITHER SEPARATELY OR TOGETHER
This decision is easy. Either get the 5 year booster of MMR, or do a blood test around age 5 to check immunity and don’t get any more MMR if immune to all three diseases. If your child is only immune to 1 or 2 diseases, but not all, it’s OK to get a full MMR. Or you can wait for the separate vaccines to come out again.
CHILDREN WHO HAVE ALREADY HAD 1 OR 2 COMPONENTS OF THE SEPARATED MMR VACCINES
Those of you who have already begun the process of separated MMR vaccines, you probably did so with two things in mind: You at least had some concern about MMR safety, and you felt comfortable to some degree with leaving your child susceptible to some of these diseases during the early years until all three doses were given. But now what do you do?
- If your child has already received 1 dose of rubella (but no mumps or measles yet), you either have to get the full MMR now or wait until 4 years of age and get it then. It all depends on how comfortable you are with leaving your child susceptible to mumps and measles. You can review the book information on mumps and measles to refresh your memory. Leaving a child open to measles is probably the riskiest of the three diseases. If you get the MMR at 4, you can verify mumps and measles immunity with a blood test about 6 to 12 months later if your state requires it, since your child only received one dose. If your state doesn’t require it, I wouldn’t bother with an immunity check since most kids get full immunity after just one dose given this late. See State Requirements below.
- If your child has already received 1 dose of mumps (but no rubella or measles), the same information applies as the previous paragraph. Rubella is extremely rare, and harmless to young children. Review the disease information in the book to remind yourself of the risk to pregnant women.
- If your child has received 1 dose of measles, but not mumps or rubella, then I suggest you wait until age 4 to do the full MMR. That will give your child the required 1 dose of mumps and rubella, and 2 doses of measles. I wouldn’t bother checking blood immunity levels in this instance – you are pretty well covered. Since rubella is harmless to young children, and mumps is virtually always harmless, it is generally safe to remain susceptible to these until 4, especially if not in school yet. However, you should fully inform yourself about the personal and public health risks of delaying these shots by reviewing those pages in the book.
- If your child has received 2 out of the 3 components already, it is not worth getting a full MMR prior to age four just to get protection from the third disease now, only to have to get another booster dose at age 5. Just wait until age 4 or 5 to get the full MMR, as long as you feel comfortable with the disease risk for a couple years for whichever vaccine hasn’t been given yet. See State Requirements below if you worry that your state laws may require you to get the shot sooner. If the third disease that you haven’t gotten the shot for yet is measles, I would just wait until 4 to get the full MMR dose.
- Technically you can get the full MMR as close as only 1 month after any doses of the separate vaccines. However, as a precaution I would suggest putting at least a few months between them if you move on to the full MMR
MEETING STATE REQUIREMENTS
If you live in one of the 20 free states (these are listed on page 218 of the book) that allows parents to skip a vaccine for personal beliefs, and you chose to skip the MMR during infancy, I would suggest getting the MMR around age 4 or 5 when your child is going to have more exposure to other children and the general public. I wouldn’t bother with immunity blood testing – this one shot works very well in virtually all kids who get it late. If you want to skip the shot until the pre-teen years, it may be useful to check blood immunity around age 10 prior to the shot, since by that time your child will have been around many kids for many years and might have acquired some natural immunity. If your child does not have immunity to one or more diseases, you can either get the full MMR or separate components if they are available at that time.
If you live in one of the 30 states that have mandatory vaccine laws, and you don’t want to claim religious exemption, realize that this doesn’t mean you absolutely have to get the MMR at age 1 and 5 years. You only have to meet the state requirements by the time a daycare, preschool, or kindergarten is going to enforce it. So, this means that if you are worried about the MMR, you can delay it for a year or two (or more) until your child enters school. Most states only require one dose of mumps and rubella if given at age 4 or older (since getting the shot at this later age works much better). Most states, however, will require either 2 measles vaccines, or a blood test to verify immunity from just the one dose. I suggest getting a blood test 6 to 12 months after the shot to prove this immunity. If not immune to measles, a second dose may be required by your state. This may mean another full MMR if the separate shots aren’t being made yet. If you do need (or want) to get the full MMR at an earlier age (between age 1 and 3 years), I suggest you do it alone, without any other shots.
SUMMARY
In the vaccine book I clearly state that vaccines are important, and that I believe the benefits outweigh the risks. Each vaccine can have a serious side effect, but in most cases this is rare. The MMR, however, is unique in that it is a triple live virus vaccine, and therefore has a more extensive list of possible reactions. These reactions mimic what the actual disease complications can be. Some of these reactions are very serious. Yes, the serious reactions are extremely rare, but it is a risk nonetheless. However, vaccinating for the MMR diseases is also a very important individual and public health concern. Measles will continue to increase if parents don’t vaccinate. Rubella may come back. The more people that don’t vaccinate, the more likely this is to happen.
I have presented the options here. It’s not based on what the right or wrong decision is. It all comes down to what you as a parent and individual believe about the safety of the MMR and the risks of the three diseases. Remember, my alternative vaccine schedule isn’t a reflection of what I believe all parents should do. It is a suggestion for parents who are more worried about vaccines than the average person, and want to vaccinate their child more carefully. Splitting the MMR was part of that approach, but now it’s not an option for the foreseeable future. If I was to have written my alternative vaccine schedule without the separate vaccines, it would probably look something like this: MMR at age one and five, with an asterisk that says if you are worried about a reaction to the MMR, wait until age 4 to get the first (and only) dose, or get it sooner if your child will be entering early preschool (and possibly need a booster dose around age 5 or 6).
LOOKING INTO THE FUTURE – WILL WE HAVE SEPARATED DOSES AGAIN?
I think that one of two things are going to happen:
1. Many angry parents are going to delay or skip the MMR vaccine (either out of protest against Merck or out of worry over side effects), and once the government notices this (as measles increases or reports on non-compliance grow) they will ask Merck to begin producing the separate doses again. Post-partum moms who need a Rubella shot, but refuse the full MMR, may add to this campaign. When outbreaks of measles and mumps do occur (and they will!), and the parents of any unvaccinated children refuse the full MMR (but make it known they would happily accept the single component vaccines), the government might take notice.
OR
2. Only a small minority will skip the full MMR. Most parents who wanted the separate shots will go ahead with the MMR at the recommended age of 1 year, and enough children will be vaccinated so we don’t see any appreciable rise in measles, mumps and rubella. Merck won’t begin making the separate shots again.
Labels: Vaccine News
Four Swine Flu Vaccines Approved by FDA
The FDA just approved four versions of the pandemic H1N1 (or “swine” flu) vaccine. Expected to become available as early as the first week of October, here is the run down on each of these four vaccines:
Sanofi Pasteur’s injected vaccine: Approved for ALL age groups (infants 6 months of age through adulthood and the elderly). It comes in several forms:- Prefilled single ½ dose syringe with NO mercury – for infants 6 thru 35 months of age. Prefilled single full dose syringe with NO mercury – for anyone 3 years and older.
- Single-dose (full-dose) vial with NO mercury – for anyone 3 years and older.
- Multidose bottle (contains ten full doses or twenty ½ doses) WITH 25 mcg of mercury per full dose – for anyone 6 months and older (infants 6 to 35 months would get a half dose (0.25 ml), 3 years and older would get the full 0.5 ml dose).
Other ingredients include: the viral proteins, egg proteins, gelatin, formaldehyde, polyethylene glycol p-isooctyphenyl ether, sucrose.
CSL’s injected vaccine: Approved for anyone 18 years and older. It comes in two forms: - Prefilled single-dose syringe with NO mercury.
- Multidose bottle with ten doses WITH 24.5 mcg of mercury per dose.
Other ingredients include: the viral proteins, sodium chloride, sodium phosphate, potassium phosphate, calcium, taurodeoxycholate, egg protein, 2 antibiotics, and beta-propiolactone.
Novartis’s injected vaccine: Approved for anyone 4 years and older. It comes in two forms: - Prefilled single-dose syringes with a trace amount of mercury (less than 1 mcg because 99% of it is filtered out).
- Multidose bottle with ten doses WITH 25 mcg of mercury per dose.
Other ingredients include: the viral proteins, sodium chloride, phosphate, egg proteins, two antibiotics, betapropiolactone, nonylphenol ethoxylate.
MedImmune’s live virus nasal spray vaccine: Approved for anyone 2 years through 49 years of age. There is no mercury.
Other ingredients include: the live viruses, egg protein, MSG, pig gelatin, arginine, sucrose, potassium phosphate, an antibiotic,
How are these vaccines manufactured?
Here is the interesting part. Everyone has been worrying and theorizing about how these BRAND NEW vaccines are going to be made and what new and dangerous ingredients they might contain. Well, what has ended up happening is that these four companies have made their “swine” flu vaccines using the exact same process and ingredients that they’ve used for their regular flu vaccines. All they’ve changed is the strain of the flu germs that go into the vaccine. Not to say that these vaccines are completely chemical free and 100% safe. But we aren’t dealing with brand new flu vaccines here. We are dealing with the same thing we face with flu shots every year: same chemical ingredients, new flu vaccine strains. You can find out more details on how regular flu shots are made in the flu chapter of the vaccine book, and apply that same process to the “swine” flu vaccines. - Sanofi Pasteur’s pandemic H1N1 vaccine is analogous to their regular flu vaccine Fluzone, a brand that has been in use for several years.
- CSL’s pandemic H1N1 vaccine is analogous to their regular flu vaccine Afluria, a newer player in the flu vaccine market that was first made last year for the 2008/2009 flu season.
- Novartis’s pandemic H1N1 vaccine is analogous to their regular flu vaccine Fluvirin, which has been around for a few years (previously made by Chiron).
- MedImmune’s live nasal spray pandemic H1N1 vaccine is analogous to their regular nasal spray Flumist.
Which one do I recommend?
At this time I have absolutely no preference whatsoever.
How many doses are needed?
All infants and children from 6 months through 9 years of age are supposed to get two doses of this vaccine, one month apart (no matter what brand you are using, and you probably shouldn’t switch brands between the two doses). This is needed to generate an adequate immune response. Anyone who is 10 years and older only needs ONE dose.
Can doses be given along with other vaccines?
The product inserts make it very clear that no testing has yet been done on these versions of the flu vaccine to determine if they can be given along with other vaccines. The government is operating under the assumption that these vaccines should behave the same way as their regular seasonal flu vaccine counterparts. So, the unofficial word is that you can give them with any vaccines, or apart from any other vaccines in any time intervals you want.
Technically you can get them together (both flu shots together) or with any other vaccine. But my advice? Get them alone, as far apart as you can from another flu shot or any other shots. More on this below.
What safety and efficacy testing has been done on these vaccines?
Here is where we are flying by the seat of our pants, so to speak. The product inserts make it VERY clear that the “swine” flu versions of these vaccines have NOT undergone any testing to demonstrate whether or not they are safe and whether or not they even work. They are relying on the fact that they are so similar to the regular flu shots that they should work just as well.
Although I don’t like that approach, I must admit that they may be right. I don’t see any reason to doubt that our immune systems won’t respond to this vaccine the same way they respond to regular flu shots. And I don’t expect that the side effects would be any different either. In The Vaccine Book, I give a lot of detail about flu vaccine ingredients and side effects that you should be aware of before getting this shot.
I’ve heard that the last swine flu vaccine caused a really bad reaction called GBS? What about THIS swine flu vaccine?
Every product insert for this new vaccine discusses this issue from 1976 in which the old swine flu vaccine caused a higher rate of GBS (weakness and paralysis reaction) than expected, so they stopped using it. That was a completely different strain of the swine flu than what we have today. Plus, that vaccine was made much differently than how they are made today. So, I see no correlation between the risk of GBS from that old vaccine and the current one.
Having said that, everyone needs to be aware that ANY flu vaccine poses a very small risk of a GBS reaction. Although I don’t think this new vaccine has an increased risk, what I DO worry about is that infants will be getting FOUR (count them, FOUR) flu vaccines this year – two doses of the regular one, and two doses of the swine flu vaccine. That’s unprecedented. We’ve never given anyone four doses of a flu vaccine in one year. There is no way to predict what the side effects might be.
What about pregnant and/or nursing mothers?
This is a little scary. The flu shots are ALREADY recommended for pregnant and nursing moms, BUT (and this is a really huge but) the vaccine product inserts make it very clear that the regular flu vaccines have never been tested on pregnant or nursing women to determine if there is any harm to fetuses or young babies (with one exception – the Flumist nasal spray brand did have some testing in this area, BUT not enough, as is stated in the product insert).
Despite this complete lack of research, it is recommended for these moms anyway. Anyone see a problem with that?
If you do get a flu shot, at least make sure it is mercury free (or at least only TRACE mercury).
What should I get first, regular or swine flu shots, and how do I space them out?
My basic advice for anyone is to only get one flu shot at a time, spaced out one month apart. So, it would take 3 months to work in all four doses (2 regular flu and 2 swine flu). I have no preference on how you go about doing this. Do get 2 regular, THEN two swine? Or the other way around? Or do you alternate between the two? Take your pick.
The seasonal flu causes about 20 infant and 100 total pediatric deaths each year in the U.S. The swine flu has so far caused 112 pediatric deaths. So, that’s about the same as the regular flu. From April through the end of July, there were about 43,000 confirmed swine flu cases, with 5000 hospitalizations and about 300 deaths in all ages according to the CDC website. More deaths have occurred since then. This is no different from the regular flu. They’ve stopped officially counting the number of cases because it’s now too widespread to keep track of. But the bottom line is that the swine flu is about the same level of seriousness as the regular flu. So, take your pick which to do first. You may want to start with the regular flu shot since it’s available right now.
What about other routine childhood vaccines that are also needed during this time?
I would advise parents to delay any vaccines for diseases that don’t pose an immediate danger to a baby’s or child’s life and catch up on those vaccines in Feb or March, a couple months after finishing the flu vaccines. Diseases that aren’t usually life-threatening (keeping in mind that ANY disease can be fatal, but the following are less likely to be) include measles, mumps, rubella, chickenpox, and Hep A. Diseases that don’t exist in the U.S. or that don’t occur during infancy in the U.S. (so even though they can be very severe, a child has almost no risk of catching it in the U.S.) that could be safely delayed are polio, Hep B, tetanus, and diphtheria (although to get a pertussis vaccine, tetanus and diphtheria have to come along with it).
Diseases that DO pose an immediate danger to babies and children are HIB and PC meningitis, Rotavitus, and Pertussis. So, I would rather children stay on time with those four vaccines and delay the flu shots (if you feel comfortable delaying flu shots).
If you want to make sure your child has flu coverage and stays up to date on these other shots, you can stagger them by two weeks. For teens, I would follow the same guidelines – don’t get flu shot around any of the other routine teen shots like HPV, meningococcal, or Tdap. The only disease here that would be more severe than flu would be meningococcal, so that’s more of a priority.
Should people even get any flu shots?
I don’t have a recommendation one way or another. There hasn’t been a lot of research on safety and efficacy of flu shots (just read through the product inserts – the sizes of the research studies are very small compared to all other childhood vaccines), and the product inserts are very clear about where the research is lacking (almost seems like a disclaimer in there).
BUT, the flu can and does kill people every year. I do believe the flu shot helps protect against the flu and lowers this risk. I go over many of the pros and cons in The Vaccine Book. Everyone has to make their own choice on this. I’m not going to make a suggestion one way or the other.
You can review all the product inserts yourself from the homepage of www.FDA.gov
Labels: Vaccine News
Flu Vaccine Update for the 2009/2010 Season
With the threat of H1N1 flu, the government is recommending everyone begin their regular flu shots earlier this year, as in right now. The available brands are virtually identical to what they were last year (and the year before) as far as manufacturing and ingredients go (including mercury). Full details on how each flu vaccine is made, what the ingredients are, and the possible side effects are available in The Vaccine Book, although published in 2007, the flu vaccine info my book has changed very little, you can click here for any updates to The Vaccine Book.
The most important thing for infants, children, and pregnant women is to MAKE SURE YOU ARE GETTING A MERCURY-FREE FLU VACCINE. Here is a list of this year’s available flu vaccines with updated info on mercury content:
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 (contains ½ dose) – 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 (25 mcg of thimerosal). Infants 6 thru 35 months would get a ½ dose of this form, all others would get a full dose.
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 to avoid mercury.
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 NO mercury (this is new this year: in past years, there was a trace 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
WHAT ABOUT THE H1N1 VACCINE THAT’S COMING OUT IN OCTOBER?
Click here to view my previous blog on this. I will be writing an updated H1N1 vaccine blog when the safety research is finished and I see what the vaccine ingredients are.
TIMING THE FLU VACCINE WITH OTHER VACCINES
Because the flu vaccine is so reactive (likely to cause fever and flu-like side effects), I prefer to avoid giving it with other reactive shots (like MMR, Hep B, Chickenpox, or the H1N1 vaccine). I recommend at least one month between the flu shot and any of these. I would place the priority on the flu shot over the MMR, Hep B or Chickenpox; delay any of those until it’s been at least a month after the flu shot. I do think it’s ok to get the flu shot with any other vaccine on the same day. The teenage vaccines (Tdap, Meningococcal, and HPV) are also fairly reactive, so it would be better to get any flu shots at least one month apart from any of those as well.
As for the H1N1 vaccine, I won’t be recommending that anyone get it at the same time as the regular flu vaccine. So, if you anticipate that you or your child will likely be getting an H1N1 vaccine in October or November, I would get the flu vaccine now (if you are going to get it). Another option, wait until November or December, 1 month after you’ve gotten the H1N1. The flu is unlikely to hit until that time anyway.
Keep in mind that infants and children 8 years or younger need 2 doses of the flu shot the first year they ever get it. So, if this is your child’s first year of flu shots, you need to plan ahead and not get any other reactive shots during those two months.
NASAL SPRAY VERSUS THE SHOT?
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. I have a slight preference for the nasal spray, because it’s a more natural form of vaccination (it is given nasally, which is how the flu is naturally contracted).
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, 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 thimerosal 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 12.5 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”. In the future I hope that more companies will change 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 the 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 immunize every child and teenager. 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.
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 http://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Post-MarketActivities/LotReleases/ucm162050.htm
Labels: Vaccines and their diseases

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